Should changing Apap to cpap mode on my machine create sleep

[3dogstew]

I was diagnosed with severe OSA and started on cpap in June 2010 with a pressure of 8cm. I had problems and ask my PCP to switch me to autopap which she did with a range of 5-12cm. I was asking for detailed reports from my DME and started noticing CA's and at that point my PCP and I agreed I should see a sleep Dr to figure things out.

My Sleep Dr seems a bit old school and made a comment on my first visit that autopap machines in the past were not reliable. I had another sleep study to see if I would do better on Bipap with a pressure of 8cm, but I had so much trouble breathing that they abandoned that and I finished up the study on a straight cpap at 5cm and did fine. He narrowed my range from 5-12cm to 5-8cm to reduce the centals and I started to feel much better and my AHI was consistently 2 or below. I had an appointment just before Thanksgiving and he said he would not need to see me for a year...great..

Then on Thursday out of the blue I get a call from the DME saying my Dr requested that my pressure be changed to a straight 5cm. I never heard from the Dr as to why the change.

Bottom line I took my machine in they changed the pressure to 5cm and I went from doing fine to not being able to fall asleep, breathing out seems more difficult and I have pain in my throat, sinus and back...I have really tried but I end up frustrated and ready to throw the machine out the window.

It is the same machine and I am hoping someone here can shed some light on how an autopap machine works when in cpap mode or is there no difference. The flex feature is set to 3 just like before but it just feels different.. When I picked up the machine I mentioned to the Respitory Therapist at the DME about getting detailed reports she said I wouldn't be able to get reports any more in cpap mode...which makes no sense.. I will call my Dr on Tuesday when he is in the office ..but until then any help would great......

[brazospearl]

3dogstew, this whole set-up seems odd to me. I don't use the same machine as you, but I can't imagine that switching from apap to cpap would somehow disable being able to see data. I can imagine, however, that a DME might lock you out of the clinical menu. I think I'd just switch back to apap with the 5-12 pressure range that was providing you good therapy before. Good luck, and let us know what happens.

[Emilia]

Yikes... set at 5? I'd be suffocating at such a low pressure. Your profile shows you have the software, what does that data show you? What was your 90th %tile pressure when you were on Apap? You are certainly capable to change your machine back to apap mode and set the range back to 5-8 as you had before. But you need to refer to your data and see if the results in that range were good or not. If you were titrated at 8, as I was, a range of 6-10 might be a better place to start. I eventually changed mine to 7-10 and have had excellent results since doing so.

EPR reduces the pressure on exhale..... and if you are using a set pressure of 5, your exhalation pressure w/EPR set at 3 is essentially a pressure of 2. This means your machine has to continuously rotate from 5 to 2 to 5 with each breath cycle.

If you have the software and clinician's manual (to allow you to make adjustments under the hood), then I would strongly suggest you become more pro-active with your own therapy and find what suits you and your therapy needs. The doctor isn't with you each day to view your results, and his change in Rx makes little sense at all.....

To answer your initial question: An Auto Apap machine is able to work either in auto mode or straight cpap mode. The difference is the auto mode gives you a range of pressures so the machine can respond to events that may need a higher pressure to resolve. In cpap mode, you are at a set pressure without the ability to respond to events that may need a higher pressure.

Good luck! Keep us posted on what happens next!

[Hawthorne]

You need to get the Clinician's Guide and the software or your machine and take charge of your therapy yourself! With the Clinician"s Guide, you can get into the setup menu and set it back to where you were starting to feel better. With the software (Encore Viewer 2 - available at cpap.com for $99), you can see exactly what is happening during the night ( apneas, hypopneas, AHI, leak rate, etc,) and make more adjustments that will help you.

Is your machine the PR System One Remstar Auto A-Flex? If it is, PM me your email address and I can send you the Clinician's Guide for that machine so you can get it set back to the settings at which you were feeling better and work from there.

Check out the software. With those tools and the help of this forum, you can optimize your therapy yourself.

Setting you at 5 cm - changing it at all - does not seem to make much sense to me.

[3dogstew]

Thanks for the input! You are so right that I need to take charge of my own therapy. I don’t understand why they want to keep you in the dark. As you can see by the number of my posts, I am new to the forum but I have found much useful info here..

