Just got an APAP

[turbosnore]

Just had a control where my Escape CPAP was exchanged to Autoset Spirit APAP.
I can't wait to try it. I mean, whether it works or not, I get to sleep .

Last Monday I reached some kind of top. I felt like I was on something for most of the day.
I don't know what the decompression sickness is like, but I guess it might have been close.
I felt easily irritated and little mean with quite weird sense of humor.
I even warned my co-workers about my possibly acting weird. They were quite understanding.
Towards the evening I got more normal though.

The next night I slept without the sleeping turbo. My wife agreed, because she thought I might
kill myself on my way to work if it got any worse. I was easily irritated and tired, but at least
I was in my normal senses (whatever that is).

I sure hope APAP works better for me.
[edit]
Which is the closest to ResMed Autoset Spirit in the profile/equipment selection?

[Wulfman]

Just had a control where my Escape CPAP was exchanged to Autoset Spirit APAP.
I can't wait to try it. I mean, whether it works or not, I get to sleep .

Last Monday I reached some kind of top. I felt like I was on something for most of the day.
I don't know what the decompression sickness is like, but I guess it might have been close.
I felt easily irritated and little mean with quite weird sense of humor.
I even warned my co-workers about my possibly acting weird. They were quite understanding.
Towards the evening I got more normal though.

The next night I slept without the sleeping turbo. My wife agreed, because she thought I might
kill myself on my way to work if it got any worse. I was easily irritated and tired, but at least
I was in my normal senses (whatever that is).

I sure hope APAP works better for me.
[edit]
Which is the closest to ResMed Autoset Spirit in the profile/equipment selection?

There is an S8 Vantage and the Autoset Spirit II (which has exhale relief) in the list.
If yours doesn't have the exhale relief (newest model), then the Vantage would be the one to choose.

Depending on what your pressure requirements are, the ResMed APAP may or may not be better.


Den

[turbosnore]

...
Depending on what your pressure requirements are, the ResMed APAP may or may not be better.

Den

I wish I knew my pressure requirements. The CPAP was set to 12 cm and the APAP to 9 - 13 cm.
I've heard someone say "from how things are, one cannot deduce how things should be".
Weird thing is, that I still snore under the mask.
Snoring with sleep turbo! I guess my nickname became closer to the truth than I could have guessed.

[MusicMan]

Weird thing is, that I still snore under the mask.

You probably need to have your pressure adjusted.

I use both a CPAP and the PureSleep mouthpiece, which keeps me from snoring at all. I would bet that the mouthpiece would eliminate your snoring. It's only $60 so it's not that huge of an expense to try out, and makes for a good backup if you ever happen to unknowingly take your mask off in the middle of the night.

[Wulfman]

Yep. If your CPAP pressure was set at 12, you probably need to set your minimum APAP pressure to 12.

Den

[daveuk]

That can't be right. Setting minimum pressure to 12 would cancel out any advantage of having APAP versus CPAP. The idea is that full pressure is used only when its needed. Setting minimum to 12 would in effect cause full pressure all the time if your fixed CPAP waqs set to 12. I think the settings you were given, min 9 max 13, allow for some variation of actual pressure as and when apneas are detected.

[Paul56]

That can't be right. Setting minimum pressure to 12 would cancel out any advantage of having APAP versus CPAP. The idea is that full pressure is used only when its needed. Setting minimum to 12 would in effect cause full pressure all the time if your fixed CPAP waqs set to 12. I think the settings you were given, min 9 max 13, allow for some variation of actual pressure as and when apneas are detected.

Titration pressure was adjusted at such a number where most events were resolved by the machine thus one of the reasons for setting the APAP minimum = titration pressure.

My own titration was 8 and I have the machine set to 8-15. Treatment has been successful... sure there are some "off" nights... everyone has them. But, for the last 3 nights my AI has been recorded as zero.

I suspect on CPAP my ideal pressure would be somewhere around 11-12 given the pressure data recorded from the APAP.

