M Series Auto Runaway pressure help

[Guest]

Does anyone have an authoritative answer for what is going on with the following scenario - my sleep doc and DME say it can't be happening:

I set the M Series auto to 4 - 20 per my doctor's instructions. I go to sleep and an hour later I wake up with the pressure at 13.5 (my initial study suggested 6cm). I am quite uncomfortable at that pressure but I stay awake trying to breath normally. After several minutes, the pressure is still at that level and I finally hit the ramp button and try again. After an hour, the same thing happens.

My doctor says, "That machine adjusts on each breath - if you get rid of the leaks, it won't happen." But, I am not experiencing leaks. I can even hold the mask against my face to make sure and the pressure will still not decrease.

My DME says, "Well, the machine is set correctly."

Cpap.com customer service says, "I have never heard of that. You can send it back if you want."

Does anyone have an authoritatvie answer for this? Is there any tech bulletins from Respironics? Has anyone had their machine do this and found an answer? Are you a Respironics tech and have experience fixing machines with this problem?

I hate to send the machine back and find out it is working properly. Is there some special medical condition I have which could be causing it?

I have been on CPAP for 6 months and still have not slept through the night - in fact, each night is still really uncomfortable. I still dread going to bed.

Thanks for any help.

[Snoredog]

your doctor doesn't know squat (especially if he sent you home with a machine set wide open at 4cm to 20cm and your last titration was 6cm).

Get out your PSG report, and read everything carefully. Look for any notation on snoring and Central or Mixed Apnea (CA or MA).

The machine can confuse a central apnea for an obstructive one. If you also snore it ramp up pressure to address the snore at the same time it triggers a central apnea.

So the machine is misreading you and responding with pressure.

If your last lab titration was 6cm, then I suggest you set your machine to:

=============Setup Mode===================
1. Hold down the (<-) (->) buttons while plugging in the power on the back,
wait for 2 beeps or 5 seconds, release buttons.
2. Press the (+) key to enter Setup.

Navigation:
- (<-) / (->) buttons move to next field
- (-) / (+) keys decrement/increment field values.
============Available Values===============
Check the following field(s):

-Therapy Mode=Auto (CPAP/Auto)

-Auto:Max=9.0 (default=20.0cm)

-Auto:Min=6.0 (default=4.0cm)

-CFlex Setting=2 (options are off, 1, 2 or 3)

-AutoRamp Time=30 (options are 05 to 45 min)

-AutoRamp Pressure=6.0cm (4cm->AutoMin)

-Mask Alert Feature=ON (On/Off)

-Auto Off Feature=Off (On/off)

-Split Night Time = Off (off, 120, 180, 240)

-Show AHI/Leak Feature=ON (On/Off)

Press On/Off button to exit.


Hopefully in your situation lowering the Auto:Max will prevent the runaway pressure. 9cm usually doesn't trigger many central apnea (if that is the cause).

If you set the Auto:Min lower say 4cm or 5cm, you will probably be starving for air just to breathe, this can prevent you from falling asleep. If the minimum pressure is too low the air will feel humid and stuffy.

Cflex: Cflex is a "comfort" setting, it can take several minutes to get used to breathing with it. If you set that too high (like at 3) it may cause you to hyperventilate. For your pressure, I would not set it any higher than 2, but again it is a comfort setting.

[Wulfman]

Does anyone have an authoritative answer for what is going on with the following scenario - my sleep doc and DME say it can't be happening:

I set the M Series auto to 4 - 20 per my doctor's instructions. I go to sleep and an hour later I wake up with the pressure at 13.5 (my initial study suggested 6cm). I am quite uncomfortable at that pressure but I stay awake trying to breath normally. After several minutes, the pressure is still at that level and I finally hit the ramp button and try again. After an hour, the same thing happens.

My doctor says, "That machine adjusts on each breath - if you get rid of the leaks, it won't happen." But, I am not experiencing leaks. I can even hold the mask against my face to make sure and the pressure will still not decrease.

My DME says, "Well, the machine is set correctly."

Cpap.com customer service says, "I have never heard of that. You can send it back if you want."

Does anyone have an authoritatvie answer for this? Is there any tech bulletins from Respironics? Has anyone had their machine do this and found an answer? Are you a Respironics tech and have experience fixing machines with this problem?

I hate to send the machine back and find out it is working properly. Is there some special medical condition I have which could be causing it?

I have been on CPAP for 6 months and still have not slept through the night - in fact, each night is still really uncomfortable. I still dread going to bed.

Thanks for any help.

"authoritative answer"??? I dunno about that, but I'd venture to guess that because of the way your machine is set up, it's working OK.

