A-Flex - First Night

roster · Post by **roster** » Thu Sep 13, 2007 9:46 am

1. Now I see what you mean about those blue lights! Fortunately they did not bother me. Probably because the machine is on a bed tray well below the top of the mattress. They do light up the ceiling but that also did not seem to bother me.

2. The machine really does have a fairly loud whine when it is cycling the pressure up. This did not bother me going to sleep but it bothered me a little when I woke at 2:00 and 4:00. I do have a white noise machine with rain playing so the whine was masked somewhat. In the long run, I don't think the whine will be a problem but I may have to keep using the white noise machine.

3. I have been using straight cpap at 10 cm. The A-Flex is set 4-10 cm, A-Flex comfort setting '2'. Wow! It is much more comfortable breathing.

4. I seem to have slept better. I am usually awake at 4 or 5 and this morning I woke at 6:30 when my wife got up and starting banging around. Usage hours 7:54.

5. Aerophagia nearly eliminated. I wonder if I should go to comfort setting '3'? Mouth was still dry last night but not as bad as before.

6. I am using the Hybrid mask version with reduced vent rate for auto machines. Data shows the system leak was 29.6 last night and I believe that is very good. Eh?

7. This morning I don't feel well, but I rarely have since I started cpap. I do feel lightheaded this morning and that is not usual.

8. 90% pressure was 10 (setting 4 - 10). AHI was 25.1!

I will go to the DME next week and have the card read. What do you recommend I do in the meantime?

BTW, before the DME set up the machine, the RT claims she talked to the sleep doc for a long time trying to convince him to set the max pressure higher. He refused.

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CPAPopedia Keywords Contained In This Post (Click For Definition): CPAP, DME, auto, aerophagia

mindy · Post by **mindy** » Thu Sep 13, 2007 10:03 am

rooster wrote: 7. This morning I don't feel well, but I rarely have since I started cpap. I do feel lightheaded this morning and that is not usual.

8. 90% pressure was 10 (setting 4 - 10). AHI was 25.1!

I will go to the DME next week and have the card read. What do you recommend I do in the meantime?

BTW, before the DME set up the machine, the RT claims she talked to the sleep doc for a long time trying to convince him to set the max pressure higher. He refused.

CPAPopedia Keywords Contained In This Post (Click For Definition): CPAP, DME, auto, aerophagia

Hi Rooster,

I am absolutely *not* an expert on this!!! So with that as a critical caveat, I will say that my RT said that a setting of 4 is basically like having almost no cpap. They set my ramp start to 5 for that reason. I have *mild* apnea and my sleep doc ordered my initial pressures to 7-12. My sleep study showed 7 on my side and 8 on my back but I don't have REM sleep in sleep lab on my back.

As I'm experimenting a little bit *within* that pressure range [oh my - slap my hand!], I find my AHI is dropping as I'm raising the minimum pressure but raising maximum pressure doesn't do anything. That would seem logical since the higher the minimum pressure, the less lag time between recognition of apnea and pressure change (at least, that seems logical to me!)

So please take this with a large cupful of sodium chloride!!!

Mindy

Snoredog · Post by **Snoredog** » Thu Sep 13, 2007 10:04 am

WHY are you using a starting pressure of 4.0cm?

4.0 is too low even for controlling aerophagia, I'm surprised you can even use it that low, I starved for air at 6.5cm and had to go to 8.0. That 4.0cm is probably WHY your AHI=25. Alternatively you can set-up Auto:Ramp and use that if you want to start out with a lower pressure. Keep in mind most masks won't fully flush out exhaled CO2 until you get up to 6.0-6.5 pressure.

You need to take your PSG titration found pressure and/or prior pressure as a guide and put that within your starting range. If that is unknown then you need to give the machine some room to work.

NO I would not increase the AFlex to 3 at this point, you need to get pressure in-line first. Increasing AFlex would probably only help you if you increased pressure and used a higher Aflex setting to compensate for that higher pressure.

