Why Not Auto?

Sleepless on LI · Post by **Sleepless on LI** » Sat Sep 03, 2005 3:23 pm

I have been down this road before, but I just don't get it. Why doesn't auto mode benefit me? I was titrated at a 10. I get the best results, always under 1.00 AHI's, when I'm at straight 10 CPAP or high and low number set at 10 on auto. Not a big difference at all between those two types of settings.
When Dr. Sue recommended, for various reasons, I try to reduce my pressure, I set it at 6.5 - 10 auto. I kept it at that setting for two nights, Yes, I slept much better. My Swift was quiet. My leak rate even went down from 32-33 to 20 last night. No gassy stomach, which always happens at 10. No problem with overproduction of saliva (I know, gross) from having the Nose Breathe device in. However, my zero snore index skyrocketed to 40 snores last night in an eight-hour period. I had an AHI of 1.3 last night and 0.8 the night before. But the strangest part is, NONE of my episodes seem to occur at 10. The only good thing was, my flow limitation was zero to four, and it's always higher.
I don't get it. If 10 is where all my pressure is supposed to be, and when it's at 10 I get very low AHI's and zero snores, why does auto of 6.5 - 10 make it so much worse? Isn't auto supposed to help suppress or reduce the amount of events per night? Am I totally misunderstanding the purpose of an auto? Am I doing something wrong?
I would appreciate anyone with any ideas or knowledge about this commenting. Thank you in advance.

Doc Voodoo · Post by **Doc Voodoo** » Sat Sep 03, 2005 4:11 pm

I think you analyze your downloads to much. The point is you feel better and an AHI of 1.3 is Great your considered normal up to an AHI of 5. The purpose of an auto is to give you the least amount of pressure through out the night to open your airway. This translates into a better nights sleep with lower leaks and less side effects. All of these you stated you’re getting on the Auto.
Sounds like your doing just fine you will loose more sleep studying your numbers .

john57b · Post by **john57b** » Sat Sep 03, 2005 5:14 pm

I will agree that you are doing better on the Auto 6.5 to 10 than the straight 10. You have to have some events in order for the auto to increase pressure as needed anyway. You are sleeping better, feeeling better, less leaks meaning better therapy. If I guesing right you were mouth leaking before and you have less of that. The machine you are using tends to be sentivitive to snore reading and I would not put alot of weight in that. You are having less gass in your stomach Are you saying that you are getting less flow limitation on Auto? If this is true that would be inpressive figure to go by. I think that Dr. Sue gave you good advise and that shows. Good luck!

Sleepless on LI · Post by **Sleepless on LI** » Sat Sep 03, 2005 5:45 pm

Thanks for the input. Just let me get your ideas correct. Even though my AHI is higher and I have a tremendous amount of snores with the auto when my snores were always zero on straight 10, because my leak rate is better and my stomach feels better, and it's easier to sleep, that's what I should judge it by?
I have to say, I don't know why, but I was more tired today than I have been in awhile. I don't know if it's due to the higher AHI, although it's not that high according to what they say. But compared to my AHI on straight 10, it's higher. Yes, my flow limitations are down drastically on auto, but it seems like a trade off.
I guess I'll continue on the auto for a few more nights and see what happens. Maybe I need to see what happens over the course of a week, rather than two nights. I know that I was mouth breathing before Dr. Sue's device, but I've been using that on both the straight 10 and auto, so I think the leaks now were coming from the mask at higher pressure.
Don't you find it odd, though, that none of my events happen at 10 even though the number is included in my settings? I don't know what to think. I would think opening the airways would mean less of an AHI or less episodes, which doesn't seem to be the case with the auto setting.

john5757 · Post by **john5757** » Sun Sep 04, 2005 9:05 am

Even though my AHI is higher and I have a tremendous amount of snores with the auto when my snores were always zero on straight 10
Why are you saying tremendous amount of snores when we are not sure what that index means or even tell us how loud the snores are? Is your snoring is waking you or your partner up? Snoring by itself does always means that you are having a obstructive event, flow limitation or causing oxygen desats.

, because my leak rate is better and my stomach feels better, and it's easier to sleep, that's what I should judge it by?
I thought that you were sleeping better meaning feeling better more rested and not just because you have less gas or leaks.

I have to say, I don't know why, but I was more tired today than I have been in awhile. I don't know if it's due to the higher AHI, although it's not that high according to what they say. But compared to my AHI on straight 10, it's higher. Yes, my flow limitations are down drastically on auto, but it seems like a trade off.
Why are you saying it is a trade off? You AHI is still low and the good news is that you are not having apnoea events which is still good and the remaining events are hypopnoeas and even people in perfect health experience some small number of central hypopnoea events each night so the question then is how severe is it? Being tired does not means that CPAP is not working it can have other causes
I guess I'll continue on the auto for a few more nights and see what happens
I think is wise to get more data before jumping to conclusions.

