Question on apap

MRH · Post by **MRH** » Tue Nov 06, 2007 12:44 pm

I have been using ther new apap for several days now, what i am wondering is, about leaks and the pressure changes. I have done a little tweaking to the settings now beacause my 90%pressure hase been running at the max setting, so after a couple days i bumped it up a few cm. The 90% still is running on the max setting (I am at 10-17cm now, started at 9-13 cm) Anyway my leak avg has ben in the 42 to 46 range, but I have a rough looking line nowhere near a flat one. Is the leaks causing it to bethe 90% on the max setting? Things haven't really changed since using the apap versus the old straight cpap.

Thanks again, I will get this figured out one of these days!!
Mark

sleepie · Post by **sleepie** » Tue Nov 06, 2007 12:58 pm

a leak sure can raise you 90% number----i look at the time spent at each pressure,,then i look at the graph and see why i was at a certain pressure for a certain amount of time--pat

DreamStalker · Post by **DreamStalker** » Tue Nov 06, 2007 1:01 pm

Yea leaks become more significant for APAP users since the machines can go into runaway pressure.

Having said that your average leak of low to mid 40s does not sound bad but if the nightly data shows your leaks bouncing all over the place ... that is a problem. Leaks cause machine to ramp up to maintain pressure and increased pressure causes more leaks ... bad cycle to get into.

My advice is to figure out what exactly is causing your leaks and get them resolved before you start messing with your pressure or else you will end up chasing leaks and you will waste time and have to start all over.

... and what Den said below.

Wulfman · Post by **Wulfman** » Tue Nov 06, 2007 1:01 pm

Mark,

Do you have software to actually see the events.....like what's causing your pressure increases. Leaks, snores, flow limitations, hypopneas and apneas will all do it.

You need to determine what's going on so you can get a handle on it.

Den

MRH · Post by **MRH** » Tue Nov 06, 2007 1:18 pm

Wulfman,

I have the Encore Pro and the Analyser too. It appears that the most apneas appear around when there are leaks. I suppose I should try to post a couple graphs, to see what everybody thinks. Another thing I am wondering about is, if I need to do a hanger thing for my hose, maybe that would help too.

Thanks,
Mark

ozij · Post by **ozij** » Tue Nov 06, 2007 1:27 pm

Hanging you hose it worth trying - it made a big diffence for me.

O.

Guest · Post by **Guest** » Tue Nov 06, 2007 1:30 pm

May I jump in here and ask what you mean by hanging your hose? Do you mean somehow getting it above you so it doesn't get as pulled on?

Wulfman · Post by **Wulfman** » Tue Nov 06, 2007 1:32 pm

Well, like DreamStalker mentioned, your leak numbers don't sound all that bad.
I'm not a particular fan of using the 90% number. Is there a particular pressure that the line seems fairly flat?.....and before things get carried away. You might want to try going single pressure and see what happens. (pick one)
The leak-pressure cycle can make a mess out of things.

Den

Wulfman · Post by **Wulfman** » Tue Nov 06, 2007 1:33 pm

Anonymous wrote:May I jump in here and ask what you mean by hanging your hose? Do you mean somehow getting it above you so it doesn't get as pulled on?

Yes.

Den

ozij · Post by **ozij** » Tue Nov 06, 2007 1:35 pm

[quote="Anonymous"]May I jump in here and ask what you mean by hanging your hose? Do you mean somehow getting it above you so it doesn't get as pulled on?

Snoredog · Post by **Snoredog** » Tue Nov 06, 2007 1:59 pm

MRH wrote:I have been using ther new apap for several days now, what i am wondering is, about leaks and the pressure changes. I have done a little tweaking to the settings now beacause my 90%pressure hase been running at the max setting, so after a couple days i bumped it up a few cm. The 90% still is running on the max setting (I am at 10-17cm now, started at 9-13 cm) Anyway my leak avg has ben in the 42 to 46 range, but I have a rough looking line nowhere near a flat one. Is the leaks causing it to bethe 90% on the max setting? Things haven't really changed since using the apap versus the old straight cpap.

Thanks again, I will get this figured out one of these days!!
Mark

Are you saying that you started with a range of 9 cm Min to 13 cm Max and increased that to 10 cm to 17 cm?

and the machine continues to "hit" what ever maximum you set it to?

Questions:

What was the pressure found by the lab on CPAP?

