Self Treating: I've got my CPAP, now what...?

[JReinhal]

Hello,
I have received my Remstar Auto A-Flex 550P. I have a nasal ComfortGel mask. Where do I go from here?
A side note, I was unable to adjust the default pressure of 6.0.

Thank you

[kaiasgram]

Hello,
I have received my Remstar Auto A-Flex 550P. I have a nasal ComfortGel mask. Where do I go from here?
A side note, I was unable to adjust the default pressure of 6.0.

Thank you

JR, in my sig box below follow the link to the video tutorials, helps to get familiar with the clinical menu first. I think your machine is at the bottom of the page.

[JReinhal]

Hello,
I have received my Remstar Auto A-Flex 550P. I have a nasal ComfortGel mask. Where do I go from here?
A side note, I was unable to adjust the default pressure of 6.0.

Thank you

JR, in my sig box below follow the link to the video tutorials, helps to get familiar with the clinical menu first. I think your machine is at the bottom of the page.

Will do it now. Thank you

[JReinhal]

Ok, the video was great. I have a much better grasp on the workings of the machine.
Two areas of concern:
It doesn't appear I have the mask leak check option
In the advanced menu setting, what should be my mode election, CPAP or Auto? If CPAP, what pressure do I start with?

Thank you

[Pugsy]

I don't think the older 50 series models had the mask leak/fit thing available...don't worry about it. Likely depends on the firmware/software in the machine itself. Not missing much. The video is likely based on a newer model.

My suggesting for DIYing diagnosing is to try Auto mode with settings
Minimum...4 to 6 as low as is comfortable for your breathing...
Maximum of 10...let's just see what the machine wants to do before worrying about fine tuning it.
Sometimes it's hard enough to sleep through the hurricane without adding wildly varying pressures
When you first start the machine you only will experience the minimum pressure...it won't do any increasing until/unless it sense the need to increase based on whatever apnea events you are having...so let's see what it thinks it needs to do first..then determine optimal pressures.

I suggest AFlex of 2...middle of the road...see if it is comfortable to you..also try the others just to see if they feel better or worse.

[JReinhal]

I don't think the older 50 series models had the mask leak/fit thing available...don't worry about it. Likely depends on the firmware/software in the machine itself. Not missing much. The video is likely based on a newer model.

My suggesting for DIYing diagnosing is to try Auto mode with settings
Minimum...4 to 6 as low as is comfortable for your breathing...
Maximum of 10...let's just see what the machine wants to do before worrying about fine tuning it.
Sometimes it's hard enough to sleep through the hurricane without adding wildly varying pressures
When you first start the machine you only will experience the minimum pressure...it won't do any increasing until/unless it sense the need to increase based on whatever apnea events you are having...so let's see what it thinks it needs to do first..then determine optimal pressures.

I suggest AFlex of 2...middle of the road...see if it is comfortable to you..also try the others just to see if they feel better or worse.

Thank you Pugsy =)

For me to discern how the machine adapted to my breathing throughout the night, I will have to use the SleepyHead software you mentioned a while back? or is there another way?

[Pugsy]

You can use SleepyHead...it's the simplest...links in my signature line. It has a Windows and Mac version available.
I thought I sent you some information on where to get EncoreBasic but maybe I forgot. It's strictly Windows 7 or older.
If you have Windows 8.xxx then let me know as we will have to do something different depending on which Windows 8 version.

[JReinhal]

You can use SleepyHead...it's the simplest...links in my signature line. It has a Windows and Mac version available.
I thought I sent you some information on where to get EncoreBasic but maybe I forgot. It's strictly Windows 7 or older.
If you have Windows 8.xxx then let me know as we will have to do something different depending on which Windows 8 version.

You did, you've given me great information.

I have a Mac but can run Windows virtually. Ill follow your guide for SleepHead.

