Results: 1st night with Auto A-Flex

[TSSleepy]

I got my M-Series Auto w/A-Flex yesterday, and had my first night's sleep with it. Prior to that I'd had 2.5 weeks with an un-prescribed CPAP w/C-Flex without data capability and had picked 10 for my best guestimate at titration.

I can't seem to sleep in a clinic, so my doc and RT had wanted to set the Auto up at 5-20 range to get a feel for what my pressure should be. But, when fitting my mask I had asked the RT to bump it up to 10, so I could get a feel for the fit with some real pressure. He forgot to turn it back down, and I just let it go last night. Only 5 pressure feels very...blah!

It seems like things went pretty well. I had trouble falling asleep and trouble going back to sleep after my bathroom break, but overall things seemed good.

I was probably asleep about 6.5 hours.
NR: 0.0 (no non-responsive)
FL: 0.6 (only 5 Flow Limitations all night)
OA: 0.4 (only 3 Obs Apnea events all night)
H: 0.0 (no Hypopnea, which seems very odd to me...)
VS: 0.9 (only 7 Vib Snores all night)

Average leak was 40 with no large leaks, but I think the RT said to expect around 30 with the Quattro FFM.

The average 90% CPAP pressure was 11.0, and the average CPAP Pressure was 10.3.

I also wore my pulse oximeter, and that looks pretty tight too. I had a couple momentary blips down to 88% saturation, but I stayed at >90% for almost the entire night.

I'm thinking of bumping the minimum down to 8 tonight, to see what happens and make sure I'm not using more pressure than I need.

[tattooyu]

Those numbers seem pretty good to me. I would almost leave the pressure alone at least for a week, unless it is REALLY uncomfortable to breathe. If that's the case, turn on the exhale relief (A-Flex) or turn it up higher rather than messing with the pressure.

[bap40]

A starting pressure of 5 is pretty low and everyone on the board would encourage you to set the lowest pressure at the very least a 6. Personally I would go for an 8 as a starting pressure. Your numbers do look good though.

Good luck,
Brooke

[OutaSync]

Looks as though your guestimate of 10 was right on. You had a very good first night. Congratulations. That quattro is a leaker for some of us, but if that isn't what kept you awake, you are doing well.

Bev

[rested gal]

10 - 20 sounds like it suits you very well.

Good job, TSSleepy, with everything you've been doing to get good treatment.

[ozij]

Those are wonderful numeric results and - curiousity apart - I'd stick to that setting for a week or two.
I do understand your curiousity, wanting to see what happens at slightly less, now that you've got an auto - and you've been on straight 10 for two and half weeks...

Did you attempt to correlate the pulse oxymetry with the events/pressure? Your machine had you at 11 for at least 10% of the night - maybe more - so clearly, you need more than 10 cms/h2o for part of the night.

O.

[TSSleepy]

Well, it's the middle of the night and here I am on the forum. Experiment over.

My doc and RT had wanted to get an idea of what my titrated pressure might be, so I went ahead and tried the wide-open setting of 5-20. I just slept about 4 hours at that range setting and it was quite... unpleasant.

It was very difficult to fall asleep at 5. It felt stifling, like I wasn't getting enough air. When I did fall asleep, my "Vibratory Snore" graph was almost a solid bar, until the pressure made it up near 10. But the darn algorithm overcompensated and put me up near 14-15 for large portions of the last 4 hours. The 90% was 14 and the average was 10.7.

After waking up and going to the bathroom, trying to fall back asleep at 14 was very difficult. So I hit the ramp button, which dropped it to 5. Moving from 14 down to 5 felt like it was sucking the life out of me. So I gave up and checked the data on Viewer. Then came on here to vent!

Now I am now going to go set my minimum back up to 10, and try to get a few more hours of sleep (if I can stop belching from the unnecessary romp up to 14-15).

I'd read here that people have been given APAPs set with HUGE windows starting with a minimum that was far too low, and had issues. I can honestly say that if I were a newbie, and this 5-20 setting had been my first xPAP experience...I'd have been horribly traumatized.

That first night above was about perfect. A minimum of 10 headed off the vast majority of snoring and events without overcompensating and causing aerophagia. The auto algorithm allowed it to go up to 11 for three periods of 30-40 minutes where I needed a bit more oomph, and some spikes of 12 when I needed a little kick. But on the whole, it stayed near 10 and minimized my discomfort.

But anyway, heading back to try and get some more sleep. Type at y'all later!

[TSSleepy]

OK, I got PrimoPDF to capture my reports (another great suggestion from this board).

Here was night 2, the miserable first half with my Auto set 5-20 and the very pleasant second half with my Auto set at 10-20. They both treated my OSA, but the latter was so much more comfortable.

5-20


10-20

[DreamStalker]

OK, I got PrimoPDF to capture my reports (another great suggestion from this board).

Here was night 2, the miserable first half with my Auto set 5-20 and the very pleasant second half with my Auto set at 10-20. They both treated my OSA, but the latter was so much more comfortable.

