transitioning from cpap to apap

So my apap (respironics auto a-flex) just arrived at work today and I've never been so eager to go to sleep before.

I'm not sure what I should set my apap to. Initially, my doctor prescribed a pressure of 12 but that was just a guess. I had a in-lab titration study this week and the technician said I went into deep sleep near the end of the night with a pressure of 9.

So two nights ago I set my regular cpap to 9 but I haven't yet gotten a restful sleep or felt any improvements. It was actually annoying when I started the machine each night. I was exhaling harder than I needed to, as if the pressure was still 12. I assume this is because my body is just used to the higher pressure but it was annoying me even though I eventually fell asleep.

Will the apap handle my exhaling harder than necessary?

Do I set my apap's range around the new pressure of 9? Changing the setting to 9 hasn't worked for 2 nights. Maybe thats normal, but I don't know and would appreciate feedback on that.

I had fun doing this. My sweet spot is 10.5, and the APAP confirmed this. I think I started with a setting of 8-12. I usually leave my settings for a week before changing them. I found that if the low setting is too low my AHI would go up because of the time it takes the machine to react. It was good data, though, and I would make changes according to the daily reports. I also found that the upper setting doesn't matter much because it never gets there anyway. I want to have it high enough that the machine doesn't top out. I ended up with a setting of 10-15. The 10 gives a good reaction time and the 15 gives it headroom. I spend most of the night at 10 with a few spikes to 12. It never goes above 12.

If I had your numbers I think I'd start with 8-16 and go from there. Remember that sometimes things happen for no reason and leave it a few nights at each setting to get an average. If it hits 16, raise that number. If it stays at 8 a lot, lower that one. I keep the AFlex at 3 and the humidity as high as possible without getting rainout.

Other Opinions?

Sam

I know the feeling! I was so excited when I got my M Series Auto! Initially, I set the pressures wide just to see what the machine would find through its auto titrating. I continue to use auto mode, but a narrower range, though many here prefer straight CPAP. Happy experimenting!

RAINSUX wrote: If I had your numbers I think I'd start with 8-16 and go from there. Remember that sometimes things happen for no reason and leave it a few nights at each setting to get an average. If it hits 16, raise that number. If it stays at 8 a lot, lower that one. I keep the AFlex at 3 and the humidity as high as possible without getting rainout.
Other Opinions?
Sam

Good Advice - also keep a log in a notebook. I might start at 9 but you'll find that out soon enuff.

You do have the software, right?

My sweet spot is 10.5, and the APAP confirmed this.

What is a "sweet spot" and how would apap confirm it?

For me, my "sweet spot" is the pressure setting that results in the lowest AHI over a period of time, along with, and most importantly, restful uninterrupted sleep. My APAP actually helped me find and "confirm" that setting through its auto setting. My sleep study set my pressure at 7, and I used my first CPAP for over a year before finding you guys, learning about data, getting software/card/card reader and learning that the reason I still felt so tired/no better than pre-CPAP was that my average AHI during that initial period averaged around 12. So, I got my auto and it got things right for me. Now my "sweet spot" setting is 12-15 in auto mode and my average AHI over a period of more than a year is 0.4. Hooray for cpaptalk.com and auto titrating machines!

Exactly. Like I said above I started at 7, which wasn't doing the job. After I found this group and bought the reader and software I started increasing my perssure, .5cm at a time, using that setting for at least a week. My AHI steadily went down. When I got to 10.5 it started going up again. I went up and down around 10.5 for awhile until I was sure that was the best setting. When I bought my APAP I fooled around with the range, but 10.5 seemes to be where I spend most of the night.

I switch around between the two machines. I love the Aflex, but the layout of the old "tank" is more user friendly for me. And, the VA will replace the tank if it breaks, but I would have to buy a new APAP if something happens to that one. So I keep putting miles on the tank and switch to the M every couple of months just for fun.

I have a backup for everything, so if anything goes wrong in the middle of the night I can stay hosed up until morning. I've been on CPAP for over two years and I have not missed a single night. It took a few months to get fully compliant, but once I got everything right (thanks, guys and gals!) it's now all night, every night.

Sam