First Night on Devilbiss Intellipap Auto, not comfortable

[yrnkrn]

Hi Shirley,
Looking at the new Smart Code Report, it shows super low leak line so no issues there.

Emilia, unlike the SmartLink report we use, the SmartCode does not show real leak data. It shows %time leaks greater than 95L/min which is very high. Devilbiss say that the IntelliPAP can handle leaks upto 95L/min but the human nose and mouth can't stand them. Even smaller leaks cause the mouth and nose to become terribly dry, leading to disturbed breathing.

[Emilia]

A-HA!! So happy to hear your mum had a great night! The report shows the AHI has come down to 7 which is a HUGE improvement, but needs a bit more lowering to go. I am happy the nasal mask is working well for her. If she develops any irritation from it, consider a mask liner. Many here use them and swear by them. So a search for mask liner and you will find tons of info. Padacheek.com also has other comfort items to make masks easier to live with.

The chin strap has been helpful, but she is still registering Exhale puffs so it isn't keeping her mouth completely shut. I rarely even register an exhale puff, and her report showed 10 last night. That is an improvement from the higher numbers before, but 10 is still too high. Her NRI was also a bit higher last night, but still below the threshold to indicate centrals.

I would bump up the lower pressure to 11 tonight as I suggested in my last past. A range of 11-16 should produce some improvement over last night. Even 10.5 may produce some reduction in AHI. I found that .5 changes helped me when I was first tweaking things. Do either and report back to us tomorrow.

The software is the only way to see the overall night minute by minute/hour by hour to ascertain any specific issues. The Smart Codes are only giving you the big picture, and while the AHI number is important, it is also beneficial to see when leaks occur, events, etc. That said, once your mum goes back to China, she will be on her own, correct? She probably won't be checking her data.... will she have anyone overseeing her care? If so, will you be briefing them on the machine/mask/therapy?

[Emilia]

@yrnkrn Yes, I am aware of the differences between Smart Link and Smart Code. However, 1% of her time with a large leak is problematic, but I suspected the mask was part of the problem. As Shirley indicated today, switching to the nasal mask and chin strap made a remarkable difference last night. Still some issues, but improving slowly.

This is a tough case to work with as her mum will be returning to China next month, and she is trying to get her settled and getting good therapy. Not sure who will oversee her mum's therapy once she returns to China, though.

[shirleyAPAP]

Ok. I'll adjust the setting to 11 and see what happens.

She plans to go back to China this Sep. I'll tell her how to read the smartcode from the machine. So she can provide me the code over the phone when she's in China. But I doubt if she can handle the software and email me the PDF file. That's one of the reason I do not want to purchase the software. Anyway, let me adjust the settings for now and see if the numbers continue to improve.

[shirleyAPAP]

7/2 night update: the smart code is F0MF-FEJ-VAQ7
I bumped up the low pressure from 10 to 11. All the other settings remain unchanged.
Compared to 7/1 report (smart code: FTMF-FCJ-5FQ9), the AHI is lowered from 7 to 6. But NRI is 9.25, which is .25 higher. EPI is way too higher, from 10 to 31.
According to Devilbiss, "If exhale puffs are present in significant numbers, the AutoAdjust algorithm will prevent the pressure from increasing because an increase in the pressure will create more exhale puff in a patient with obstructive sleep apnea." Do I need to lower the pressure a little bit to reduce the exhale puff?
Any suggestions?

[shirleyAPAP]

I started a new post "Need suggestion on Devilbiss Intellipap Auto setting". Please continue our discussion in the new post. I'll close this post, since the problem is solved Thanks!

[Emilia]

Exhale puffs are when your mum inhales via her hose but exhales through her mouth. As a result, some of her therapy is literally going out her mouth. Chin straps are not something I've ever used, but from what I've read on this forum, they work for some and not for others. Pressure probably won't do much to eliminate the puffs. Alternatives would be to get a FFM to work, move to a hybrid mask that uses a mouth piece plus nasal pillows, or try taping the mouth. Search for taping to read more about that. Some folks train themselves to keep their mouths closed by taping, and others find that training themselves to keep their tongue placed on the roof of their mouths just behind the ridge located behind the upper teeth helps greatly (this is what I did).

Remember that in Smart Codes, the NRI is a total of all kinds of issues (see the quote I have in post above), including the puffs so that is probably why it went up. Glad her AHI went down a bit even in light of the extra puffs. The good news is that no leaks were recorded for the 2nd night.

I suspect that if she can get rid of the puffs, everything else would fall into place. Leaks are now controlled, and the AHI is falling. Remember, also, that DeVilbiss contends that and AHI under 10 is considered good. I've never agreed with that because, for myself, I notice a discernable difference in how I feel if I even get an AHI of 3 vs. my usual 1.5.

