Autopap questions

[Babbie]

Have a couple of questions to you "veteran cpapers" out there. I've requested to use an autopap for a bit to see what my numbers are (my DME loans them out). How much different is an autopap than a regular cpap? I'm using a Remstar Plus with Cflex. My understand is that an autopap go up to the correct number to get the apnea stopped. Right now mine is set at 8 for the highest, and I can ramp down to 4 to start out. So if I need more than an 8, this autopap will go up farther, right? And do you feel any notable difference when it goes higher? Thanks!!
Kathy

[Sleepless on LI]

Kathy,

You were given the same machine I use. If you have your machine set for 4-8, it will NOT go over 8 cms. That is your high pressure setting, 4 being not only your lowest, but the lowest the Remstar with Cflex can be set for. And it might make you feel like you're suffocating until you get used to 4 cms. It's bare minimum.

What was your titrated rate? This is a very narrow range for auto settings. If you want, it's probably a better idea to keep the bottom number, USUALLY, closer to your titrated rate. The DME's usually suggest 4-5 above and below your titrated pressure as the settings. So if you were titrated at 10, let's say, you would set the auto normally at 5/6 as a low and 14/15 as a high. But, as Rested Gal suggests, and I believe she's right, you usually get better results on auto if you keep the lower number closer than 4 or 5 below the titrated rate. If I was using auto with a 10 titration rate, I would probably choose either 7 or 8 as a low and 13 or 14 as a high. And if I didn't go that high at nights, I would bring the top number down, too, to about 12.

Realize that the machine will only raise the pressure if it feels it needs to. You can go an entire night at the lowest pressure setting if the machine doesn't think it needs to adjust based on what is going on with you that night. And that is the beauty of auto. Less mask leaks, less aerophagia and more comfortable sleeping if the machine stays lower than straight CPAP at a higher setting.

Let us all know how you do on auto. If I were you, though, a bit of a larger span would probably make for a better trial. You won't go past 8 cms. regardless if your machine is set like you said.

[tommy]

An Auto is normally set for a range of pressures...say 8 (cm of H2O) to 14. The machine will stay at the low setting until you need the higher pressure and then will slowly return to the lower pressure once your event has been stopped. Most people set the top end fairly high at first and then lower it based on the pressures actually needed. Most of these Autos have software so you can see how the pressure changed while you slept. After about a week of this data, you will have a better idea of what pressures you need. The value of the auto is that you spend most of the night at much lower (more comfortable) pressures. Most of us have pushed to get a permanent auto. That way we can monitor our sleep at home and change pressure as we lose weight or other factors change. Good luck
Tom

[Babbie]

Lori - I don't know what my titrated rate was---I'll quote from my study while wearing the cpap: "cpap at 8 cm of water pressure can be considered optimal for this patient's management. At this level of cpap the apnea hyponea index would be less than 1 event per hour." (I know I'm supposed to type CPAP in caps---I'm just too lazy to do it! The DME girl is supposed to come set this thing up for me - I'm guessing that she'll set the numbers on it?? I hate to sound clueless but I am!! I'm going to show her my sleep studies and see what she says. They just don't give me a whole lot of info--not like what I've read that others on here have said. My MD never did go over it with me, just said I need a cpap. The DME said there's a card in this that records the data and she'll look at it when I've used it for a week or two. The reason I want to use an autopap is because in the sleep study, it seemed like the mask I was using was VERY leaky and just wonder if I'm using the correct pressure. Yes, when I ramp it down to 4 I don't really feel much air---don't feel like I'm suffocating but there's just not much pressure there.
Tommy - thanks for your input too ---yes, it really would be nice to have an auto all the time so we can track our progress better than just how we're feeling.

[Sleepless on LI]

Kathy,

That means you were titrated at 8 cms. That is not very high, so that's good. However, on auto, you wouldn't want to set the high number at your titrated rate of 8. My suggestion would be about 4 or 5 as a low and about 12 to start at a high. You probably won't even get the machine up to a 12 (God willing). In some instances, you may not even reach your titrated rate of 8. But you don't set the high number at the titration pressure. You should go above just a bit.

