Just Got My Pressure For APAP

General Discussion on any topic relating to CPAP and/or Sleep Apnea.
CaptainRaven40
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Just Got My Pressure For APAP

Post by CaptainRaven40 » Thu Sep 03, 2015 1:30 pm

I have been using my Autoset in CPAP mode, but contacted my doctor about using it in APAP. She thought that would be fine and she would make the call about it. Well last night I go to get in bed and get the machine going and notice that it had been changed to auto with a min of 5 and a max of 20. This to me is a HUGE range. My pressure was set at a 12 for straight CPAP. Of course I have already been trying the auto setting before I called the doc and I started it at 10-20, then went to 12-20 and my AHI was very low. About a .5 consistently with about 4 OA's over the course of the night. I tried the setting that the doctor gave me last night and I had 4 OA's and my AHI is higher obviously and I didn't sleep well at all. At times it was hard to breathe because the pressure seemed so low and I noticed I was snoring like a freight train again... Was not happy. I got up last night to use the restroom and when I came back I turned the machine up to 14 min and 20 max and slept about 2 more hours and it was great sleep! Also no events are showing in Sleepyhead during that time. So I guess my concern is that with the 5-20 that I am not going to get the best therapy I can, but I also don't know where to start to really get to the setting I need. I was just playing around before when I used my pressure of flat 12 to 20 in auto, but it worked and the the 14-20 for a couple of hours worked great too. So... any help would be more than appreciated. If you need more information from me just let me know. Thanks everyone! Cheers!

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Sheriff Buford
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Re: Just Got My Pressure For APAP

Post by Sheriff Buford » Thu Sep 03, 2015 1:47 pm

You need to get the clinical manual. It will tell you how to adjust your settings. I would put my setting around 8-18 l/h2o. That will stop the suffocating feeling. The lower number is close to the cpap mode setting. It will give the machine more time to respond to an event. Pugsy used to have a link to the clinical manuals, but things have changed in the last couple of months. Morbis was gathering the clinical manuals. I'm sure someone will send you the manual.

Sheriff

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Wulfman...
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Re: Just Got My Pressure For APAP

Post by Wulfman... » Thu Sep 03, 2015 1:48 pm

CaptainRaven40 wrote:I have been using my Autoset in CPAP mode, but contacted my doctor about using it in APAP. She thought that would be fine and she would make the call about it. Well last night I go to get in bed and get the machine going and notice that it had been changed to auto with a min of 5 and a max of 20. This to me is a HUGE range. My pressure was set at a 12 for straight CPAP. Of course I have already been trying the auto setting before I called the doc and I started it at 10-20, then went to 12-20 and my AHI was very low. About a .5 consistently with about 4 OA's over the course of the night. I tried the setting that the doctor gave me last night and I had 4 OA's and my AHI is higher obviously and I didn't sleep well at all. At times it was hard to breathe because the pressure seemed so low and I noticed I was snoring like a freight train again... Was not happy. I got up last night to use the restroom and when I came back I turned the machine up to 14 min and 20 max and slept about 2 more hours and it was great sleep! Also no events are showing in Sleepyhead during that time. So I guess my concern is that with the 5-20 that I am not going to get the best therapy I can, but I also don't know where to start to really get to the setting I need. I was just playing around before when I used my pressure of flat 12 to 20 in auto, but it worked and the the 14-20 for a couple of hours worked great too. So... any help would be more than appreciated. If you need more information from me just let me know. Thanks everyone! Cheers!
Of course not. That range of 5 - 20 would offer substandard therapy.
Sounds like you had a better range before you had them reset it.
I can't tell what you're trying to accomplish, but maybe a straight pressure somewhere in one of those ranges would give some good therapy.


Den

.
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Wulfman...
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Re: Just Got My Pressure For APAP

Post by Wulfman... » Thu Sep 03, 2015 1:51 pm

Sheriff Buford wrote:You need to get the clinical manual. It will tell you how to adjust your settings. I would put my setting around 8-18 l/h2o. That will stop the suffocating feeling. The lower number is close to the cpap mode setting. It will give the machine more time to respond to an event. Pugsy used to have a link to the clinical manuals, but things have changed in the last couple of months. Morbis was gathering the clinical manuals. I'm sure someone will send you the manual.

