CPAP ----> APAP \o/\o/\o/

[Uncle_Bob]

I had my 6 month service at the sleep docs yesterday. Finally the doc expresses some concern over the events that I'm still getting despite pressure changes on my CPAP. I've gone from 7 to 11 with various levels of EPR but mostly use EPR of 3. I get some good days of AHI 0.1 - 0.3 and AHIs of 6-8 but they are getting less frequent now.

He explains that he has no idea if the remaining events are obstructive or central in nature and then mentions that he is considering another sleep study. That's where i chime in and ask if i would be a candidate for an APAP machine, to see if i can go after those events as likely being obstructive. The events always seem to follow a sharp rise in the HIs graph. He pauses for a moment, I'm starting to think he's worried about me asking to exchange my machine with the DME (he co-owns) for an APAP machine. So i try to persuade him further by stating that i would purchase my own using left over money in my Healthcare FSA account, otherwise i would have to spend that $300 dollars on dental floss and band aids at the end of the year to avoid loosing the money. So I leave with my APAP rx and feel hopeful once more

Despite the newer APAPs arriving on the scene i decided to purchase an S8 Elite Autoset II so i can use my humidifier and software etc. So while I wait for that I was wondering if anyone has any advice on going from CPAP to APAP and what to expect ? The rx has a pressure of 7 - 12 should i start there or not?

Thanks
UB

[roster]

Do I understand correctly that you are using 11 now? If so, I would start with the APAP at 10 -12. Then look at the data and decide what to do next. And don't think you have to run a week at one setting before making a change. If I were suffering and thought I knew what to do next, I would make a change every night until I got it right. Then you can watch the data for a week. You are seeking good therapy not data trends.

[Uncle_Bob]

Do I understand correctly that you are using 11 now? If so, I would start with the APAP at 10 -12. Then look at the data and decide what to do next. And don't think you have to run a week at one setting before making a change. If I were suffering and thought I knew what to do next, I would make a change every night until I got it right. Then you can watch the data for a week. You are seeking good therapy not data trends.

I'm running at 9.6 right now. Given that i will probably use EPR at 3 i think setting the lower pressure to 7 will be too low as actual pressure could be as low as 4. I read some posts where some people just have the defaults of 4-20 but hardly any state their EPR setting. I am definitely seeking good therapy and have been for 6 months

[DoriC]

Bob, I'm certainly no expert so I would defer to Rooster on his recommendation of 10-12cms. My husband does best at a very narrow range or straight pressure. Have you tried not using EPR? It's my understanding that on your machine it is actually lowering the pressure by 3cms. Dori

[roster]

I'm not a fan of EPR, so I will defer to others to recommend settings for you.

I will say, your minimum pressure needs to be near what an effective straight CPAP pressure for you would be.

[Uncle_Bob]

I've tried no EPR and didn't like fighting the pressure that much.

Setting the min pressure to what i currently think works best using CPAP makes sense. But I'm still confused as to why my doctor started me off on CPAP at 7 and wants my lower range to be 7 on APAP even though i was titrated at 10

[timbalionguy]

I've tried no EPR and didn't like fighting the pressure that much.

Setting the min pressure to what i currently think works best using CPAP makes sense. But I'm still confused as to why my doctor started me off on CPAP at 7 and wants my lower range to be 7 on APAP even though i was titrated at 10

A lot of folks here seem to recommend setting your minimum pressure about 2 cm below your titrated pressure. This gives you some additional comfort when no events are happening, but is close enough to your pressure that it can ramp up to it quickly enough to stop apnea events. Although a little lower than folks here recommend, I think your doctor's recommendation is in the ballpark. You can always discuss this with your doctor, or try setting it to 8 yourself. And I am with Rooster-- wean yourself off of EPR, if you can. Or at least get it down to 2 or 1.

[Uncle_Bob]

My doctor has always said that EPR of 3 is fine so i can't help to wonder why is it that EPR is so socially unacceptable in this forum? I'm just trying to understand We are talking about exhale not inhale, has anyone seen events eliminated by lowering or reducing EPR?

I think i'll try the narrow pressure range first and then if i'm still getting events I can try the EPR reduction and see what it does for me.

Thanks

[roster]

My doctor has always said that EPR of 3 is fine so i can't help to wonder why is it that EPR is so socially unacceptable in this forum? I'm just trying to understand We are talking about exhale not inhale, has anyone seen events eliminated by lowering or reducing EPR?

I think i'll try the narrow pressure range first and then if i'm still getting events I can try the EPR reduction and see what it does for me.

Thanks

UB,

If you have events while exhaling, using EPR could allow more events.

Regarding "socially unacceptable", it is what works for you that counts. Advice by members is just advice.

As for the doctors, most of them don't have a damn clue.

You have the tools now, have fun!

[DoriC]

My doctor has always said that EPR of 3 is fine so i can't help to wonder why is it that EPR is so socially unacceptable in this forum? I'm just trying to understand We are talking about exhale not inhale, has anyone seen events eliminated by lowering or reducing EPR?

I think i'll try the narrow pressure range first and then if i'm still getting events I can try the EPR reduction and see what it does for me.

Thanks

UB,
As for the doctors, most of them don't have a damn clue.
You have the tools now, have fun!

Rooster, I'm so glad you said what I was thinking. At our first meeting with our "specialist",he knew titration was 13cms but he set the machine on auto from 8-18 for no reason to just "let the machine find the right pressure". As soon as we got home I changed it to 11-15cms on advice I got here and started from there. As for our M Series, when we turned off the Aflex/Cflex my hubby's AHIs were much lower as well as his breathing pattern became more normal. With flex he seemed to breathe too fast. Just some observations. Dori

[Muse-Inc]

My doctor has always said that EPR of 3 is fine so i can't help to wonder why is it that EPR is so socially unacceptable in this forum? I'm just trying to understand...

Exhalation relief seems to be controversial...I have no idea why. Have come to believe it is a highly individual response: works for some, creates problems or lousy numbers for others. I don't have EPR; when the pressure on my CPAP is set to 10, my lower ribcage gets sore and I find exhaling against that pressure challenging.

[rosiefrosie]

I don't use the EPR on my machine because I'm comfortable without it. I always assumed that most people here didn't use it for the same reason and not that it was socially unacceptable. I too think that if it's more comfortable for you to use the EPR then, by all means, use it. You may find that after awhile you won't need it. It reminds me of when I first started therapy and I used the ramp feature. Now, I find I don't need to. Just my thoughts.

Rosie

[Uncle_Bob]

If you have events while exhaling, using EPR could allow more events.

Regarding "socially unacceptable", it is what works for you that counts. Advice by members is just advice.

As for the doctors, most of them don't have a damn clue.

You have the tools now, have fun!

It has been my experience that the advice from members here has been far more helpful than any advice given by my doctor, that's why i was asking further questions about the EPR.

So last night i set the EPR to 2, i didn't really notice any discomfort with it this time so i slept with it. Woke up with AHI of 4.3 = lowest ever
Still some AI's though (0.7)

I've been getting way to excited about trying the APAP, I've been tracking the shipping more than once a day Now its at my local post office and i hope it gets out for delivery today

[2flamingos]

If you have events while exhaling, using EPR could allow more events.

How do you know if events are during inhalation or exhalation?

[roster]

If you have events while exhaling, using EPR could allow more events.

How do you know if events are during inhalation or exhalation?

That can only be detected during a true PSG. No CPAP machine has the capability.