2nd APAP experiment - 10-13cm & Cflex

[Babette]

Good Morning! And for the first time in a couple of weeks, it IS a good morning!

Not GREAT, but better. I went back to CPAP w/Cflex at 10 cm (scrip pressure) for the last 7 days, and sent my card off to a WONDERFUL RT ON THIS FORUM for a read. There are wonderful RT's on this forum. Trust me.

Anyway, got my results back. We had a quickie conversation, which I had to cut off because work was impinging on my cpap life. SHEESH! Anyway, in looking at my report, it consistently says 90% at 13cm. Which is what my screen consistently said everytime I checked it during this experiment (10 cm to 20 cm, Aflex @ 3). It verified that my numbers were low (AHI). Showed that I was NOT shooting up to 20 (for those that were afraid of the wide spread).

BUT... I have NO IDEA why the report claims I spent 90% of my time at 13. If you read the chart numbers, that doesn't add up. For example, on the first night of this, I spent 88 minutes at 13, and 178 minutes at 12. My AHI at 13 was 2.7. My AHI at 12 was 1.7. Now, my vibratory snore at 13 was 2.7, and at 12 4.4, but WHO CARES???? I'm much more interested in that AHI than snoring.

Should I care about Vibratory Snore? Other than as an irritant to the bed partner? Since I'm on the machine, surely that should be a non-issue?

ZERO Non Responsive A/H at any pressure. .7 Obstructive Apnea at 12, vs. 1.4 at 13. Hypopnea 1.0 at 12, vs 1.4 at 13.

See a trend here? I'm really thinking 12 looks WAY better to me than 13. So, why does the report highlight 13 and claim it's 90%?

Okay, so after a week feeling like I'd back-slid to pre-cpap days, I decided last night to try another experiment. I set APAP to 10-13 (narrower range, not seeing any numbers over 14, anyway), and chose Cflex at 3 instead of Aflex. I really didn't LIKE Aflex. I THOUGHT it was an APAP issue, but now I see it's an AFLEX issue.

THE DIFFERENCE BETWEEN AFLEX AND CFLEX, IN MY HUMBLE EXPERIENCE:
On Cflex, the machine follows MY breathing. I can breathe deep, the machine follows me. I can breathe quick and shallow, the machine keeps up. On Aflex, the machine has a set limit. When I pull a deep breath, at about 80% of that breath, the machine STOPS. I'm not 100% sure it's AIR PRESSURE that's slacking off, but the machine noise cuts out. Maybe all I'm talking about is machine noise, but when the machine makes a noise in time with my breath, I become trained to believe that it's "working" when I hear that noise. When that noise STOPS, I get a jolt of adrenaline, glance to the machine, and stop breathing. Then I deliberately try to take shallower breaths, to keep in time with the machine.

YUCK!!!!!!!!!!!!!!!! No wonder I felt so crappy and tired that week! Getting back on CFLEX was a nice improvement, but didn't fully return me to the previous "euphoric" mornings. It was so hard to wake up all this week. In fact, I spent Friday and Saturday pretty much napping all day.

YOUR MILEAGE MAY VARY. I have found I don't like Aflex so far. I may find a better way to do this in the future. For now, I'm sticking wtih Cflex.

So, last night I re-set the APAP, and chose Cflex @ 3 (my preferred setting all along). Felt very good all night. Other than the pimple developing in the base of my right nare... Woke up very early - 6 am. Back hurt from too much inactivity the past few days. Felt yawny in the body, but very alert mentally. Did some stretches, decided I wasn't going to sleep anymore no matter what position I tried, and got up.

Actually feel perky and alert right now. Great change from the past 7 days.

So, we shall see what happens the next 7 days. For those that claim Auto with Aflex didn't work for them, try Auto with Cflex, and narrow your range. Which is what I was told originally to do, but you know me - I have to re-invent the wheel and test-drive it for myself.

Would love some input on that report. PM me if you want to see it. I can't figure out how to post a 10 page PDF file here.

Many thanks!
Barbara

[Wulfman...]

Babs,

That 90% number means that you spent 90% of the night AT OR BELOW that number. You may only have been at that highest number for a couple of minutes, but if that's where it hit the 90% number......THAT'S what it will report as the 90% number.

Den

[Babette]

Den, that still doesn't make sense to me. AND... There is a time listed for each chart. It's a different time each night.

Is that the "90% of the night" mark I'm seeing? Are those the numbers recorded at that particular time?

I'm so confused... Which is why I really didn't want to get into reading my own data.

But I shall persevere...

OR.... Are you saying that the point where it's saying "90%" is the point in the chart that is 90% from the lowest point to the highest point, forget about the minutes at pressure, forget about the stats at that pressure?

So, between start (10) and end (14), 13 is 90%? Even though I set it to 10-20, I only USED 10-14, and 90% of THAT is 13?

Ooops! No, next night I went up to 15. Oooh, and night after that, I went to 16. AND, unnoticed previously, that night it claims 14 as the 90% point.

That dash to 16 only happened on a few nights, and only for 1.5 minutes.

Okay, so 13 is 90% between 10 to 15?

And the theory is that patients do best at the 90% point on their chart, so the doc would choose the 90% pressure to "scrip" me?

Cheers,
B.

[Babette]

AND..... What magic number do you look at, to determine your optimum pressure to go forward on? The lowest AHI?

It's more complicated than that, isn't it?

LOL,
B.

