Help With AutoSet II Pressure Adjustment, Please

Slinky · Post by **Slinky** » Tue Jun 24, 2008 8:11 pm

A friend asked me the following and I'd appreciate input from the more experienced here, please.

I have a question about setting my new Resmed Auto II. My doc set it at 8-12 since my cpap pressure was 12.0. I am having a LOT of GERD and aerophagia and want to try to reduce these symptoms. That is why my doc finally prescribed an APAP for me two weeks ago. What would you put the lowest setting at? I raised the higher pressure to 12.2 since my AHI was getting high and that seemed to help some. My AIs seem to be very low and HIs are around 2.8 at this 12.2 setting. Would you lower the 8 pressure some? What is a good range for this APAP setting? Is 7.0-12.2 too wide a range? Would that mess up my good AI results?? What's your opinion??

bigk · Post by **bigk** » Wed Jun 25, 2008 1:52 am

If the CPAP pressure was 12, I'd suggest 11.

But Slinky - you are a very experienced user - I've only been on this thing since December.

I am a fan of setting the minimum just below the 95% level.

Slinky · Post by **Slinky** » Wed Jun 25, 2008 7:08 am

BigK, I very seldom make a suggestion about pressure changes since I only did a few times of my own in the very short time when I was using an auto. For the most part I used my Elite for the 13 months of its capped rental and shortly after that was switched to a bi-level and since I have COPD have not felt it wise to try making changes on the bi-level yet. I'm still w/in the first 3 monts on this bi-level.

ezstreet · Post by **ezstreet** » Wed Jun 25, 2008 9:54 am

Slinky and BigK,
Sorry to butt in, but I notice you both have ResMed equipment. I just changed to the new ResMed S8 AutoSet II and want to get the correct/latest compatible ResScan software. Can you tell me which version (3.4 or 3.5) is for the S8 AutoSet II and where it is available?
Thanks.

Snoredog · Post by **Snoredog** » Wed Jun 25, 2008 2:10 pm

I would put the EPR or easy breathe or whatever they call that now at 2, I would lower the Minimum pressure as low as can be tolerated (most likely in the 6.5 to 7 cm range).

I would limit the Maximum 2 pts higher than any prior 95% pressure found. So if it was 12 I'd set it to 14, OR, OR, OR if machine is running up in pressure as a result of other artifacts such as snoring, then I would "limit" the Max to a pressure that brings "AI" into acceptable levels, meaning they only need to monitor AI results.

Keeping the Minimum pressure below 10 allows the full algorithm to fully function to the best of its ability. Above 10 cm, it only responds to snore and FL. So if allowed to address events at a lower pressure it may treat minor events before they become larger events resulting in overall lower pressure needed.

IF aerophagia is a problem you have to sometimes allow AHI to climb higher than what you would normally accept until that condition lessens. That may even mean lowering the Maximum pressure to "limit" a machines response if there are factors such as snore which drive up the pressure, again use "AI" indice as the guide.

grumpygirl · Post by **grumpygirl** » Wed Jun 25, 2008 6:18 pm

Okay Snoredog- Here's what I have planned to do tonight. I have set my Autopap pressures at 8.0-12.6 with an EPR of 1. My original pressures from the doc are supposed to be 8.0-12.0 but I find I still have lots of bloating and aerophagia. So, little by little I am going to try to alleviate that as much as possible by tinkering with my pressures. Do you think I should raise the higher pressure to 13.0? I'm afraid to raise it too much too quickly for fear of really suffering with aerophagia and GERD. IF I lower the lowest pressure to around 7.0 will it take too long for the machine to catch an event and it will be chasing my apneas all night with little success? I'm desperate to find the "sweet spot" everyone refers to on this site. I apologize for sounding stupid with all this stuff but I still like a newbie after 6mos. of this. THANKS for all your help!!!

