Help me please, new user, new to message board

[TylersDad]

Wolfman, I sleep on my sides for probably 90% of the night. I turn side to side and sometimes stop on my back but not for long.

My question is if I set the lower pressure to 11, will it then adjust higher automatically or should I just keep going one number at a time?

Is it correct to assume, my magic number is definitely higher than what I am at now?

Lee, I am married, but my wife cant really tell anything because I am wearing a full face mask so she cant really hear much that is happening.

[Wulfman]

Wolfman, I sleep on my sides for probably 90% of the night. I turn side to side and sometimes stop on my back but not for long.

My question is if I set the lower pressure to 11, will it then adjust higher automatically or should I just keep going one number at a time?

Is it correct to assume, my magic number is definitely higher than what I am at now?

Lee, I am married, but my wife cant really tell anything because I am wearing a full face mask so she cant really hear much that is happening.

In all probability, it will NOT go up (to any degree) as you keep increasing the minimum pressure. In other words, you'd be about as well off using your Elite II or setting the the Autoset II in CPAP mode and keep moving the pressure up like you're going to be doing in Auto mode.


Den

[Pugsy]

I agree with Den. Bear in mind I am newbie myself. I am just comfortable testing new waters.

Yes, by aggressive, I mean I would increase the minimum pressure and/or run the machine in CPAP mode with a pressure of 10 or 11 just to see what happens.

Forget trying to correlate pressure requirements with whether OSA is severe or mild. There are people with "mild" OSA based on AHI numbers that need 15-18 cm pressure and there are people with "severe" that get by with 6-9 cm of pressure. The pressure needed to prevent events is determined by physical needs to maintain an open airway, not the "severity" level that the AHI points to.

[TylersDad]

Wulfman, Pugsy, you guys lost me on these last two posts.

I set the auto to 11 minimum last night so now the range is 11 - 20.

I try to thing in common sense terms and I guess that gets me in trouble. An auto machine I thought was supposed to "automatically adjust" some to try to eliminate episodes? If I have the minimum set on 11 with an EPR of 1, wouldn't that be a better situation than running my ellite on 11 with an epr on 1?

If the machine will only go up a point or so to overcome an episode, why does the DME set it on an 8 - 20 range, why not just set it on an 8 - 10 range?

I think I will just go up one number a night on the setting until I see the numbers go down to some normal readings?

One question that I still have is, is it ALWAYS safe to assume the setttings must go up to help reduce the AHI numbers? It seems safe to assume that to me because whatever the restriction is will need more flow to overcome it? Correct?

Thanks again for your help.

[Wulfman]

Wulfman, Pugsy, you guys lost me on these last two posts.

I set the auto to 11 minimum last night so now the range is 11 - 20.

I try to thing in common sense terms and I guess that gets me in trouble. An auto machine I thought was supposed to "automatically adjust" some to try to eliminate episodes? They don't know what pressure you need until they test each pressure setting as it moves upward. And, with a ResMed Auto, they won't pursue a sudden apnea above the pressure of 10 cm. because of the A10 algorithm ResMed uses in their Autos. They don't want to induce Central Apneas, which are more prevalent above the pressure of 10 cm.
If I have the minimum set on 11 with an EPR of 1, wouldn't that be a better situation than running my ellite on 11 with an epr on 1? Again, if you have sudden apneas above that pressure, the ResMed Auto won't go any higher anyway.

If the machine will only go up a point or so to overcome an episode, why does the DME set it on an 8 - 20 range, why not just set it on an 8 - 10 range? Your DME doesn't know how the ResMed Autos (or probably any others) work.....nor does your doctor.

I think I will just go up one number a night on the setting until I see the numbers go down to some normal readings?
Sounds reasonable to me (or every other night).

One question that I still have is, is it ALWAYS safe to assume the setttings must go up to help reduce the AHI numbers? It seems safe to assume that to me because whatever the restriction is will need more flow to overcome it? Correct?
For the most part that's true......unless pressures are inducing Central Apneas......which I highly doubt that to be the case in your therapy.

Thanks again for your help.

Den

[Pugsy]

I try to thing in common sense terms and I guess that gets me in trouble. An auto machine I thought was supposed to "automatically adjust" some to try to eliminate episodes? If I have the minimum set on 11 with an EPR of 1, wouldn't that be a better situation than running my ellite on 11 with an epr on 1?