If you can tolerate 4 cms. without feeling like you're suffocating, you COULD set it at 4-11 or 12. The best case scenario would be having the software and being able to monitor just where your pressure goes during the night at certain settings. Being this is a loaner, I highly doubt that is the case. But I'll bet your DME sets it at about 4/5 to 12/13.

Let us know how you do, please.

[Babbie]

Thanks for the input, Lori. I was thinking the high number should be around 11-12 too. Yes, I'll post and let you know. She said she may not have one in for another week, but I'll keep you posted. I'm anxious (as well as a lot of others) to know how you do with your oxygen testing. Hope things turn out well for you--I know this has been a difficult time for you. Take care- Kathy

[Sleepless on LI]

Please post when you finally get the auto and tell us, first, what setting they put the machine at and, second, how you like it compared to straight CPAP. I have a feeling you will.

Thanks for your continued concern with my "situation." I would say that I hope to have good news hopefully by tomorrow, but any news at all at this point will be welcome. The not knowing is the hardest part. Don't get me wrong, I am wishing for good news, but any news will be better than waiting. Will let you know when I find out. I keep singing Tom Petty's "The Waiting Is the Hardest Part" in my head.

[Guest]

Th upper number is not that important. You want to set it with a wide enough range that it will never reach it. 12-14. The bottom range is the comfort range. You don't want it so low you suffocate. If 8 is optimum, I would increase it to a max of 6 for comfort if I couldn't tolerate the lower rate but only after trying it. If 4 is hard to breathe, move it to 5 and if necessary 6. You don't want to get so high that the machine doesn't have room to "titrate" and adjust.

[HeidiHose]

This may be a strange question, but I am wondering WHY anyone would want to use a straight CPAP, even with C-Flex, when they could use an AUTOpap?

[mxylplik2]

This may be a strange question, but I am wondering WHY anyone would want to use a straight CPAP, even with C-Flex, when they could use an AUTOpap?

_________________

I wondered that myself. Let's say my titration study was WRONG - and that I need more than a 10 to keep me from having events. The autopap has a margin of error built in - so that if I need 13, it will go up to 13. The straight CPAP machine will only know to keep the pressure at 10. After using an APAP for three nights, I feel slightly better than when I was using the straight CPAP. Can't wait to buy the Silverlining software and see what the data looks like.[/quote]

[Guest]

Here is an example of when CPAP-mode might be preferable to APAP-mode. The beauty of an APAP is that you can use it either way, and you can always conduct self-titration experiments whenever you want.

CPAP is better than APAP (for me..)

[Sleepless on LI]

I preferred CPAP actually to APAP. I found it gave me better results. The one problem was, it also gave me more side effects. But I usually felt better and it TOTALLY eliminated my snores, which no setting on auto usually did. CPAP, if your study was done correctly, works great. I think I was one of the lucky ones because whenever I'd use CPAP, it would give me great results. My average AHI was .01-.03 on CPAP. And although it still stayed under 1 with auto usually, it was higher all the time.

Auto did HELP, not alleviate, the aerophagia that I had. It does also help with leaks since the pressure never usually rose that high for me. So my mask was quieter and had less leaks. I just found the results better for me on CPAP, energy level and numbers. But as with everything else in this realm, it's an individual choice to make. Whatever floats your boat.

[sthnreb]

Or, however the cookie crumbles, or the mop flops, or whatever trips your trigger, etc.

[Sleepless on LI]

Or, however the cookie crumbles, or the mop flops, or whatever trips your trigger, etc.

Yeah, what he said...

[CollegeGirl]

It was so interesting to me to read Derek's post on the "CPAP is better for me" thread. I, too, have that same U-shaped curve in my APAP results. I've been wondering if perhaps I might not fare better on straight CPAP. I'm going to talk to my sleep doc about it in a couple of days. One thing I have been wondering though -

I have the fewest events at a pressure of 12, but the APAP spends 90% of the time at 11. I obvious don't fully understand RemStar algorithms yet. Can anyone explain?