The best guideline, in my opinion, is how does your mum feel? Is she feeling more rested and able to remain alert during the day?

The 90/95thtile is still up there at 15 so it is hard to recommend a lower starting pressure at this time. Theoretically, it ought to be bumped up more, but until the puffs are under control, I am not sure that is advisable. Generally one looks at the 90/95%tile to set the range by using 2 below and 2 above. In this case a range of 13-17. I don't see her handling that very well.

Work on the EPI issue and keep things where they are for another couple of nights.....

[yrnkrn]

I routinely get exhale puff index (EPI) of 1-2 with a taped mouth or with a FFM. I don''t believe this number.

[Slartybartfast]

Good to see the problem was in the mask. As I mentioned earlier, masks seem to be the biggest problem most people have with CPAP therapy. I'm glad she responded well. Especially if she notices feeling better after having the mask on all night. That's a great motivator.

While it's tempting to continue increasing pressure, remember, the higher the pressure, the more problems you'll have with leaks, expiratory puffing and eventually, non-responsive ("central") apneas. The pressure you're at now is getting rather high for an (I presume) elderly woman of smallish build. You don't want to inflate her like a balloon and have her fly away!

And regarding the AHI reported by the Intellipap, I have noticed that the numbers I get on my iPap are usually twice as high as the numbers my ResMed S9 Autoset reports. I believe that's just the way the machines score events, rather than being a real difference. As I keep saying, I can't tell the difference between the two machines, so whether I'm registering a 0.2 AHI with my S9, or a 2.5 with my iPAP, I feel great in the morning. So I wouldn't worry about the absolute value of the numbers. What is more important is to seek to reduce the numbers.

Shirley, you've got a couple of months to fiddle with the settings. That should be plenty of time to get your mum comfortable with the machine and get the settings optimized for her. Keep at it and keep running your data past us and we'll help all we can. Re: the software, it might also be that the U.S. version of the Intellipap software might not be compatible with whatever version of Windows is available in China. So if you're considering getting the software, the compatibility issue might be worth running by our very helpful resident DeVilbiss rep. ARE YOU LISTENING, DEVILBISS?

[Emilia]

@slarty.... Shirley doesn't have the Smart Links software; she is using Smart Codes only. She is trying to avoid buying the software since her mum would never use it and Shirley won't need it come Sept.

[Slartybartfast]

Yep, I read that. Just in case she was thinking of getting the software for Mum later, I thought maybe we could get clarification on whether that's an option for a machine using a non-US version of Windows. I suppose maybe, though, that's polishing the fruit at the bottom of the bowl. . .

[DeVilbiss Marketing]

There shouldn't be a problem as long as she meets the following computer requirements:

Operating System: Microsoft® Windows 7, Windows® Vista or Windows® XP.
Processor: 400 MHz Pentium processor or equivalent (minimum) or 1GHz Pentium
processor or equivalent (recommended)
RAM: 512 MB (minimum), 1 GB (recommended)
Hard Disk: Up to 2 GB of available space is recommended
Monitor Display: 1024 x 768, 256 colors (minimum); 1024 x 768 high color, 32-bit (recommended)
Software: Adobe® Reader®, Release 6.0 or greater
Hardware: For Data Card – SD Card reader supporting FAT16 format or USB Port
for external SD card reader — For Direct Connect to CPAP – Serial Port or USB port

[shirleyAPAP]

Thanks all for the help.
I'm monitoring the smartcode data these days, trying to figure out the best suitable settings.

[DaveLP]

Emilia's got you covered. I'd just like to add that this machine has a lot of flexibility built in and the setup is important. If you got the machine from our sponsor, CPAP.com, the machine will have come with the clinical manual.

I was just browsing the forum since my Devilbiss Intellipap Auto was delivered tonight. I've been looking all over for the clinician's manual, but it wasn't in the box. I have requested a download from another site and should get it soon, I hope.

I've used a Respironics Remstar M100 (plain jane manual CPAP) for almost three years now, and I'm well adjusted to my 9.5cm pressure. I noticed that the menus show the pressure on my Intellipap auto to be set at 4 and 20. I even received an email to that effect among the buy confirmation and shipping emails. It included the name of the clinician that set it. My prescription shows 9.0 as my sleep lab study prescribed pressure.

I've heard that some people have issues with the Intellipap maxing out at times and causing sleep interruptions. I'd rather have mine set at 8 and 11 than 4 and 20. Is it common for suppliers to send out auto machines with the range set at the full capabilities of the software?

I'm looking forward to my first night using the Intellipap. I hope I don't wake up with my cheeks bulging! More than likely It will be a huge exhale puff.

[Emilia]

Hi Dave... check your PM for info.