If the machine will only go up a point or so to overcome an episode, why does the DME set it on an 8 - 20 range, why not just set it on an 8 - 10 range?

I think I will just go up one number a night on the setting until I see the numbers go down to some normal readings?

One question that I still have is, is it ALWAYS safe to assume the setttings must go up to help reduce the AHI numbers? It seems safe to assume that to me because whatever the restriction is will need more flow to overcome it? Correct?

Auto machines are "supposed" to increase pressure in response to certain event indicators (Flow limitations, snores, etc) and each brand has a different set of standards that they follow in doing this. The ResMed auto won't respond and push pressure above 10 cm UNLESS those certain indicators are present. When they are present the machine won't go higher than needed so this is why we see settings with the 20 max. Some people will have times where higher pressures are needed on a random basis (I am one of those people) but for the most part we only need something close to the minimum. About once or twice a week I might need 15 or 18 but for the most part I do very well at 9 or 10.

Your doctor prescribed auto unit with max of 20 so I will assume that he isn't worried about higher pressures triggering central apneas. Same with me, so I wasn't afraid to set my minimum above 10 cm in a trial.

So far your machine won't go above 10 cm in the auto mode and we don't know exactly why unless it is because the ResMed thinking part doesn't sense the indicators that it needs to try to prevent the events that you are having. So even though a machine has the capability to go to 20 doesn't mean it will unless it senses the need and that need has to meet certain criteria. Your events don't appear to meet the criteria to drive the pressure upwards so you have to set the pressure yourself.

I wish you lived close to me and I could let you try my Respironics auto just to see if its auto algorithm would work better for you.

Is it always best to "increase" pressure? Hmm, with the exception of pressure induced central apneas, I would suppose that is the way most tweaking is done. Especially in your case where you were started out with a relatively small amount of pressure with no improvement. There is no room to go down..so the only way is up.

Sorry if I lost you in my previous posts... which part and I will try to explain. Sometimes my brain and fingers don't correlate thoughts too well. I know what I mean but that doesn't mean someone else does.

I see Den has commented also. Same thoughts as mine with different words. Hopefully I am not confusing things more.

[ozij]

If your DME is cooperative, ask him for another company's auto. Respironics, Covidiens', Sandman Auto, or Fisher and Paykel.

O.

[DoriC]

Wulfman, Pugsy, you guys lost me on these last two posts.

[/b]
If the machine will only go up a point or so to overcome an episode, why does the DME set it on an 8 - 20 range, why not just set it on an 8 - 10 range? Your DME doesn't know how the ResMed Autos (or probably any others) work.....nor does your doctor.Thanks again for your help.

Den

Pugsy, Really, your explanation was perfect, but I didn't see you using these same words as Den's. Did I miss something?

[Pugsy]

Pugsy, Really, your explanation was perfect, but I didn't see you using these same words as Den's. Did I miss something?

Dori, you didn't miss anything. My thoughts mirror Den's, I just expressed them differently. With your experience here you understood what I was saying. I only hope that TylersDad is not confused by my words.
We know his present therapy is not effective, even his doctor admits this. He may be one of those people that straight CPAP gives better therapy but we don't know what pressure will be needed. He may or may not be one of those few people that a different auto machine brand and thus a different algorithm, might be better suited for.

In this instance if it were me and I was using the ResMed auto and I was still having these numbers and I had no history of centrals, I would probably give 11 cm a try and then even 12 cm as a minimum or even set it to straight cpap at those pressures. It isn't likely to raise the pressure in auto mode but I suppose it wouldn't hurt to leave it in auto mode either.

TylersDad is caught between a rock and a hard place. The original intent of the APAP was to see what pressure it rose to in response to events. The ResMed machine apparently will not do it so other choices must be made.

[TylersDad]

Guys,

Here is the update.

I got pretty aggressive with my settings. I went up one point a day until I got to 12. The AHI number if anything got worse (due to both AI and AHI). Based on my changes and my data collection, the higher numbers were making my HI worse, not better and my AI was getting worse. I found that the sweet spot was around 9.4 on the pressue and this had my AH at 2.8 one night and 3.3 the other night yet my HI was still high (14.8 and 12.7), but nowhere near as high as when I was on the higher pressures (HI was over 20).

