Newbie again after 13 years-need advice with Intellipap

[topper]

Hi,

This is my first post and I'm really glad for this forum. I've learned a lot by reading on it.

I just started using CPAP again after not using it for about 12 years. I had surgery (UP3, Tonsillectomy, Turbinate Reduction) back then and thought that it had fixed me.

I went back to the Dr. because I was occasionally totally choking during the night, I assume due to my tongue falling back when I went into a deep sleep. It only happens every month or so.

So I had a sleep study where I only slept for 169 minutes. My total AHI was 6.8 but the Dr. said the total RDI of 32 was the thing to pay attention to. I had 19 Hypoapneas and 71 RERAs during the study. No other apneas.

He mentioned trying an oral appliance but I have jaw problems so he recommended CPAP.

I then had another sleep test where they determined an optimal pressure of 10cm.

Using their DME company (I didn't know any better) I ended up with a System One with C-Flex+ and a Quattro FX mask. I started using this around 2/7/12. The DME had the C Flex turned on, and that's how I rolled with it. I used some fleece material to help seal the mask (read about it on a message board) as I have a pretty good sized beard and mustache.

I did pretty well with this setup getting my AHI down to around 3.

Then I had to return the machine due to a change in insurance carriers, and I bought the Intellipap Travel Auto machine.

I then mistakenly used it the way it came, set from 4-20 cm.

After doing lots of reading on this board I have tried using a straight 10cm pressure, with and without Smartflex. Last night I tried Auto mode with Smartflex set at 9-12cm.

I still can't seem to get my AHI down below 5 with this machine. Last night I had an AHI of 7.34 with 6.53 Hypoapnea and .82 Obstructive. NRI of 5.95% and leak of 0% (using Sleepyhead software).

Sorry for the length of the message, I was just looking for any input into other things I could try or anything I've missed.

I plan on switching Doctors, as I've called this Dr a couple of times to ask questions and he never called me back. He was also texting while I was talking to him in his office (unfortunately not the only Dr who's ever done that).

Thanks
Todd

[Riorican]

Welcome.

I don't know your machine so can't answer except to say that the numbers won't necessarily be the same from one brand of machine to another. They figure events differently. You've been back on treatment for about a month now but just recently to the Intellipap. It's going to take some time to adjust to therapy and get the numbers down, but also adjust to a different machine.

You may want to edit your subject to include Intellipap and see if you can get specific help from users who know your machine and may have suggestions.

[Emilia]

Can you tell us your complete machine settings:

Pressure: 9-12
SmartFlex: on... full time?
iRounding:
eRounding:
hose length? 6' or 10' be sure your machine is set for the correct hose length.

Your mask is one that folks have issues with, but you seem to have that working well for you.

What was your 90%tile pressure last night? Keep an eye on the 90th and 95th%tile for few nights....it is a good way to judge where your pressure setting should be. For example, if your have a 90=95th%tile reading of 9, you would do better with a range of 7-11. The general rule of thumb is 2 above and 2 below that reading.

Keep in mind, that your SmartFlex settings will reduce the overall pressure settings. You can adjust your pressure by .5 increments which can make all the difference in the world in terms of results.

I get excellent results with my Intellipap... consistently average an AHI of 1.5. My pressure is set at 7.5-10.5 with SmartFlex on full time. iRounding is at 1 and eRounding at 2. Keep tweaking...it can be done!!

[topper]

Thanks for the input.

Here's the missing info:

6 foot hose
Smartflex 1 Full time
IRnd 2
ERnd 4

I used the Smartcode to get my 1 and 7 day info.

7 day

AHI 5.5
95th Percentile 11
90th Percentile 10.5
High Leak 7%
Pressure Plateu 0%
NRI 2.75
EPI 1

1 Day

AHI 7.5
95th Percentile 11.5
90th Percentile 11
Pressure Plateu 3%
NRI 6
EPI 1

Thanks
Todd

[Hawthorne]

You settings sound reasonable, given that your suggested titrated pressure is 10 cm. You do need to give it more than 1 night at a particular setting to let everything, including yourself, adjust. A few nights to a week would be best. Don't make any other adjustments until you have tried your current settings for that time period, unless you are feeling very unrested.

I use the Intellipap all the time now. I did use a PR System One Auto for a couple of years and always had used Respironics machines before that (been on cpap for 10 years now).

I really like the Intellipap and get great therapy with an AHI mostly at 2 or less - often below 1. It take some time and some tweaking though. I have the rounding set at 4 for both erounding and irounding (Smartflex set at 1) and do not even notice the exhaltion relief with this setting. With the PR System One I was aware of the pressure droppng on exhalation so I find this better. I did have to play with the rounding a bit though. I find it quieter than the PR System One. I have the same pressure setting on the Intellipap that I had on the PR System One.