5-20


10-20

Great comparison! Also a great way to show newbies how the sleep pros do get it wrong especially when they set the AUTOs wide open. The main reason the sleep pros often discourage the use of AUTOs is because they themselves don't understand how they work.

Just look at the data showing the 5-20 wide open setting and you can see that the auto was unable to move quickly enough to prevent the snores during that second half hour period at the beginning of your sleep. The pressure ramped up and overshot causing mask leaks and which then took a couple of hours to settle down and then the cycle started all over again.

With the 10-20 setting, the machine took care of your snores and didn't run away on you keeping your mask leaks stable. The pressure then only ramps up every now and then to take care of any apnea/hypopnea events as needed ... most likely when you rolled over and changed sleeping position.

A properly set up APAP is one where the min pressure is set just at or below what your optimal CPAP pressure would be set at and the higher setting is to catch any stray events that may occur as a result of changing your sleep position, or medications, or any other factors that affect the variability of air flow limitations of your throat.

[rested gal]

Great comparison! Also a great way to show newbies how the sleep pros do get it wrong especially when they set the AUTOs wide open. The main reason the sleep pros often discourage the use of AUTOs is because they themselves don't understand how they work.

-----

A properly set up APAP is one where the min pressure is set just at or below what your optimal CPAP pressure would be set at and the higher setting is to catch any stray events that may occur as a result of changing your sleep position, or medications, or any other factors that affect the variability of air flow limitations of your throat.

I agree absolutely with DreamStalker. Not only is the "wide open" 4 - 20 or even 5 - 20 often going to result in the kind of treatment mess TSSleepy got on that first night, here's the worst thing about "wide open", imho:

Look on the far right of the graph picture, at the 90% pressure for that first night -- 15 (meaning the machine had to use that pressure and pressures below it, 90% of the time.

Now look at the 90% pressure for the second night, when the autopap was set at a much smarter range of 10 - 20. 90% pressure 11.

Most doctors who prescribe an "autopap trial" for a couple of weeks or a month are going to prescribe the "90%" number (95% number when using a ResMed machine) when the trial is over. The autopap is taken away and the person is put on straight CPAP. The pressure the doctor will prescibe for the straight CPAP is almost always going to be the 90% number, or even a cm or two more.

The doctors are blindly going by the manufacturers' recommendation for doing an "autotitration" trial. Unfortunately.

A lot of doctors say they don't like autopaps. I wouldn't like an autopap either, if I had to use it the way they prescribe them!

One other word here, about "narrowing the range" that we keep seeing people on the message board talk about. Most of the time they are talking about raising the minimum AND lowering the maximum, all at the same time. When it's only the MINIMUM that needed adjusting upward, most of the time, imho. The MAXIMUM doesn't matter, as long as it's high enough to give some unused ceiling up there, so you can see what the machine actually uses. For most people, it's fine to leave the max at 20, in my opinion. (I'm not a doctor, though!)

Look again at TSSleepy's two nights. The max is set at 20 for both nights. He didn't have to bring down the max to get good treatment. All he had to do was raise the MINIMUM to an effective level.

Unused pressure up above is exactly that -- not used.

If a person were having terrible leaks, I could see setting the max pressure down a good bit until the cause of leaks was identified and brought under control. But if the leak line is normal for the mask and pressure being used, I think the minimum pressure is the main setting to really concentrate on "getting right."

Yeah, I do carry on about that a lot. LOL!!

November 2008 Just got an APAP (topic started by turbosnore)
viewtopic.php?p=319619#p319619

October 2008 Turning off Aflex and Cflex (topic started by DoriC)
viewtopic.php?p=307265#p307265

September 2008 New Guy - Need Help w/Settings (topic started by alanhj13)
viewtopic.php?p=294319#p294319

[mindy]

Although I hesitate to slightly add to our trusty and very knowledgable Rested Gal's post, for me that wide-open max pressure on a Respironics M-series is no fun. My AI went crazy at a pressure of 14, but it took 13 to get my AI below 3 on the M-Series so I ended up with a fixed pressure of 13. On the Sandman, on the other hand, I now have the minimum at 10, max at 20 and I rarely go above 10.5 and my AHI ranges from 0.5 to 2.0. It's nice to have a lower pressure. I'm sure my situation isn't necessarily typical but it does illustrate the difference in algorithms and some different issues with both different people and different machines.

Mindy

[rested gal]

I'm sure my situation isn't necessarily typical but it does illustrate the difference in algorithms and some different issues with both different people and different machines.

Mindy

You're absolutely right, Mindy. Different machines, different people, different sleep disordered breathing issues. One of the many reasons it's nice to have software to get a good look at what's happening.

[rainbow2009]

pret auto
Not anly different machines, different people, different sleep but also your moos disordered breathing issues

[rainbow2009]

pret auto
Not anly different machines, different people, different sleep but also your mood disordered breathing issues

[Plowboy]

Maybe I am technically challenged but I am still trying to figure out how to adjust the range on my machine.