Newbie, still some confusion

I'm still quite new at this stuff...

Well I've had my gear since late October, doing better now that they have me on this AutoPAP. I'm still having some major apnea episodes where I wake up gasping similar to before my sleep study. For instance last night I awoke with a start, gasping for breath and my wife woke up with conceren as well since I had 3 major episodes in the same night. Should this be happening since I have the autopap?

My sleep study results were 32 episodes per hour. They set my max pressure to 14.

My original CPAP was a Respironics M-Series CPAP at a constant 14 with ramp up. What a pain that was. I argued with my medical company the day they brought it over. They took about 2-3 weeks before they brought over my Auto. This one is great! No forced exhaling thank god!

Thanks for hosting this forum. I've been visiting for about 2 months and it's been quite useful to me early on with my multitude of questions.

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CPAPopedia Keywords Contained In This Post (Click For Definition): respironics, hose, CPAP, Ramp, auto

CompuTech007 wrote:I'm still quite new at this stuff...

Well I've had my gear since late October, doing better now that they have me on this AutoPAP. I'm still having some major apnea episodes where I wake up gasping similar to before my sleep study. For instance last night I awoke with a start, gasping for breath and my wife woke up with conceren as well since I had 3 major episodes in the same night. Should this be happening since I have the autopap?

My sleep study results were 32 episodes per hour. They set my max pressure to 14.

My original CPAP was a Respironics M-Series CPAP at a constant 14 with ramp up. What a pain that was. I argued with my medical company the day they brought it over. They took about 2-3 weeks before they brought over my Auto. This one is great! No forced exhaling thank god!

Thanks for hosting this forum. I've been visiting for about 2 months and it's been quite useful to me early on with my multitude of questions.

What pressure settings is your Auto configured for?

If it's 4 - 20, that would be the reason. That's a recipe for failure. If your titrated pressure was previously determined to be 14 and your machine has to start at 4 to get to a pressure to interupt of terminate an event, it'll probably never get there.....at least in a reasonable amount of time. You'll probably wake up gasping before it happens. Sound familiar?

I also see you have a nasal mask. Are you taping your mouth shut or in some other way making sure it's sealed? If you were also leaking therapy air out your mouth, that could be another clue as to why you had that experience.

Den

Thanks for replying Den.

Being a natural born tweaking guy, computer consultant by trade. I have adjusted my initial settings from the 4-14 to 6-14 during the first week after receiving my APAP. I might try increasing this tonight and see how it goes. And no, I do not tape my mouth in any way as I'm not a mouth breather to any great extent. I do have a leak rate of about 20% showing in the history over the week. I've also played around with various pillow sizes and settled upon the medium for the time being. This adujstment period of pillow sizes may contribute to the 20% leak rate perhaps.

I'm considering purchasing a card reader and software so I can manage this better. Good idea me thinks.

CT

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CPAPopedia Keywords Contained In This Post (Click For Definition): APAP

CompuTech007 wrote:Thanks for replying Den.

Being a natural born tweaking guy, computer consultant by trade. I have adjusted my initial settings from the 4-14 to 6-14 during the first week after receiving my APAP. I might try increasing this tonight and see how it goes. And no, I do not tape my mouth in any way as I'm not a mouth breather to any great extent. I do have a leak rate of about 20% showing in the history over the week. I've also played around with various pillow sizes and settled upon the medium for the time being. This adujstment period of pillow sizes may contribute to the 20% leak rate perhaps.

I'm considering purchasing a card reader and software so I can manage this better. Good idea me thinks.

CT

Been there.....done that.

Me thinks that would be a good idea, too. (I started with mine from the beginning.)

Again, if 14 was your titrated pressure, you need to get MUCH closer to that.....just in case they got your titration correct. It might be OK to have your upper pressure a bit higher, but to PROPERLY monitor one's therapy with an Auto.....you NEED the software to see what's going on. Otherwise, you're better off to do it by tweaking single pressure settings till you find the sweet spot.

Good luck and welcome to the forum.

Den

Wulfman wrote:if 14 was your titrated pressure, you need to get MUCH closer to that.....just in case they got your titration correct

I agree with Den that it would be better to have your minimum pressure set considerably up closer to 14. Perhaps set the minimum at 10 instead of down at the 6 or so it's at now.

It's the minimum pressure setting that is the most important to "get right" with an autopap, imho.