So, I spoke with my DME since it had been almost two weeks with the loaner Auto machine and here is his suggestions and thoughts:

He recommended that we do another titration study and try the BIPAP Auto SV. He said that I had central apneas in both my initial study and I still had some during my second study when they determined my pressure.

He thinks this is the best course of action.

Am I going in the right direction? It just did not seem to me the auto machine was really adjusting up more than one point or so and I was still having many events.

Thanks again for your help!!!!!

[ozij]

TD, the DME is making sense.

However, some people respond with more apneas (central, not obstructive) to higher pressures, and it is possible the apneas we were seeing were actually pressure induced, and not obstructive. For some, they (their body and brain) just need to get used to the pressure. Others do indeed need a machine that can take care of central apnea - an SV titration is a great idea.

Till then: you did a great job of narrowing the pressure to a sweet point.

I'm thinking of Uncle_bob's recent posts. He suddenly did much better when he followed his doctor's suggestions, and lowered his pressure to a 5-10 range.

Suppose you were to raise the EPR, while keeping the max at 9.4 -- I wonder if the would make tings better.

How about a 5-9.4 range?

O.

[Pugsy]

He recommended that we do another titration study and try the BIPAP Auto SV. He said that I had central apneas in both my initial study and I still had some during my second study when they determined my pressure.

He thinks this is the best course of action.

Am I going in the right direction? It just did not seem to me the auto machine was really adjusting up more than one point or so and I was still having many events.

I agree with Ozij. You went to 12 which would have been my stopping point also if I had been in your shoes. I don't remember your ever mentioning centrals but now that I see that, then that pretty much explains things. The machine won't respond to what it perceives as central events. Anyway, you now know what happens at higher pressures and I think doing what the DME guy suggests would also be what I would do if I were in your shoes.

[dlp1195]

Tylersdad, Sounds like you are having the same problem with numbers I am (see my other posts) and my DME and doctor are going to titrate me on a BIPAP Auto SV on the 18th. Was suppose to be the 11th but they called yesterday and said they did not have that machine and it would be the 18th before they could do the study. It is kind of scary to me being new to all this and getting into what seems like a more complicated machine and treatment. I really enjoy this forum and find it offering hope that I can over come this disease.

[Wulfman]

Guys,

Here is the update.

I got pretty aggressive with my settings. I went up one point a day until I got to 12. The AHI number if anything got worse (due to both AI and AHI). Based on my changes and my data collection, the higher numbers were making my HI worse, not better and my AI was getting worse. I found that the sweet spot was around 9.4 on the pressue and this had my AH at 2.8 one night and 3.3 the other night yet my HI was still high (14.8 and 12.7), but nowhere near as high as when I was on the higher pressures (HI was over 20).

So, I spoke with my DME since it had been almost two weeks with the loaner Auto machine and here is his suggestions and thoughts:

He recommended that we do another titration study and try the BIPAP Auto SV. He said that I had central apneas in both my initial study and I still had some during my second study when they determined my pressure.

He thinks this is the best course of action.

Am I going in the right direction? It just did not seem to me the auto machine was really adjusting up more than one point or so and I was still having many events.

Thanks again for your help!!!!!

Had you mentioned that before? If that's the case, I may have to (partially) retract what I said about your DME. On the other hand, in view of that information, I wonder why they didn't do a titration on an ASV machine in the first place......and why waste these last weeks on an Auto CPAP. Some things just don't make sense with these doctors and DMEs.


Den

[TylersDad]

Guys,

Here is the update.

I am scheduled to go tomorrow night to have a new study done with the BIPAP Auto SV. This was scheduled to help with the central apneas I have been having.

1) Is there any helpful hints of things I need to ask about or consider?

2) I think this is a respironics machine? Is that the best?

3) I understand fully how the CPAP takes care of regular OSA (common sense), but how does a machine take care of central apneas when it is your brain telling you not to breathe. How does it trigger that breath? Do it push the pressure up real high, real fast to get it to make you breathe?

4) Do any of your have experience with the BIPAP Auto? Does it bring your HI numbers down?

5) Will I have to buy software to use with the Respironics machine?

Thanks again for your help.