I would set the machine to the following:

-Therapy Mode=AFLEX (CFLEX/AFLEX)

-Auto:Max=15 (default=20.0cm)

-Auto:Min=6.5 (default=4.0cm)

-FLEX =2 (options are off, 1, 2 or 3)

-AutoRamp Time=30 (options are 05 to 45 min)

-AutoRamp Pressure=6.0cm (4cm->AutoMin)

-Mask Alert Feature=ON (On/Off)

-Auto Off Feature=Off (On/off)

-Split Night Time = Off (off, 120, 180, 240)

-Show AHI/Leak Feature=ON (On/Off)

Press On/Off button to exit.

Bamalady · Post by **Bamalady** » Thu Sep 13, 2007 10:34 am

Oh, wow...AHI 25.1! I would agree with Snoredog. Either change the pressure yourself, or call and let folks know that the pressure settings are not working for you!

But glad to hear that otherwise things look good, and that you are finding the machine to be comfortable.

roster · Post by **roster** » Thu Sep 13, 2007 11:01 am

Thanks guys, I will change that pressure tonight - more in line with your recommendations.

One question, since my 90% pressure was 10, why should I be concerned about the minimum setting of 4? The machine was running at 4 only 10% or less of the night.

BTW, I have had this discussion with the sleep doc before about 4 min pressure probably being too low but they won't do anything else. They are in a high income/high rent area in swanky facilities and everyone they send out of there with an auto has it set at 4 min pressure. Are these docs stupid?

If I have time this afternoon, just for fun, I will call the sleep doc and see what he says about 25 AHI.

bdp522 · Post by **bdp522** » Thu Sep 13, 2007 11:48 am

As I understand it; your machine was running at 10 or below for 90% of the night(someone please correct me if I'm wrong!). That means it could have been at 4 for quite a while.

Brenda

roster · Post by **roster** » Thu Sep 13, 2007 1:36 pm

bdp522 wrote:As I understand it; your machine was running at 10 or below for 90% of the night(someone please correct me if I'm wrong!). That means it could have been at 4 for quite a while.

Brenda

Brenda,

I am sure you are correct. What I wrote doesn't make sense. The max pressure is set at 10 and the data the next morning said the 90% pressure was 10. I have to think about the math on this and I have being running all over two towns doing other things today. Add in that I am feeling funky and my cognitive ability today is probably around 85 IQ.

Tomorrow will be better, maybe.

Bamalady · Post by **Bamalady** » Thu Sep 13, 2007 2:06 pm

The max pressure is set at 10 and the data the next morning said the 90% pressure was 10.

That does make you wonder where you were for the other 10% of the night!

I simply don't get enough air at 4 cm. My ramp was set to start at 4, and I don't use it. Maybe you can and do alright. Everybody is different. But something definitely needs changing. If you want to stick with 4 as the lower number, just increase the upper number and see how well you do.

dsm · Post by **dsm** » Thu Sep 13, 2007 2:21 pm

[quote="rooster"]Thanks guys, I will change that pressure tonight - more in line with your recommendations.

One question, since my 90% pressure was 10, why should I be concerned about the minimum setting of 4? The machine was running at 4 only 10% or less of the night.

BTW, I have had this discussion with the sleep doc before about 4 min pressure probably being too low but they won't do anything else. They are in a high income/high rent area in swanky facilities and everyone they send out of there with an auto has it set at 4 min pressure. Are these docs stupid?

If I have time this afternoon, just for fun, I will call the sleep doc and see what he says about 25 AHI.

RosemaryB · Post by **RosemaryB** » Thu Sep 13, 2007 3:52 pm

rooster wrote:Are these docs stupid?

Yes

rested gal · Post by **rested gal** » Thu Sep 13, 2007 6:42 pm

I'm not a doctor or anything in the health care field.

