From CPAP to APAP and more tired than ever.

[vrgsph]

I just got a new APAP two weeks ago. I was excited. Since then, I notice that I am more tired than I have ever been on xPap.

My DME set my unit for 4-20cm. I knew this was too wide, but I didn't argue. For kicks, I tried 4-20cm. I couldn't breath at 4cm -- I was gasping for air.

The DME left the programming card for my M Series Auto with the manual. I changed it to 8-18cm -- 8cm is my prescribed CPAP flow.

I still find 8cm on the Auto to be harder to breath than 8cm on my old CPAP.

I am using the same mask, and I am sleeping the same length of time, but I feel way more tired since getting the new unit.

My AHI has been about 1.5. My leak rate is 22.0. My average CM flow is 9.8.

Any thoughts on why I am so tired?

[Wulfman]

Doesn't surprise me at all.

The pressure changes are probably disturbing your sleep.....hence, you're tired from all of those micro-arousals. I experienced something similar.

Den

[ozij]

[quote="vrgsph"]
The DME left the programming card for my M Series Auto with the manual. I changed it to 8-18cm -- 8cm is my prescribed CPAP flow.

I still find 8cm on the Auto to be harder to breath than 8cm on my old CPAP.
I am using the same mask, and I am sleeping the same length of time, but I feel way more tired since getting the new unit.

My AHI has been about 1.5. My leak rate is 22.0. My average CM flow is 9.8.
Any thoughts on why I am so tired?

[Snoredog]

if you were used to 8.0cm on CPAP and you are now using Aflex, you need to bump up the pressure by at least 2 cm for the same feeling, the 8 on Aflex will feel like 6 cm on CPAP.

Bumping up your Auto:min=10 then using the Aflex feature should result in even a lower AHI than CPAP and yet feel the same.

[vrgsph]

My Auto is with C-Flex.

My sleep study suggested I did best on 8cm straight cpap.

I had my doctor prescribe an Auto so that I could, at least, have the option. He understood that I wanted a data capable machine, so he had no problem.

It was my DME that set the machine to 4cm - 20cm with C-Flex 1 (of 3).

As I said, the bottom number was unbearable. Since I knew how reprogram the unit, I upped the bottom to 8cm, and I lowered the top to 18cm.

I set the ramp to 0. So, when it turns on it starts at 8cm. This 8cm does not feel the same as 8cm on the Cpap.

The 9.8 number I reported is from the M series itself (I don't have my card reader yet). I don't know enough about it all to know what that number really means (Average overall or 90% average -- whatever).

I guess I am asking if 8cm on Apap with Cflex is same as 8cm on Cpap.

I have already read the responses so far and understand that I am probably more tired because of the change in pressures during the night. I am glad to hear that I am not just imaging that I am tired -- I have a possible culprit, now.

The M-Series is also quieter, yet more disturbing than my old Respironics Plus CPAP. The reason for this is that old unit was loud all the time and became "white noise" like. The new unit is quiet but there is a discernable pitch difference in inhale, rest, exhale on the machine. Sometimes, it is like hearing someone else snore. If I think about it, it bugs me.

[hades161]

Well it looks like your leak rate is good and so is your AHI. If your hanging around at 9.8 I would adjust it to a range of 8 to 12 or 13. The reason 8 doesn't feel the same is most likely due to your Cflex setting of 1. I found for myself a setting of 2 to work nicely, not max exhale relief nor min but middle of the road so to speak. If I remember right 1 is the least relief you can get but its been so long since I looked that over I could be wrong. Try setting it to 2 and see how it feels.

By narrowing down the ranges you can minimize some of the changes in pressures. Until you come down to a magic range of numbers or a single pressure.

It does take sometime to adjust to new equipment as well but you might want to try a straight 10 setting if the reported pressure stays at around 9.8 all the time.

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CPAPopedia Keywords Contained In This Post (Click For Definition): cflex, AHI

[Captain_Midnight]

S-Dog writes...if you were used to 8.0cm on CPAP and you are now using Aflex, you need to bump up the pressure by at least 2 cm for the same feeling, the 8 on Aflex will feel like 6 cm on CPAP.

Bumping up your Auto:min=10 then using the Aflex feature should result in even a lower AHI than CPAP and yet feel the same.

I find this quite interesting (as one who changed from CPAP to AFLEX). Are you saying that to get the AHI-reduction therapy one would get at 8 cm CFLEX, one would set the MIN AFLEX range to 10?

And, if I might ask, is this based on several observations, or just a few cases?

If this info hasn't been presented in a scientific forum, it really needs to be confirmed, and "out there."

Again, this is most interesting, and could be valuable to lots of AFLEX folks down the road.

