new APAP is arriving today -- what pressure should I use?

[jamor]

I was prescribed an 8 setting by my doctor 3 years ago, and my machine is a CPAP only. My apena is fairly mild (diagnosed AHi of 7.6) but even at that level using the machine is noticeably effective.

Anyway I was given a usage only tracking machine (and not knowing anything about apena I didn't know what I was getting). I recently bought a Dreamstation APAP that should be arriving today. I am looking for suggestions on how to proceed with setting the machine up. Should I set my new machine to CPAP mode and a pressure of 8 and monitor for a while, or start straight away using the APAP function? If your recommendation is APAP can you suggest a range to set the machine to?

I am leaning towards going CPAP mode with a pressure of 8 to monitor how things are working for me in current state, but I am def. open to other opinions.

[Pugsy]

Some people will say start with what you have been using...cpap fixed at 8 but I would be horribly curious as to what apap mode does so if it were me and I had been using fixed for years...I would just start with apap mode.

Your choice though....how curious are you?

Obviously if using fixed cpap mode...start with 8 cm and see what happens. Please do note that Respironics machines in fixed mode don't turn on the Flow limitation flagging feature so your will get 0.0 FL (on the software reports) but it won't necessarily mean they didn't happen.

For Respironics users who prefer fixed pressures I usually suggest apap mode with the minimum set to the maximum. This will deliver a fixed pressure just like cpap mode but turn on the Flow Limitation flagging.

Now if you want to satisfy the curiosity itch about apap mode...but given you have been using fixed for years...I wouldn't go wild with the ranges because if the machine does change the pressures a lot those changes might disturb your sleep.
So I would suggest maybe a tight range to start with just to see where the pressure wants to go and then maybe do a bit of tweaking.
Something like 7 cm minimum and 10 cm max.
You are used to 8 cm...and if you start out much lower than the 8 cm it is likely not going to be all that comfortable. You might feel a bit like you aren't getting enough air. Heck with 7 cm you might feel that way and if that happens set the minimum to 7.5 or 8.0. Gotta be comfortable first and foremost.

Or you could just do the wide open thing and see if the machine wants to go somewhere but I would keep the minimum close to the 8 that you are used to.
The machine won't go up with the pressures without what it thinks is a good reason. Problem is sometimes what it thinks is a good reason might not be the best thing to do if going higher creates issues ...like waking you up or aerophagia or stuff like that.

If it were me...and I am a curious type.. I would do apap mode with a tight range to start with and see what happens. It can always be adjusted later if the data shows the need.
I would try 7 min and 10 max if it were me.
Flex setting....try all of them...choose the one that feels more natural to you regardless of the setting number.
If off feels better..turn it off.
There should be a Demo mode available to make it easy to try all the Flex settings without having to go into the clinical setup menu each time.

If you don't have the provider/clinical manual for your new machine go here and request it.
It explains a lot more than the user manual.
http://www.apneaboard.com/adjust-cpap-p ... tup-manual

[palerider]

I was prescribed an 8 setting by my doctor 3 years ago,... I am leaning towards going CPAP mode with a pressure of 8 to monitor how things are working for me in current state, but I am def. open to other opinions.

nah, set it to auto mode, min 8, max 20, then look at the data.

[Julie]

+1

[Pugsy]

nah, set it to auto mode, min 8, max 20, then look at the data.

I knew you would chime in with that idea. Gutsy little devil that you are.
That's why I covered it in my thoughts but added the caution about higher pressures maybe causing a problem.
I would hate to wake up tomorrow and have him come here complaining of this.
While I haven't had the aerophagia real bad very often...I have had it often enough and bad enough to know that I don't wish it on my worst enemy...well, maybe one person at the moment I would wish it on.

[palerider]

nah, set it to auto mode, min 8, max 20, then look at the data.

I knew you would chime in with that idea. Gutsy little devil that you are.
That's why I covered it in my thoughts but added the caution about higher pressures maybe causing a problem.
I would hate to wake up tomorrow and have him come here complaining of this.
While I haven't had the aerophagia real bad very often...I have had it often enough and bad enough to know that I don't wish it on my worst enemy...well, maybe one person at the moment I would wish it on.

it's always possible (though the percentages are low) that higher pressures would cause a problem, it's also possible that he won't need more than 8 cm, and the machine won't raise pressures.

but, without experimentation, we'll never know. that's my basic take on it.

if tonight isn't good, examine data and change.. if it's good... well, examine data and fine tune.

we both want to get people to the best rest they can get, we just have slightly different paths to that goal.

[Pugsy]

we both want to get people to the best rest they can get, we just have slightly different paths to that goal.

Very true...just slightly different ways to get to the same goal.

You know what's funny? Truth be known...for myself I am more like you with the wild child wide open stuff. It's just that when recommending to others I tend to be more conservative.. I guess that comes from having some negative experiences when I have done the wild child thing and hate for someone else to have it happen to them if it can be prevented.

[palerider]

we both want to get people to the best rest they can get, we just have slightly different paths to that goal.

Very true...just slightly different ways to get to the same goal.