Sleepless on LI · Post by **Sleepless on LI** » Sun Sep 04, 2005 10:14 am

John,
Thanks for taking more time to answer me again. I will try to reply to your questions.

Why are you saying tremendous amount of snores when we are not sure what that index means or even tell us how loud the snores are? Is your snoring is waking you or your partner up? Snoring by itself does always means that you are having a obstructive event, flow limitation or causing oxygen desats.

I don't know if it's waking my partner up as he usually snores himself and hasn't said he's heard anything. But it went from no snores at 10 straight to20-40 events recorded per night. I don't think snoring is a good thing since it's usually an indication of something going on with your airways or the soft palate, which is what leads to OSA.

I thought that you were sleeping better meaning feeling better more rested and not just because you have less gas or leaks.

I am sleeping better because the gas has eased up and the lower pressure seems to cause me to produce less saliva, which has been a problem since I started using the Dr. Sue device and was causing me to wake up. Also, no mouth puffs at all. Not feeling more rested at all, but more confortably sleeping.

Why are you saying it is a trade off? You AHI is still low and the good news is that you are not having apnoea events which is still good and the remaining events are hypopnoeas and even people in perfect health experience some small number of central hypopnoea events each night so the question then is how severe is it? Being tired does not means that CPAP is not working it can have other causes

I don't know where you got the imression I wasn't having any more apnea events. Just the opposite. My AHI has risen from a nightly norm of 0.1-0.5 to the past three nights on auto being 0.8 (the lowest), 1.1 and 1.3. I am having more apnea AND hypops than before, and am now snoring again. The only reading that has gotten better is my flow limitaiton and mask leak rate. And the reason I mentioned being more tired is, I have had an endless amount of energy from the second I get up in the morning until I go to bed which has now changed out of nowhere. Coincidental to the auto setting? I don't know. It's been two out of three days so far. The past two mornings I have not felt as I have been feeling since therapy kicked in.

By the way, what is a central hypopnea event? I have never heard it called that before, with the "central" in front of it. You learn something new every day, I guess.

I think is wise to get more data before jumping to conclusions.

Which is why I didn't change the settings back to 10. I did drop from 1.3 to 1.1 last night. I guess a few more nights to gather data and see how I'm feeling then.

Thanks for caring so much with that long reply. I appreciate the concern and help.

heretolearn · Post by **heretolearn** » Sun Sep 04, 2005 10:43 am

Sleepless on LI, your comment about partner's report had me ROFLOL!
Honestly though, you remind me of myself trying to understand the logistics of all of this OSA info! That's why it sure is nice to be able to ask people here! (I have found out, firsthand, that they are even patient with you if you need repetitionon and/or remediation )

Sleepless on LI · Post by **Sleepless on LI** » Sun Sep 04, 2005 12:04 pm

I have found out, firsthand, that they are even patient with you if you need repetitionon and/or remediation

And amen to that. I always need some repetition or remediation. Must be all those years of interrupted sleep (caused permament dain bramage).

And the saddest part about what I wrote about my husband is, IT'S TRUE!!! Oh, what we go through in life. I have to believe it's how you handle things on earth that is testing to see where you go after we leave here. If I'm wrong, what a waste of being good .

By the way, any news on the dremmel yet? Have you done anything with the NB?

Guest · Post by **Guest** » Mon Sep 05, 2005 8:18 am

Don't you find it odd, though, that none of my events happen at 10 even though the number is included in my settings? I don't know what to think. I would think opening the airways would mean less of an AHI or less episodes, which doesn't seem to be the case with the auto setting.

I don't find this odd at all. If your titration study was a good one, and it sounds as though it was, then 10 would prevent all events. You could stay at a CPAP of 10, with all events prevented, and just 'put-up' with the associated gas, bloating, whatever.

When you use an autoPAP, even though 10 is in the range, you pretty much have to accept that as the machine attempts to identify and react to airflow restrictions in your airway. it is going to miss some of them as it's reaction is not instantaneous. That your snore index is going up is a dead giveaway of this dynamic as it is often a 'first' event. As our airway loses muscle tone and gets floppy, snoring can begin. The machine attempts to respond to this and increases pressure BUT, as the algorithm is not instantaneous, some snoring gets through.

So, in my totally non-medical opinion, you could try the following:

1) Set your flow generator to CPAP mode, at 10 and you will get sleep that is esentially unobstructed by snoring, hypopnea and apnea. You will simply have to get used to the irritation that you feel from bloating, etc.

2) Set your flow generator to auto mode, at a range of 7-13, accept that you will have some arousals (snoring, etc.,) but that you will have less gas, bloating, etc.

3) Try a flow generator from a different manufacturer -each manufacturer uses a proprietary algorithm. The algorithm from one manufacturer may work better than the algorithm from another manufacturer such that one machine will do a better/quicker job responding to your events than another.

