First 10 days of APAP w/C-flex

As mentioned in an earlier post the following link shows the first 10 days of therapy with my APAP C-flex unit.

Before getting to the link here are the settings I'm using:

Low = 8
High = 16
C-Flex is set to highest pressure which I think is setting of 3

My sleep lap recommended 4 and 11. The 4 wasn't enough to keep the safety valve on my FF mask close (it whistled), plus I didn't feel enough air flow for my comfort.

I raised the upper to 16 which is what my prior sleep lab had my CPAP set to.

Other than not being able to go to sleep on time I am feeling much more rested and dreaming with the current settings.

What worries me is that the pressure seems to runaway. It is at maximum most of the time, I believe, in response to the snoring. I tried raising pressure to 18 and it peaked at 18 as well, so I lowered back to 16 which is more comfortable for me.

Also I am seeing a lot of FL but not sure what they represent.

So anyway, here are the first 10 days. Any suggestions are welcome, naturally I'll also run these past my doctor to see what he says.

HERE IS THE LINK:

http://sawgrasstech.com/apnea/stats1/apnea.htm

If I decide to change settings I'll post the next 10 days results.

Thanks for your feedback!

jdacal, I'm no expert at all in figuring out what's happening in data graphs/charts. If that were my data chart, I'd experimentally try raising the lower pressure in hopes of controlling the massive snores better. Perhaps raise the lower pressure to 10. If that doesn't cut the snores back, raise the lower pressure to 11 or 12.

Eliminating the heavy snoring by raising the lower pressure closer to your original titrated pressure of 16 might, just might, stop the machine from running up to higher pressures so much. Worth a try, anyway.

I'm not a doctor. Good luck.

I have been suspecting some sort of flaw in the algorithm that Respironics uses in their REMStar Auto. There has been this ongoing theme from many posters about run-away pressures with it. I also began to notice my machine running up to high pressures and staying there. Using the extra data available in the MyEncore software I could see this was not doing me any good. Derek's MyEncore plots Snore Index vs. pressure and AHI vs. pressure. I could see my snores were eliminated at any pressure of 10 and above... as pressure dropped below 10, my snores increased dramatically. I also could see my AHI was at it's lowest point at at 9 cm and increased with increasing or decreasing pressure. There were other pressures where my AHI came to a minimum, but never as low as at 9 cm. At 9 cm my AHI is still around 8. I suspect the machine logic is telling it to increase pressure to prevent the OSA's it was detecting, but as pressure increased it would detect even more OSA's, and this would continue until it hit my upper limit setting, then stay there thinking I needed the pressure to stop the OSA's. In reality it passed the point where my AHI (mostly OSA's) was at a minimum across the pressure range. The failed logic seems to be that increasing pressure always reduces AHI/OSA's... WRONG!!

To resolve this problem I ran through some experiments where, using the MyEncore data, I changed my upper and lower limits to validate I could predict my AHI based on the data from the MyEncore charts. In fact it was right on. I also could predict my snores based on my pressure settings. I have had to accept higher snores in order to keep my AHI down. I feel it's more important to reduce AHI than snores. So now I'm effectively running my APAP as a CPAP now to prevent it from running up to a pressure that is uncomfortable, and frankly results in a high AHI.

In conclusion I believe that Respironics needs to fix their algorithm on their auto pap machines. My sleep docs told me that the ResMed algorithm is more accurate, and now I believe them. In my home sleep study they gave me a Resmed Spirit auto for a week. From the spirit data they wrote my prescription for 9 cm CPAP but said it was ok if i wanted to use an auto. The interesting fact is, I have in effect validated the prescription as through my independent process ended up adjusting my REMStar to a fixed pressure of 9 cm to minimize my AHI. Even though the data I used came from the REMStar, the machine itself is unable to settle in on this pressure automatically. Prior to this I was waking with the machine running anywhere from 14 to 20 cm and getting AHI's in the 20's. With manual adjustments I have reduced my AHI to under 8 and running at a very comfortable 9 cm.

