APAP and 90 percent ???

[andyomega]

Okay, I broke down and actually read the instructions.
90% pressure means that I spend 90% of the time at or below the number it says.

What good is this information to me?

A) Would it be a good idea to make the minimum pressure the same as the most common pressure so the machine can respond quicker?

B) OR do Hypopnea and Apnea happen gradually enough that the machine can track and adjust on the fly?

[DreamStalker]

C) All of the above.

Actually it all depends. APAP allows you to use lower pressure and it increases pressure as needed. However, if it is set too low, it may not respond quickly enough.

The best thing to do is to get yourself a copy of JSkinner's Encore Pro Analyzer and plot your AHI, OAI, and HI against your pressure and try to determine the min/max pressure settings that way.

http://james.istop.com/EncoreProAnalyzer/

[rested gal]

Andy, I may be wrong about this but I think autopaps were originally developed just to be a temporary machine for people to be put on for a week, or two weeks, or a month. Just to "auto-titrate" long enough for the doctor to determine what's a good SINGLE pressure to put the person on.

After the auto-titrating trial was over, the autopap was usually taken away from the person and he/she was given a CPAP machine. Set at one straight pressure -- that "90th" percentile pressure, or perhaps even a cm or 2 more than the "90th." I believe that's what that measurement is designed into autopaps for -- to give a doctor a reasonably effective pressure to glance at and prescribe at the end of an autopap trial.

With that background about autopaps in mind, I personally don't think the 90th percentile pressure is of much importance (other than of passing interest to see) to those of us who are using our autopaps as our permanent treatment machines.

I personally like to use my autopap with the lower pressure set up almost high enough to be what I'd be prescribed as a straight pressure, in order to prevent apneas right from the get-go. For many people that probably would turn out to be what they're seeing as the 90th percentile pressure over time. But not necessarily.

I like to put the top pressure considerably higher than what it would ever, ever use. I want to see a lot of blank margin up there so there's no question in my mind that the machine had plenty of room to use "whatever", but never had to.

Each person needs to tweak their own autopap to what suits them, however. If I got aerophagia at a certain threshold of pressure, and it was painful enough to make me consider not using the machine, I'd sacrifice "optimum treatment pressure" for comfortable pressure I could actually sleep with.

A lot of this kind of treatment is a trade-off. We trade away sleeping as we used to (or what we thought passed as "sleep") , in order to struggle with mask and machine but not have debilitating apneas cutting off our air all night.

A) Would it be a good idea to make the minimum pressure the same as the most common pressure so the machine can respond quicker?

I do think it's better to have the lower pressure up high enough to be almost like using CPAP. If you're thinking of the 90th percentile pressure as being "the most common pressure", that's not what it is. Remember what the manual said. The 90th percentile pressure means you spent 90% of the night at OR BELOW that pressure. You might have spent very little time AT that pressure and most of your time at pressures BELOW it.

B) OR do Hypopnea and Apnea happen gradually enough that the machine can track and adjust on the fly?

Sometimes the throat closure or tongue relaxing way back happen gradually. Flow limitations often are the sign to the machine that collapse is a'comin'. The machine will take gradual preemptive action to try to normalize the limited air flow before it turns into something worse.

And of course, sometimes apneas and/or hypopneas could happen rather suddenly. For example, if you are sleeping on your side and turn onto your back. Or go into REM.

I'd just set a range that seems to give you a nice low AHI. I wouldn't shoot for zero...I'd just want it below 5.0 AHI. Actually, for me, I'd want it not to get above 3.something. No particular reason. I just don't want to see an AHI of 4 or 5 myself.

If I were satisfied that the machine and mask suited me, but I still felt sleepy or worn out, I'd work on all the other things in life that can mess up getting good sleep. Sleep hygiene that needs improvement. Other health issues that can leave a person tired. Med side effects. Need for a healthier diet. Perhaps vitamin/mineral supplements. Lots of things to look at even if "cpap" is doing its part of the job just fine.