[BrianRT]

Hey sweetheart. Did you ever try a set pressure of 13?

[Babette]

No, not straight 13 yet. I was afraid. You said I should work my way up to it. I thought I'd test-drive the APAP last night, and maybe work my way up to 13. You know me, gotta try out all the bells and whistles...
B.

[BrianRT]

Much like trying all the syrups on waffles...........

[Babette]

Now now... people will begin talking...

Hey, why aren't you being FAMILY GUY this Sabbath AM, instead of goofing with us?

LOL,
B.

[Wulfman...]

OooooK.....
If you have your Auto set to 10 - 15 and you spend 75 percent of the night at 10 and 5 percent of the time at 11 and 5 percent of the night at 12 and 5 percent at 13.....then 13 will be your 90% number because that's where you reached 90% (you may also have smaller percentages at higher numbers, but whatever it determines you reached your 90th percentile of the night is what it reports as your 90% number)
In any case, it's the highest pressure at which the percentage reaches the 90% number.

In my experiment last year, I had my range set from 10 - 15. My "Average" pressures were mainly at the 10 and 11 numbers, but my 90% fluctuated between 12, 13 and 14 each night. I only reached 15 for 1 1/2 min. on ONE night (my sleep doc had prescribed 18 cm. for me).
I ended up using 12 as my pressure. I could probably achieve lower numbers with a little higher pressure, but for me, I'm satisfied with my average below 1.0 and it seems to be comfortable for sleeping.

Hope that I didn't further confuse the issue.

Den

[mindy]

Hi,

I'm a new user ... Respironics M-series with AFlex, just finished third night and think I'm starting to feel better.

I'd very much like to get my hands on Encore Pro 1.8 so I can see better how I'm doing.

Any ideas on how/where to get it?

thanks!
Mindy

[BrianRT]

Babs.....I AM being the family guy........actualy I'm Mr. Mom as DW is working 12hrs at the hospital today (she's an RT too).

Besides....<sniff>....you guys are my family too (a collective "awwwww" rises from the forum)

[Cliff]

Interesting stuff.

In my case, I spent the first several months @ 9, CPAP, and was still tired most days. It was not until I went on auto with A-Flex, with the settings of 9-14, that my energy levels seemed to improve. I also noticed I am now spending most of my time in the 12-13 range ( Encore Pro 1.8 ).

My sleep study clearly showed my problems going away @ 9, but from what I can see, the higher pressure is helping me recover my energy faster. Changing masks seems to also help. The optilife is getting lower leak rates than my CL2.

Go figure

Cliff

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CPAPopedia Keywords Contained In This Post (Click For Definition): CPAP, auto

[rested gal]

It's more complicated than that, isn't it?

Well, we can make it complicated when we change more than one thing (like changing your range AND switching to C-flex) at the same time. Not that there was anything wrong in your doing that. But if a person wants to really zero in on what works for them and what doesn't, it's better to stick with one change for at least 4 or 5 nights, before throwing in another change.

Most people who have reported using A-flex do like it very well. But hey, what makes you comfortable while getting good treatment is what to use. It's nice that the M Auto with A-flex lets you use whichever suits you better...its C-Flex feature or its A-Flex feature. Or even neither, if turning both off suits a person better.

Babette, the 90% pressure number does not mean you spent 90% of the time AT that number.

It means you spent 90% of the time at that pressure AND AT PRESSURES BELOW that pressure.

Very likely most people spend most of their time BELOW that pressure. For me, just a small amount of time is actually spent AT that pressure. Most of the time is spent below that pressure.

I'd think that just about the only way to actually spend most of the time AT the 90% pressure would be if a person had the minimum pressure setting in their range set up so high that they were using the autopap almost exactly like a cpap machine. In other words, setting the minimum pressure up high enough to keep the throat so well and truly open all the time that there's practically no need for the machine to ever raise the pressure.

The 90% pressure number also means that 10% of the time the machine had to use pressure ABOVE that 90% pressure.

[Snoredog]

I'm going to keep using my A-Flex, I find it much more comfortable than C-Flex mode. It has allowed me to bump up my Minimum pressure up by a full 2 cm over C-Flex without bringing back aerophagia and at the same time lowering my AHI. If I dropped Cflex from #2 to #1 my aerophagia would return the next day.

I use it on A-Flex setting #2, using #3 makes it feel like I'm not getting enough air even being it is 2 cm higher than when on C-Flex. My range is now 8.5 cm to 14 cm, not a single runaway that I can tell, my breathing pattern usually sends most autopaps to the top shortly after turning it on.

It is kind of like a car radio, you have different channels to listen to, select the channel that works the best for you.

But if you are having trouble tolerating breathing against the machine, A-Flex is pretty hard to beat in my opinion. For me it is effortless to breath against.

[birdshell]

Now now... people will begin talking...

Hey, why aren't you being FAMILY GUY this Sabbath AM, instead of goofing with us?

LOL,
B.

Dear Babs,

I cannot remain silent! Maybe it is because for him, that it was already afternoon on Eastern Daylight Time, while you are on Pacific Daylight Time ... According to my calculations, that is a 3 hour delay.

Besides which, I've recently been party to some EXTREMELY good care for my apnea and I want to help out the "breathing disordered" treatment professionals. (Yes, that was a warning to look for another post detailing the experience.)

And I also am having fun finding appropriate smileys!

Now, any one of us who has NOT done something on a par with this--KEEP QUIET!