I've been looking for a thread on here regarding Auto pressures and can't find it. I'm sure I've read on here several times that the pressure for Auto should NEVER be set at 4-20 because at the higher pressures, it can cause more apneas--is this correct and why does that happen? I'm asking because I have an auto that is set at 4-20. I've told my RT a couple of times that I think the lower number should be higher and the higher number be lowered but her answer was that it would go into CPAP mode (which isn't what I want). I used straight CPAP for awhile, then got a loaner APAP and the 90% looked to be about 11. Went back to CPAP and she set the higher number at 11 (ramp was 4 I think - I was originally titrated at but I couldn't stand the constant pressure of 11. Later I switched out the CPAP for APAP and this was when she said it HAD to be 4-20---if we changed the pressure settings it would go back to CPAP mode. I plan to send my card to her on Monday and asked that she print out a daily report for at least a week, preferably 2 weeks. When I get those back I'll see how the AHIs are and where the 90% mark is, then I plan to call her and get the pressure changes. I didn't talk to her on the phone yesterday but I told the receptionist that I think the numbers need to be changed because sometimes if the the pressure is too high, it can bring on more events or chase snores. She said she'd never heard of that. She also said if I want a pressure change I'll need to get a script from my doctor. My doctor is just an MD - I'm sure she has no idea whether I need a change or not. I know I should get my own card reader but honestly I'm kind of technically challenged with that kind of thing. I've been on the hose since a year ago August and don't know that I feel that much better so I think it's time that I take charge of my own therapy. I guess I need someone from here to clarify that I do understand correctly that the numbers should be changed and why a higher pressure can cause more events so I have something to substantiate this to my RT. Sorry this is so long and rambling. Thanks for any input you all may have.
Kathy
Pressure settings for Auto
11 posts
• Page 1 of 1
A setting of 4 to 20 cm, is what I call failure mode, At a CPAP pressure of 8 cm, I would set the machine at 6 to 10 cm.
And the software and reader can be the most important part of your treatment, Especially if your MD, is in charge and has little knowledge of apnea. Being proactive is the best treatment, it's your life, maximize it. Jim
And the software and reader can be the most important part of your treatment, Especially if your MD, is in charge and has little knowledge of apnea. Being proactive is the best treatment, it's your life, maximize it. Jim
Use data to optimize your xPAP treatment!
"The art of medicine consists in amusing the patient while nature cures the disease." Voltaire
"The art of medicine consists in amusing the patient while nature cures the disease." Voltaire
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Guest
you are correct in your assumptions about the pressure settings needed. Your RT is either not being very truthful with you or they are simply ignorant.
If your cpap titration was 8.0cm, then I agree your range should be 6.0cm to 10.0cm and it will NOT be in CPAP mode.
You can change the settings yourself, it is not illegal.
Hold down the <> buttons at the same time while plugging in the power cord, it will beep twice, release keys. Ramp keys ^v toggle the value, <> keys move forward/reverse to next parameter. On/Off button exits setup.
Setup may vary depending on model you have:
hour glass with >4 will be displayed, press > key.
mode=AFLE or APAP (AFLE is cflex), press > key.
CFLEX=2 (options are 1, 2 or 3), press > key.
Min:=6.0cm (minimum/starting pressure) press > key.
Max:=10.0cm (maximum pressure) press > key.
timer:=00:00 (should be 00:00 for autopap modes), press >key.
Alert:=0/1 (mask off alert, 0=off, 1=on), press > key.
LED:=0/1 (lights on buttons lit, 0=off, 1=on) press > key.
Note: Some models don't have Min./Max prompt, it will display a Ramp symbol, bottom of Ramp is Min. pressure, top of Ramp is Max. pressure.
If your auto is the early model it will NOT have Cflex feature, then mode=options are APAP/CPAP.
The above will setup your machine in autopap mode with 6.0 to 10.0cm pressure range with Cflex enabled at setting 2.
When you turn on the machine it will start at 6.0cm instead of current 4.0cm, 4.0cm is too low for most people, they starve for air, feel congested, get rainout etc. machine will automatically increase as needed up to the Max. limit of 10.0cm.
If you wake up disturbed by the pressure, you may push the Ramp down button any time and pressure will drop back down to the Min. pressure of 6.0cm.
If your cpap titration was 8.0cm, then I agree your range should be 6.0cm to 10.0cm and it will NOT be in CPAP mode.
You can change the settings yourself, it is not illegal.
Hold down the <> buttons at the same time while plugging in the power cord, it will beep twice, release keys. Ramp keys ^v toggle the value, <> keys move forward/reverse to next parameter. On/Off button exits setup.
Setup may vary depending on model you have:
hour glass with >4 will be displayed, press > key.
mode=AFLE or APAP (AFLE is cflex), press > key.
CFLEX=2 (options are 1, 2 or 3), press > key.