[ozij]

I'd just set a range that seems to give you a nice low AHI. I wouldn't shoot for zero...I'd just want it below 5.0 AHI. Actually, for me, I'd want it not to get above 3.something. No particular reason. I just don't want to see an AHI of 4 or 5 myself.

I do have a clear reason for that - 3 or higher - and I just don't feel good enough.

O.

[Patrick A]

Andy, I may be wrong about this but I think autopaps were originally developed just to be a temporary machine for people to be put on for a week, or two weeks, or a month. Just to "auto-titrate" long enough for the doctor to determine what's a good SINGLE pressure to put the person on.

After the auto-titrating trial was over, the autopap was usually taken away from the person and he/she was given a CPAP machine. Set at one straight pressure -- that "90th" percentile pressure, or perhaps even a cm or 2 more than the "90th." I believe that's what that measurement is designed into autopaps for -- to give a doctor a reasonably effective pressure to glance at and prescribe at the end of an autopap trial.

With that background about autopaps in mind, I personally don't think the 90th percentile pressure is of much importance (other than of passing interest to see) to those of us who are using our autopaps as our permanent treatment machines.

I personally like to use my autopap with the lower pressure set up almost high enough to be what I'd be prescribed as a straight pressure, in order to prevent apneas right from the get-go. For many people that probably would turn out to be what they're seeing as the 90th percentile pressure over time. But not necessarily.

I like to put the top pressure considerably higher than what it would ever, ever use. I want to see a lot of blank margin up there so there's no question in my mind that the machine had plenty of room to use "whatever", but never had to.

Each person needs to tweak their own autopap to what suits them, however. If I got aerophagia at a certain threshold of pressure, and it was painful enough to make me consider not using the machine, I'd sacrifice "optimum treatment pressure" for comfortable pressure I could actually sleep with.

A lot of this kind of treatment is a trade-off. We trade away sleeping as we used to (or what we thought passed as "sleep") , in order to struggle with mask and machine but not have debilitating apneas cutting off our air all night.

A) Would it be a good idea to make the minimum pressure the same as the most common pressure so the machine can respond quicker?

I do think it's better to have the lower pressure up high enough to be almost like using CPAP. If you're thinking of the 90th percentile pressure as being "the most common pressure", that's not what it is. Remember what the manual said. The 90th percentile pressure means you spent 90% of the night at OR BELOW that pressure. You might have spent very little time AT that pressure and most of your time at pressures BELOW it.

B) OR do Hypopnea and Apnea happen gradually enough that the machine can track and adjust on the fly?

Sometimes the throat closure or tongue relaxing way back happen gradually. Flow limitations often are the sign to the machine that collapse is a'comin'. The machine will take gradual preemptive action to try to normalize the limited air flow before it turns into something worse.

And of course, sometimes apneas and/or hypopneas could happen rather suddenly. For example, if you are sleeping on your side and turn onto your back. Or go into REM.

I'd just set a range that seems to give you a nice low AHI. I wouldn't shoot for zero...I'd just want it below 5.0 AHI. Actually, for me, I'd want it not to get above 3.something. No particular reason. I just don't want to see an AHI of 4 or 5 myself.

If I were satisfied that the machine and mask suited me, but I still felt sleepy or worn out, I'd work on all the other things in life that can mess up getting good sleep. Sleep hygiene that needs improvement. Other health issues that can leave a person tired. Med side effects. Need for a healthier diet. Perhaps vitamin/mineral supplements. Lots of things to look at even if "cpap" is doing its part of the job just fine.

I am more confused than I was when I got out of bed this morning after reading this post

[rested gal]

I am more confused than I was when I got out of bed this morning after reading this post

Prolly 'cuz you know I use a BiPAP Auto now, and you saw me writing as if I were using an autopap.

I used autopaps for about three years.

And I've been confused for a lot more years than that.

[Snoredog]

The 90% seen should correlate to any pressure found at the lab. Even that pressure may leave you with a higher >AHI=5 than we typically see here.

While we strive to get below that "normal" finding many times we don't sleep any better once you get down to that sub 1 AHI number.

I actually do worse at a fixed pressure as opposed to autopap so for me the auto seems to work better.