Snoredog · Post by **Snoredog** » Wed Jun 25, 2008 8:45 pm

[quote="grumpygirl"]Okay Snoredog- Here's what I have planned to do tonight. I have set my Autopap pressures at 8.0-12.6 with an EPR of 1. My original pressures from the doc are supposed to be 8.0-12.0 but I find I still have lots of bloating and aerophagia. So, little by little I am going to try to alleviate that as much as possible by tinkering with my pressures. Do you think I should raise the higher pressure to 13.0? I'm afraid to raise it too much too quickly for fear of really suffering with aerophagia and GERD. IF I lower the lowest pressure to around 7.0 will it take too long for the machine to catch an event and it will be chasing my apneas all night with little success? I'm desperate to find the "sweet spot" everyone refers to on this site. I apologize for sounding stupid with all this stuff but I still like a newbie after 6mos. of this. THANKS for all your help!!!

grumpygirl · Post by **grumpygirl** » Thu Jun 26, 2008 6:53 am

Thanks Snoredog for your post. I did set my machine to 8.0-12.4 last night with an EPR of 1. Here are my results: Pressure: 12.0, Leak: .12, AHI: 3.4,
AI: 0.3, HI: 3.1. I woke up still suffering with aerophagia and some fatique. I'm beginning to think this is hopeless besides very frustrating. I don't understand your info in your last post about this machine not responding to apnea above 10cm pressure. What does that mean exactly?
I probably misquoted you but you get the idea. Tonight I think I will skip the EPR and just lower my lowest pressure to 7.0 and leave the upper pressure at 12.0 When I had my pressure at 8.0-12.0 my results looked like this: Pressure: 11.4, Leak: .16, AHI: 3.2, AI: 0.3, HI: 2.9 but I was having a lot of aerophagia still. Do you think lowering the minimum to 7.0 would help a bit? It seems when I get my AHI, AI, and HI to very low numbers, like 1.8 or 1.6 I am soooo tired the next day. I know that sounds kinda backwards but it is true. I seem to actually feel better when the results are a tad higher. Go figure??? Thanks again for your time and input!!!

Snoredog · Post by **Snoredog** » Thu Jun 26, 2008 7:37 am

grumpygirl wrote:Thanks Snoredog for your post. I did set my machine to 8.0-12.4 last night with an EPR of 1. Here are my results: Pressure: 12.0, Leak: .12, AHI: 3.4,
AI: 0.3, HI: 3.1. I woke up still suffering with aerophagia and some fatique. I'm beginning to think this is hopeless besides very frustrating. I don't understand your info in your last post about this machine not responding to apnea above 10cm pressure. What does that mean exactly?
I probably misquoted you but you get the idea. Tonight I think I will skip the EPR and just lower my lowest pressure to 7.0 and leave the upper pressure at 12.0 When I had my pressure at 8.0-12.0 my results looked like this: Pressure: 11.4, Leak: .16, AHI: 3.2, AI: 0.3, HI: 2.9 but I was having a lot of aerophagia still. Do you think lowering the minimum to 7.0 would help a bit? It seems when I get my AHI, AI, and HI to very low numbers, like 1.8 or 1.6 I am soooo tired the next day. I know that sounds kinda backwards but it is true. I seem to actually feel better when the results are a tad higher. Go figure??? Thanks again for your time and input!!!

well what it means is that AHI is achieved at 10 cm or less as that machine does NOT respond to apnea over 10 cm pressure. That is based upon its A10 algorythm.
So that 12 cm pressure you are giving yourself is only to address snores and flow limitation which don't show up in that AHI score anyway.

and if you want more relief from the aerophagia you lower the 8 cm to something lower.

other than that well, good luck with that.

grumpygirl · Post by **grumpygirl** » Fri Jun 27, 2008 6:38 am

Well, I think I may have finally found a good setting on this new APAP. Last night I set the pressures at 7.6-12.0 with no EPR. I slept like a baby-didn't even wake to pee. My results this morning look like this: Pressure:10.6, Leak: .02 (the lowest it has EVER been),AHI:1.7, AI:0.1, HI:1.6. I do still have some aerophagia but not painfully so and I don't feel quite a tired as I did over the last few days. Hopefully this may be solving the problems, but I guess it may be too early to tell!! I am still having some GERD but I didn't take my Pepcid this morning either so maybe that is the cause. THANKS to all of you who gave me some input on this especially Snoredog!!!!! I really am grateful. Now, let's just hope this all continues to improve. Thanks again!!!!

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