First my DME keeps me locked out of just about everything , I don’t have any clinician guide…If they have me locked out how will the guide help?. I know they do not like it when I request detailed data and I do it every 1-2 weeks.

Second, I do want to buy my own machine before the beginning of the year before my deductible kicks back in…My insurance only pays for renting, will never own. While my deductible is met this year I wanted to try the Resmed S9 thinking their breathing algorithm might be better for me and I got my Dr to reluctantly write a script but the DME informed me that I own the humidifier for my Respironics and so I would have to buy the humidifier for the S9 if I wanted to switch .
I want to stay on the good side of this sleep doc so he will write me a script so I can buy my own.. When I mentioned buying a machine…. he was reluctant saying that I would have to find someone to change the settings?...seriously

[helpful1]

3dogstew? I was a bit offended when I saw your handle, but in some cultures dogs are used for human consumption. Are you Korean?

Forget that you have met your deductible for the year. You need a new sleep doc, a new sleep tech (there are at least two good ones on this forum from CO), a new DME, and possibly new insurance (or one with a high deductible - use the savings to buy a machine). In the meantime, I hope you have received the information on how to adjust your machine until you find a more competent team.

Good luck and welcome to the forum!

[Hawthorne]

With the Clinician's Guide, you can get into the setup menu. You will not be "locked out". You aren't really locked out. They are just are not telling you how to get in. This is the way it is with most doctors and DMEs. They want you running to them to get any information.

With the software, you can see you own detailed data at home. You don't need to run to them and beg for a printout of the details.

I don't understand why you do not have a script for the machine you have and that you say with your insurance you cannot buy, only rent. I am not in the US though so someone else may understand this. I'll bet the DME has your script. It is my understanding that, by law, in the US, you are entitled to your script.

This whole situation sounds like you have a controlling doctor and DME.

You won't be "on their good side" if you go ahead and, with the Clinician's Guide, make changes based on the detailed data you will get from the software should you choose to buy it. You probably will, however, feel better and be able to get better cpap therapy. You said they set it at 5 cm for no apparent reason and that you were beginning to feel better at a auto range before they did that. This does not make any sense to me. That says to me that you need a higher pressure and do perhaps do better at an auto range.

Your doctor and your DME are controlling you and your therapy and not doing a very good job of it if you felt better and now feel much worse with a setting change that appears not to have been necessary.

I don't know how to advice you further but you need to get the best therapy you can. That probably means take charge of your own.

[jonquiljo]

This whole situation sounds like you have a controlling doctor and DME.

You won't be "on their good side" if you go ahead and, with the Clinician's Guide, make changes based on the detailed data you will get from the software should you choose to buy it. You probably will, however, feel better and be able to get better cpap therapy. You said they set it at 5 cm for no apparent reason and that you were beginning to feel better at a auto range before they did that. This does not make any sense to me. That says to me that you need a higher pressure and do perhaps do better at an auto range.

Your doctor and your DME are controlling you and your therapy and not doing a very good job of it if you felt better and now feel much worse with a setting change that appears not to have been necessary.

I don't know how to advice you further but you need to get the best therapy you can. That probably means take charge of your own.

I totally agree with Hawthorne! Certainly change sleep Dr's and DME's - but frankly if you think you can, you may be best off getting out of the dark and talking to people here and changing your setting accordingly. I can tell you to get into clinicians set-up mode, you turn the dial to setup - then press down the dial and ramp button (for about 5 seconds) until you hear a beep. You will then be in clinicians mode. You don't have to change anything, but you can read what they have you set at. If Flex is OFF - that's one potential problem. There are lots of things you can do with this ... and if you write down what you were set up as by the DME - you can always put it back to that way.

It's not irreversible and you cannot be locked out of your own machine. A constant pressure of 5 seems way too low for anyone to breathe at all. But you will need to get the Encoreviewer software to actually read your own data. It costs about $99 at cpap.com, and is most worth having. Good luck.

[3dogstew]

Jonquiljo - thank you sooo much for the information. I changed it back to auto with the range I had before..I documented each item so I can change them back. Now I feel better that I will be able to use my machine tonight ,which I haven't been able to do for the last two nights. The only question I had was.....there is an item "A-fex" which is set to 3 which is what I was using, but just below that there is an item "System One Resistance System" which is set to 0 and I'm not quite sure what this is for...I thought it might have something to do with A-flex.?