Any "CA" or "MA"s noted on your PSG report? You should have a copy of that report, if not go back to the lab that did your study and obtain copy of it, tell them you need it for a 2nd opinion and don't let them tell you they will mail it to the other doctor, tell them you will take it to the doctor yourself. Optionally you can request a copy from your doctor (they should give you a copy of it).

You have the A-Flex machine listed in your profile, what exactly are the settings you are using?

Respironics M Series Auto with C-flex/A-Flex:

1. Hold down the <- -> buttons while plugging in the power on the back, wait 2 beeps, release buttons.
2. Press the + key. <- -> buttons move to next field, -/+ keys decrement/increment
3. Check the following field(s):

-Therapy Mode=AFLEX (CFLEX/AFLEX)

-Auto:Max=20 (default=20.0cm)*

-Auto:Min=6.5 (default=4.0cm, AFLEX doesn't work below 6.5 cm)

-CFlex/AFLEX Setting=2 (options are off, 1, 2 or 3)

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

-AutoRamp Pressure=7.5cm (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.

Note: If your CPAP titration was below 10 cm and your PSG report shows CA and MA events, you should move the Auto:Max=10 or lower or to what your CPAP titration indicated.

CA's, MA's, shallow breathing & snoring are all factors that can drive your pressure up to any maximum set limit which may be what is happening.

A avg. leak of <50L/m should not impact your therapy (need >75L/m with that machine). If "Max Leak" is greater than 75L/m then you can assume your data is skewed or flawed.

If you can put up one of your Auto Daily reports that would help.

MRH · Post by **MRH** » Tue Nov 06, 2007 2:19 pm

[quote="Snoredog"][
Are you saying that you started with a range of 9 cm Min to 13 cm Max and increased that to 10 cm to 17 cm?

Yes

and the machine continues to "hit" what ever maximum you set it to?

Yes also

Questions:

What was the pressure found by the lab on CPAP?

11cm But I wonder as she said I slept 4.5 hours and that is when I was diagnosed plus titrated

Any "CA" or "MA"s noted on your PSG report? You should have a copy of that report, if not go back to the lab that did your study and obtain copy of it, tell them you need it for a 2nd opinion and don't let them tell you they will mail it to the other doctor, tell them you will take it to the doctor yourself. Optionally you can request a copy from your doctor (they should give you a copy of it).

I have the report, if I can find where my wife hid it
I didn't have any centrals

You have the A-Flex machine listed in your profile, what exactly are the settings you are using?

Right now it is set on auto
aflex :1
min: 10.5
max:17
no ramp used, no black bars on the leak chart
I will try to post a chart later when I get home
Thanks again,
Mark

Respironics M Series Auto with C-flex/A-Flex
1. Hold down the <- -> buttons while plugging in the power on the back, wait 2 beeps, release buttons.
2. Press the + key. <- -> buttons move to next field, -/+ keys decrement/increment
3. Check the following field(s):

-Therapy Mode=AFLEX (CFLEX/AFLEX)

-Auto:Max=20 (default=20.0cm)*

-Auto:Min=6.5 (default=4.0cm, AFLEX doesn't work below 6.5 cm)

-CFlex/AFLEX Setting=2 (options are off, 1, 2 or 3)

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

-AutoRamp Pressure=7.5cm (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.

Note: If your CPAP titration was below 10 cm and your PSG report shows CA and MA events, you should move the Auto:Max=10 or lower or to what your CPAP titration indicated.

CA's, MA's, shallow breathing & snoring are all factors that can drive your pressure up to any maximum set limit which may be what is happening.

A avg. leak of <50L/m should not impact your therapy (need >75L/m with that machine). If "Max Leak" is greater than 75L/m then you can assume your data is skewed or flawed.

If you can put up one of your Auto Daily reports that would help.

MRH · Post by **MRH** » Tue Nov 06, 2007 5:37 pm

Ok here it is people critique away

Mark

Wulfman · Post by **Wulfman** » Tue Nov 06, 2007 8:49 pm

Mark,

Do you have a beard? (as per your avatar/picture)

You seem to be leaking at every pressure setting.

I still stand by my previous post about switching to single pressure. Starting with your lower setting and then work up, if necessary, after a few nights.

If the mask is the wrong size or improperly adjusted (and you can't get it resolved), you may need to look at another one.

Den

DreamStalker · Post by **DreamStalker** » Tue Nov 06, 2007 8:55 pm

Are your leaks coming from the nose area of the chin area?

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