Resetting the pressures on my M Series APAP

[fortomorrow]

My doctor was kind enough to prescribe me an upgraded machine, but bless him, he's set the pressure range at 5-20cm. I know that the range needs to be a lot smaller than that, my pressure on CPAP is 12cm, so perhaps it should be at 9-13cm?

Results of my titration study below. I think it's interesting that they titrated by 2s. What if 11 is actually the perfect pressure? How would they know?

Total recording time 272.9 minutes. Total sleep time 233.0 minutes. Sleep onset latency is 23.0 minutes with a REM latency of 30.0 minutes. The patient was started on nasal CPAP, 5cm water pressure, recorded for 44.4 minutes, but slept only 21.5 minutes. Efficiency was low at 48.4%, therefore titrated to a higher pressure.

CPAP at 8cm water pressure recorded for 109.5 minutes, slept for 106.0 minutes, sleep efficiency 96.8%. Entered REM sleep supine, 1 mixed apnea, 1 respiratory effort related arousal, fairly well-maintained oxygen saturations. Tried a 10cm water pressure with equally good sleep efficiency at 87.4% (EDITOR'S NOTE: How are 96.8% and 87.4% equal?), entered REM stage sleep, only 1 central apnea, 4 respiratory effort related arousals, well-maintained oxygen saturations. Also tried 12cm water pressure, excellent sleep efficiency of 93.1%. Patient was supine. No obstructive sleep breathing. Appeared to do best at this pressure. Significant reduction in periodic limb movements, down to 2.3.

Can someone send me the clinician manual for the M Series Auto CPAP with A-Flex? Or at least tell me how to get in and re-do the settings?

[Guest]

Try this
http://www.cpap-supply.com/Articles.asp?ID=130

[fortomorrow]

Ah ha, I knew I'd read that *somewhere* before. Thanks!

[rested gal]

My doctor was kind enough to prescribe me an upgraded machine, but bless him, he's set the pressure range at 5-20cm. I know that the range needs to be a lot smaller than that, my pressure on CPAP is 12cm, so perhaps it should be at 9-13cm?

I'm not a doctor or anything in the health care field, but I don't think that it's that the range needs to be "smaller" if you mean raising the minimum pressure AND lowering the maximum pressure all at the same time.

What's important, imho, is that the minimum pressure be high enough to prevent most apneas/hypopneas right from the get-go. It doesn't really matter, in most cases, for most people, how high the maximum pressure is set, as long as it's set high enough to give plenty of UNused ceiling room up above. So, unless a reason crops up during your use of the machine, that you need to set a lower pressure than 20 for the max, I'd leave the max pressure set at 20.

If it were me, and I'd been prescribed "CPAP at 12", I'd set the machine at 10 - 20, or 11 - 20, or 12 - 20.

I'd also want to be using the Encore Viewer software that Respironics machines use, to monitor how my treatment was going. Especially to get a look at the leak rate in the Daily Details graph of that software.

If you'll PM me your email address, I'll be glad to send you the full Provider manual (clinical manual) for your machine.

[fortomorrow]

Yeah but according to my titration study I did pretty well at 8cm. I've been having problems with aerophagia and acid reflux so I'd like to have my low-end pressure as low as I can get away with. I'll try it with the top end pressure left at 20cm though.

I've got a card reader and Encore Pro installed on my backup PC. All I need now is the machine itself! Apria is dragging their heels. I might just show up there tomorrow.

I'll PM you now. Thanks!!

[fortomorrow]

Success! I finally have my APAP machine in my hands. *pets it* As soon as I get home I'm going to set it to 8-20 (they set it from 5-20) and then wait impatiently for bedtime.

Thank you to EVERYONE who helped me get the darn thing. It felt like there were a million hoops to jump through but finally, over a month later, I have the machine, a card reader, the card, and I'm ready to go.

(I've also collected four masks, some PurSleep samples, a ton of Benadryl, I've sewed myself a hose cover, and I've dug my neti pot out of the medicine cabinet.)

[Babette]

WOO HOO!!!!!!!

Yeah, I think 8-20 is a good idea, given your other issues. I THOUGHT I has having trouble with letting the machine run up to 20, but it turns out what I was having trouble with was the stupid AFLEX setting. It just doesn't work for me. Now I'm running 11-20 with Cflex, it's working much better for me.