[kaiasgram]

You can use SleepyHead...it's the simplest...links in my signature line. It has a Windows and Mac version available.
I thought I sent you some information on where to get EncoreBasic but maybe I forgot. It's strictly Windows 7 or older.
If you have Windows 8.xxx then let me know as we will have to do something different depending on which Windows 8 version.

You did, you've given me great information.

I have a Mac but can run Windows virtually. Ill follow your guide for SleepHead.

Mac will run SleepyHead, you don't need to set up a virtual Windows environment. Just be sure to download the Mac version

[Sandra_ON]

I"m fairly new to this at about 2 months however if you're self treating how do you know what pressure to set the machine at? Too high pressure (only 1 point) has caused me to have some breathing problems.

[nanwilson]

Sandra, Pugsy has suggested he set a range from 4/6 to 10 to start off with. A "range" is not a fixed pressure and it will only go where needed within that range. If he needs a higher pressure since it hits the higher end of 10, then I'm pretty sure she will up his range to compensate. Once he knows where his 90 0r 95% pressure sits then he can set his range at a tigher formula. For instance, if his 90% pressure is around 11, then the optimum range to set would be 9 to 15. That way his usual pressure of 11 will be well covered. It doesn't mean having a high end of 15 that it will always go there.... only IF it is needed.

[Pugsy]

I"m fairly new to this at about 2 months however if you're self treating how do you know what pressure to set the machine at? Too high pressure (only 1 point) has caused me to have some breathing problems.

Self diagnosing and self treating can be done successfully with proper education.
It's fairly simple to find an appropriate pressure and even figure out if there is a fine line where one pressure works great and 1 cm more creates a problem like it does in your situation. Most people do well with a range of pressures but if not...it's pretty easy to figure out what to do.
Range of pressures meaning I might do well with cpap at 10 or 11 or 12...with results being about the same...in fact when I was using apap and experimenting with minimums I went from 9 to 13 to see if anything changed or I had any problems...nothing changed at 13..AHI was the same as it was at 10...so no real need to use more but I didn't have any problems using 13 minimum.

With the OP here...we are starting off with very low pressures just to get
1. accustomed to using the machine in the first place
2. just find out if there is a real need for the pressure because if there are OSA events occurring then the machine will likely need to increase the pressure to try to prevent them. Most people need more than 4 to 6 cm pressure to effectively prevent OSA events.
3. using a small lower range will enable us to find out if there is a problem when a certain pressure is hit...like if we see 9 cm hit for a prolonged period of time and he says he feels like a puffer fish from air in the stomach

It's not hard to do this..just takes some education and patience. The majority of sleep apnea is going to be obstructive in nature and fairly easy to deal with. Should we see something else pop up (like a ton of centrals indicating other issues) then we defer to the pros if at all possible. OSA itself...with no complicating factors...is fairly simple to deal with in most cases.
There's always going to be some outliers who have issues but given the choice between no therapy and self treating...some therapy is better than no therapy and it isn't rocket science. Go with the odds and at least try...if we don't try we know what the end result is.

Is this self diagnosing and self treating the "ideal" way to go about it? Of course not, a real sleep study tests for a lot more than OSA but in the real world we don't always get "ideal" and sometimes we just gotta do what we gotta do and if that isn't ideal then so be it.
Should we run into problems...I am the first person to say...go see a doctor as there may be things going on that need a pro.

[djhall]

In the advanced menu setting, what should be my mode election, CPAP or Auto? If CPAP, what pressure do I start with?

My suggesting for DIYing diagnosing is to try Auto mode with settings
Minimum...4 to 6 as low as is comfortable for your breathing...
Maximum of 10...let's just see what the machine wants to do before worrying about fine tuning it.
Sometimes it's hard enough to sleep through the hurricane without adding wildly varying pressures
When you first start the machine you only will experience the minimum pressure...it won't do any increasing until/unless it sense the need to increase based on whatever apnea events you are having...so let's see what it thinks it needs to do first..then determine optimal pressures.

I suggest AFlex of 2...middle of the road...see if it is comfortable to you..also try the others just to see if they feel better or worse.