Min:=6.0cm (minimum/starting pressure) press > key.
Max:=10.0cm (maximum pressure) press > key.
timer:=00:00 (should be 00:00 for autopap modes), press >key.
Alert:=0/1 (mask off alert, 0=off, 1=on), press > key.
LED:=0/1 (lights on buttons lit, 0=off, 1=on) press > key.
Note: Some models don't have Min./Max prompt, it will display a Ramp symbol, bottom of Ramp is Min. pressure, top of Ramp is Max. pressure.
If your auto is the early model it will NOT have Cflex feature, then mode=options are APAP/CPAP.
The above will setup your machine in autopap mode with 6.0 to 10.0cm pressure range with Cflex enabled at setting 2.
When you turn on the machine it will start at 6.0cm instead of current 4.0cm, 4.0cm is too low for most people, they starve for air, feel congested, get rainout etc. machine will automatically increase as needed up to the Max. limit of 10.0cm.
If you wake up disturbed by the pressure, you may push the Ramp down button any time and pressure will drop back down to the Min. pressure of 6.0cm.
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rested gal
- Posts: 12881
- Joined: Thu Sep 09, 2004 10:14 pm
- Location: Tennessee
Re: Pressure settings for Auto
Babbie, I'm not in the health care field at all, so what I'm gonna say is just my opinion...
Most people are going to end up being prescribed at least 5 or 6 anyway, so I don't see that it hurts the goal of gathering auto-titration data to set the bottom pressure to a more comfortable level for most people.
Higher pressures causing more "apneas"... what you've seen in posts is probably a tad different. The posts were probably talking about "central" apneas. For some people, high pressures can cause some pressure induced central apneas. Some people, not all; and probably not even the majority. I really think the scare about "high pressures are apt to cause central apneas" is somewhat overstated. Besides, what's a "high" pressure for one person is not "high" at all for another.
Even "pressure induced central apneas" could be so few as to be no problem. Or could be transient, in that when the person's body was more used to the pressure, the centrals would disappear.
At any rate, there's a distinction between "apneas" (we usually use that term on the message board to speak of obstructive apneas) and "central apneas" which have a different cause, not airway closure at all.
1. Switch the operating mode itself to "CPAP" instead of "APAP"
or
2. Set both the maximum pressure and the minimum pressure for the same number, like 10 for the high and 10 for the low.
or
3. Set a Remstar auto to "split night" therapy mode, by deliberately (or inadvertently by confusing "Start" with "Ramp Start") setting a "Start" time in the clinical menu to 2:00, 3:00, or 4:00 hours instead of leaving Start at the default of 0:00, as it should be. A "Start" setting of 2:00, 3:00, or 4:00 would make the REMstar auto use only the minimum pressure in the range for that many hours no matter how many apneas or hypopneas were happening, after which it would begin operating as an autopap varying the pressure as needed.
In the same way that she thinks an autopap has to operate at 4 - 20 to be in "APAP" mode, the Summary report might be all she's ever seen or known about in Encore Pro.
So, when you ask for the printout, be sure you explain you especially want printouts of the charts from page 4 on. If you don't receive those and she says what she's giving you is all there was, that will be incorrect. She would still be able to go back and pull up the Detailed Report to print for you, if she can figure out how. To make it easy for her if you have to ask her for it again, print out the steps ...
viewtopic.php?t=14000
That kind of delay is why many of us do our own "tweaking". Some of us do it on our own, according to what we think best. Some do it after consulting with the doctor ourselves to keep the doctor in the loop. Some leave it all up to the RT and doctor. You just have to decide what you feel comfortable with doing on your own, if anything.
Kathy, it's most unlikely that the REMstar autopap is going to ever run up anywhere close to your current upper limit of 20. If you left it set at 4 - 20, or changed it to 5 - 20, or 6 - 20, that top pressure setting is almost surely not going to matter at all. There's no particular reason to drop it down from 20 unless you were waking up during the night feeling the machine blowing a humongous amount of air at you. That's really most unlikely, snores or no snores.
But, I'd also say it wouldn't harm the data gathering a bit to change the top of the range down to a lower "maximum". However, given that your previous 90% pressure was 11, I wouldn't put the top any lower than 16 during this trial period. You really should let it have considerable ceiling room above your current single prescribed pressure. You do want to see how high it needs to go, so you need some margin up there that it will never touch. Otherwise, you wouldn't know what it DID need to use.
Good luck! Hope you get to keep the autopap after this trial is over. Good machine.
I wouldn't say "never" although I agree with goofproof that a somewhat narrower range is a better way to use an autopap, even just for an auto-titrating trial. Mainly, I think setting the lower pressure up some ( at 5 or 6) is better, since 4 can make breathing through a mask feel stifling.Babbie wrote:I've been looking for a thread on here regarding Auto pressures and can't find it. I'm sure I've read on here several times that the pressure for Auto should NEVER be set at 4-20 because at the higher pressures, it can cause more apneas--is this correct and why does that happen?