Good luck and SLEEP WELL!!!!!!!
Babs

[Guest]

fortomorrow - it's best to consult with your doctor if you want to change pressures. Don't take the opinions of a bunch of people who have no idea about your medical background. Don't be misled.

[fortomorrow]

Oh, but I *should* listen to a guy who can't even be bothered to login to the forum?

Sorry, thedean, but I've heard all about you. And none of it has been good.

[Craig-Tx]

fortomorrow - it's best to consult with your doctor if you want to change pressures. Don't take the opinions of a bunch of people who have no idea about your medical background. Don't be misled.

I'm in the same boat as fortomorrow. I had CPAP at 10 cm. when I got my APAP, they prescribed 4-20. I talked to my "doctor" (Well somebody at the office - I've never actually met my sleep dr.) After a length argument over how an APAP works, he finally agreed to check with somebody else.

I asked them about raising the minimum from 4. He stated very clearly an APAP gives you the pressure you need and that it shouldn't be restricted. I had to correct him in that it starts at the minimum and gradually increases based on detected apneas. I think he believed an APAP can scan your body somehow and automatically deliver the correct pressure. Ok, I don't have any idea what he thought...

It's a week later and he never did get back with me.

I personally am set now to 8-14. Anything below 8 I know doesn't sufficiently treat my apneas. So far my 90% has been hovering around 9. I didn't want anything above 14 because I have never been titrated that high, I don't know what my body will do. If I find that my 90% begins to get close to 14, I would want to go in for another titration, primarily to check for centrals at the higher pressure.

-craig

[fortomorrow]

Thank you Craig. I've been having problems with aerophagia and GERD and I want my pressure to be as low as possible, but at the same time I can look at my titration study and see that 5cm didn't do anything. I also know that it can take a bit of time for the pressure to increase in response to an event, so if I need 10cm to deal with an apnea, how long am I going to have to wait for the machine to get to 10 from 5?

Luckily I know how to reset the thing by hand, BECAUSE I CANNOT GET THE SODDING CARD READER INSTALLED.

*throws it out the window*

I hate PCs.

[Craig-Tx]

Luckily I know how to reset the thing by hand, BECAUSE I CANNOT GET THE SODDING CARD READER INSTALLED.

If it makes you feel better, I can tell you from experience, it is MUCH easier to just change the pressure on the machine than to use Encore Pro and the smart card.

As for your card reader problems, common things that first come to mind: Make sure the reader is NOT plugged into a USB HUB. (And always use the same USB port once it works.) Don't use the driver that came with the card reader, instead use the driver on the Encore CD. There are probably a LOT of threads on the forum that could help you diagnose the problem. It can be tricky,but once it works, it's worth it.

Good luck.

-craig

[fortomorrow]

I got it to work last night, but I've just plugged it in and tried to download the data and it says "The patient on the card does not match any active patients in your database. Please open the patient to download and try again."

But there's no patient info listed when I preview the card.

RARARARAR.

[Wulfman]

I got it to work last night, but I've just plugged it in and tried to download the data and it says "The patient on the card does not match any active patients in your database. Please open the patient to download and try again."

But there's no patient info listed when I preview the card.

RARARARAR.

Doesn't it give an option to override it and download anyway? Normally, that message comes up because the card has no name (patient info) on it and it asks that question to make sure you have the right patient file open. I got a message similar to that for about the first year of my downloading and once I re-formatted the card and inserted my name and patient number on it, I quit getting that message.
Additionally, did you have your patient file set up and were you in it when you went to download? (I'm presuming so, but wanted to ask, just to make sure)

Den

[fortomorrow]

Nevermind, in my haste to get things going (and my unfettered joy at having bested the thing after two hours of battle) I just forgot to set up the card before I got started last night. So I lose last night's data, boo.

I pulled it off the machine though.

8.42 hours of therapy time
90% pressure was 9.5
Leak rate was 35.6
AHI was 1.3

Woo, and also hoo.

Last night was also my first time with the Hybrid. It is SOOOOOO much better than the Liberty, I'm glad it worked out. Although now I've got a spare Liberty floating around.

Oh and A-FLEX! How great is A-Flex! It feels so much more natural than C-Flex did! I am so glad I got the new machine.