NOW......the reason it's doing what it's doing is because it isn't set up correctly......and your doctor and DME are clueless.

Without seeing any reports, I would guess that your "special medical condition" is SNORING (and hypopneas and apneas).

A wide-open range of 4 - 20 is a recipe for failure. The bottom pressure needs to be increased and depending on the nature of your events, the top pressure may need to be reigned in (but to WHAT, depends on what's showing on any reports that would need to be generated from Encore Pro.....which you probably don't have).

If you don't have Encore Pro and the card reader, I would urge you to get it so you will know more than your doctor and DME.

Edit: If you're using a nasal mask and leaking air out your mouth, it could be driving the pressure up, too. Mouth taping, Polident adhesive strips or a full face mask......

Best wishes,

Den

[DreamStalker]

Chances are that the reason your machine was set wide open (4-20cm) is that your sleep study was flawed and your doc needs to collect data to determine your correct pressure or ... your doc and/or DME are not competent in what they are doing with your treatment.

I would do as others are suggesting and get a copy of your sleep study to determine why exactly they set it wide open and then go from there.

[BlueHairBob]

I must not have been logged in when I posted the initial post.

The reason Doc said set it wide open is because she expected that the machine would adjust properly.

My sleep study said 6cm - 9cm.

I do have software and card reader and I am able to take a look at the data.

I do snore and the machine data is saying that I am snoring.

Why doesn't the machine adjust downward after I start breating normally after waking up?

If it just goes to max, what good is auto?

[DreamStalker]

Your sleep study should say a lot more than just 6 cm to 9 cm ... are you sure you are not confusing that with your prescription?

[girlsaylor]

Please do yourself a favor and get your software and card reader, so you can benefit from these guys on this forum.

I also had a miserable experience and my doc and DME were also clueless. These guys patiently went through everything with me, despite my high level of frustration. Well, who wouldn't be frustrated when the medical community seems not to help, or worse yet, doesn't have the knowledge they should have in regards to treating sleep disorders.

In a nutshell, these guys coached me through getting the software installed and working on my computer with Windows Vista. When I couldn't get my report posted, I was helped getting the file converted and posted so they could look at it. I used suggested beginning pressures given by the knowledgeable people here, and it still didn't resolve, tho it did improve things. Then we found I had medication issues that were preventing the bipap therapy from doing its job.

Now, we've got those hurdles all cleared and we're down to the business of tweaking my already good AHI numbers.

It's all too easy for DMEs and docs to blame the mask, and I also insisted leaks weren't a problem. I couldn't have gotten last night's 2.0 AHI if my mask was leaking like a sieve.

Patience! Stay here. I'm not knowledgeable like these guys, but I do know they know their stuff alot better than my highly-paid sleep doc/pulmy and DME rep did.

girlsaylor

[Wulfman]

I must not have been logged in when I posted the initial post.

The reason Doc said set it wide open is because she expected that the machine would adjust properly.

My sleep study said 6cm - 9cm.

I do have software and card reader and I am able to take a look at the data.

I do snore and the machine data is saying that I am snoring.

Why doesn't the machine adjust downward after I start breating normally after waking up?

If it just goes to max, what good is auto?

Why did they set the machine wide open if the settings were supposed to be 6 - 9?

If the Autos aren't set up properly, they are little better than nothing.
Too many people don't understand how Autos work.

Den

[SleepySandy]

Why doesn't the machine adjust downward after I start breating normally after waking up?

I'm wondering this as well. I do understand all of the recommendations about lowering the pressure range on the Auto.

I would like to know why the machine doesn't lower the pressure from 13.5 after he wakes up and breathes normally for a while. If he's awake, he's not having any centrals or snoring or anything. Why doesn't it go down?

Why did they set the machine wide open if the settings were supposed to be 6 - 9?

because

The reason Doc said set it wide open is because she expected that the machine would adjust properly.

This is the second post I've seen today about someone having an Auto set wide open. On the other forum, the Auto keeps going down to 4 and the person feels like they're not getting enough air. That's a great way to start off your xPAP treatment

If the Autos aren't set up properly, they are little better than nothing.
Too many people don't understand how Autos work.

Ya think???

[Wulfman]

Ya think???

POSITIVE!

Den

[BlueHairBob]

So, how does the auto setting work?
What does it do?
Why does it need to be set to a narrorw range?
How does it decide to increase - and especially decrease pressure?
What advantage does it have?
Why is there a setting for 4 - 20 if that is never the correct setting?

I think I would be better equiped if I understood exactly what auto did.

