New and wondering what is going on with this Auto CPAP

[ww]

Hi - I am new to CPAP and this forum.

Took sleep test in two parts:
Obstructive apneas declined from 34 to 0.
Mixed and Central were both 0.
Rem AHI declined from 70.3 to 0.9 events per hour
Supine AHI declined from 13.8 to 5.2 events per hour
Total AHI declined from 13.6 to 2.3 events per hour
Diagnosis was mild OA overall severe in REM sleep.
The prescription was CPAP at 7 in/h20 setting.

The equipment supplier didn't want to dispense ResMed Auto CPAP equipment and they reluctantly agreed to change their Respironics standard unit to a Respironics Auto M with Aflex (and Cflex) and heated humidifier. They did not have the ResMed Mirage Swift II nasal pillow mask that I wanted and substituted a Respironics OptiLife. I was tested with the Swift II nasal pillow mask. They set up the Auto mode with 5 min and 10 max. They had turned off the patient displays, but I found how to turn them back on.


1st Night (Auto 10 max and 5 min) got AHI=8.4 and 90% pressure=10. This seemed much worse than at the sleep clinic, so I found how to set the machine back to simple CPAP with pressure of 7 as originally prescribed.
2nd Night (CPAP with 7 setting) AHI=11.5 avg or 14.4 for that night. This seemed even worse. I slightly increased the upper pressure on the auto mode to 12 and the min pressure to 6.
3rd Night (Auto 12 max 6 min) AHI increased to 12 avg or 11.2 for this night with 90 pressure 10.7. At least it didn't go to maximum this time.

It seems that I have to buy a usb card reader (resp or equiv) and have to find the Encore Pro Software Used since it apparently can no longer be bought new and I guess a used copy can be updated to the M Series version. I found a free Encore Pro Analyzer program, but so far no free or inexpensive software to use to see exactly what is going on.

Everything may be just fine, but I do not want to wait a month to see the sleep doc for the first time to see if things are working properly and they don't look right.

The firmware version of the Auto CPAP is 4.03. Is there any way to know if that is current or can it be upgraded by someone?

Any suggestions as to what is going on with the treatment? and/or any suggestions on finding an inexpensive way to analyze the data from the smart card?

[Wulfman]

Your minimum pressure is still way too low. You'll need to increase it closer to what your 90% pressure is. Too many events occurring before your pressure can get to where it needs to be.

https://www.cpap.com/productpage-bundle.php?BundleID=64

There's some less expensive ways to get the software and reader, but even at $200, the information is well worth it, compared to going back for repeated doctor visits.

Den

[Slinky]

One night's data on a fully data capable CPAP "or" an autoPAP does NOT the entire story tell. Heck, even just one night at a good sleep lab for a titration study isn't always adequate to find your ideal pressure range!!!

QUIT PLAYING with your pressure settings every night! There is a REASON your doctor scripted the pressure(s) that the DME supplier set your autoPAP to. And there was a reason your sleep doctor scheduled an appt w/you in 30 days.

IF YOU INSIST on "playing" w/your pressure settings, then set them back to the original settings and LEAVE THEM THERE for ONE FULL WEEK. DO NOT make ANY other changes, not even mask changes for that one full week.

Pay attention to your leak rate. The change in mask and mask fit alone could account for the difference between your titration results and your autoPAP results.

Make only ONE change at a time and STAY w/that ONE change for one full week BEFORE making ANY other ONE change for ONE FULL WEEK.

Patients constantly making therapy changes every night or every couple of nights are one of the strongest reasons AGAINST giving patients access to their data and ability to change their pressures. And heaven knows we are bucking an uphill battle to establish the right to have some control over our own therapy as it is.

[Wulfman]

I reset my pressure after less than one hour after starting with my machine (from 18 to 10 cm.)......I was suspect of my titration and the prescription my sleep doctor wrote......however, I also had the Encore Pro software from the very beginning.
Using an Auto-titrating machine without software is very difficult, at best. Looking at the summary numbers just doesn't give a picture of what happened during the night......like when and what events took place and what the "leak line" looked like throughout the night.

You're probably not going to "hurt" yourself by changing your settings.....after all it's ONLY AIR......and some stupid doctors/DMEs hand out machines set at a pressure range of 4 - 20, which is DEFINITELY not good therapy.


Den

[ww]

One night's data on a fully data capable CPAP "or" an autoPAP does NOT the entire story tell. Heck, even just one night at a good sleep lab for a titration study isn't always adequate to find your ideal pressure range!!!

I certainly agree with you, but does the data look reasonable on the basis of the sleep lab testing and titration results?

I forgot to post that Hypopneas decreased from 25 to 12 in the 2nd sleep lab.

The leak data was 26 liters/minute (and pretty consistent night to night) and that seemed to match the mask manufactures rate (which the equip supplier did not give me). The mask was given to me in a sack with no fitting, but leak looks pretty good.

After the data looked so bad to me, I set it back to exactly what the sleep lab had titrated, and it was actually worse!

