Never surpass minimum pressure (IntelliPAP)

[deanpence]

Hi all,

I'm not new to sleep apnea, but I'm new to *PAP machines. (I used to use a mouth appliance.)

I'm in the unfortunate situation of both being across the country from my original sleep specialist (in NYC; I'm in Texas now) and lacking money or insurance to see a new one, so when I gained 50 pounds after moving to Texas and being extremely tired ALL THE TIME, I simply decided that CPAP (or other *PAP) was my best option for now.

I've read the instruction manual pretty carefully, and I've even watched the redundant video for the machine I bought, the deVilbiss intelliPAP with SmartFlex. There is one thing that continues to evade me, though:

Whatever I try, my pressure never exceeds the *minimum* configured pressure (even after the delay is done or I turn off the delay) of 5.0, which seems barely enough to blow a breeze across my nose, much less help with my apneas. What's more, the minimum and maximum pressure settings do not seem to be configurable, at least by any means the manual discloses. So I have two questions:

1) Why might the pressure never exceed the minimum configured pressure?
2) How can I change the pressure settings?

It's possible I am simply not seeing what's right in front of me, and I apologize if that's the case. In whatever case, I really do appreciate any help anyone can provide to this n00b.

[Bobby269]

If you PM me with a E-mail address. I will send you the clinical guide for your unit. This will tell you how to make any changes needed.

[Emilia]

What are your pressure settings? What is the Delay set to and for how long? Did you invoke the SmartFlex? If so, what is that setting and how about the iRounding and eRounding settings? Once you have the clnician's manual and can get 'under the hood,' you'll be able to tweak things, but you should be doing that with an understanding of how and why. Since you were able to obtain a machine without seeing your doctor or having a recent sleep study, how do you even know what pressures to use? You really should be doing a 'home titration' for a few nights and reviewing the data to find a good range for yourself. Did you get the software for your machine? Smart Codes will give you information, but they will NOT provide you with the detailed information to 'see' what happened overnight.

You can either PM Bobby269 or me to request the clinician's manual be sent to you... you'll need to provide your email address as we cannot attach doc via this system.

If you have the Smart Link software, I also have a quick guide I wrote for that to help you get your data read.

If you have any other questions, let me know. There is a small but loyal group of Intellipap users on this forum so it is to your benefit to title any posts about the machine/software usage with that in the title to draw our attention to it. You can, of course, always PM me as well, but public postings may help others.

[deanpence]

Thanks so much to both of you for the quick replies!

The pressure settings right now are a low of 5.0, a high of 15.0, and a delay pressure of 4.0. Real-time pressure always varies between 3.0 and 5.0.

I have been using it with a delay setting of 0 minutes and without enabling delay when turning on for the past few nights. I tried out a delay of 5 minutes today (while awake) to see if it behaved any differently. I use SmartFlex set at 3 with both iRounding and eRounding settings at 3. I tried turning off SmartFlex just now, and through a few minutes of test with the mask on, it still varied from 3.0 to 5.4 or so, only going past 5 when I took a huge breath as quickly as possible.

I haven't purchased the Smart Link software yet. I wasn't aware that was an option until reading some forum posts here today. I'd previously thought that Smart Link was only for uploading stats to a clinician. I'll look into it.

Is all the Smart Link software for Windows only? If so, time to make a new Windows VM I guess.

[yrnkrn]

Is all the Smart Link software for Windows only? If so, time to make a new Windows VM I guess.

SmartLink is windows-only software. You will also need the SmartLink module as shown here
https://www.cpap.com/productpage/devilb ... odule.html

or buy the whole package
https://www.cpap.com/productpage/devilb ... ystem.html

[Emilia]

Be aware that SmartFlex, like all flex setting on machines, actually reduces your pressure by a like number. Having it set at 3 across the board, in actuality, reduces the 15 to a 12 and the the 5 goes down to the lowest, a 4.

For myself, I use a pressure range of 7-10 with SmartFlex on Full Time at 2. My iRounding is at 1 and my eRounding is at 2. My AHI is consistently around 1.5

I do not use Delay at all and most folks, especially with lower pressures find it useless. Those with high pressure find it a nice way to ease up to their low end pressure setting.

I didn't receive a PM from you, so I assume you asked the other poster for the clinician's manual?

You can purchase the DeVilbiss software package for our host site or secondwindcpap.com

I am a Mac person, but I own a small PC netbook and was able to install the software on that. I works perfectly!

[physicsbob]

Just as a added note the Smart link software works on windows7 -32 bit, except the view template editing part. The help files are also very minimal and leave a lot of things out, But the software is intuitive and with a little effort you can get things set up and working well using the default settings. Reading through the manuals, it says that if the Intellipap senses leaks it won't increase pressure, so once you get the software up and running you can check for leaks and apnea events and take corrective actions to reduce the leaks.