This is the great thing about fully data capable machines... one can record data for at least a week, review the data and make machine adjustments based on that data. It is so very easy with the Resmed boxes being able to read the pressure, leak, AHI, AI & HI off the LCD. This data can be recorded daily on a spreadsheet. I find that data as useful as the ResScan software.

[rested gal]

That can't be right. Setting minimum pressure to 12 would cancel out any advantage of having APAP versus CPAP. The idea is that full pressure is used only when its needed. Setting minimum to 12 would in effect cause full pressure all the time if your fixed CPAP waqs set to 12. I think the settings you were given, min 9 max 13, allow for some variation of actual pressure as and when apneas are detected.

I think there can be many ways to look at how to use an APAP most effectively. And I think those reasons can be quite different for each person.

I'm not a doctor or anything in the health care field, so the following is just my opinion:

Some people get along nicely with the APAP's minimum pressure set considerably lower than the single pressure they'd need to use on a straight CPAP. Others, though, might have such sudden hard obstructive apneas, that they do best with the minimum pressure preventing most events right from the get-go -- setting the minimum pressure up at, or very close to, the "prescribed single pressure."

I already know, from experimenting with different straight pressures while awake, lying down, and deliberately making my throat relax as much as possible, that it takes at least a pressure of 10 or 11 to keep it well and truly open. Relaxing it lets it collapse at less pressures. If that can happen immediately while I'm awake and trying to relax the throat, I can imagine how much more easily it can happen while in the full relaxation of sleep. Therefore, I believe I need to set my minimum pressure on at least 10 (actually been using 12 as my min now for quite a few months.)

If the pressure I need bothered me, though...caused painful aerophagia, for example... then I'd choose to tweak the minimum pressure down to a point that I could tolerate. I'd trade off "optimum" therapy for more comfortable "ok, THIS I can do" therapy. Fortunately, I have both; as either of the machines I use (Auto with A-flex, BiPAP Auto with Bi-flex) are so comfortable to breathe out with, that "12 cm" doesn't feel like much pressure at all.

Autopaps are designed to not yo-yo pressure up and down rapidly. They make their changes gradually. So, another point in favor of setting the min pressure up at "CPAP" single pressure level, is that for people who have hard, fast apneas, it can take the autopap a pretty long time to work its way up to a pressure that can prevent those events. A person like that could have quite a few apneas during the slow "pressure going up" process.

For some people, frequent pressure changes can be disrupting to their sleep. There's no way to really know if that's happening without watching, in real time, for arousals in a PSG sleep study. But some are able to deduce that might be happening to them if they consistently feel better rested at one straight "cpap" pressure than they do when using a autopap range of pressures, especially with the minimum set quite low.

The nice thing about having software to see plenty of detail about what's going on while we sleep with a machine going, is that we can experiment to find what minimum - maximum pressure range works best for each individual. Or even find that switching to just CPAP mode works best for some.

I personally like to set my APAP with the minimum pressure (or the BiPAP Auto with min EPAP) on what I already know it takes to keep my throat open well all night. That begs the question, of course..."Why even use an autopap if you're going to be using it, in effect, as if it were a straight "cpap?!!!" My answer is that by being able to set a much higher max pressure...giving the machine room to go up if needed... that takes care of the occasional times during some nights when I do happen to need more pressure than usual.

I do see that happen on my data. Many nights the pressure line rocked along pretty steadily right on 12 all night. But on more than half the nights, I'll see an hour or so on the data where the machine did have to go up to 13, 14, or 15 to deal with whatever. Happens on enough nights that I'm glad to have a margin available up above that can be used when necessary. With my APAP, I set it for 12 - 20. With my BiPAP Auto, I set if for min EPAP 12, max IPAP 20. Twelve is my magic "efficacious treatment" number.

I agree, daveuk, that if turbosnore set his autopap at 12 - 13, he might as well still be using "cpap." I'd set the range for 12 - 15 and see how that goes for awhile. Well, actually if it were me, I'd set it 12 - 20.

