First Night on Auto CPAP Problems

General Discussion on any topic relating to CPAP and/or Sleep Apnea.
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First Night on Auto CPAP Problems

Post by pdblues » Thu Jun 19, 2008 8:07 am

Hi all.

I am a newbie to Auto CPAP. I've been on plain old CPAP for 5 years. Recently the effectiveness of my treatment on that was going downhill rapidly. My pressure was set at 8 cm initially but I always thought this was wrong. My first sleep doc would never call back when I asked so I reset my own pressure to 10 and had success with it for a couple years. Now I'm seeing a new doc who is much more on the ball and she has set me up with an auto CPAP to see if the pressure needs to be changed. It's set from min 5 to max 15 and last night felt like someone beat me up!! I remember snoring all night (something I didn't do on regular CPAP) and read my data card to see what looked like almost constant vibratory snores and lots of obstructive apneas. The auto pap only boosted the pressure to 7 cm last night and I think that's just way too low.

Does anyone know how the machine goes about setting the pressure when you have an event? Has anyone else had a bad first night on APAP? I'm going to call the doc now but I'm curious if this has happened to anyone else...


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Post by JeffH » Thu Jun 19, 2008 8:30 am

WAY too wide a range.

Sounds like simple mouth leaking to me. I had the same problem and APAP won't "fix" it.

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Post by Lineman » Thu Jun 19, 2008 11:10 am

Yeah, I agree that is too wide a range. If you had success with a CPAP at 10, that is where you should start (min pressure). 15 is ok for a starting max pressure (that's where I have mine set). But higher is ok too if you do spend signficant time at max each night.

When I went from a CPAP (at 12) to an APAP, I tried pressures as low as 8 figuring the machine would compensate for higher needs (as probably your Dr did/does). But the data card said I had a worse AHI that way so I raised the starting pressure (to 10) and got a significantly lower AHI. I do hit the max number a couple of times a night but only for a few seconds. 90% of the time, I'm at the low pressure number and sleeping better for it.

Everybody is different so don't be afraid to try different settings until you find what works best for you. Using the data recorder and software, you can be the best judge of your therapy IMHO.


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Post by pdblues » Thu Jun 19, 2008 8:21 pm

thanks for the replies thusfar. I spoke with my doc today and she is going to set the range to min 10 - max 20 cm and see how that goes. I think that will be much more effective. I was a "treat yourself" kind of person before because my old doc wasn't a good partner in my treatment (a real in and out kind of doctor) but this new doc seems much more responsive so I think I'll have better experiences.

Does anyone know how the machine works as far as each night I use it does it learn the optimal pressure for me or will it always start out at the min and move around based on how my apneas are?

I always thought it moved quickly through the pressures until it felt you start breathing again, but I don't think that's the case since last night I only got from 5 up to 8 and had all kinds of events!

I'm also curious if anyone has had a real great experience on APAP since I was doing well before and went downhill on CPAP quickly.


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Post by Snoredog » Thu Jun 19, 2008 9:18 pm

Your Auto:Min pressure should be set where it is "comfortable" for you to breathe, this makes it much easier to fall asleep. The lower the pressure the quieter the machine will be and least annoyance experienced at the mask.

However, that pressure should NOT be so low you feel "starved" for air or feel stuffy. Start low (6.5 or higher) and set any Cflex or Aflex where it feels comfortable to breathe. Then increase the minimum pressure to where it is the most comfortable. If the Xflex setting has changed allow 30 minutes or so of breathing with it before changing it.

Auto:Ramp: Auto ramp is used on those nights that any cpap pressure is annoying, you may go 6 out of 7 nights starting with 8 cm pressure and be just fine, then some nights that may drive you nuts, for those nights you have your machine already set to go with Auto:Ramp. Auto:Ramp pressure can be set a tad lower than your normal Auto:Min pressure. As for the timer I suggest 30 minutes. Keep in mind if your Ramp pressure is 6.5 and your Minimum is 7.0 then the timer will be pretty much ignored as it will be at 7.0 in 5 minutes. But the machine will limit any response until that timer expires unless it is an apnea.

The machine has a built-in settling period (thought to be 20 minutes) during this time the machine may ignore artifact events as SDB events. Everyone has these and they are considered normal, these can sometimes falsely drive up the pressure prematurely on the machine that is why many ignore or limit any onset response.

Auto:Max Pressure: There is really no reason to limit the Max pressure on the machine unless you have other events which drive up pressure prematurely such as snoring. If those pressure increases from snores tend to drive up your pressure to the point where they cause unstable breathing and more SDB or even centrals then you would want to limit any maximum pressure response. But you should observe reports in order to do that effectively.

Once a normal AHI is obtained there is really no reason to increase pressure further.

There is no rule of thumb for pressure ranges, one is not too wide or another too narrow, it is what works best for you. Only concern you should have is using a too low a Minimum pressure, doing so can cause you to starve for air and/or cause features like xflex to become disabled when below 6.5 cm or based on the machine mask or hide certain type of events. In the case of the latter for example if a person starts having central apnea at 9 cm pressure and you start your Minimum at 10 you may completely blow by those events and never know they existed yet when pressure rises above such as from snore more apnea is seen, those apnea may be totally confused by the machine as obstructive when they may have been central.

A little experimentation with settings and observance of reports you can determine which works best for you.

Everyone has a few rough nights when starting out, in fact the average is 4-6 weeks worth.

Vibratory snores: There are a couple ways to look at those, most apnea follow a snore so most machines try to eliminate any snores with increased pressure. Snoring can be a sign of full relaxation and increased risk of apnea showing up as a result. Some snores cannot be eliminated with pressure so in case of those you have to ignore the snores. Remstars will determine this on their own and limit any response to the snores.

Snores can also be a sign of mouth breathing, so if you are using a nasal mask and observing heavy snores consider mouth breathing being a cause. While nasal snores are possible you are less likely to snore with your mouth closed.

someday science will catch up to what I'm saying...

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Post by deerslayer » Thu Jun 19, 2008 9:26 pm

my auto was originally set 5-15 range. after observing daily results on the encore, 5 turned out to be too low to head off events soon enough. over a period of time i slowly raised min pressure to 8.5, but have not seen the need to raise max. pressure. keep an eye on your leak data -this can skew your #'s & cause poor therapy at best . using a 10 minute ramp when turning out the light will help you to relax & settle in. once you have the right mask setup you are comfortable with you can dial your pressures in. just do one thing at a time and take it slow, otherwiseKnock Knock..CPAP POLICE.. We know your in there

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