Just didn't seem right when the auto 90% pressure was equal to the max pressure setting and 50% above the sleep lab titration which the original CPAP setting of 7 was based on.

Looks like I am going to have to get the software so I can post better data. Appreciate any assistance anyone can give me.

[ww]

You're probably not going to "hurt" yourself by changing your settings.....after all it's ONLY AIR......and some stupid doctors/DMEs hand out machines set at a pressure range of 4 - 20, which is DEFINITELY not good therapy.

Den

Thanks for the information. Maybe I will learn how this thing really works, yet. Yes, I asked him about setting it up with a wide range, and he did not want to. Yes, it looks like I need the software to actually see what goes on.

Does anyone know if the Encore Pro Analyzer program will work with the Encore Viewer Software and does the Analyzer program produce any more data than the Encore Viewer that is useful?

[goose]

Both Den and Slinky are right and have valid points.

It's apparent that the titration did not get you right (me neither....I titrated at 5 and I can barely breathe at 5....I'm at 10).

At this point I'd consider changing to a range of around 8-12 to check it out -- look at the data, but leave it for a minimum of 1 week -- I generally make a change once a month unless there is something seriously wrong.
You can't determine how your treatment is going with one or two nights of data...you can see a trend, but generally it takes a while for things to settle in -- you want averages over time, not nightly knee jerks.

Every time I make a change it takes 2-4 days for it to really settle in and give me numbers that I trust....I go by how I feel in the morning....If I feel realllllly crappy, then there's something wrong -- pressure wrong, mask leaking badly. my own perception.....
If I feel ok, then I keep an eye on things to see how the numbers do....
I'm presently at 10cm H2O and my AHI averages 2.5 (over a few months)....

The card reader you want to get is a DT3500 -- I got mine directly from Hong Kong but for the life of me I can't find the vendor name. I think if you search the forum you can find it....it' was $35 plus shipping....

By the way -- Welcome to the forum. You've found an excellent place for advice and support. If you haven't heard or found them yet -- try the yellow light bulb (Our collective wisdom) and the red balloon (CPAP FAQ). They are a wealth of information!!!
And please continue to let us know how you're doing!!!

Take care
cheers
goose

[BigMoose]

I just picked up my MAKO Infineer DT-3500 USB Card reader from Secure Tech last week. It was 49 bucks and like 12 bucks shipping to Ohio. This reader works perfectly with Encore Pro.

http://www.securetech-corp.com/mako_dt.html

It WAS also available from http://www.two-factor.com for 24 bucks and shipping, but it has been out of stock for a while.

http://www.two-factor.com/shop/index.php?productID=115

There are a lot of good threads on these readers, and installing the software. Search should find them.

I concur with others advice to be careful and prudent when we start setting our machines. Even though I have an APAP machine, I am running it in my prescribed CPAP mode and pressure until I am thoroughly acclimated and familiar with my bodies response to it. The day may come when I can refine and optimize my treatment, but I know I am not ready at the present time. I have my hands full tracking down my mask leaks, and getting used to my new "friend" on the nightstand. The "friend" that likely will allow me to have many more productive years than if it were not there, for that I am thankful. ... but my "friend" and I are not yet on a "first name basis."

Hope this helps.

[cflame1]

Does anyone know if the Encore Pro Analyzer program will work with the Encore Viewer Software and does the Analyzer program produce any more data than the Encore Viewer that is useful?

Analyzer massages the data from Encore Pro. Viewer doesn't use the database that Pro uses, and so Analyzer doesn't work with Viewer at this time.

[ww]

Based on the advise given here, I am settling in for a week with auto set to 8/12, but it is not easy. AHI <4 yesterday but avg >4 today. Thanks for all the input and I will be back with further information.

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CPAPopedia Keywords Contained In This Post (Click For Definition): respironics, AHI, auto

[rested gal]

Encore Viewer gives me all the detailed data I need to tweak my treatment.

The Hong Kong store goose mentioned that sells the card reader cheap is two-factor.com

It's this reader -- the link that BigMoose gave:

http://www.two-factor.com/shop/index.php?productID=115

Often "out of stock", but keep checking back each day and it's usually available again soon.

Or, check the U.S. store that BigMoose mentioned:

http://www.securetech-corp.com/mako_dt.html

[mbrown]

I had the same problem with my AHI going up. I found out it was associated with my mouth not being open wide but actually just blowing open a little bit at higher pressures. When my machine would increase from 10-12, my lips would come open just enough to release a little of the pressure. This caused the machine to stay at 12 longer and sometimes go to 13 which increased the problem. This did not show up as massive leaks but did increase my AHI from 1.0 range to 4.0 range. They say less than 5 is normal, but I could sure tell a difference. I fixed up an elastic strap that I put around the top of my head and under my chin fairly tight. This has helped a lot and my AHI is back in the 1.0 range the last three days. I was titrated at 8 but I have adjusted my machine to 10-14 on A-flex for my best results. The way I found this problem is my wife watched me sleeping when the machine started to increase in pressure.

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CPAPopedia Keywords Contained In This Post (Click For Definition): AHI