First Night on Devilbiss Intellipap Auto, not comfortable

[shirleyAPAP]

Can you tell us a bit more about your mother? Why it is you posting, and not your mom? How do you know she's still snoring? Is she involved in her therapy, cognitively capable of understanding why it is necessary?

My mum lives in China and speaks only Chinese. She's currently visiting me and will stay with me for another 2/3 months. She had her sleep study done back in China and was diagnosed sleep apnear and need to use CPAP machine. Since the the price of CPAP machine is much higher in China, I bought her the machine here last week.

Can you borrow or rent a different type of machine before the time runs out for exchanging the one you have?

I will if need to. I'm trying to contact her doctor in China first. Hopefully I can talk to him on the phone

If you absolutely can't get your mother to use the machine for longer periods at the present settings, try capping the Max (e.g. at 10) and then raising the Max gradually - at little bit higher every 4 days or so.

Will probably try tonight. Thanks!

[Slartybartfast]

She is using full face mask. Is it normal for people to snore when using CPAP/APAP machine? (even though she snores far less than usual)

No, if the machine is set at the correct presssure, she should not snore. Snoring occurs when the airway partially collapses. Snoring indicates the pressure in her airway is not high enough to keep the airway open.

On your later posts, 0.6 hours isn't enough for most people to get to sleep when they're first on CPAP. And collecting statistics on such a short time is worse than meaningless, as has already been pointed out, because the quality of the data is so poor it can cause you to draw the wrong conclusions. I wouldn't pay any attention to the statistics until you have at least a few hours of uninterrupted sleep. More is better.

I'm concerned that the pressure ran so high, so quickly. However the Intellipap responds aggressively to snores just as the S9 responds to flow limitations. Was your mum lying flat on her back? Lying on one's side helps to keep the airway open. You might try having Mum lie in different positions and see how it goes tonight.

I wonder what the second line in your report "Sofpap" refers to. I Googled it and it might indicate she was titrated using a bi-level machine. If that's the case, then others need to chime in because I know nothing of bi-level machines.

I also wonder whether at this point it might be worthwhile to set the machine in CPAP mode as 12.0 cm and see if your mum is more comfortable at a constant pressure. Once she is able to sleep for more than a short period of time without waking feeling she can't breathe, then you might return to automatic mode. But for now, I think I'd give constant pressure a try and see what happens. Constant pressure is still the standard choice of many (most?) sleep docs. Automatic machines are a relatively new development. Fortunately, your Intellipap is capable of being set in constant pressure mode.

[jmcanzo]

The short amount of time on the report may be due to the time the "smartcode" was read. The intellipap without the software module will reset every 12hrs. Depending on when the machine was plugged in, is when the 12hrs start. I had it happen to me a couple of times. Best bet unplugged/plug back in intellipap right before bedtime. (Suggestion from Devilbiss Rep here)

[ozij]

Thanks for the additional info, that makes things much clearer.

[Emilia]

The OP told me via PM that her mom is now wearing the mask during the day to acclimate to it. She did, indeed, only get very short amounts of sleep with the machine before giving up. She hope with practice, she can wear the mask longer to get some data. She also has written to her mom's doctor in China to get add'l info.

I wondered if the FFM was given to her out of necessity or just because it was considered convenient. I suggested that if mouth breathing was not the issue, she should consider another mask that is more open for her mom to feel more comfortable. Not knowing the details of her study or data, we'll need to wait to find out.

[archangle]

Wearing the mask is good. Actually doing CPAP during the day is better, although it may screw up your numbers on the machine because you don't breathe while awake the way you do while sleeping.

I think people have too much faith in "auto" machines and often set the minimum pressure too low. You start out low, and have to suffer from some apneas before it adjusts up to the correct pressure. I'm also suspicious that the machine may settle into a final pressure setting that eliminates the "hard" apneas, but still leaves you with some difficulty breathing that doesn't clearly show up in the results. Auto is good, but your minimum pressure needs to be high enough to give you good therapy most of the time.

What problem is she having when she takes the mask off? Is she having a hard time getting enough air, or does she feel like too much air is coming in? Is it difficult to inhale, or difficult to exhale?

[Slartybartfast]

Bump. Hoping to hear some encouraging news. . .

[shirleyAPAP]

I wonder what the second line in your report "Sofpap" refers to. I Googled it and it might indicate she was titrated using a bi-level machine. If that's the case, then others need to chime in because I know nothing of bi-level machines.

That's a good point. When I take a second look at the titration report, on the bottom, the doctor wrote "recommend using BiPAP or Auto-cpap" Now I'm wondering what type of the machine they use for the sleep study. So confused about the recommendation. As I know, Bipap and auto-cpap are different types of the machines, right? My mum can use either of them? I was able to email her doctor in China, but he did not answer my question about the exact type of the machine they use for the sleep study. That's frustrating. I will follow up with him

I also wonder whether at this point it might be worthwhile to set the machine in CPAP mode as 12.0 cm and see if your mum is more comfortable at a constant pressure. Once she is able to sleep for more than a short period of time without waking feeling she can't breathe, then you might return to automatic mode. But for now, I think I'd give constant pressure a try and see what happens. Constant pressure is still the standard choice of many (most?) sleep docs. Automatic machines are a relatively new development. Fortunately, your Intellipap is capable of being set in constant pressure mode.

