Enlightenment

[jayman13]

I posted before about APAP problem that I am using for a month. As several people pointed out, it appears the doctor (nurse pract) don't appear to be that knowledgeable regarding the machine. With my regular machine set at 17, trying to use APAP at 5-20 setting they ordered, was a disaster. They reset it to 12-20 and still didn't provide results. Last night I took matters in my own hands and set it at 15-20. I don't know what the data will show in two weeks when it is downloaded, but I do know I had a pretty good sleep last night. No waking up with headaches and no getting up to pee.

I am supposed to call on Monday to let them know how it went. Should I simply say to my doctor (nurse pract), "You don't know what you are doing"? Do I say, I got the right advice from CPAP Talk forum? or is there some kind of manufacturer's instructions regarding APAP hi-lo pressure setting? Not withstanding the knowledgeable people on this forum, does anyone have credentials that a doctor would recognize?

The whole purpose of using the APAP is to determine what my pressure should be. (this after adjustments made by me over the last year and having occasional headache problems) They wanted me to do a whole sleep study and I don't. I wanted to use a home pulse ox and they suggested the APAP.

[J Neutron]

I am supposed to call on Monday to let them know how it went. Should I simply say to my doctor (nurse pract), "You don't know what you are doing"? Do I say, I got the right advice from CPAP Talk forum? or is there some kind of manufacturer's instructions regarding APAP hi-lo pressure setting? Not withstanding the knowledgeable people on this forum, does anyone have credentials that a doctor would recognize?

Ummmm.... I'm no expert, but an adversarial relationship isn't going to produce satisfactory results.

It sounds like they didn't believe you knew better than they did. Point to the data, which is what the techies believe in. Don't say "na na na boo boo". Do say that the data supports the new settings.

This is a learning experience for the NP.

Jim

[kteague]

J Neutron sounds the voice of reason. Good advice. Too bad they are learning at your expense, but good for the next person(s). Although not on target, hopefully their goal is the same as yours - to see cpap be successful for you.

Have they discussed with you that if the new settings aren't satisfactory over time, a bipap may be the next step? Good luck at continued progress.

[Wulfman]

I posted before about APAP problem that I am using for a month. As several people pointed out, it appears the doctor (nurse pract) don't appear to be that knowledgeable regarding the machine. With my regular machine set at 17, trying to use APAP at 5-20 setting they ordered, was a disaster. They reset it to 12-20 and still didn't provide results. Last night I took matters in my own hands and set it at 15-20. I don't know what the data will show in two weeks when it is downloaded, but I do know I had a pretty good sleep last night. No waking up with headaches and no getting up to pee.

I am supposed to call on Monday to let them know how it went. Should I simply say to my doctor (nurse pract), "You don't know what you are doing"? Do I say, I got the right advice from CPAP Talk forum? or is there some kind of manufacturer's instructions regarding APAP hi-lo pressure setting? Not withstanding the knowledgeable people on this forum, does anyone have credentials that a doctor would recognize?

The whole purpose of using the APAP is to determine what my pressure should be. (this after adjustments made by me over the last year and having occasional headache problems) They wanted me to do a whole sleep study and I don't. I wanted to use a home pulse ox and they suggested the APAP.

The problem with the ResMed machines in trying to use them in Auto mode at pressures above 10 cm. is that they won't pursue an apnea unless it's preceded by snores or flow limitations. That's probably why your 12 - 20 setting still didn't work very well. With the ResMeds (as well as all other Autos), the minimum pressure needs to be set to what will take care of almost all of the events. Not all Autos were created equal. Each manufacturer has their own algorithms and ways to detect and treat these events.


Den

[jayman13]

No,I don't intend to do the na na boo boo thing and understand creating an adverserial relationship isn't a good thing. However, my main question remains: Are there any documented, technical recommendations by the makers of the machines or other experts?

If the machine set pressure below 12 won't pursue apneas, is having this machine doing any good at all? Should I just go back to my regular machine at 17 and forget the APAP? Again, the whole purpose of this loaner (rented) machine is to determine what the correct pressure on my regular machine should be. If I use it at 15-20, will the data be useful at all?

If I were to purchase an APAP and use it at 15-20 would the automatic feature benefit me at all?

[Wulfman]

No,I don't intend to do the na na boo boo thing and understand creating an adverserial relationship isn't a good thing. However, my main question remains: Are there any documented, technical recommendations by the makers of the machines or other experts?

If the machine set pressure below 12 won't pursue apneas, is having this machine doing any good at all? Should I just go back to my regular machine at 17 and forget the APAP? Again, the whole purpose of this loaner (rented) machine is to determine what the correct pressure on my regular machine should be. If I use it at 15-20, will the data be useful at all?

If I were to purchase an APAP and use it at 15-20 would the automatic feature benefit me at all?

< Sigh >

I'm not sure how well I'll answer your questions, but.......

Most of the critiquing of the machines and their abilities and limitations seem to be discussed here, by the users of them and those who have located the patents for them. The manufacturers know their machines capabilities and limitations, but they're in the business to sell them and make money. It's usually not until after the patient buys them that they discover that the way they work either does or doesn't provide them with the best therapy.
Unfortunately, it would appear that far too many of the doctors have no idea how the different machine algorithms work either.

In theory, an APAP would/should allow for more comfortable sleep at somewhat higher pressures.....only moving upward when the need arises. However, in reality, the pressure changes can (and do) disturb sleep for some people. The APAPs move their pressure upwards cautiously and slowly in the case of apnea events, however, for leaks and snores they can be very aggressive. In your case, the pressure of 17 is approaching Bi-Level pressures. There are lots of people who get prescribed straight-pressure CPAP at those higher numbers (16 - 20), but I know what a pressure of 18 cm. feels like (my original prescribed pressure) and I think it's somewhat sadistic on the doctors' part to prescribe straight CPAP at those pressures.

I've also seen far too many people trying to use APAP machines at ranges of pressure and they end up with massive leaking and other problems trying to get their therapy nailed down because of pressure changes during the night.

I'm all for people being able to get APAPs (Autos), but they need to recognize what does and doesn't work for them. Just because a person owns an Auto, doesn't mean they have to run it in a range of pressures.

On a side note......I've been thinking for a couple of years that I'm going to set my machine up to my original pressure of 18 cm. and refresh my memory about how that feels and whether I could still keep my mask from leaking......but so far, I haven't had the nerve to do it for a whole night. Maybe for a nap some afternoon.......?

Den

[plr66]

In theory, an APAP would/should allow for more comfortable sleep at somewhat higher pressures.....only moving upward when the need arises. However, in reality, the pressure changes can (and do) disturb sleep for some people. The APAPs move their pressure upwards cautiously and slowly in the case of apnea events, however, for leaks and snores they can be very aggressive. Den

I am a relative (completely dedicated) newbie here with 4.5 months "on the hose." But I would add my experience that these "chased event" increases to intolerable and unhelpful pressures using APAP ranges can sometimes relate to breathing that is characteristically somewhat flow-limited, if I understand that concept correctly. In other words, I have had no issues with leaks or snores; I am a consistent side-sleeper; and yet I did have many runs of FL which apparently jacked up my pressure to the set max at times.

Since setting my machine to straight pressure on CPAP, my AHI has consistently been below 1.0. I still look like a mack truck ran over me every morning with the bags under my eyes (and can't figure out why), but generally feel pretty good all day, require no naps, and am much less foggy-brained.