[andyomega]

Its amazing that the director at the sleep clinic simply tells me "oh its automatic, you don't need to worry about anything".

I think I felt better with the minimum at the 90% level.
I wish I had a PRO machine with software and tracking features.
All I can do is go into the menu and see the averages.
7 day average AHI says 1.5.
I know I have other problems with arousals but this is still encouraging.

Thanks everyone !

[Wulfman...]

Andy,

Do you have the Encore Pro software to monitor your therapy?.....or are you looking at your numbers on the LCD screen on your machine?

To flip-flop what Snoredog said, I actually do worse on a range of pressures (Auto mode) and single-pressure works best for me.

In determining CPAP or APAP pressures, I think a person has to look at a lot of factors (particularly from the software reports) in an analytical way to zero in on the pressure(s) that work best. In looking at 90% numbers, I believe a person has to look at what drives the pressures up. Is it snoring....leaks....events? I actually settled for a (single) pressure of 12, even though my 90% numbers were running at 13 and 14 because some residual snoring was increasing the pressures. With a range of 10 - 15, I was spending the vast majority of time at 10 and 11, but my 90% was a bit higher. My AHI is as good or better at 10, but another cm or two kills the snoring. So, that was the rationale I used in setting MY pressure at 12. I also found the pressure changes disturbed my sleep.

I think if a person had to do this without the software and only the LCD information, narrowing in on a short range and then trying single pressure and being willing to tweak it up and down one cm at a time (for a week or more) to see which pressure works best.

Just because a person has an Auto, doesn't mean they HAVE to use it in a range of pressures. The focus should be on what works best for YOU. The fact that a range of pressures (or single-pressure) works better for somebody on a forum, doesn't mean that it will be YOUR best therapy mode.

Also.....get ENOUGH sleep.

This is YOUR therapy.....make the best of it......you're worth it.

Den
AHI = <1.0

[Wulfman...]

Its amazing that the director at the sleep clinic simply tells me "oh its automatic, you don't need to worry about anything".

I think I felt better with the minimum at the 90% level.
I wish I had a PRO machine with software and tracking features.
All I can do is go into the menu and see the averages.
7 day average AHI says 1.5.
I know I have other problems with arousals but this is still encouraging.

Thanks everyone !

Well, that answers some of the questions I had (already posted).

You can still change your machine from Auto to CPAP mode and focus on which pressure works best for you. The sleep clinic director is clueless.
On the other hand, your 7-day average is still good at 1.5.
As I pointed out previously, maybe the pressure changes are causing sleep disturbances for you, too.

Good luck,

Den

[socknitster]

Ok, totally off topic, Roberto, but is your avatar from Jethro Tull's Aqualung?

jen

[socknitster]

[quote="andyomega"]Its amazing that the director at the sleep clinic simply tells me "oh its automatic, you don't need to worry about anything".

I think I felt better with the minimum at the 90% level.
I wish I had a PRO machine with software and tracking features.
All I can do is go into the menu and see the averages.
7 day average AHI says 1.5.
I know I have other problems with arousals but this is still encouraging.

Thanks everyone !



Andy,

Your machine is capable of data storage. You can get a card reader and software and pull that smartcard out of the back and look at everything yourself. You are EMPOWERED!

If you feel better at 90%, go for it! If you feel you still need improvement, try stepping up the min pressure by 1 cm a week and tracking your trends. Keep reading and learning. You are your own best advocate!

jen

[DreamStalker]

Ok, totally off topic, Roberto, but is your avatar from Jethro Tull's Aqualung?

jen

I thought I looked more like the guy on the cover of the cpaplung album

[socknitster]

Too funny!

Jen

[Snoredog]

Ok, totally off topic, Roberto, but is your avatar from Jethro Tull's Aqualung?

jen

LOL I used to have that album, it was great! Aqualung my friend don't you start away uneasy...

We used to watch the early days of SNL and play the video running through the jungle or I guess it was Bungle in the Jungle off the Greatest hits album

I just found it on iTunes, may have to order it.