I just went through this process myself earlier this year, and Pugsy's advice was what worked for me.

To elaborate a little, in CPAP mode you are going to control the settings entirely yourself and the machine is just going to do what you tell it to and not change or react to anything on its own. That is great if you know what you want or want to control every step of the process yourself. In AUTO you are going to give the machine a minimum and maximum range instead of a fixed pressure. The machine will start at the minimum setting each night. If you have apneas it will increase pressure until either the events stop or it reaches the maximum pressure setting. If you stop having apneas it will decrease pressure until they start again or it reaches the minimum pressure setting. Seeing what the machine does over several nights should give you a pretty good idea of what pressure you actually need.

If you were to set the machine wide open with the minimum of 4 and the maximum of 20, it is possible you would start the night at 4 and climb to a pressure of 15 to 20. That big an increase in pressure can be disruptive, and high pressures can take time to adjust to. By using a smaller range like 6 - 10 you prevent the possibility of falling asleep to a gentle pressure and waking up in a panic at what feels to a new user like a hurricane in your mask! When I did this the machine went straight to 10 and stayed there all night. When I was comfortable with 10 I raised the range to 8-12, then 10-14, then 12-16. The 12-16 range was the first time the machine didn't go straight to the max and stay there the entire night, but I still spent most of time at the max. My personal auto range works best at 16 - 20. At that range I spend roughly two-thirds of a normal night at 16 with the machine climbing above 16 during the REM sleep stages when I tend to need more pressure. By keeping the range limited to 16 - 20 I don't have large pressure swings during the night and stay close to the effective pressure all the time. But I discovered this using Pugsy's advice. If I had started wide open at 4 - 20 auto, or my current 16 - 20 auto, I don't think I could have stuck with it. It would have been too much too fast.

[djhall]

I"m fairly new to this at about 2 months however if you're self treating how do you know what pressure to set the machine at? Too high pressure (only 1 point) has caused me to have some breathing problems.

From what I have read, during a typical sleep study they start with a pressure of 4 or 6. If you are having multiple events at that pressure they increase pressure by 2 and monitor that pressure for a while. If you still have multiple events they increase it by 2 again and monitor that pressure for a while. They repeat this process until they reach a maximum pressure that either stops multiple events or causes breathing problems and/or sleep disruption for the patient. Then they back the pressure down in steps of 1 until multiple events reappear. That gives a rough minimum / maximum range to work with and the remainder of the time available is spent fine tuning around that range to find the best balance between effectiveness and patient comfort/tolerance.

If you roughly follow the same process but spend a few nights at each step and track your progress, you will know roughly at what point increases in pressure either stopped improving your sleep or even started making it worse. If you slowly back down your pressure until you stop improving or start making it worse again you will have roughly replicated this process and established for yourself a minimum / maximum range in which you "ideal" pressure lies. Once you know that nothing in that pressure range is terrible for you and you just aren't certain what in that range is ideal, you can start fine tuning by making small adjustments, staying on that pressure for a while, evaluating the improvement or lack of it, and then deciding if you need to make another small change or not. Eventually you will find the sweet spot that works the best for you.

[avi123]

Ok, the video was great. I have a much better grasp on the workings of the machine.
Two areas of concern:
It doesn't appear I have the mask leak check option
In the advanced menu setting, what should be my mode election, CPAP or Auto? If CPAP, what pressure do I start with
Thank you

As of 2008, according to The American Academy of Sleep Medicine, using Auto CPAP is contraindicated for those who have these underlying medical conditions. So I would stick to CPAP mode until I knew for sure:





Patients with congestive heart failure, significant lung disease such as chronic obstructive pulmonary disease (COPD), patients expected to have nocturnal arterial oxyhemoglobin desaturation due to conditions other than OSA (e.g., obesity hypoventilation syndrome), patients who do not snore (either naturally or as a result of palate surgery), and patients who have central sleep apnea syndromes (CSAS) are not currently candidates for APAP titration or treatment. (Standard)