Min. Pressure Tweaking?

[JohnO]

Greetings All,

I'm on Day 42 of Auto-CPAP therapy. I've had a 10 day review and a 30 day review with my Sleep Doc (PA). On day 32 I switched from a True Blue nasal mask to an Aloha Nasal Pillow Mask. Overall, the therapy seems to be working very well. My report numbers seem good, as do my SpO2 numbers.

When I received my Auto-CPAP machine the morning after my sleep study, the initial settings were 9-15 cmH2O. At the 10 day study, my Sleep Doc switched the minimum from 9 to 10. I'm not sure why she did that, other than she said, "it looks like you are spending your time at 10-11."

So I'm curious. How would you determine an appropriate minimum pressure? Keeping it at 10 instead of 9 doesn't seem to give it much wiggle room, but perhaps that is better for the therapy. Any thoughts?



Thanks,

John

[LSAT]

In my opinion this was an insignificant move. I would have stayed at 9 with your average CPAP pressure at 10

[chunkyfrog]

Too many practitioners are enamored of the idea that auto machines are not for long-term use.

[DoriC]

I agree with LSAT, why mess with success. Your report looks great, congrats. How do you feel?

[JohnO]

I would have stayed at 9 with your average CPAP pressure at 10

That's what I was thinking.

[JohnO]

Your report looks great, congrats. How do you feel?

I feel very well, thanks!

Of course, I felt pretty well before starting CPAP too. But as my wife and pulse oximeter both indicated -- I was stopping breathing many times a night.

Now with my Aloha mask, it is getting to be a non-issue to mask up and fall asleep.

I do wonder, though, if it is easier on the body to have the minimum effective pressure. And, if so, could mine be lower than 10 and still be effective?

John

[DoriC]

The object is to find the lowest most effective pressure to prevent apneas so as said before, 9cms seems like a good minimum pressure since for part of the night that's the pressure that was doing the job. You may need some tweaking later on if things change but for now I think you're pretty well dialed in. Keep us posted.

[hyperlexis]

Let the machine compute it. The PR60 Auto has an option in the menus called Opti-Start -- the machine will determine the best average starting pressure based on numbers compiled over the prior 30 hours of use. It will then adjust the start pressure up or down to that level. Any events during the night will still be dealt with by the algorythm and it will continue to adjust the start pressure every 30 hours based on your performance. Plus the machine will stay within the range prescribed by your actual MD who assumedly knows what she's doing.

Check out your manual how to allow the machine to enable this feature.

[JohnO]

The PR60 Auto has an option in the menus called Opti-Start -- the machine will determine the best average starting pressure based on numbers compiled over the prior 30 hours of use.

That's right! I had read about that feature, and meant to ask here on the CPAPTALK forum to see if others had tried it. I'll have to review the manual to see if they give any details on how they determine where to start.

Thanks,

John

[Pugsy]

The PR60 Auto has an option in the menus called Opti-Start -- the machine will determine the best average starting pressure based on numbers compiled over the prior 30 hours of use.

I have only seen this option for the Opti Start 30 day thing be associated with the PR System One Auto IQ machines.

I just now reviewed 2 separate PR System One 60 series Auto CPAP model 560 clinical manuals and I didn't see the OptiStart mentioned in either manual and nothing shown on the clinical menu pictures.

Where did you get the clinical manual that shows this option? Are you sure it is for model 560 machine?

[hyperlexis]

The PR60 Auto has an option in the menus called Opti-Start -- the machine will determine the best average starting pressure based on numbers compiled over the prior 30 hours of use.

I have only seen this option for the Opti Start 30 day thing be associated with the PR System One Auto IQ machines.

I just now reviewed 2 separate PR System One 60 series Auto CPAP model 560 clinical manuals and I didn't see the OptiStart mentioned in either manual and nothing shown on the clinical menu pictures.

Where did you get the clinical manual that shows this option? Are you sure it is for model 560 machine?

