HELP!!

[CruzTerri]

My pressure is 17 and I didn't like the ramp feature, so I turned it off all together within just a couple of days. I do have the CFlex set at 3, but I think I'm going to reduce that this weekend as well. By the time I wake up in the morning, the noise is my only indication that the machine is on because I can't tell with the pressure I'm so used to it.

[jobe2433]

Doric I am not sure LOL I am going tomorrow to find out.

[rested gal]

Oh When I was talking to his nurse on the phone she told me they have never done an auto pap. Why would this be?

I had to laugh when I read that. Reminds me of an olddddd topic:

Feb 19, 2005 subject: "Sleep Doctor" doesn't like autopaps
viewtopic.php?t=1461

[archangle]

My doctor won't do an APAP either. He explained why, but I think it is BS. I will switch doctors.

Some possible reasons doctors don't like APAP.

1) They'd rather run expensive tests and have you make a lot of doctor visits. In theory, this is because they can manage your therapy better than a machine can. I'm sure it's only a coincidence that they earn more money this way.

2) Lots of bad sleep "professionals" set Auto machines to something like 4-20 pressure and leave them there. This doesn't work well, because you start the night without enough pressure and have to have breathing problems before it gets up to a useful therapeutic pressures.

The proper procedure is to set the lower pressure to a workable therapeutic pressure based on a sleep test or to look at the results of home use of the APAP machine after a few nights and adjust the minimum pressure.

3) They will also claim that Auto CPAP machines "run away" and put too much pressure on the patient. This may happen sometimes. I suspect that what happens a lot of the time is that the doctor orders a sleep test and prescribes, for instance, 10 cmH20 pressure. The sleep test is a one night test in a strange bed, with wires on the patient, a nervous patient, surly sleep techs, a noisy, lab, etc. The patient may not sleep much during the 4 hour titration period. When the patient gets home in his own bed, the auto machine figures out correctly that the patient needs a pressure of 12. The doctor can't conceive that he was wrong, so he blames it on the APAP.

The proper way to handle this is to look at the results of the APAP. If the APAP actually "runs away" and doesn't give better treatment at the higher pressure, you can set an upper limit. You can even set a small pressure range. If you think the patient needs a pressure of 8, set the maximum pressure at 12 and see what happens. The machine will record actual apneas under the pressures it chooses and let the doctor evaluate how the therapy works in the real world.

Many modern CPAP machines can be checked wirelessly or by modem every night by the doctor. They can even adjust pressures every night. There's no valid reason not to adjust the CPAP to actual conditions in the home.

4) There are a lot of misconceptions about APAP. They are not "set and forget" devices. They do give some extra capabilities and extra feedback for a good medical professional to help. They need to be set to a correct pressure range and monitored. Remember, if APAP doesn't work, you can always set it to a manual pressure or to a small pressure range.

5) DMEs make less profit on APAPs than they do on manual CPAP. I suspect that DMEs poison the doctors minds on APAP or even data capable CPAPs whenever they have the chance. Are DMEs like everyone else where the company gives seminars and demonstrations with nice dinners or other perks attached?

6) There's a fear that an APAP will "run away" and cause central apneas. I think the fear of central apneas is overblown, but once again, you can limit the upper pressure range and monitor the data.

7) There's a big fear that CPAP machines scoring of events is wrong. There is probably some truth in that, but the machine scoring tends to over report problems, not under report problems. If you have a central apnea and stop breathing for 20 seconds, it will score an apnea. It may or may not correctly report a central vs. an obstructive apnea, but it will show something.

[Bluecat]

A too low minimum setting on an APAP can lead to higher 90% pressures. The machine starts too low, an event happens and the machine can't get the pressure high enough quickly enough and ends up going too high. No events happen so the machine goes back down to the lowest pressure, events happen, the machine can't go up quickly enough so ends up going to high, no events happen, the machine goes back down, etc... you see the picture!

I started with a 6-18 range, that gave me a 90% pressure of around 14.5 (with lots of variations during the night).
Looking at my results on Encore, I noticed that most events happened under 10. So I set the machine to a range of 10-18. My 90% pressure is now 11.5 and very very rarely does it go over 13.

So, if the low boundary of your APAP range was much lower than your CPAP pressure, I wouldn't put too much faith in that 14.5 pressure it gave you. Can you do another try with a range starting at 9 (you can leave the top of the range wide open, if your min pressure is about right, there should be no runaway pressure). If there is still a lot of variations in pressure due to missed events, try increasing the minimum (0.5 at a time, or with information given by the software).

I believe that an APAP should stay around the minimum pressure all night and only have to increase pressure for "special" events (like rolling onto your back, etc...).

My results:
6-18 range: 90% pressure 14.5, average AHI 1.6
10-18 range: 90% pressure 11.5, average AHI 0.7