You know what's funny? Truth be known...for myself I am more like you with the wild child wide open stuff. It's just that when recommending to others I tend to be more conservative.. I guess that comes from having some negative experiences when I have done the wild child thing and hate for someone else to have it happen to them if it can be prevented.

I certainly can't fault you for being cautious, I'm just impatient and want to get to "hey, I feel so much better" from the person sooner... lol, though that can have the risk of a few bumps in the road. I think it's good to offer the options, and let them choose whether to take it slower, or jump in with both feet. (and you're very good about laying out all the options)

[D.H.]

Since 8 is working well for you, that seems to be a good option for the min. You might want to try the auto mode and set the max to 20 (i.e as high as it goes). If you experience "Clear Airway Events," leaks, or discomfort at the higher pressures, then you can roll the max back. Also, if you find your 90% pressure is considerably higher than 8, you might want to consider raising the min at that point.

BTW, if you're not planning on using the Auto-mode, why did you order an auto in the first place?

[jamor]

Since 8 is working well for you, that seems to be a good option for the min. You might want to try the auto mode and set the max to 20 (i.e as high as it goes). If you experience "Clear Airway Events," leaks, or discomfort at the higher pressures, then you can roll the max back. Also, if you find your 90% pressure is considerably higher than 8, you might want to consider raising the min at that point.

BTW, if you're not planning on using the Auto-mode, why did you order an auto in the first place?

I def. do plan on using auto-mode. But this is also my first machine, so I wasn't sure what the best course of action was - especially since my last machine gave no feedback on my therapy.

[Pugsy]

It's really up to you and how gutsy you are what to do with apap mode.
Are you in general a more cautious individual or do you enjoy jumping right in the deep end and all that?

I like trying new stuff and jumping right in the middle of the deep end but that's me...that's they way Palerider is...doesn't mean that you have to be like us though. We understand the pros and cons and accept them.
For advising other people though...I don't usually go that way because I don't know how they might do with the cons that might crop up. I tend to lean toward a more conservative approach when advising someone that I don't know much about them.

I don't know what machine you used in the past or how different it might feel even at fixed 8 cm...I don't know how easy it might be for you to adjust to something new. I can quickly adjust to just about anything but other people have a lot of difficulty with the least little change in something.

You have been giving several choices.
The one thing I would strongly suggest is try it out before bedtime and see how things feel.
I don't know that I would start the minimum below 7...not because it might not work well but more from a comfort aspect of things. You have been using 8 cm for a long time and I have been there with a higher pressure for a prolonged period of time and go down in pressure...it was uncomfortable for a little while. I felt like I was suffocating. Of course I wasn't but sure felt that way. If I hadn't known to expect it and known what the feeling was and that I could get through it...it could have caused problems falling asleep. And the drop I made was only a 2.5 cm drop...and I felt quite air starved...went from a minimum of 8.5 down to 6. It was so uncomfortable that I increased it to 6.6 for a while and then went back to the 6 cm minimum.

You don't have to make all your changes in one night...you can take smaller steps if you wish. Nothing wrong with taking the slow road to anywhere...doesn't have to be the turnpike at max speeds.
So it's really up to you and how gutsy you feel.

[Julie]

Be adventurous! So many of us have machines (autos - all of which do cpap mode if wanted) that didn't come with orig. scripts, but e.g. from Secondwindcpap.com or even Craig's list, but managed to set things up. You at least have some experience to go by so it's unlikely you'll do much very wrong... I'd set the min. at 7 or 7.5 myself, and the max at e.g. 15 or 18 - which can always be moved to 20 in future. And get Sleepyhead... no machine's stats come close.

[ChicagoGranny]

aerophagia real bad

If you are worried about that, schedule the max pressure change to 20 for the day before you will be behind the mule plowing the back 40. If you get a bad case of aerophagia, you and the mule can enjoy yourself.

[ChicagoGranny]

if 8 is working and what the doctor prescribed why would anyone want to set it to 15 or 20 at all

Duh, He doesn't know if 8.0 is working and neither does the doctor who prescribe it three years ago.

If he sets it at 8 - 20, and 8.0 works, the machine won't raise the pressure.

[GoodGuysFinish]

one thing to note is that your prior machine was probably in CPAP mode, which to us means that the inhale pressure and exhale pressure were the same. (and a fixed pressure) 8 inhale 8 exhale.

But, the new machine is generally set in APAP mode, and that means the exhale pressure is actually about 2 cm H2O lower that the inhale pressure. so a setting of 8 on the new machine is 8 inhale and 6 exhale. this is an interesting feeling if you were used to having same inhale as exhale.

the exhale pressure is usually the pressure that has the most impact on holding your airway open. Let's assume your fixed 8 cm did work. That would mean you'd likely need about 10 to be as effective.

Ok with Pugsy's suggestion of 7 thru 15, you'll have inhale 7 and exhale 5 until the machine figures out it needs to increase it. You should not be surprised if it climbs up to around 10 or even more. That doesn't mean your treatment was ineffective with past machine. We'll just see, and run along beside you.

Congrats on getting a nice good working machine. It will serve you well.

GGF