New to Auto CPAP

[Super_Dad]

I have had a RemStar Pro M Series for about ten years.
It started acting weird a month or so ago and now it will barely work at all. I haven't gotten a really good nights sleep in a couple of weeks. I don't know how long a CPAP should last, but according to what I have read 10 years is longer than I should have stayed with this one.

I bought a DreamStation Auto and it should be here tomorrow. I never used the humidifier on my old CPAP so I didn't order the Dreamstation with one. Hopefully that wasn't a mistake. My insurance has a really high out of pocket so I just paid for it myself.

I downloaded Oscar and I will work out how to post the results here once I get the new machine.
All this to say I am not knowledgeable on CPAP settings and I don't want to get another sleep study done unless there is a compelling reason to do that.

I scrolled through the menu of settings (the ones I wasn't locked out of) and it looks like my ramp pressure is 6 and my pressure is set to 12. CFlex was set to 1 but I don't know what that means.


I am pretty savvy with technology so I am glad to see that I can manage my own treatment. I got my CPAP at a fairly young age (early 40s) due to snoring that bothered my wife a lot.

Here are my initial questions. I am sure there are questions I should be asking that I will ask later once I learn more.

1. How many days should I collect data before I post results?
2. Should I just plug in my machine and start using it or should I change the minimum/max pressures right away?

I appreciate any help or guidance this group will provide.

[Julie]

Your questions -
1) couple of nights
2) I wouldn't change pressures until knowing first how the set ones are doing for you... again, couple of nights.

C-flex (and A-flex) allow people who are bothered by too-strong exhalation pressure to lessen it to their comfort zone... understanding that your AHI will likely rise by 1-2 as a result, but the trade-off may be worth it for you (experiment).

Good luck!

PS - download clinician manual from Apneaboard.com so you can make any change you want to YOUR therapy. Nothing is 'locked down', it's just what they tell patients to keep power to themselves - the heck with how well you do!

[Pugsy]

The default settings in apap/auto mode are 4 minimum and 20 maximum. I don't think that will work out so great and probably won't be comfortable at 4 cm since you are so used to a lot more.
I suggest a 10 cm minimum if you want to use auto mode and if you want to have it function like your old machine then cpap mode set to 12 like you are used to.

You can request the clinical manual from here which explains how to get into those secret areas
https://www.apneaboard.com/adjust-cpap- ... tup-manual

Ramp is separate and your choice if you wish to use it or not...and you can also change the starting ramp pressure if you wish. The default is 4 cm.

[Super_Dad]

Thank you for the advice on getting the manual and on a recommended starting pressure. The machine arrived about an hour ago and I am unboxing and setting it up now.

I suspect my old machine has been failing for some time because I have felt tired a lot over the last few years. I have been taking naps daily for the last couple of years because I could not stay productive at work without one.

In fact, I am going to take a nap with this new machine today since I have not been sleeping well. One thing I have noticed is that I feel more pressure at 10 than my old machine was producing at 12 so I guess it has been weakening and I just didn't know. Now that I have Oscar and the Dreammapper app I will be able to see my events and make adjustments. The old machine used a smart card instead of an SD Card so I don't have a device capable of reading its data. It is probably faulty since I doubt it was really producing the correct pressure.

Thanks for giving me the tools to manage my own therapy. I will post results soon. Probably this weekend.

[Super_Dad]

My nap wasn’t great. I was too focused on the pressure and the sound of the new machine..

I noticed that my dreammapper showed that part of the nap was yesterday and part was today. Since I didn’t have it until today that seems odd.

Can I just delete this questionable data from the card so that I start with a full nights sleep on my data for tracking?

If yes, how do I do that?

[Pugsy]

You can delete the nap data from the SD card manually (it's in the P0 folder under the serial number folder) but it's also in the machine's internal memory storage and the machine will put it right back on the SD card.

There should be a way to erase the data on the machine. All Respironics machines have a way and it's usually over in the section where the run hours show up. I haven't seen a DreamStation but I have owned several models between the M series and the System One.
Usually it's a combination of button pushing that lasts for 10 seconds once you find the erase data menu selection in the setup menu.
Check the manual and see if it mentions it.

Or just leave things alone and that data will quickly get absorbed in your subsequent data.

[RPDM]

Your finding is caused by how the machine records the day. It counts from noon on day 1 to noon the next day.

I assume you napped from before noon today 'till afternoon today
For the machine that is a split over 2 days.

OSCAR has a setting to deal with that (under preferences), BUT that has other side effect; pls read the OSCAR manual on that.

I guess once a xPAP the manufacturers assume you don't nap in the daytime anymore... waking up refreshed every day and btw we also forego the thought of night shifts

[Super_Dad]

I figured out how to delete the data (thanks Pugsy) so I will have clear data starting tonight.