Given some time and maybe a little more tweaking you probably will do well with this machine.

[Emilia]

With those 90th%tile readings, you might try a range of 8.5 to 13 and see what happens for a few nights. Your Smartflex settings are a bit high, IMO, and that does impact your pressure. In essence, if you keep those at your current settings, you are making your inhalation pressure lower by 2 and your exhalation pressure lower by 4. That will make a big difference in your results. You may need to play with those settings a bit, or tweak the pressures to compensate for those reductions.

Let us know how things go as you change things.....

[Hawthorne]

Just for clarification, Emilia, do you mean that the OP's "rounding" settings may be too high? I ask because the OP said that his SmartFlex was at the lowest (1), I thought I read.

[topper]

Yes, I'm curious about this too. Are you saying a setting of "4" means "4 cm"?

Thanks

Todd

[Hawthorne]

For me, my SmartFlex setting is 1 (the same as yours). I have set the "eround" and the "iround" both at 4 because this gives me a comfortable transition from inhalation to exhalation.

The eround and the iround are ways of making the exhalation relief offered by SmartFlex less noticeable and, therefore - for me, lest disruptive of my sleep.

Do you have the Clinician's manual? It would help you change these more refined settings to help with your therapy? If you don't have it, PM me your email address and I will send it to you as an email attachment.

[Emilia]

@topper.... You stated your iRounding was at 2 and your eRounding at 4. These will reduce your pressure at inhalation and exhalation by that many notches. So if your pressure needs at inhalation is 8, you're actually getting 6; if your exhalation pressure is at 10, it will actually be 6. These are comfort settings, and IMHO, are best suited to those who have very high pressure needs and really need some relief at exhalation so they aren't pushing against a high pressure. I keep mine very low since my pressure range is low ( 7.5-10.5) and I don't discern much pressure change, anyway. If you are super sensitive to pressure changes, it may help, but just be aware of the net impact on your therapy.

topper... I am going to send you a PM with links to some documents on the Intellipap that you may find helpful.

[Hawthorne]

My understanding is that the Smartflex setting determines the difference in pressure from inhalation to exhalation and back (ie - 1 in the case of the OP and myself - and I guess you as well Emilia). A SmartFlex setting of 1 is very low - the lowest you can use.

I thought that the eround and the iround just made the pressure change from inhalation to exhalation and back smoother and less noticeable but had no effect on the pressure change which is determined by the SmartFlex setting.

Emilia, you are saying that the rounding settings also affect the pressure but dropping it more or less. Am I understanding you correctly?

[Emilia]

This DeVilbiss site explains Smart Flex: http://www.devilbisshealthcare.com/prod ... /smartflex

My bad.... I really didn't explain that right at all. SmartFlex setting reduces the exhalation pressure; the Rounding settings adjust the pressure transitions. Watch the video via the link on the left on the page I linked to above.

[Hawthorne]

That's what I thought. I originally tried the Intellipap in March of last year. I did not get good AHIs. They were quite high. I went back to my System One Auto at that time but always was aware of the pressure change on exhalation with the A-Flex. It also seemed to rush me. I got very good AHIs.

In November, I went back to the Intellipap, after some reading, and tried the exact same settings as on my System One - Auto - setting 11 cm to 13 cm, A-Flex 1 -SmartFlex 1. I only changed the rounding to iround 4 and eround 4, based on my reading about this feature on the Intellipap Autoadjust. That made all the difference for me. I now get my very low AHIs again and do not notice the SmartFlex exhalation relief at all. Great sleep!

Those may not be the right settings for everyone (I'm sure they aren't) but it sure made the difference for me.

[topper]

I switched my rounding settings to 4 (both of them) last night and got an AHI of 2.5!

So that worked for me to, and I feel a lot better when my AHI is 2.5 compared to 5.5. It's amazing how different I feel.

Hopefully I can keep it going....

Thanks for all the help,

Todd

[Hawthorne]

Low AHIs like that sure make a person feel better don't they! That's great!

It LOOKS like a rounding of 4 for each, gives you good results as well. Be sure to give it several days at those same settings (even if it is not quite as good tomorrow). There is an adjustment period and it differs for everyone. Sounds like the lower roundings were making the pressure change on exhalation a bit disruptive of your sleep even if you didn't feel any disruption. I find it so smooth at a setting fo 4 for each, that I am hardly aware of any pressure change on exhale.

Hope it continues to be good settings for you 2. I had an AHI of 3 on Sunday night and last night it was 0.5! I do have 0.5 quite often as well as 1. An AHI if 3 is rare for me and I usually know because I have Rheumatoid Arthritis and have a restless night with pain, it will be up at or towards 3.

Hang in there! You are doing great!