Ron

IWS,

Do you have severe apnea? You are not able to get your AHI below 8, even using a fixed pressure?
My perception of the REMstar auto run-up problem is that is is directly related to a high level of snores or mask/mouth leaks. My guess is the ResMed auto-pap may not do any better for you than any other auto. If a pressure of 9cm leaves you with an AHI of 8 I wouldn't say that pressure is what you need unless the nature of your apnea is that an AHI of 8 is the best you are going to do.

The beauty of the auto machine is that if it doesn't work for you, it can be switched to a fixed pressure machine. For those that can't get the auto algorithm to respond correctly due to their particular breathing patterns, I would suggest trying a fixed pressure.

wading thru the muck! wrote:IWS,

Do you have severe apnea? You are not able to get your AHI below 8, even using a fixed pressure?
My perception of the REMstar auto run-up problem is that is is directly related to a high level of snores or mask/mouth leaks. My guess is the ResMed auto-pap may not do any better for you than any other auto. If a pressure of 9cm leaves you with an AHI of 8 I wouldn't say that pressure is what you need unless the nature of your apnea is that an AHI of 8 is the best you are going to do.

The beauty of the auto machine is that if it doesn't work for you, it can be switched to a fixed pressure machine. For those that can't get the auto algorithm to respond correctly due to their particular breathing patterns, I would suggest trying a fixed pressure.

Yes, I have severe apnea, my initial testing showed an AHI of 45, so 8 is pretty good. Also my follow-up oxymetry test showed my blood oxygen levels are staying in the normal range throughout the night which is the most important factor. Especially since it was falling to 79% before.

And yes, I have been running at a fixed pressure for the past 4 nights and an AHI of 8 is the best I can do. I'm not saying the ResMed Auto would give me better results than this, now that I'm running at a fixed 9 cm. What I am saying is that the Resmed auto at least zeroed in on 9 cm, where the RemStar just kept running the pressure up even though it was achieving progressively worse results.

My snores go to 0 at 10 cm and above... that's 0....none... no snores. And, my RemStar continued to run pressures up to the limit i set. I do not have a mouth or mask leak problem. My large leak last night was 0 and my average leak was 29.

I went ahead and raised my LOW to 10 and my High to 17 last night.

I noticed a HUGE reduction in snoring, but discomfort due to the high pressure of 17. Anything above 16 is uncomfortable for me and causes me to wake up several times during the night.

I'm going to bring the high back to 16 tonight and see if my AHI doesn't increase. AHI did go down by eliminating the snores, but the machine was again at max pressure most of the night. Maybe it's not the snores after all raising the pressure.


I'll post the results in about 7 to 10 days, after I have more data.

My problem is that I use a Bi-PAP. I needed to adjust both the IPAP and the EPAP.

If you look at the data below, you will notice that increasing pressure can cause central apneas. These are mis-reported as Apneas. My snore index never went to zero as this is a very sensitive measurement, any noises may be reported as snores. My best setup is a 9.0/8.0. There may be a 1/2 either way that may help slightly. This data represents 2 days at the lower 2 settings and a week at the higher settings. There can be some error in the sensing of the events, so multiple days can help average out the anomalies.

Reducing your Apneas is most important, with Hypopneas as secondary. Snores are really a bi-product of the pressure and are least important. Many people ignore the Bi-PAP, but it is more comfortable than an Auto or CPAP.

Bi-PAP Pro 2/Swift/Encore Pro

Data
IPAP EPAP Apnea Hypop Snore AHI
8.0 8.0 4.2 9.2 1.3 13.4
9.0 8.0 3.0 3.4 0.8 6.4
9.5 8.0 4.6 2.2 1.1 6.8
10.0 8.0 4.8 2.0 1.2 6.8
10.0 8.5 7.3 2.4 1.1 9.7
10.0 6.0 5.6 7.9 1.4 13.5
12.0 6.0 9.0 6.0 1.0 15.0
15.0 6.0 19.0 4.0 2.0 23.0

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