Well I have a Remstar Auto A-Flex with heated humidifier option which is model DS560HS. Opti-Start is listed on Page 3 of the Provider Guide manual included with the PR60, and falls under the "Setup Screen" as an on/off option. And it's listed on Pg. 9 of the User's Manual.

The guy who set up my machine left it off (and I turned it on.....) I have one more night of sleep hours before it should kick in. So far I am doing 4/20 (in so many ways) but most of my 90% numbers fall around 11. So I'm thinking the machine will start pressurizing around that level once Opti-Start kicks in. It may render my subsequent titration study unnecessary.

I'm surprised but it seems to be one cool feature that the S9 Autoset actually doesn't have. Take that S9! LOL

[Pugsy]

Well I have a Remstar Auto A-Flex with heated humidifier option which is model DS560HS. Opti-Start is listed on Page 3 of the Provider Guide manual

This may be something new that they have added or it may just be specific to your particular model.
Not all the 560 machines have it.
I found a manual for a 560TS but not the HS and the TS definitely does not mention it on any page.
Also the provider manual for a 560 that I got directly from Respironics marketing does not mention it.

Sounds like you have a special 560 machine. That's wonderful.
When you mention Opti Start you might bear in mind that some people with a 560 machine may not have that option.
It very well be something new that the latest 560 machines have incorporated into it. It also might be something that is there short term and they decided not to offer for subsequent models...like the GMT offset clock setting change that used to be offered on some PR S1. Some people have it and some don't.

[hyperlexis]

Well I have a Remstar Auto A-Flex with heated humidifier option which is model DS560HS. Opti-Start is listed on Page 3 of the Provider Guide manual

This may be something new that they have added or it may just be specific to your particular model.
Not all the 560 machines have it.
I found a manual for a 560TS but not the HS and the TS definitely does not mention it on any page.
Also the provider manual for a 560 that I got directly from Respironics marketing does not mention it.

Sounds like you have a special 560 machine. That's wonderful.
When you mention Opti Start you might bear in mind that some people with a 560 machine may not have that option.
It very well be something new that the latest 560 machines have incorporated into it. It also might be something that is there short term and they decided not to offer for subsequent models...like the GMT offset clock setting change that used to be offered on some PR S1. Some people have it and some don't.

I just called Respironics and talked to their engineering department. They said that Opti-Start began with all 60 series Autopap machines from when they were first sold in the US, using software 3.01, in May 2012. It is not a feature available on any CPAP-only machine and also not on any bi-pap machines.

I do know that using the manual on their website it is not included, but, frankly, their website is very poor, in so many ways. The link for the "REMstar Auto A-Flex" user's manual is actually for the OLD model, the 50 series, so it lacks any reference to Opti-Start. (You can tell in part because the last page of the manual shows a date of 9-21-10 which is before the 60 series was ever released.) PR should have updated this months ago. On my 60-series machine, the print date on the back of the user's manual is 5-25-12 and includes Opti-Start.

Your manuals which lack reference to the feature are either obsolete and/or erroneous.

[Pugsy]

Your manuals which lack reference to the feature are either obsolete and/or erroneous.

Yeah, they are but mine was given to me April 11, 2012. And none of my other sources has anything newer.
And the other sources for downloads...well that is all they offer also.
What happens is that someone copies the first provider manual and then shares it and no one bothers to copy another one and update it....so what is out there is the older one.

I would love to have an updated version.. hint...hint.

It's good to know that the Opti Start thing is being provided on all machines now. It was not provided on the first models.

[JohnO]

I would love to have an updated version.. hint...hint.

It's good to know that the Opti Start thing is being provided on all machines now. It was not provided on the first models.

Just confirming that my (two ) DS560s have Opti-start. It is also referenced in the Provider Guide of with a data of 5/25/2012.

I'll try to make a copy today for you, Pugsy.

John