DevilBliss DV54 AutoAdjust CPAP -Help

[Bill44133]

Mr Concerned - I don't know if you will be back or not. I am wondering though - are you a doctor (maybe a Sleep Specialist) , a DME or someone from a forum that disagrees with the freedom we enjoy on this forum?

I am some one who is actually from THIS forum. But it is very silly to ask some one who he is when he has obviously gone through a lot of effort to conceal his identity. I can understand your curiosity but please understand my position. This is not about me. This is about unlicensed medicine being practiced on the internet. The kind of thing which causes irreparable harm to others.

You need not tell me that you have never practiced medicine here on these forums and I suspect you know full well that I have not done it here on these forums either. So my presence here, much like yours, is not the issue.

We are simply a group of people who have sleep apnea and have been through the trials an tribulations of adjusting to life using a cpap machine, sharing our experience with newly diagnosed people who are not getting enough help from their Sleep Specialists, Doctors or DME suppliers.

Really? Can you honestly speak for everyone with that statement?

He can say he speaks for me.. The help and education I have gotten on this board has helped me get a good nights sleep, and now I am slowly getting my life back.

[Mr Concerned]

He can say he speaks for me.. The help and education I have gotten on this board has helped me get a good nights sleep, and now I am slowly getting my life back.

And you do not practice medicine here? You do not lend medical advice to those who request it? You do not ship medical equipment to friends or advise others to stop treatment, alter treatment, continue treatment or begin a new treatment?

You do not speculate as to the pathology of another person's illness or the treatments which may improve their situation?

You have NEVER in your time on the forums....

Told another forum member that he/she should discard the recommendations of a physician or adopt the recommendations of another forum user?

[Madbear]

Alexchetty - hopefully we can get back on topic here! Congratulations on getting your AHI down, especially getting it under 5 - something I was not able to do on the Devilbiss in 5 months. I do agree with 49er though and I wouldnt worry too much about getting the AHI to zero but concentrate on feeling better. Your numbers look pretty good now with the exception of the EPI. I found air escaping from my mouth quite disconcerting so I am wondering if you are experiencing minor arousals when air escapes which could be limiting your therapy success. Might be worth trying one of 49er's suggestions to limit air escaping from your mouth during the night.

Good luck.

[alexchetty]

Please define "minor arousals when air escapes"?
I'm not sure what this means. Actual experience wise; I do wake up alot during the night, either to change position or to make slight adjustments to the mask because of air blowing up into my eyes.

[Madbear]

Slight awakenings which you probably dont remember but enough to disturb your continuity of sleep making you feel less rested. It is possible that when you open your mouth to exhale you might have one of these slight awakenings. I am a light sleeper so when it happens to me I wake up rather abruptly. My EPI was generally only 1 or 2.

[alexchetty]

I'm not aware of these. maybe that's exactly what happens when i wake to change position or adjust mask.
I'm a real heavy sleeper, so don't know, but now that i'm aware that this could happen, I will try to look out for it.

thanks.

[alexchetty]

11October2013
95th Percentile Pressure 13.0
90th Percentile Pressure 12.0
AHI 9.0 --- high increase
Pressure Plateau Time 0%
High Leak Flow Time 18% ---Mask was leaking air out the sides.
NRI 2.00
EPI 2
Mask: Full Face Mask

--Pressure at low 7.5 - high 20
--Note: AHI has drastically increased with the full face mask.
--First night with the new mask.
--During the night (I recorded the machine), the pressure fluctuates between 10 and 15, at this time the mask leaks a lot and I wake up. Seems like the amount of air the machines supplies is more than the amount of air i can breathe in with one breath. any suggestion on how to over come this?
--However, I do seem to be feeling a more fresh and awake this morning.

[sleepyb]

Some info on the intellipap that I found:
I have noticed my AHI is much higher when using it then when I use the S9 or PRS1. I believe it's just the way it records events.
That said, I love the Devilbiss and I feel just as rested with a 3.5 or 4 AHI on it as I do with a 1.0 on the PRS1 or a 0.2 on the S9. So, having a 4 or 5 on the intellipap is not terrible.
Another thing I found is that I had to reign in the upper level on the intellipap or it had a tendency to run away. (probably what happened to you
when it jumped to 14) I Don't know what causes that but lowering the top level to 1 above my 90% stopped this and stopped being awakened by this "feature" (Or setting it to CPAP instead of APAP)

When you were titrated during your sleep study, did the Dr. give you a number like 10 cm/H20 for a constant CPAP number? You should request that, it would give you a good median for low/high pressures or
you could set the machine on CPAP with that number and it might actually work better for you.
Sometimes the APAP setting on the machines can actually make it harder to sleep with them and the machine itself might be waking you up with the pressure changes.

