experienced c-pappers please weigh in-suggested tweaks?

[Aggiehorntwins]

hi, I am a few months in to therapy and am trying to optimize my pressures on my own, as the sleep medicine clinic is not really helping me. I am now on APAP 11-15 and I have not had an OA in several days and now mostly have CA or H. Can anyone tell me if there are any other changes that might help reduce the hypopneas? I have a recording oximeter and have still had some increased heart rate and O2 sat decreases with hypopneas only, so am anxious to improve. I turned off the ramp and turned off EPR after reading some information on this site. Thanks in advance.

[Pugsy]

Have you tried the same settings but in the regular auto adjusting mode instead of the for Her mode?

[Aggiehorntwins]

No, what could that do, and how would I change it?

[Pugsy]

You need to go into the clinical menu set up area and change the mode. I think choices are cpap, auto and for Her....you just need to change to regular "auto" mode.
Explained in the manual.
https://www.respshop.com/manuals/ResMed ... %20her.pdf

The for Her mode has some specific criteria for increasing the pressure beyond 12 cm and you may not be having enough of that criteria close enough together for the machine to be more responsive and go above 12 cm which I think you may need.

The regular mode won't be so quick to stop at 12 cm and your flow limitations should reduce a bit and hopefully the hyponeas as well.

Worth trying. Some people do better in the regular mode than they do in the for Her mode.

[Aggiehorntwins]

Hmmmm. Well, could be worth trying. The sleep clinic was none to thrilled that I changed my own minimum pressure from 9 to 10 because I saw on Oscar data that I still had OAs. Then the NP agreed I wasn’t wrong to change it and increased it to 11 at my request. I am an NP myself, but have not had experience in sleep medicine. I will check out the link you sent and may do a trial run on the auto titrating mode. I think I am going over 12 cm at times. Thanks for the info!

[chunkyfrog]

Many of us would have to look very, very hard to find a provider who knows
more about our therapy than we do--from experience, and this forum.
It is not that big a priority.

[Aggiehorntwins]

You are exactly right, chunkyfrog. Too many patients to do adequate follow up and so many new patients to order sleep studies on for the real money. I finally convinced them to order an overnight oximetry and all they gave me for a report was that my oxygen dropped several times but not long enough to require oxygen, ha ha, as if that is what I wanted! Just needed to know how to adjust the pressures to prevent all the desats. Pretty remarkable. Now I am all set on plain auto titrating instead of “for Her” so see what will happen tonight.

[palerider]

Hmmmm. Well, could be worth trying. The sleep clinic was none to thrilled that I changed my own minimum pressure from 9 to 10

So, do you work for them? no? then who cares what they think?

[Aggiehorntwins]

Re: per advice from Ms. Pugsy, I changed my mode from "For Her" to regular Autopap mode. It does seem like the flow limits are reduced, although I did see on another post that flow limits appear worse on "For Her". Anyway, it seems I am much improved on this different mode for whatever reason, so thanks so much Pugsy for all your help. I have learned a lot from reading this forum.

[Pugsy]

Good job.
How are you feeling and sleeping? That's always more important to me than just the numbers by themselves.
If sleeping good and feeling good I wouldn't worry about the FLs and I would just run with these settings.
If not sleeping good or not feeling so good then I might try increasing that minimum to 12 and see if the FLs reduce and/or it makes any difference in how you sleep or feel.

[Aggiehorntwins]

I feel good, nearly back to my old self. I was wondering about going to 12 but for now will just see how it goes. I was having episodes of increased heart rate, which I have not had in a few weeks, and for sure have not had since I changed the mode. My Pcp thought there was something about the pressure changes or something else that was causing the increased heart rate. It did not always correspond with an apneic event upon review of my apple watch data. I now have an oximeter and my oxygen sat has been good. So will just keep on keeping on.

[Pugsy]

Back quite a while ago I established that with the machine I was using at the time that a minimum of 10 cm seemed to be where I needed to be but always at the back of my mind was the nagging question....what would happen if I went higher.
So I set about an experiment where I systematically raised the pressure 0.5 cm every 7 days.
So over 6 weeks I worked my way up to 13 cm minimum. After the last week at 13 cm I looked back over all my results and notes.
AHI never changed, hours slept didn't change, how I felt during the day didn't change. ....So I aborted the experiment since I really couldn't tell anything changed.

So if you want to try 12 at sometime just because you are curious...by all means give it a try. Being curious is a good enough reason.