[DoriC]

RG, on those nights where your pressure went up to 14,15, did you have as restful sleep and did the pressure changes affect you at all.? My husband seemed to become restless, maybe even slightly awakened when the settings were 11-15, more leaks, snores,etc. He did much better at straight CPAP at 12(titrated at 13), less leaks and snores,less movements, and now I'm experimenting with auto at a narrow range of 12-13 to see if 12 is his best pressure or does he truly need the 13. The narrow range does not bother him, in fact he said he likes the way the "new" setting feels? Thanks, Dori

[rested gal]

Dori, I seem to have restful sleep no matter what. I'm lucky, I know. CPAP, APAP staying pretty much put, or APAP soaring up occasionally. Doesn't seem to bother me. But some people are more sensitive to changes, so whatever works best for each person is the thing to do. There's nothing at all wrong with using straight cpap if that gives the most restful sleep.

[sleepyangler]

That can't be right. Setting minimum pressure to 12 would cancel out any advantage of having APAP versus CPAP.

That not only can be right, it most likely will be right, considering the fact that he is using a resmed apap. The A10 algorithm used by resmed will not respond to an apnea if the pressure is already at or above 10cm. It is set up that way to prevent chasing after central apneas. Works will for those who's OAs respond to pressures below 10cm and not so well for those who require a pressure above 10cm. The resmeds will still raise the pressure above 10cm in response to hyponeas. So depending on why the original titration of 12cm was needed, setting a resmed apap at 9-13cm may be less effective then running it at something like 12-15.

There are apaps available which will allow changes to the max pressure at which the machine will not respond to an apnea. I wish my resmed vantage was one of them but it is not.

[echo]

Just my 2 cents...

Dori - I think trying a fixed CPAP pressure is always a good idea. There can be reasons to use an APAP if one has widely varying pressure needs, for example: sleeping on your bad vs. side, REM vs. nREM events, intermittent congestion, or varying sleep for other reasons. But for others, their pressure needs may not vary as much, and/or they will not be able to tolerate the continual pressure changes, so a fixed pressure will be better for them. It's a very personal decision and I think the only way you can determine it is thru trial & error (and tracking with software and tracking how you feel).

Those are also reasons why your ideal bottom APAP pressure may or may not be your 'titration pressure'. In addition, the results from the night that we are titrated may not be truly representative of our true needs. I for one did not sleep very well during the titration because the mask was leaking, it was uncomfortable, it was the first night I was sleeping with air blowing into my nose, and I had all these cables around me so I couldn't sleep in my normal position. For those reason, I believe that the number they gave me was not my ideal pressure. I think this situation can be the case for many people - so I personally would take the titration pressure as more of a guide than anything else (remember I am not a doctor and this is just my personal opinion based on my own situation and what I have read).

Whether you put your bottom pressure at the titration pressure or a few cm's below, the whole point is that you can use the software to see whether that pressure range is ideal for you. I would say it's always better to start a few cm's below so that you're not overtitrating, but in the end you'll be able to see if that's the case using the software. If your 95% pressure is always at your bottom pressure, you can always lower it a notch to see what happens.

[DoriC]

Great information, it explains a lot of things. Thanks.

[turbosnore]

Well, here in Finland we cannot buy the HW/SW to get the data out of the machine.
I guess there is some deal between the equipment selling companies and the doctors' union.
What else can it be, because the customs is not especially interested, if I buy the stuff abroad.

Another thing, while on xPAP, I still sleep a lot worse than before (a bit over 1 month now).
In the sleep study my brain was not monitored, so there is no info about my sleep architecture,
but I have a feeling that the xPAP may have affected my sleep architecture in a bad way.

Well, I'll probably have a control next week. I guess the high limit will be set higher.
I wander if buying the data reading HW/SW needs presciption there? I've been thinking of
buying them.

[Hawthorne]

If you buy the software and reader to get your data, online, you do not need a prescription.

Cpap.com has them in a bundle.

I have no idea what shipping costs to Finland would be!

I live in Canada and the shipping costs are very reasonable. There is no customs or duty to ship from the US to Canada and cpap.com ships things as medical equipment through the Postal Service.

There is also the exchange rate on the dollar to consider in the cost.

I don't know if that is much help to you but thought I would post it. You can get in touch with cpap.com via email and ask your questions.