Thanks much - - Tom

[ozij]

I guess I am asking if 8cm on Apap with Cflex is same as 8cm on Cpap

In theory it should be. Certainly if both have the same Cflex setting.

O.

[xyz]

> This 8cm does not feel the same as 8cm on the Cpap.

Just to be sure, ask your DME to check/calibrate your new machine's pressure to be certain that an 8 is really an 8. That will allow you to eliminate the possibility of some sort of problem with your new machine. Set the biflex setting to the lowest value (1).

While not likely, it's possible that your old machine was out of spec, and an 8 on it was really higher than 8.

> Any thoughts on why I am so tired?

Perhaps it's unrelated to your new machine. Or it's just that your new machine is different. It's like changing to a new/different mask. It takes time to adjust to the change.

> I don't have my card reader yet

It's all just a lot of speculation until you get your card reader and software installed and running. Order an extra card too.

Start by downloading your data daily. Save the report to a file. In addition to Encore Viewer you also need the utility from ... encore.org (?) that allows you save a .bin file and to format the card. You also need a utility that allows you to save the report in a .jpg or .pdf format.

Create a folder that all your data will be saved into, e.g., My Sleep Data. In that folder create a folder with the last night's date, e.g., 2008-02-18.

Load your card in your card reader. Using EV read the card and then generate the report.

Using the jpg/pdf utility, save a copy of the report into last night's folder. Open that document to assure that it is OK.

Using the encore.org (?) utility 1. save the contents of the card into last night's folder (it's a .bin file). 2. Format the card.

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CPAPopedia Keywords Contained In This Post (Click For Definition): CPAP, DME

[DreamStalker]

S-Dog writes...if you were used to 8.0cm on CPAP and you are now using Aflex, you need to bump up the pressure by at least 2 cm for the same feeling, the 8 on Aflex will feel like 6 cm on CPAP.

Bumping up your Auto:min=10 then using the Aflex feature should result in even a lower AHI than CPAP and yet feel the same.

I find this quite interesting (as one who changed from CPAP to AFLEX). Are you saying that to get the AHI-reduction therapy one would get at 8 cm CFLEX, one would set the MIN AFLEX range to 10?

And, if I might ask, is this based on several observations, or just a few cases?

If this info hasn't been presented in a scientific forum, it really needs to be confirmed, and "out there."

Again, this is most interesting, and could be valuable to lots of AFLEX folks down the road.

Thanks much - - Tom

I think what the SD is saying is that if you had effective treatment with CPAP without any flex, then when using AFLEX, you need to increase pressure setting of AFLEX machine to compensate for lower exhalation pressure offered by AFLEX setting (ie. inc press setting by 3 for AFLEX setting of 3, inc press setting by 2 for AFLEX setting of 2, etc.).

[Guest]

I also believe I noticed a difference. I swtiched from a non data capable RemStar CPAP with CFLEX to an Auto CPAP with CFLEX and felt I was getting a better nights sleep with the straight CPAP. Not sure why but I was sleeping 4 hours without awakening with the CPAP and now I awaken every 2.5 hours with the APAP. My pressure is 12 cm-H2O with CPAP and I have the APAP set at 11.5 -13.0. Usually when I check the stats I run at 12.0 for approximately 330 minutes and usually spend about 30 minutes at 13.0. Not sure how many times it switches between 12 and 13. Sometimes the AHI is better during the time spent at 13.0 and sometimes AHI is better for the time spent on 12.0, which is why I have not set the machine to run as a striaght CPAP... but maybe that should be my next step. This morning I checked and my AHI for both pressures was 0.0.

[xyz]

I wrote:
> you also need the utility from ... encore.org (?)

That would be http://www.mycpap.org.

[roster]

......... if you had effective treatment with CPAP without any flex, then when using AFLEX, you need to increase pressure setting of AFLEX machine to compensate for lower exhalation pressure offered by AFLEX setting (ie. inc press setting by 3 for AFLEX setting of 3, inc press setting by 2 for AFLEX setting of 2, etc.).

That is exactly what I experienced. I did it the reverse route. My cpap machine was not data capable. I got an A-Flex and started with an A-Flex setting of 3. Some experimenting showed a low AHI with pressure range of 10 - 12.

For some reason, I did not like the A-Flex and went back to straight cpap (on the same machine). I started at pressure 10 and gradually lowered it to 8.5 and found anywhere between 10.5 and 8.5 my AHI was near zero.

I kept lowering it from 8.5 and the AHI started climbing. At 7.0 the AHI is about 2.0 with mostly hypopneas and few apneas. I seem to sleep better and feel better (or maybe feel less badly) the next day at 7.0. Certainly the pressure is less uncomfortable and the aerophagia is less. The few apneas I have are running about 10 to 20 seconds.