I'd set the machine at 8 for the minimum pressure, 16 for the maximum pressure. Try different A-flex settings to see which feels most like natural breathing to you.

I'd keep ramp turned off unless you absolutely need a ramp time with a lower pressure to start out. But I'll bet that using A-flex will make ramp unnecessary for you.

rooster wrote:One question, since my 90% pressure was 10, why should I be concerned about the minimum setting of 4? The machine was running at 4 only 10% or less of the night.

Autopaps are designed to change pressure up (or down) gradually. They don't abruptly jump the pressure either way. Rapidly yo-yo'ing pressure changes could be disruptive to sleep. Because of the rather slow pressure movements I think it's better to have the minimum pressure up pretty close to what would preemptively ward off most events in the first place.

I like to use an autopap almost as if it were a straight cpap, regarding where to set the minimum pressure. I also like to give it a large margin of pressure above (the max pressure setting) - high enough to include pressures that will never even be used.

Statistically most people's airway is kept open at a pressure of 10. I seem to fall into that category. When using an autopap I want my minimum pressure to be set on at least 7 or 8. Actually, I keep my minimum on 9. That way, if 10 (or more) is needed at some points during the night to correct a flow limitation that could possibly become an hypopnea or apnea, the machine won't have to waste time working its way up slowly from 4 or 5 to correct the situation. It's already delivering a minimum pressure that is preventing most apneas/hypopneas to begin with, and will already be "almost there" if more pressure is needed occasionally during the night; especially if more is needed to deal with a sudden apnea.

Getting the minimum pressure "right" is the important one, imho. In your case, rooster, I think both the pressures set for your machine are too low. But...I'm no doctor.

You might want to ask your doctor exactly why he doesn't want your max to be set for more than 10. If it's not because of some particular medical problem you have, he may simply not trust autopaps in general. I'd think your RT is aware of your medical history, and your RT seems to think 10 is not high enough for the max setting for you. If mistrust of autopaps rather than a real medical reason applying to you is behind your doctor's adamant "no higher than 10" notion, I'd use my own judgment and use whatever pressure settings I thought best. But that's just me -- a born tweaker.

roster · Post by **roster** » Thu Sep 13, 2007 7:25 pm

Thank you all very much. IMHO, each one of you has given me good advice.

I will raise both min and max pressures and tighten the range tonight.

I will check the data tomorrow and consider another change if the AHI is still high.

I guess having the software would speed up this process.

Can someone refer me to the post on which card reader (and whatever else is needed) to order?

roster · Post by **roster** » Thu Sep 13, 2007 7:36 pm

"Yeah (sing the song brother...)
Now if uh, 6 uh, huh, turned out to be 9
Oh I dont mind, I dont mind uh ( well all right... )"

------- If Six Was Nine - Jimi Hendrix

Wow, look what this thread stirred up in my brain. It was great being a teenager and college student in the late sixties.

packer · Post by **packer** » Thu Sep 13, 2007 8:26 pm

aflex user here- cpap for almost year- aflex for 3 months

not a doc-- just offering my experience

I needed to set my low to 8.5 to feel like I was getting enough air

leave ramp off - aflex does quite well with breathing

throw a pillow over machine-- cuts lights and noise- [ i truly dont get the noise part- mine is quieter than old tank]

mine is set 8.5 to 15 my 90% is 11 ahi 2.3

mask is the big deal in my opinion- even straight leaf blower would help if no leaks and right level-- [ some here brag about how much they can "take"- but why?? why not be comfortable and get good tx??]] I think you have best machine available- goodluck

Bamalady · Post by **Bamalady** » Thu Sep 13, 2007 8:32 pm

two-factors.com has the reader for just over $30.00, which includes shipping, but will take about 10 days to arrive. cpapusa has it for $47.50 plus shipping.

RG has the links, of course:

http://tinyurl.com/2xsaou

A-Flex - First Night

A-Flex - First Night

Re: A-Flex - First Night

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