"The REMstar Auto M Series with C-Flex is is an auto-adjusting CPAP machine which is set for a range of pressures, then seeks out and delivers the lowest level of pressure needed to keep the airway open."

Mine does not appear to be delivering the lowest pressure needed to keep the airway open. And, if it did, why would setting it to 20 max be a problem. It sounds like people are saying auto does not work in that it cannot be trusted to deliver the lowest pressure required. I can set mine to a max of 8.5 and then it goes to 8.5 after an hour or so - and then it will not come down and i have to hit the ramp.

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[Snoredog]

Your automobile has a speedometer that may go from zero 0 to 120MPH. you don't drive around doing 120MPH all day do you?

Same for the machine, it has a "range" of pressure it can traverse to from 4cm to 20cm.

When you wake up during the night and find the pressure at 13.5cm there usually is 1 of about 3 reasons why that happened:

1. The 13.5cm pressure was too high for you and it caused a pressure induced central apnea. Central apnea is more likely to take you from a sleep state all the way back to a wake state. Or

2. You had started mouth breathing and/or developed a large mask leak and the pressure needed to splint your airway wasn't high enough to do that because of the leak, which allowed a apnea to happen which eventually woke you up as your fight or flight reflex took over. Or

3. There was some kind of outside influence that woke you up, such as a noise and the 13.5cm pressure is truly needed and the waking was just a coincidence.

If you have the reporting software pull up the report and see what happened, if you went back to sleep the answer should be right before the break in the report.

In a perfect world where all you have is plain jane obstructive sleep apnea, leaving the machine set wide open at 4cm to 20cm works just fine. But not everyone has plain jane obstructive sleep apnea, they may have other syndromes that can cause the machine to misread your SDB events such as Central Apnea.

If you set your maximum pressure down to 9cm and you need more pressure it will flat-line on the reports at 9cm, then you decide if it should be raised or not or if waking you up during the night is okay. If setting it to 9cm allows you to sleep all night without interruption then you have your answer.

But if you have the reports, pull up the report and see what it says.

[rested gal]

Why doesn't the machine adjust downward after I start breating normally after waking up?

Autopaps are designed to not yo-yo up and down abruptly. Fast up/down pressure changes would be disrupting to sleep. If they need to work up to a higher pressure to prevent or deal with an event during sleep, they'll work their way back down gradually, checking all along to be sure breathing is staying normal.

Autopaps aren't going to simply drop abruptly down to the minimum just because you woke up and are breathing normally. The pressure will go down in baby steps -- very slowly -- to be sure the breathing stays normal as the pressure is gradually reduced.

That slowness can make it seem to the wide awake watcher that it's not coming down at all. Kind'a like "a watched pot never boils."

[Wulfman]

Bob,

I went back and read some of your posts from last November. In one, you indicated you were setting your machine for 6 - 9 and in another one, it sounded like you were using a fixed pressure of 6 and weren't feeling so hot.

In December you raised questions about running Encore Pro on Vista. Did you have Vista and if so, is Encore Pro running on your computer?

If you have Encore Pro running, you should be able to see what's happening in your reports.
I suspect that even a pressure of 6 is too low for you.....and/or you have mouth leakage that's compromising your therapy.

As has been previously stated, you need to find the optimum range of pressures that will benefit your therapy. If your machine is sitting at 4 or even 6 and you need a pressure of 9, 10 or 12 to clear or prevent an event, it'll be long over with by the time your machine can get there......and probably several others, too. Then, you have the events, you experience oxygen desaturations and your body suffers. (and you feel like crap the next day)

Den

[Goofproof]

Why doesn't the machine adjust downward after I start breating normally after waking up?

Autopaps are designed to not yo-yo up and down abruptly. Fast up/down pressure changes would be disrupting to sleep. If they need to work up to a higher pressure to prevent or deal with an event during sleep, they'll work their way back down gradually, checking all along to be sure breathing is staying normal.

Autopaps aren't going to simply drop abruptly down to the minimum just because you woke up and are breathing normally. The pressure will go down in baby steps -- very slowly -- to be sure the breathing stays normal as the pressure is gradually reduced.

That slowness can make it seem to the wide awake watcher that it's not coming down at all. Kind'a like "a watched pot never boils."

Also the machine expects you to be sleeping, if you are awake you aren't breathing the same as when you sleep. Just because you see a number on the readout doesn't mean that's the pressure you were at when you were asleep. That means that's the pressure you were at when you awoke. Jim

As Den says their are a lot of people who don't have a clue how to set APAP's, and a lot of them have Dr. infront of their names.

P.S., Ramp, is Not your friend.

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