Need Advise

[guffy2]

Hello everyone,
Went to the sleep Dr. on Monday. Ask about a auto CPAP machine because my AH1 was been running 7.5 to 9 , and wanted to see about getting it lower. Dr was happy about my AH1 now because it was 89 at the sleep study. But he was willing to work with me and set up a two week trial with a Remstar auto a flex . Here is my concern, talking to the "RT" from my DEM
about the new unit , I believe I probably know more about CPAP therapy , then she does,and
I know squat. The only thing know is what I have gleened from this forum. She set the pressures for the new unit at between 4-20 my pressure setting now is 13 .
Do you thing that is too large a margin or should I just let it go.
Thanks
Bob

[Pugsy]

Do you thing that is too large a margin

Yep. If 13 cm now straight cpap is giving you AHI higher than you want... there is no way the machine can get to 13 or higher fast enough from 5 cm to do an effective job. Now once it gets there ...yeah maybe.

Sad when you know more than the people who are supposed to help us isn't it?

Minimum of 10 would be a better starting point IMHO. 20 maximum is fine.
Minimum of 5.. those events will come and go and give the special finger to the pressure as it slowly rises to try to kill them

[DoriC]

Pugsy, can you explain how you arrived at 10cm for the min setting if 13 on cpap was giving him an AHI in the 7-9 range?

[archangle]

Whatever you do, monitor the results and figure out the right pressure range for you based on data and your own feelings.

If it were me, I'd start at 13 manual or 13-14, then start widening the pressure range to see what happens, while watching the results.

[Pugsy]

Pugsy, can you explain how you arrived at 10cm for the min setting if 13 on cpap was giving him an AHI in the 7-9 range?

Because it is close enough to 13 that was already likely almost there (AHI 7 to 9 isn't horrible it is in theory close enough to acceptable that a very minor change in cpap could have fixed it) in what he needs. You know me...always wanting to start out as low as possible. For all we know 14cm cpap might have done the trick. Besides it is just a starting point really, heck of a lot better than 5. Also, I haven't seen the real graphs to get any feel as to when or why that AHI is just a little more than we want to see. I prefer to be conservative until an established need is present. From 10 cm minimum it should be able to get to 16 quick enough to make enough of a difference if it needs that much. Remember I used 10 APAP min and the machine could get to 18 cm quick enough to keep my AHI down to less than 2 and I saw 18 often.

So use 10 cm for a couple of nights and then look at the reports and fine tune it then. 12 cm minimum would for sure do it but what if he only happens to need a higher pressure for part of the night (like REM) and would do well with the lower number and let the machine go up to where it needs to be for the part of the night that needs it? Just because 13 isn't quite ideal doesn't mean that the entire night needed more than 13. Maybe the bulk of his events are supine or REM. All scrunched together and the bulk of the night nothing exciting going.

He very likely will need a bit higher minimum...but there is a good chance that 10 is close enough to get the job done. 10 is close enough to get to where I suspect the pressures need to be. If it is off it won't be off by much. I don't think minimum needs to be 13....not now and not without seeing any reports

[Pugsy]

Question???? What is your clear airway index? How much of your AHI is CA index? Kinda important to know.