fumbling through different pressures

[miggity]

My basic question is whether you can actually have more apneas with a higher pressure than with a lower pressure. I was having bad results with a low pressure, but then increased the pressure, and got worse results than before ---- with leak being constant the whole time. Seems like the higher pressure led to more apneas?!

[Wulfman]

Your profile shows you have a REMstar M Series Auto with A-Flex.
Can you be more specific about what pressures you're talking about?
Do you actually have the Encore Pro or Viewer software? Things can be pretty hit or miss without it.

Den

[miggity]

Hi --- I actually have a biPap auto also, and was using that because that's what i was initially prescribed. I originally set a wide range --- probably 5 to 15, and let it auto titrate from there. Then i set a small range, and lower pressure --- around 4 to 5, and saw better results.

I have the Encore software, and am using it to guage my results

[echo]

Some people are more prone to central apnea's at higher pressures. This is the reason that most machines don't respond to apnea events when the pressure is > 10cm.
Did they notice any central's on your PSG or during your titration? What was your actual prescribed pressure?

The Puritan Bennet's actually try to detect central apnea's... on the other machines I think it shows up as a NR = non responsive, but don't quote me on that.

When you say the leak rate was constant - that's a bit strange. The built-in leak (vent) rate of the mask will go up naturally when you increase the pressure. Or are you programming in the type of mask into your machine?

I have no knowledge of bipap auto's so I'll handover the rest of the discussion to someone else ...

[Wulfman]

My basic question is whether you can actually have more apneas with a higher pressure than with a lower pressure. I was having bad results with a low pressure, but then increased the pressure, and got worse results than before ---- with leak being constant the whole time. Seems like the higher pressure led to more apneas?!

Do you have a copy of your sleep study?
Do you have GERD? (there is also a "silent" version)
At what point does the low pressure and high pressure merge? In other words, at what point do the results get worse?

Den

[Slinky]

Hoooo boy! A bi-level device is a LOT more complicated than "just" an autoPAP! I was just switched from a CPAP to a bi-level auto but not a Respironics so I'm totally unfamiliar with Respironics' settings.

With my Resmed VPAP Auto (bi-level auto) there are a lot more settings that can affect your therapy than just inhalation and exhalation pressure settings (IPAP and EPAP) making it one heck of a whole lot trickier to find your ideal therapy.

Do you have ANY idea of what your original settings were supposed to be according to your in-lab titration? It might be well worth your while to go back to the Default settings and then reset to just your original in-lab titration settings, gather ONE FULL WEEK of data BEFORE making any ONE more change and staying there for ONE FULL WEEK before making another ONE change, etc., etc.

You are shooting at windmills changing your pressures willy-nilly every night or two. And if you are working now w/an autoPAP instead of an auto bi-level that will make it a lot easier to find your ideal therapy settings w/a straight CPAP as a starting point for your pressure settings w/a bi-level.