Finally, If you take care of the leaks and any mouth breathing you will likely get a much better sleep. The mask is much more important than the machine. If you can possibly manage it, try a few different ones
until you find one that is comfortable for you and doesn't leak. Once you get the mask (and maybe chin strap) issues taken care of you should feel much better and should be able to manage the pressure issues.

[Madbear]

The change of mask has certainly taken care of the EPI but at the expense of AHI but pleased you are feeling OK. Do you use the Smart Flex and if so at what setting? I found this to be a very good feature and had it set to the maximum of 3.

Incidently do you use the ramp feature at all? I used this when I was just starting but after I got used to everything I found I was fine at my normal pressure and was struggling for air with the ramp on. Do you also have the humidifier?

[alexchetty]

Madbear,

I do use SmartFlex and it is set to 3. What exactly does SmartFlex do? (machine default had SmartFlex on)

I don't use the ramp feature. Should i be using it? what does it do? (I'm assuming gradually ramps up the pressure [but does that not happen automatically anyway])
I do have the humidifier attachment and it is on: heat: 2

[Hawthorne]

I don't think you need ramp at this stage. Your minimum pressure is low as it is.

Do you have the "Clinician's Guide" for the Intellipap? How do you have the rounding set? I found that the rounding is a great feature of this machine. With the right erounding and irounding (individual) settings, I find the machine matches my breathing very well and I sleep better because the exhalation relief (Smart Flex), with the right rounding settings, synchronizes the exhale and inhale with my breathing pattern and gives me great sleep and great therapy.

I find that full face masks just don't work for me. I get too many leaks and my sleep is very interrupted.

Let me know, in a PM, if you want the Clinician's Guide. Give me your email address in the PM and I will send it to you.

[Madbear]

alexchetty - as Hawthorne said Smart Flex is is Devilbiss's version of exhalation relief. With a setting of 3 the pressure on your exhale will drop 3cm from your inhale pressure. You should be able to see this on your LCD screen. I agree with with Hawthorne that you shouldnt need the ramp. it is more useful for those new to CPAP and struggling with the pressure or those on higher minimum pressures to gradually reach their minimum pressure while they are falling asleep.

I have seen people on here swear by the Remzzz mask liners for stopping leaks and I seem to remember seeing someone here who was making their own. Might be worth a forum search or Yahooing it (do you think that will catch on? ).

Hawthourne - do you have any tips for getting the rounding right for your breathing? I played around with it using trial and error but wasn't really sure what I was doing. Is it something you could fine tune while awake with the mask on?

sleepyb - I also reached the same conclusions as you on the Devilbiss and also found I did much better with a narrow range to stop it running away and waking me up. I also felt as good with an AHI of 5 on the Devilbiss as I do with an AHI of 0.5 on the S9.

[alexchetty]

12October2013
95th Percentile Pressure 16.0
90th Percentile Pressure 15.0
AHI 7.0 --- decrease
Pressure Plateau Time 0%
High Leak Flow Time 5% ---Mask was leaking air out the sides.
NRI 1.25
EPI 3
Mask: Full Face Mask

--Pressure at low 7.5 - high 20
--Note: AHI has dropped from 9 to 7 not sure if this was due to me waking up or moving to adjust the minute i heard the leak. I feel like I've woke up a lot during the night to make this adjustment.
--Second night with the FULL FACE mask.
--However, Still feeling fresh. but feel I need more sleep.

[Hawthorne]

Madbear - I don't have any real tips about setting the rounding. It is quite individual. I just worked at it until I felt that my breathing and the machine were in sync, trying one setting for a few nights and then changing it until it felt natural. I don't remember that it took very long.

For me, iround and eround are both at 4 but others it would be different.

[alexchetty]

13October2013
95th Percentile Pressure 14.0
90th Percentile Pressure 12.5
AHI 7.0 --- same as yesterday
Pressure Plateau Time 0%
High Leak Flow Time 0% ---Mask did not leak.
NRI 2.00
EPI 2
Mask: Full Face Mask

--Pressure at low 8 - high 17
--Delay: 10min
--Delay pressure: 5.0
--Sarttflex: 3
--rounding set to 4 for both.
--Third night with the FULL FACE mask.
--woke up with a slight headache, this morning and not so refreshed as yesterday.