I need some opinions

[Billyboy]

I was titrated at 19 after two nights of extremely poor sleep. I was told I had several central apenas after the first night but had few or none the second night. I ended up with a Resmed Vpap Malibu after telling Dr. I could not tolerate the pressure of 19. the Malibu was set up at 8 min, 19 max,pressure support of 6. After nearly 2 months of use my 95% avg pressure is 13.6 with avg AI =.9, HI =16.1. My Dr has decided he can't interpret the high HI and is letting me play around with my first cpap machine a M Series Remstar Pro with Cflex. I started this recent search with a pressure of 13.5 resulting in an AHI = 9.5. I don't have a card reader yet so I'm not sure what is what. I have increased the pressure to 15 and have been alternating between the Remstar(AHI has increased to 15) and the Malibu (AHI increasing here too). It seems I running off the road and its time to stop playing. Sorry for the long introduction to my question which is ,do you think the Malibu's 95% pressure of 13.6 should be close to my proper pressure on straight cpap and I just need to set the Remstar and leave it alone for a week or two ? (I only gave it three days at 13.5 before) Thanks

[hades161]

I guess I am confused here but why would you down grade from the Vpap Malibu. Was this a rental? The Vpap has many more features that most likely helped get your AHI down to a seemingly reasonable amount.

The M Series Remstar Pro is a plain jane Cpap with few options. Based on the data from the Malibu the 13.5 setting would seem ok but your going from an apple (malibu) to an orange(m series pro) with no way to properly monitor or adjust to these changes. These units are not the same, even though they do the same job, they do it in very different ways.

It seems I running off the road and its time to stop playing.

This scares me, are you talking about when your driving now or before when you were on the Vpap? or just talking about your treatment? If your nodding off as you drive something is still way out of wack after 2 months or more of treatment.

To help us help you please fillout your profile and more fully explain whats going on. The profile will help us know what equipment your trying to get to work and what features and capabilities they have.

It sounds like they are doing a hell of a lot of guessing if your titration showed 19, and then the Vpap found 13.5, now your trying to find a pressure for a M series Pro and that unit has no way to help you find it except trial and error over a long period of time.

It seems your doctor and equipment people are giving you a lot of latitude so this is what I would do.

I would request a M Series Auto CPAP with A-Flex. Link below for reference.

https://www.cpap.com/cpap-machine/remst ... -flex.html

Use this in auto mode with A-flex. This unit is more like the Malibu in its ability to adjust. Set it at 10-20 run that way for 2 weeks and then get the data from the card, NOT the LED and see what it reflects and how you feel. Then narrow down the range. This to me would seem to be the safest and fastest way to get your treatment under control. Without the data from the card your are very limited in figuring out whats going on. Seeing your PSG's went poorly and so high in pressure there might be other issues effecting things as well.

But keep in mind I am NOT a doctor but this is my best advice based on what you have posted. It would be best if you could post your PSG's and all your equipment though so some of the more experienced members of this board can maybe help you nail down what else is going on.

[Slinky]

You sure are trying to compare apples and oranges!!! First off, the Resmeds report the pressure at or below which you spent 95% of the night. The Respironics report the pressure at or below which you spent 90% of the night. If the Malilbu were set in straight CPAP mode and set at the EXACT same pressure as the Pro you STILL would not get any where near a similar reported pressure.

I take it the Malibu was a loaner to home titrate your pressure and the Pro is intended to be your personal CPAP?

Quit alternating the two machines. Stick w/the Malibu, its easier to check your data. I assume you have 7 solid, consecutive nights of data on the Malibu at min 8 cms and max at 19 cms? I'd raise the minimum pressure to 9 cms and leave the maximum pressure at 19 FOR ONE SOLID WEEK. No changing mask, no alternating w/the Pro. No changes whatsoever. Compare the data from the two weeks. Decide from there whether to up the Malibu's minimum or not. If you get a better AHI at the 9 cms-19 cms I'd raise that minimum pressure by 1 cm until I got to a week averaging close to an AHI of 5.0. When I started getting close then I'd up make smaller changes, say just .4 or .4 cms at a time. And I would stay at EACH CHANGE for ONE SOLID WEEK before comparing data.

AND DON'T overlook the fact that you well might need to DROP the maximum pressure from 19 cms. If you get close to an AHI of 5.0 whilst raising the minimum pressure and then the following week the AHI starts to rise again. Then I'd back the minimum pressure back down to the previous week's level and DROP the maximum pressure by 1 cm to 18.

Do your drops the same way you upped the minimum pressure, 1 cm at a time for one solid week of data before making the next change. When you get close to a 5.0 AHI then make SMALLER adjustments, .2 to .4 cms at a time.

OR get one solid weeks' data with ONLY the Pro set at 13.5 no alternating w/the Malibu. Then get one solid week's data on the Pro at 13. From those two weeks of data decide whether you need to go down to 12.5 or up to 14 for one solid week. Do NOT use the C-Flex until you get to an AHI of 5.0 or darn close to it. And when you DO start utilizing the C-Flex, it is still ONE SETTING FOR A WEEK before trying another setting.

Regardless which xPAP you use you need to make ONE CHANGE AT A TIME FOR ONE SOLID WEEK OF DATA BEFORE making one more change for one more week of data for comparison to decide if you need to raise or lower your pressure for a better AHI.

[Billyboy]

Thanks guys for the advice. I know these are two different types of xpaps. I like the comfort of the bilevel vpap and I can track my progress better since I do not have software and a card reader yet for the cpap. The issue for me is that I haven't had one night resulting in a good AHI<5(with either machine). My Dr. has seemed to give up on the malibu and is concerned because it hasn't ramped up above a 95% pressure of 13.6 in it's attempt to clear hyponeas. I think the malibu is saying his(the Dr.) titration of 19 is not correct and a pressure near 14 is closer. I raised my min up to 10 last week and the 95% still goes around 13.5-14.0. I was alternating to the cpap thinking a non fluctuating pressure would give better results,not true! My Dr. approved the change to the cpap but not the jumping back and forth between the two machines. That was my mistake and has made things very inconsistant lately , thats what I mean by running off the road with my thearpy. This stuff is harder than I thought it would be and I may make mistakes along the way and I may have to look for a new Dr. but I realize that it's my thearpy and I have to get through it. This forum has helped me alot. Thanks for the support.

[hades161]

Ok to sum up then your using the Malibu and can't get below a total AHI of 5.0 and have Central Apnea's. Your Doctor seems to be at a loss on how to deal with this but I would bet its because of the poor study results and most likely not understanding the machines, what they do, and how they do it.

Cool, I would follow the line of action that Slinky outlined for you. Use the Malibu, make sure your leaks are under control as this can effect how the machine adjusts pressures. I would also study the details of the malibu more in depth and make sure your setting everything up right.

A vpap or bi-level is a bit trickier to setup and trouble shoot then normal xpap's. Also I would look up on the forums here and ask around about how to hunt down and nail Central Apnea's. There are a few people who post around here, that have been fighting them and prolly can assist you more then I. They can, from what I have read be very hard to treat and figure out.

Rested Gal and a few others here come to mind. You might wish to hang out in the chat here and or PM some of the people who are fighting them in other threads. But without data reports that can be posted, or emailed hunting down centrals will be difficult.

Hang in there Billyboy =) and keep plugging away.