Setting the maximum pressure a lot higher than necessary really doesn't matter for most people, since what doesn't need to be used up there....well, just doesn't get used.

What matters more is setting the minimum sufficiently high enough to ward off most problems (apneas, hypopneas, flow limitations) BEFORE they can get started.

I know, ...the thought of using an autopap that way sounds like a person might as well be using just straight cpap. But if you can get good treatment with minimum pressure set at 10, or 11, instead of a straight 14; and if you need 13 or 14 just occasionally during the night, it sure can be much more comfortable to be using 10 or 11 most of the night instead of straight 14. Higher pressures often cause more mask leaks, too. And more chance of aerophagia, if that's a problem.

I'm not a doctor or anything in the health care field. That's just how I'd set the autopap if it were me and I'd been prescribed "14". I'd set it 10 - 20. Or 11 - 20. Or 12 - 20. Or....you get the idea.

If you're going to tweak, do get that EncoreViewer software and the necessary card reader.

Least expensive place I've seen to get the correct card reader:
http://www.two-factor.com/shop/index.php?productID=115

CompuTech007 wrote: I do have a leak rate of about 20% showing in the history over the week. I've also played around with various pillow sizes and settled upon the medium for the time being. This adujstment period of pillow sizes may contribute to the 20% leak rate perhaps.

I'm considering purchasing a card reader and software so I can manage this better. Good idea me thinks.

CT

Hello CT,

IMHO, a leak rate of 20 (liters per minute rather than %) seems to me to be quite good no matter what the mask on a Respironics machine. It's my understanding that the machine adjusts for leaks as long as they're not "large" leaks. I don't think it's feasible to get leaks down to 0.

Good for you for holding out for a machine that is data capable and provides exhalation relief!

And yes, good idea methinks, too.

Mindy

rested gal wrote:... if it were me and I'd been prescribed "14". I'd set it 10 - 20. Or 11 - 20. Or 12 - 20. Or....you get the idea...

Sorry RG, I don't get the idea. Why would you want to go lower than your "prescribed 14"? My understanding is that that is the minimum you'd need to ward off potential events.

The idea of using the APAP, iis to allow you to only use the pressure need to hold your airway open. If you set the low at your CPAP pressure you wouldn't get the relief of using less pressure. A 4 cm spread allows for the machine to react faster and better meet you needs.

You could run it as CPAP and hold your airway open at any cost, that being more discomfort and leaks than or necessary. Also with a nasal mask, the higher the pressure over what you need the more likely you are to mouthbreath.

Mouthbreathing not allowed! Without the software you may be mouthbreathing and not know it. Jim

Goofproof wrote:Without the software you may be mouthbreathing and not know it. Jim

Yep. That's one of the biggest of the many good reasons to have the software to check what's going on while we sleep. While the leak rate won't actually tell us where the massive leaks come from -- mask, or mouth -- it can point to a problem that needs to be solved.

Thanks for all your comments.

I'm not too excited about using my apap as a cpap since the reason was my difficulty exhaling against the 14cm to begin with.

However I have adjusted my low setting to 8 and I'll find out tonight if it makes much difference. I have also ordered my smartcard reader which I will be very impatient on waiting for.

CompuTech007 wrote:I'm not too excited about using my apap as a cpap since the reason was my difficulty exhaling against the 14cm to begin with.

CT,

With my M-Series AFlex, if I set my machine into straight CPAP mode, I can then still use CFlex for exhalation relief. I don't know if that will help at your pressure or not. I found it quite comfortable at a pressure of 11.

Mindy

CompuTech007 wrote:Thanks for all your comments.

I'm not too excited about using my apap as a cpap since the reason was my difficulty exhaling against the 14cm to begin with.

However I have adjusted my low setting to 8 and I'll find out tonight if it makes much difference. I have also ordered my smartcard reader which I will be very impatient on waiting for.

I don't think you understand how Autos/APAPs work, yet. And, don't overlook/ignore the virtues/benefits of single pressure.

Den

Also try setting your C-Flex to 3. I have similar machine, not Auto, with pressure @ 17 . No problems breathing against it. haven't used Ramp in a LONG time. Do not like it now.

I'm in the "higher-pressure-freaks-me-out-and-I-can't-exhale " party...

But I'm also in the "Hey, you do get used this! " party.

Try raising the bottom level gradually.

O.