[Super_Dad]

Well I am encouraged with my first night with the Dreamstation. It is a little quieter than the RemStar Pro M-Series but not by a lot.

I slept for ten hours and I woke up with a backache from being in one position for so long. That is a good problem to have. I have been on little sleep for 2-3 weeks as my old machine valiantly tried to live long enough for me to decide to get a new CPAP and then actually get one. I hope that soon I can be refreshed with 7-8 hours like I could in the past.

Getting a prescription could have been a major pain since I got my last one ten years ago, but I thought to call Doctor on Demand and they talked to me for 5 minutes and gave me an RX. Considering that I have had a CPAP for ten years there was no question that I need one. My company gives me appointments with them for $4.00. Super glad I avoided a costly sleep study.

I will wait one more night before I pull the card and pull the data into Oscar.

According to Dreammapper I had 1 AHI. I am looking forward to seeing the more detailed reports from Oscar.

One thing that I thought of last night is that maybe I should turn ramp off since 10cm is not uncomfortable for me. Looking for advice on that. Right now I have it starting at 8cm and going for 20 minutes.

My old machine ramped at 7cm and was a constant 12cm.

In the report it shows min (10cm) and max pressure (currently 20cm, should I lower it?) as well as "90% Pressure", which showed as 11cm. What does that mean?

[Pugsy]

Ramp is simply personal choice. If you don't really need it then don't use it if you don't feel the need.

90% pressure number is just a number where the pressure was at OR BELOW for 90 % of the night. It is not an overall average number.

The maximum setting...doesn't need to be lowered. The machine won't go up near it unless it has a need and it becomes a moot point and doesn't really matter in the overall machine response.

Depending on what the detailed software reports show...you might be able to lower that minimum a bit but it's hard to say for sure until we see the detailed reports because there are some data points that aren't included in the AHI that might point to keeping that minimum where it is.

[Super_Dad]

What is the benefit of lowering the minimum pressure?

If it would be best to wait until I am able to post a two night or longer report that is ok.

[Pugsy]

Some people just like to use as low a pressure as possible that gets the job done.
Some people get air in the belly issues and lowering the minimum can help reduce those issues.

Often when people are on a fixed pressure it is what we call a worst case scenario pressure....it covers the worst of things just in case the "worst" happens. Sometimes the "worst" only happens for 20% of the night and the other 80% of the night they could do very well with much lower pressures. Some people just prefer lower for the bulk of the night and let the machine deal with the "worst" if/when it is needed....

I suspect that since you used 12 cm fixed for so long without any real issues that you are probably going to be the most comfortable with a minimum pressure up near that 12. That's why I suggest 10 cm minimum for now. You might do well in terms of AHI reduction at a lower pressure but you might not be all that comfortable with much lower. It might seem a bit stifling to you.

At any rate...hurts nothing to use more pressure than one might really technically need to keep the AHI low as long as it doesn't cause any problems and in your case it doesn't seem to have caused any problems or you would be complaining about something.

Sometimes people get the apap machine after being on fixed cpap for so long...they just want to experiment and that's fine too.

[Super_Dad]

Thanks for the prompt reply Pugsy.

I like to experiment so I may try to lower the minimum but I want to get a few nights of good sleep first. I feel great right now. For a long time I was just thinking of when I could get back in bed.

When my machine started malfunctioning I got really fatigued and I couldn't get enough sleep no matter how many hours I spent trying to sleep.

I appreciate you running this site and being so supportive to the people who come here with doubts and fears. I wish I had looked into getting a different CPAP a long time ago.

A lot has changed in the apnea world in the last ten years. I am glad that I have some control instead of having to go through a DME for every little thing. Even when I had insurance that would pay for it I was tired of dealing with them and their condescending attitude. They treated me like I was a child or an elderly person that couldn't comprehend what they were doing. I was in my early 40s and in the IT industry so I could have managed my own settings if I had the tools. Now I have them.

[Super_Dad]

Here is my report. Please advise on changes you recommend and why.
Thanks

[Pugsy]

Please include how you are sleeping and feeling. Those are very important parameters as well.

Your leak statistic is incorrect because it's based on a ResMed leak threshold which doesn't work so great for Respironics machines.
Lets fix it.
Go to Preferences/CPAP tab and change the 24 L/min threshold for red line leak calculations to something more suitable for your machine at your pressures....which is probably around 70 L/min. It's not a static number which makes it hard to set a single threshold. Red line varies with pressure and mask used.
You really only had one small very brief episode of large leak...at around 05:40....see the LL on the Events graph? That's large leak.
If the machine doesn't flag it here...you didn't have a large leak despite the statistics % numbers.

Overall....if you are sleeping good and feeling good I see no reason to change anything unless you just want to experiment with settings to see how things go. Some people like to experiment and some don't. There's no urgent need to change anything though based on this report.

The variable breathing report...I have no clue what that is. It's a new thing with OSCAR and this is the first I have seen it.