Most people are going to end up being prescribed at least 5 or 6 anyway, so I don't see that it hurts the goal of gathering auto-titration data to set the bottom pressure to a more comfortable level for most people.
Higher pressures causing more "apneas"... what you've seen in posts is probably a tad different. The posts were probably talking about "central" apneas. For some people, high pressures can cause some pressure induced central apneas. Some people, not all; and probably not even the majority. I really think the scare about "high pressures are apt to cause central apneas" is somewhat overstated. Besides, what's a "high" pressure for one person is not "high" at all for another.
Even "pressure induced central apneas" could be so few as to be no problem. Or could be transient, in that when the person's body was more used to the pressure, the centrals would disappear.
At any rate, there's a distinction between "apneas" (we usually use that term on the message board to speak of obstructive apneas) and "central apneas" which have a different cause, not airway closure at all.
The RT is absolutely incorrect about that. The autopap will NOT go into straight CPAP mode just because the range of pressure is narrowed. As far as I know, the ONLY ways the REMstar autopap could be made to behave like a straight cpap would be to:Babbie wrote: I'm asking because I have an auto that is set at 4-20. I've told my RT a couple of times that I think the lower number should be higher and the higher number be lowered but her answer was that it would go into CPAP mode (which isn't what I want).
1. Switch the operating mode itself to "CPAP" instead of "APAP"
or
2. Set both the maximum pressure and the minimum pressure for the same number, like 10 for the high and 10 for the low.
or
3. Set a Remstar auto to "split night" therapy mode, by deliberately (or inadvertently by confusing "Start" with "Ramp Start") setting a "Start" time in the clinical menu to 2:00, 3:00, or 4:00 hours instead of leaving Start at the default of 0:00, as it should be. A "Start" setting of 2:00, 3:00, or 4:00 would make the REMstar auto use only the minimum pressure in the range for that many hours no matter how many apneas or hypopneas were happening, after which it would begin operating as an autopap varying the pressure as needed.
She's wrong.Babbie wrote:Later I switched out the CPAP for APAP and this was when she said it HAD to be 4-20---if we changed the pressure settings it would go back to CPAP mode.
As clueless as the RT sounds about how autopaps work, she may be equally clueless on how to get to the "REMstar Auto Daily Details" chart and the "REMstar Auto Daily Events Per Hour" chart. She might just print out the Summary report instead of the Detailed Report.Babbie wrote: I plan to send my card to her on Monday and asked that she print out a daily report for at least a week, preferably 2 weeks.
In the same way that she thinks an autopap has to operate at 4 - 20 to be in "APAP" mode, the Summary report might be all she's ever seen or known about in Encore Pro.
So, when you ask for the printout, be sure you explain you especially want printouts of the charts from page 4 on. If you don't receive those and she says what she's giving you is all there was, that will be incorrect. She would still be able to go back and pull up the Detailed Report to print for you, if she can figure out how. To make it easy for her if you have to ask her for it again, print out the steps ...
viewtopic.php?t=14000
For the RT to make the pressure change, yes, she'd need permission from the doctor.Babbie wrote:She also said if I want a pressure change I'll need to get a script from my doctor. My doctor is just an MD - I'm sure she has no idea whether I need a change or not.
That kind of delay is why many of us do our own "tweaking". Some of us do it on our own, according to what we think best. Some do it after consulting with the doctor ourselves to keep the doctor in the loop. Some leave it all up to the RT and doctor. You just have to decide what you feel comfortable with doing on your own, if anything.
Many of us worried that we couldn't do the software/reader thing, and found that it really wasn't difficult after all. Don't be put off by the number of trouble-shooting posts. Most get through the Encore Pro software installation fine the first time. If not, you'd get plenty of help getting it going from people on the board. And plenty of help understanding what the data showed.Babbie wrote:I know I should get my own card reader but honestly I'm kind of technically challenged with that kind of thing.
Kathy, it's most unlikely that the REMstar autopap is going to ever run up anywhere close to your current upper limit of 20. If you left it set at 4 - 20, or changed it to 5 - 20, or 6 - 20, that top pressure setting is almost surely not going to matter at all. There's no particular reason to drop it down from 20 unless you were waking up during the night feeling the machine blowing a humongous amount of air at you. That's really most unlikely, snores or no snores.
I really wouldn't say that the range should be changed, during this autotitration period. Other than getting up a little off the low of "4" if that felt uncomfortably stifling to breathe at. Personally, I'd just leave the top at 20 for the trial.Babbie wrote: I guess I need someone from here to clarify that I do understand correctly that the numbers should be changed and why a higher pressure can cause more events so I have something to substantiate this to my RT.