[deanpence]

@Emilia: Yeah, Bobby269 got me the clinician's manual.

My machine already has the SmartLink module, thankfully, so I won't be spending an egregious amount of money. It's just a pain setting up new VMs since all I have is a semi-legal copy of XP.

I still don't really have an answer to why the pressure never exceeds 5.0, the minimum end of the configured range, though. Anyone have any thoughts on that? It can't totally be the fault of my SmartFlex settings (all 3s), can it?

As I stated before, when I tested briefly with no delay and SmartFlex turned off, my pressure varied between 3.0 and 5.4 or so, which seems to completely violate the boundary settings of 5.0 to 15.0.

In any case, I can't afford to drop US$150 right now for the software (though I'll get it within the next week or so), so I'll be using the very rough approximation called the "how miserable do I feel today" test plus the one-day stats I can get from the machine. Tonight I'll try turning the lower bound up to 7.0 and turning all the SmartFlex settings down.

[yrnkrn]

deanpence, I have been using the IntelliPAP for five months now. I have never seen the pressure go below the lower bound minus SmartFlex or above the higher bound except very slightly for a very short time when inhaling or exhaling.

Other then testing, I do not use SmartFlex or delay. I find it easier to breath with constant pressure. After a minute I don't feel I'm breathing against it at all. This is highly individual.

The IntelliPAP adjusts pressures quite slowly compared with other APAPs. If you have relatively few events it may not change pressure at all. You will have to set the lower bound yourself for the next night. In my opinion this is a serious weakness in an otherwise excellent APAP. I found the IntelliPAP more useful as a CPAP than as an APAP. If you require low pressures only that's not an issue but if you require high pressures part of the night but can't stand them for the whole night the IntelliPAP may not be the right APAP for you.

[camman595]

I still don't really have an answer to why the pressure never exceeds 5.0...

Is it possible that it is running in CPAP mode rather than APAP mode?

[Emilia]

We've all been discussing pressures and the fact yours is staying at the low end of your settings, but you haven't told us what your AHI is at that setting. If you are getting good results, it may be that is all you need. For myself, when I started my bottom pressure was set at 6 and my AHI was higher although not bad... a 4 or so. I went to 6.5 and got some improvement, and then to 7 where I remain today with an average AHI consistently at 1.5. If your AHI is above 5, you may benefit by slowly moving the lower end of your range up by half points until you get a better result.

FWIW, my range is now set at 7-10 but I rarely ever go over 8 and usually stay at 7 most nights.

[deanpence]

@yrnkrn and @Emilia: It didn't sink in until later that the way the machine works in APAP/auto-adjust mode is to stay at the minimum pressure and increase it as needed, up to the maximum pressure. Sorry. Sometimes I just have to think about it for a while, especially when my sleep hasn't been productive, which is about the last 10 years.

Its behavior, at least in this aspect, makes sense to me now. When breathing normally, I get minimum pressure on inhalation and minimum pressure - SmartFlex setting on exhalation. (Rounding settings just seem to control the rate of pressure change of pressure between inhale and exhale and vice-versa; i.e., it rounds out the otherwise sudden pressure change.)

I got the SmartLink software and installed it today.

@Emilia: My average AHI for all usage (7 days) is 8.1/hour. After I raised the pressure boundary to 7-17 from 5-15, the average only dropped by 0.1/hour.

[Emilia]

Oh, good... you got the software! Now you're cooking..... give us a breakdown of the info tomorrow, or if you can, post a report. To do that you'll need a photo sharing account elsewhere...like Flickr, Picasa, or Photobucket. Once you have the jpg of the report (you'll need to convert the exported pdf to a jpg file) on the photo sharing site, you can grab the file url location and then post that in the edit box here. Once you have the url in the editor, highlight it and then click Img above the editor. Click Preview to be sure it worked right and shows up then click Submit to show it in the published post.

Once we have a good picture of your therapy.... leaks, 95th%tile pressure, any spikes..... you'll be able to see what issues may be hampering your therapy. OTOH, you may have a great night. But, if tweaking is necessary, you'll be able to make those decisions on good info.

[deanpence]

Here's my 7-day report. Hopefully I completely anonymized it.

(Just as a side-note: It may not matter a whole lot, but I think either a GIF or a PNG, instead of a JPEG, will give you a smaller file size when exporting a report to an image.)

[Emilia]

You definitely need to tighten up the pressure range. Your 90/95th%tile is at 11 so I would bump up the low end pressure to 9 and the high end down to 13 or 14. That should bring your AHI down.