I may have a try

After one week, she still does not feel comfortable about it. Now I doubt if I need to try bipap. Anyone have any idea about the bipap?
BTW, she was able to sleep with the machine for 4.5 hours. The smart code for last night is FZ8M-3ZH-NQQA. The numbers are too high. Anyone has any comments?
My current setting is: low pressure: 7; high pressure: 15.5

[Emilia]

Hi Shirley,
Looking at the new Smart Code Report, it shows super low leak line so no issues there. The 90/95th%tile pressure for 4.5 hours was 15.5 which kind of tells me the pressure needs to be raised. The AHI is also 15.5 which is way too high.

Since you have the range set at 7-15.5, I consider changing it to 11-16 with Delay set to start at 6.5 for 15 minutes to get her used to getting up to 11.

Try this for one or two nights and let's see what the results are. Sure would be nice to see more detailed graphs from software..... are you going to get it? Can't remember is you said you purchased it or not.

[Slartybartfast]

It would be nice to know what's going on. With AHI that high, it indicates something's wrong. Earlier report on 0.6 hours said lots of non-obstructive apneas, which Resmed would have called Centrals, indicating that the pressure is too high. But we discounted that based on insufficient sampling time. Now, with 4.5 hours, the same thing happens. I wonder whether perhaps her problem isn't simple obstructive sleep apnea. Maybe she needs a bipap, or maybe even a ventilator. At this point, it's hard to tell what is going on. The fact that she's not responding to CPAP the way most people do makes me wonder if something else is going on.

Any chance of taking her to a sleep doc here in (I presume) North America for a second opinion? I know it's expensive, but she's your mum, after all. Sat up all night with you when you had the colic, wiped your nose when you had a cold . . .

[Emilia]

The DeVilbiss publication says: "Non-Responding Event Index (NRI)
NRI is provided as a number and as a graph. The NRI includes all the non-responding events considered by the AutoAdjust PAP: leaks, non-obstructive apneas, and exhale puffs. The NRI is the average number of non-responding events per hour. If the number is higher than 10, the patient may be exhibiting primary central apneas and need clinical intervention.
NOTE: If non-responding events are present, the algorithm prevents a further increase in pressure because increasing the pressure in the presence of these events is thought to produce central apneas which could be detrimental to a patient with obstructive sleep apnea.3"

However, the new Smart Code report shows the NRI has lowered to 5.75 -- much lower than the first report. The Exhale puffs also lowered to 13 in this report. Still a bit high, but one wonders why she is exhaling via the mouth unless she has some congestion.

I don't think it would hurt to try the higher pressure range for a night or two to see if it helps considering the 95%tile being at her top pressure.

[Slartybartfast]

Ok, I read your earlier message, and it appeared nothing had really changed. If the numbers have come down, then I stamd corrected. Never mind.

[shirleyAPAP]

Hi Shirley,
Looking at the new Smart Code Report, it shows super low leak line so no issues there. The 90/95th%tile pressure for 4.5 hours was 15.5 which kind of tells me the pressure needs to be raised. The AHI is also 15.5 which is way too high.

Since you have the range set at 7-15.5, I consider changing it to 11-16 with Delay set to start at 6.5 for 15 minutes to get her used to getting up to 11.

Thanks for the analysis. I'll try it tonight and see how she feels

Try this for one or two nights and let's see what the results are. Sure would be nice to see more detailed graphs from software..... are you going to get it? Can't remember is you said you purchased it or not.

I have not decided to buy the software yet because I'm not sure whether my mum needs to try a bipap machine or not. I'm waiting for her doctore's reply and want to figure out which machine does she really need. If the doctor said the APAP machine is ok for her, I probably will get one

[shirleyAPAP]

Any chance of taking her to a sleep doc here in (I presume) North America for a second opinion? I know it's expensive, but she's your mum, after all. Sat up all night with you when you had the colic, wiped your nose when you had a cold . . .

Yes. I'm thinking about it. I contacted a sleep doctor yesterday, trying to figure out how much it would cost without insurance, still waiting for his reply.

[shirleyAPAP]

I finally figured out what the issue is: MASK
My mum tried Mirage FX Nasal mask with chinstrap last night. She slept quietly (without snoring) for almost 8 hours and no dry mouth! haha:o She got up this morning with a refreshed mind. It's really fantastic.
The data also improved a lot. Here is the smart code for last night: FTMF-FCJ-5FQ9
Special thanks go to Emilia and Slartybartfast and other members who have given me suggestions.
Now comes my other questions (sorry guys)
If possible, I do not want to buy the software (want to save the $150). But I want to continue to improve the data. Any suggestion to adjust settings a little bit by looking at the graphs?
My current setting is: Pressure is 10-16 with Delay set to start at 6.5 for 15 minutes