Do you make changes to your therapy in any certain order?

Billmanweh · Post by **Billmanweh** » Tue Jul 22, 2008 1:33 am

Assuming your mask fits and leaks are under control...and you make one change at a time in order not to get the effects mixed up with other changes...

Is there a particular order in which you make, or made, changes to your therapy? Humidity, C-Flex/A-Flex levels, ramp, pressure levels, etc?

alnhwrd · Post by **alnhwrd** » Tue Jul 22, 2008 3:28 am

For me it was ramp (stopped using it after the first few nights) leaks, humidity (rainout), pressure, leaks, EPR, pressure, and lately, because it was winter when I started and is now summer, humidity again. I switched to a full face mask and the roller coaster started up again. I think everyone is different and their needs will be addressed in a different order, but I also think getting leaks under control is a #1 priority. Otherwise your therapy is escaping out into the room. They are also really annoying! IMHO, YMMV.

tangents · Post by **tangents** » Tue Jul 22, 2008 6:25 am

Bill,

What part of your therapy are you trying to fix?

Cathy

DreamStalker · Post by **DreamStalker** » Tue Jul 22, 2008 7:09 am

Ramps and flex levels are mostly comfort options.

If mask fits and leaks are under control and you are trying to lower AHI, and assuming you are using auto mode ... start with min pressure about 2 cm below titrated pressure.

If your sleep study report showed sensitivity to central type apneas, setting the max is a little more complex and caution should be exercised. If you have plain old "obstructive" type apnea, set max pressure to high setting like 15 or 16 or even 20 cm. Then look at software reports for a week to determine what min and max you should try and target.

If you are prone to central apneas, set max about 2 or 3 cm above titrated pressure then adjust accordingly up or down but only make changes after about a weeks worth of averaged data.

Slinky · Post by **Slinky** » Tue Jul 22, 2008 7:22 am

As far as humidity, you can change that any time w/o regard to any other changes. I've found in the good ole Saginaw valley in Michigan that humidity changes can be necessary sometimes almost on a day to day basis. Well, not really THAT often but it is something that you can change as needed.

The next step, depending on what you think your need might be, would be either the Ramp or the C-Flex. Most likely the Ramp. At least that was what I eliminated first once I was falling asleep fairly quickly, 10 minutes or less.

I was started w/an EPR of 3 (C-Flex 3) so then went to 2 and then to 1 and then eliminated use of it. (I later did go back to an EPR of 1).

But since I have COPD I was perhaps more cautious than most. DreamStalker's suggestion sounds about what I would be inclined to suggest as well.

Guest · Post by **Guest** » Tue Jul 22, 2008 8:19 am

I like to have my doctor make my adjustments.

DreamStalker · Post by **DreamStalker** » Tue Jul 22, 2008 8:31 am

Anonymous wrote:I like to have my doctor make my adjustments.

Well good for you ... then you probably don't need to be reading this forum if your doc is taking good care of you right?

See 'ya!

roster · Post by **roster** » Tue Jul 22, 2008 8:40 am

tangents wrote:Bill,

What part of your therapy are you trying to fix?

Cathy

Cathy's question needs to be answered before any advice could make sense.

What is not right with your sleeping or therapy?

Regards.

Wulfman · Post by **Wulfman** » Tue Jul 22, 2008 8:42 am

Billmanweh wrote:Assuming your mask fits and leaks are under control...and you make one change at a time in order not to get the effects mixed up with other changes...

Is there a particular order in which you make, or made, changes to your therapy? Humidity, C-Flex/A-Flex levels, ramp, pressure levels, etc?

Do you have the software to monitor your therapy? It sounds like you do, but if you're getting your numbers from the LCD, that might not be the best solution for monitoring......especially with an Auto.

Like Cathy/Tangents asked......what are you trying to "fix"?

There's no particular order other than tweaking "whatever" to get your AHI down and get the most comfort out of it.
Don't overlook trying straight pressure (CPAP mode) to get BOTH......best AHI and comfort.
I've never used Ramp and except for one or two nights in the beginning, have always used pass-over (cool, no heat) humidification and a C-Flex setting of 2.

I haven't made any "changes" in my therapy settings for over two years. I found what works best for me.

Den

Wulfman · Post by **Wulfman** » Tue Jul 22, 2008 8:46 am

DreamStalker wrote:
Anonymous wrote:I like to have my doctor make my adjustments.
Well good for you ... then you probably don't need to be reading this forum if your doc is taking good care of you right?