Sheriff
It sounds like he's already been self-adjusting his therapy pressures........12 - 20 and 14 - 20 settings.


Den

.
(5) REMstar Autos w/C-Flex & (6) REMstar Pro 2 CPAPs w/C-Flex - Pressure Setting = 14 cm.
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Pugsy
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Re: Just Got My Pressure For APAP

Post by Pugsy » Thu Sep 03, 2015 1:54 pm

I don't know why docs don't understand how to optimize apap therapy but I guess they just don't.
Anyway...that 5 to 20 range would work great if you only eventually needed 8 or 9 cm to keep the airway open but doesn't work so great when you need more than 10 cm.
These machines don't respond that quickly and while it is increasing to 10 or more the airway can still collapse and the events come and go and flip you off while the machine is trying to get to where it needs to be.

Your discomfort at the lower setting...that's to be expected since you have been using 12 cm for a while. Anything less would make you feel like you are suffocating. I had the same experience when I tried using 13 minimum for a couple of weeks and figured out it wasn't any better than what 10 cm minimum was doing so I dropped it to 10 cm and spent 3 nights feeling like I was suffocating until I got used to 10 cm again.

I don't know what might be a good minimum for you..probably don't need that 14 cm minimum...maybe not even 12 cm but I would need to see a few nights detailed reports to get a feel for a suitable minimum that will get the job done in terms of enough of a head start for the machine to get to where it needs to be in a timely fashion and not suffocate you.

The machine won't go where it doesn't think it needs to go without what it thinks is a good reason so the maximum pressure is not that critical. Just because it can go there doesn't necessarily mean that it will go there.

Usually....a good rule to start with for a minimum is maybe 2 cm below what someone has been using in cpap mode...see what happens and make adjustments as needed. It should get you real close.

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CaptainRaven40
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Re: Just Got My Pressure For APAP

Post by CaptainRaven40 » Thu Sep 03, 2015 2:00 pm

Thank you all for the replies! I think I will try what Pugsy suggested and start with 2cm below my cpap pressure. So I will start with 10 min 20 max and go from there. Thank you all again so much!

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Wulfman...
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Re: Just Got My Pressure For APAP

Post by Wulfman... » Thu Sep 03, 2015 2:01 pm

CaptainRaven40 wrote: My pressure was set at a 12 for straight CPAP.
So, how was this pressure working for you?
How long did you use that pressure before trying ranges?
And, what was your reasoning for experimenting with ranges?


Den

.
(5) REMstar Autos w/C-Flex & (6) REMstar Pro 2 CPAPs w/C-Flex - Pressure Setting = 14 cm.
"Passover" Humidification - ResMed Ultra Mirage FF - Encore Pro w/Card Reader & MyEncore software - Chiroflow pillow
User since 05/14/05

CaptainRaven40
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Re: Just Got My Pressure For APAP

Post by CaptainRaven40 » Thu Sep 03, 2015 2:08 pm

Wulfman... wrote:
CaptainRaven40 wrote: My pressure was set at a 12 for straight CPAP.
So, how was this pressure working for you?
How long did you use that pressure before trying ranges?
And, what was your reasoning for experimenting with ranges?


Den

.
The pressure worked pretty well. It had me under 5 every night for about 2 1/2 weeks, but I had the auto and wanted to see if I could get it lower. So I just started experimenting and when I did my AHI dropped drastically to 1 or below every night. I just wanted to see if I could drop it lower and the first night I really just wanted to try out the auto setting because I had it. Then it made some drastic changes so I stuck with experimenting.

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Wulfman...
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Re: Just Got My Pressure For APAP

Post by Wulfman... » Thu Sep 03, 2015 2:22 pm

CaptainRaven40 wrote:
Wulfman... wrote:
CaptainRaven40 wrote: My pressure was set at a 12 for straight CPAP.
So, how was this pressure working for you?
How long did you use that pressure before trying ranges?
And, what was your reasoning for experimenting with ranges?


Den

.
The pressure worked pretty well. It had me under 5 every night for about 2 1/2 weeks, but I had the auto and wanted to see if I could get it lower. So I just started experimenting and when I did my AHI dropped drastically to 1 or below every night. I just wanted to see if I could drop it lower and the first night I really just wanted to try out the auto setting because I had it. Then it made some drastic changes so I stuck with experimenting.
If you're using Sleepyhead (as noted in your profile), the pressure answers should be in your reports. If straight 12 cm. wasn't getting you below 1.0 AHI consistently, then dropping your starting pressure to 10 cm. is going to cause lots more pressure changes if it needs to go higher.......and it sounds like it does.