[Hawthorne]

That "System One Resistance System" setting has to do with your mask. If you were using a Respironics mask, you would set that accordingly.

You are not using a Respironics mask. The Swift FX is a Resmed mask so the 0 setting is correct. With any mask make other than a Respironics mask, 0 is the correct setting there. With a Respironics mask, you can set it for optimum breathing with each mask.

It's not a problem to use another type of mask. It just means you don't use this setting so it set at 0 or "off".

[trike-mike]

I hope you are able to sleep better tonight back at your original settings.

When I first started I was set at 5cm H2O which was at odds with the method used to get my pressure, which given the little time I had to be measured, turned out to be almost 7. I struggled mightily for quite some time until good advice here helped me along the way. I too felt like I was suffocating at 5cm H2O and was either consciously or unconsciously in the night yanking the mask at not more than a couple of hours into any sleep segment.

If you have the software, start to look daily at what you are getting for results. With my APAP now set for a range of 7 - 13 (with that lowest setting what was told to me by sleep clinic might bump it to for CPAP). I fall asleep quick and am now STAYING asleep. My 90% pressure is now ~9.5 which is what I set my travel CPAP to. Using either method (the APAP or the CPAP fixed pressure with results measured by setting APAP to emulate the CPAP function) my AHI is always <2 and typically <1.

Once you start looking at the results each day, pay attention to the 90% value just for interests sake as well as the graphs for the night. I suspect you'll find your 90% value (90% of the night at or below stated pressure) is significantly higher than 5. Also, look for the pressure graphs to be going up to 8 and peaking there. you were at 5 - 12 and narrowed quite a lot. I had my range a bit more open (7 - 14) for one night when I first started with the APAP and had a horrid night. Ever since I throttled it to 7 - 13, nothing but good nights (unless issues external to OSA impinge). Maybe 12 is too high if the machine thinks it should get to it but if you see your pressure pinned at 8 for extensive periods of the night, maybe nudge that up by one and try it for a few nights and look at your results.

Also, even with a Respironics mask with the resistance setting marked right on it, I've never used it. I simply don't like how the machine behaves with it. I leave it at "0" all the time.

Just my thoughts from my limited experience...

Good luck.

[Willtry]

I have always wanted to KNw as I am from OZ what is DME?

[trike-mike]

I have always wanted to KNw as I am from OZ what is DME?

Durable Medical Equipment <Supplier>.

Others may have more colorful versions of this acronym.

[3dogstew]

Thanks to everyones input I was able to get a pretty good night's sleep.

I would love to be reviewing my detailed reports but my problem is that even though my profile says I have the software, I personally don't have it, but have to ask the DME to print me off the detailed reports, which they tell me they can no longer do because they switched me to straight cpap mode..I know it's crazy........If it wasnt' for me bugging them for the detailed reports when I first started my therapy , I would not have known that I was having central apneas when my range was wide open....I had to take the reports to my PCP and explain them to her and show her what was happening... I will be purchasing the software...I had been waiting to see what machine to purchase, but now I think I will just purchase the same model I'm using.

I have started researching my DME benefit through my Insurance Company....not depending on what the DME tells me....for instance my DME told me that my Insurance only rents will never own....i called my Insurance to get the lowdown, they said after 6 months I have the option to purchase it from dme...Lesson #1 for newbies ---understand your benefit inside and out before you meet with the DME...

It's funny, but when I was diagnosed and once I started therapy, I thought I was being very proactive but as time goes by I realize how steep the learning curve can be.. And how much mis-information you get within your medical/insurance/dme. Thank heavens for forums like these...

I will be calling my sleep dr tomorrow (he's only in office tues-Thurs) to find out why he changed me to cpap 5cm just before the weekend when he knew he or the DME would not be in the office ....basically left me hanging....and I want to get a script from him to order my machine online..

[BadThad]

Some good advice here. The bottomline....nobody knows you like you. You need to take control, monitor your results and adjust accordingly. I found the doctors only to be helpful at the start and after that just money machines. I know better than they how I'm feeling and how I'm sleeping. I look at my data frequently, I know how I feel and how I am doing. After the first year I felt they wanted nothing but my money to keep "checking" me and I was spending tons of money on their DME with supplies. TIME TO BREAK FREE!