See 'ya!

Probably one of those brainwashed folks from the ASAA board.

Den

Slinky · Post by **Slinky** » Tue Jul 22, 2008 12:59 pm

Aww, come on, folks. If Guest has a good doctor and Guest feels more comfortable only making therapy changes upon doctor's recommendation - hey, so what? Whatever works for the individual and they are comfortable with.

We've seen a FEW here and in other forums who have this new "toy" and have learned how to make therapy changes and just plain can't wait to do so and make changes willy-nilly every night until they get better advice to slow down and be systematic and patient when making changes from the great folks in this forum.

Some folks need more guidance than others. And I can think of one person, posting at another forum, who probably should NEVER be told how to change ANYTHING about his therapy w/o the doctor ordering it!

roster · Post by **roster** » Tue Jul 22, 2008 1:27 pm

Slinky wrote:Aww, come on, folks. If Guest has a good doctor and Guest feels more comfortable only making therapy changes upon doctor's recommendation - hey, so what? Whatever works for the individual and they are comfortable with.

..........

Slinky,

By all means Guest should continue as you say.

But that is not the issue here. The issue is Guest is a hit-and-run type who can be given no credibility.

Guest only makes a simple statement of his preferences. He expresses no rationale or logical arguments. He is a waste of time on this thread.

Rooster

Wulfman · Post by **Wulfman** » Tue Jul 22, 2008 1:31 pm

Slinky wrote:Aww, come on, folks. If Guest has a good doctor and Guest feels more comfortable only making therapy changes upon doctor's recommendation - hey, so what? Whatever works for the individual and they are comfortable with.

We've seen a FEW here and in other forums who have this new "toy" and have learned how to make therapy changes and just plain can't wait to do so and make changes willy-nilly every night until they get better advice to slow down and be systematic and patient when making changes from the great folks in this forum.

Some folks need more guidance than others. And I can think of one person, posting at another forum, who probably should NEVER be told how to change ANYTHING about his therapy w/o the doctor ordering it!

There's the crux of this issue and why so many people come to the forums/boards for help.......they ain't gettin' it from their "medical professionals" (doctors, RTs or DMEs).

When people (usually anonymous guests on this forum and the admins on that other forum) keep saying "Go back to your doctor.....", it's a good probability that that's where they DON'T want to go......otherwise why would they be asking the questions on an Internet forum? This therapy isn't "rocket science". It's so easy, a caveman could do it.

Den

Billmanweh · Post by **Billmanweh** » Tue Jul 22, 2008 5:48 pm

Well, I'll give a short background. I started out with a mask that didn't fit and my machine running from a 4-20 pressure. It was unusable. Leaks were crazy and waking me up, I had rainout and didn't know why or what to do about it and the yo-yoing pressure was waking me up. So I used my CPAP a few days a week for a few hours a night.

Then I found this forum and got the Encore Pro software. I got a smaller mask that fits better. And I eventually changed my pressure to ~12-15. I've now ordered the aussie heated hose and I'm waiting for it to arrive.

I now use my machine 7 days a week and averaging 7.5 hours a night. So at this point I'm just trying to tweak my numbers a little and see if I can get my AHI down.

Running wide open my mean pressure was 11.1 and 90% was 13.4. With a range of 12-15 the mean is 13.1 and the 90% is 14.8. I don't think my doctor ever gave me a specific titration pressure. My prescription just read "4-20".

My other numbers before and after the changes I've made (bold are my current numbers);

AI before/after: 1.4/1.3
HI: 2.4/1.7
AHI: 3.8/3.0
FLI: 1.3/1.0
SI: 17.3/2.8

So once I get the heated hose I can finally try actually using the humidifier. And I don't use the ramp feature, I'm pretty comfortable starting at 12. So I guess I want to experiment with the other stuff and see if I can tweak my numbers a little and get better quality sleep.

DreamStalker · Post by **DreamStalker** » Tue Jul 22, 2008 9:00 pm

Did your sleep study show you as being sensitive to central apneas?

Also, not clear how you got where you are. Before making changes to your pressures you need(ed) to get the leaks under control. Making changes on data that includes leaks is the wrong way to go about it.

Do you make changes to your therapy in any certain order?

Do you make changes to your therapy in any certain order?

Re: Do you make changes to your therapy in any certain order