But, I'd also say it wouldn't harm the data gathering a bit to change the top of the range down to a lower "maximum". However, given that your previous 90% pressure was 11, I wouldn't put the top any lower than 16 during this trial period. You really should let it have considerable ceiling room above your current single prescribed pressure. You do want to see how high it needs to go, so you need some margin up there that it will never touch. Otherwise, you wouldn't know what it DID need to use.
Good luck! Hope you get to keep the autopap after this trial is over. Good machine.
ResMed S9 VPAP Auto (ASV)
Humidifier: Integrated + Climate Control hose
Mask: Aeiomed Headrest (deconstructed, with homemade straps
3M painters tape over mouth
ALL LINKS by rested gal:
viewtopic.php?t=17435
Humidifier: Integrated + Climate Control hose
Mask: Aeiomed Headrest (deconstructed, with homemade straps
3M painters tape over mouth
ALL LINKS by rested gal:
viewtopic.php?t=17435
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rested gal
- Posts: 12881
- Joined: Thu Sep 09, 2004 10:14 pm
- Location: Tennessee
ROTFL!! Chuck, you sweet l'l ole goofball.
I could say, "Doesn't take much to impress you." I could also say, "Hey, I can be wrong a lot!" (And that would be the truth!)
But I'll just say thanks. Chuck, for your much too kind words.
I could say, "Doesn't take much to impress you." I could also say, "Hey, I can be wrong a lot!" (And that would be the truth!)
But I'll just say thanks. Chuck, for your much too kind words.
ResMed S9 VPAP Auto (ASV)
Humidifier: Integrated + Climate Control hose
Mask: Aeiomed Headrest (deconstructed, with homemade straps
3M painters tape over mouth
ALL LINKS by rested gal:
viewtopic.php?t=17435
Humidifier: Integrated + Climate Control hose
Mask: Aeiomed Headrest (deconstructed, with homemade straps
3M painters tape over mouth
ALL LINKS by rested gal:
viewtopic.php?t=17435
I've got it.....
R.G actually stands for Resident Guru!!
Great job RG.
TerryB
R.G actually stands for Resident Guru!!
Great job RG.
TerryB
_________________
| Mask: Swift™ FX Nasal Pillow CPAP Mask with Headgear |
| Additional Comments: 14 CM , C-Flex Off |
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Guest
Can't thank you enough for your responses. It sounds like I've misunderstood some things - thanks for setting them right for me! I don't know if the RT is necessarily clueless or she just doesn't want to fool with changing the pressures (although clueless does seem correct - the last time I asked for daily reports for at least 7 days and preferably 14, she sent 2 daily and then combined both days. Thanks, Guest for the set up directions - it's much appreciated. Part of me is afraid to change things on the machine - even though the insurance company has paid for it, I'm afraid if I change them the RT will come back and say that I'm in trouble with the insurance somehow(I know that probably doesn't make sense--just don't want her to get nasty with me). You guys are awesome to take so much time trying to help me (especially RG ---what would we do without you??) For the past few days i've been extremely foggy in the mornings and this hasn't happened since I started this hose journey over a year ago so that's partially why I thought I may need some pressure changes. I'll get my readings, see where my 90% is most days and go from there.
. Also need to seriously look into getting the software myself and try to figure out how things are going. Once again, and fat THANK YOU!! I'll let you know how things turn out.
Kathy
. Also need to seriously look into getting the software myself and try to figure out how things are going. Once again, and fat THANK YOU!! I'll let you know how things turn out.
Kathy
You have a lot more interaction with the RT that I do. I've seen them twice. Once when I picked up my first machine, and once when I picked up my second machine.
Never did they look at the data or in the second visit even bother to program the machine correctly, though there was a sticker on it sayint it had been programmed.
They have not impressed me as really understanding how the machines work, need to be configured etc... Kinda makes the Resmed stance sound like a really bad joke.
I'm on my own... getting the software will help so that I can get some feedback on my own.
Never did they look at the data or in the second visit even bother to program the machine correctly, though there was a sticker on it sayint it had been programmed.
They have not impressed me as really understanding how the machines work, need to be configured etc... Kinda makes the Resmed stance sound like a really bad joke.
I'm on my own... getting the software will help so that I can get some feedback on my own.
Current Settings PS 4.0 over 10.6-18.0 (cmH2O) - Resmed S9 VPAP Auto w/h5i Humidifier - Quattro Air FFM
TNET Sleep Resource Pages - CPAP Machine Database
Put your equip in your Signature - SleepyHead v1.0.0-beta-1
Kevin... alias Krelvin
TNET Sleep Resource Pages - CPAP Machine Database
Put your equip in your Signature - SleepyHead v1.0.0-beta-1
Kevin... alias Krelvin
11 posts
• Page 1 of 1