Don't get me wrong. I'm not arguing against using an APAP in a range of pressures, I'm just suggesting that you need to study your Sleepyhead reports to see what types of events are causing the pressure changes and what pressure(s) are resolving the majority of your events to get you below 1.0.
It may be that your minimum pressure needs to be closer to 14 cm. if that worked well for you.


Den

.
(5) REMstar Autos w/C-Flex & (6) REMstar Pro 2 CPAPs w/C-Flex - Pressure Setting = 14 cm.
"Passover" Humidification - ResMed Ultra Mirage FF - Encore Pro w/Card Reader & MyEncore software - Chiroflow pillow
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CaptainRaven40
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Re: Just Got My Pressure For APAP

Post by CaptainRaven40 » Thu Sep 03, 2015 2:26 pm

Wulfman... wrote:
CaptainRaven40 wrote:
Wulfman... wrote:
CaptainRaven40 wrote: My pressure was set at a 12 for straight CPAP.
So, how was this pressure working for you?
How long did you use that pressure before trying ranges?
And, what was your reasoning for experimenting with ranges?


Den

.
The pressure worked pretty well. It had me under 5 every night for about 2 1/2 weeks, but I had the auto and wanted to see if I could get it lower. So I just started experimenting and when I did my AHI dropped drastically to 1 or below every night. I just wanted to see if I could drop it lower and the first night I really just wanted to try out the auto setting because I had it. Then it made some drastic changes so I stuck with experimenting.
If you're using Sleepyhead (as noted in your profile), the pressure answers should be in your reports. If straight 12 cm. wasn't getting you below 1.0 AHI consistently, then dropping your starting pressure to 10 cm. is going to cause lots more pressure changes if it needs to go higher.......and it sounds like it does.

Don't get me wrong. I'm not arguing against using an APAP in a range of pressures, I'm just suggesting that you need to study your Sleepyhead reports to see what types of events are causing the pressure changes and what pressure(s) are resolving the majority of your events to get you below 1.0.
It may be that your minimum pressure needs to be closer to 14 cm. if that worked well for you.


Den

.
I will go back over my sleepyhead data and see what it says again when I get back to my computer. I know you aren't arguing you are just wanting me to get the most out of my therapy and I appreciate it.

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englandsf
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Re: Just Got My Pressure For APAP

Post by englandsf » Thu Sep 03, 2015 5:37 pm

Lots of evidence to suggest 12-20 range would be optimal for you.

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MarylandCPAPer
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Re: Just Got My Pressure For APAP

Post by MarylandCPAPer » Thu Sep 03, 2015 8:00 pm

Just my 2 cents worth from the start of my CPAP therapy 5 years ago. The sleep dr. from the sleep lab prescribed CPAP pressure for me of 13, based on a fairly good sleep study titration. That pressure was too high for my tolerance as a newbie, even with a ramp. When I asked about an APAP pressure, the sleep doctor prescribed 10-16 as my range. That worked well for most of my first five years of treatment. I have recently changed it from 10.6-20 when I got a new machine, because 10 felt like I was suffocating. The new range appears to be working well for me, per Sleepyhead data, with an AHI of between1 and 3 most nights. I would suggest that the bottom of the pressure range be a pressure that is comfortable for you when you are awake, so you aren't suffocating for lack of air, but the pressure isn't so high you can't get to sleep. These were the things that were considered when determining my APAP range.

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englandsf
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Re: Just Got My Pressure For APAP

Post by englandsf » Fri Sep 04, 2015 8:56 am

There is never really a downside to leaving your "top" pressure open but much to be lost by having your "bottom" pressure more than 1-2 cm below you 90% pressure. It just makes the machine work harder and increases to deal in ramping up your pressure. I have run from 10-20 up to 12-20 and now have settled at 11-20 but watch my numbers almost every day.

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Additional Comments: Sleepyhead SW. NeilMed and Alkalol Nasal rinses. Veramyst. AutoPAP 11-20 cms. Started June '14, untreated AHI 31-38, with PAP around 1.