I am sleeping better because the gas has eased up and the lower pressure seems to cause me to produce less saliva, which has been a problem since I started using the Dr. Sue device and was causing me to wake up.

I strongly suspect that it is not the pressure that is causing the saliva as much as it is the Dr. Sue device. When I first started using a bite-guard to prevent teeth grinding, I was a spitty mess. I got used to the bite-guard and the saliva production stopped. I think that you will get used to the Dr. Sue device and this problem will let up.

WillSucceed · Post by **WillSucceed** » Mon Sep 05, 2005 8:20 am

Got guested! That last post was mine.

Sleepless on LI · Post by **Sleepless on LI** » Mon Sep 05, 2005 10:02 am

WS,

My first line in the reply to "Guest" was, "I'm so sorry you didn't sign in as that was an incrediblly informative and easy to understand response that I really appreciated." Then I read the next post and saw it was you.

So I will tell you, WS, thanks! That was a great explanation and I appreciate your taking the time to make me understand what is going on. I think that maybe I am going to end up going back to the straight CPAP because I am seriously feeling the interruption in sleep for the past four nights and my husband told me he did hear me snoring again when I askaed this morning. The gas was back last night anyway and so was the overproduction of saliva. Don't see any benefit now in using the auto.

I guess the next time around, I will try to PB420e. Maybe if I can find someone selling one, I'll try to pick it up. My insurance just bought me the Remstar Auto last month and the main reason I wantd that over the PB was the CFlex, which I don't use anyway. Plus, the carrying of the machine every morning upstairs to my computer/office would be a bit of a pain.

I guess I have a lot of nerve to complain, which I won't, about not being able to use the auto without getting as good results as I do on straight 10 or 10-10 auto. Either way. Now I'm a bit nervous to go back because maybe I've jinxed myself and I won't be able to get those low AHI's and restful sleeps again. Guess I'll have to see.

If this overprodution of saliva from the NB device doesn't subside soon, I may go back to taping with the Tegaderm, which worked just fine for me. I just like being able to speak if someone knocks on my bedroom door during the night or if the phone should ring, which takes a few minutes with the Tegaderm on to be able to remove.

Will, thanks again for the great reply. I really do appreciate it.

barbyann · Post by **barbyann** » Mon Sep 05, 2005 1:41 pm

I am new to all this but have to tell you that my DME explained to me that the APAP machines are constantly challenging your airway to then adjust the pressures. He even tried to talk me out of Auto and into CPAP. He said I would get a better outcome without all the "challenges". He went on to say that is why I had the titration study so I would only need to be challenged on one evening. Lucky for me I have been reading this site daily and knew enough to remind him that an autopap can run in CPAP mode. He was obviously surprised by my response. Anyway, I got the APAP. I am happy because now I can try different settings to see what works for me.

_________________

CPAPopedia Keywords Contained In This Post (Click For Definition): Titration, CPAP, DME, auto, APAP

Sleepless on LI · Post by **Sleepless on LI** » Mon Sep 05, 2005 3:04 pm

After listening to all the replies and mulling it over, I am going to now change the title of this thread to "Why Auto?" I don't know why anyone wants to use auto if it doesn't work as well as your titrated pressure. Is it basically for people who can't stand to have their pressure as high as what it was titrated at during their PSG, so with auto they have times when it doesn't have to be that high or do others usually get better AHI's from it? I am not in that category, for sure.

As far as what I can gather, your titrated pressure is what will stop your events best. So why not just use that instead of playing Russian roulette with your events, which seems to me to be what auto is, at least in my case.

WillSucceed · Post by **WillSucceed** » Mon Sep 05, 2005 4:23 pm

As far as what I can gather, your titrated pressure is what will stop your events best. So why not just use that instead of playing Russian roulette with your events, which seems to me to be what auto is, at least in my case.

Lori:

I think that you have hit the nail on the head -->CPAP with a properly titrated pressure is the 'gold standard' in treating OSA. If the patient can tolerate the pressure prescribed and finds a mask that is comfortable, all should be just spiffy.

It seems that many of us don't tolerate the titrated pressure well and want the comfort benefit of lower pressures during the night. For those of us who are in this situation, APAP is a blessing. Further, an APAP is able to tell the user if things have changed such that a different pressure is needed. A vanilla CPAP won't give this info. A recording CPAP, like the PB420S can give info that would tell the user if a pressure change is warranted.

In your case, I really think that the RemStar algorithm is just not right for you. At the risk of sounding soft, celebrate your individuality! RemStar is not right for you -this is RemStar's flaw, not yours. If you get the chance to try a PB 420E or a ResMed Spirit, go for it. I wish I had a second machine to lend to you -I'd love to know how you do with a non-Respironics auto.

Regarding the bloating, etc., I suspect that you will get used to the pressure and the bloating will let up. You could try propping yourself up with pillows somewhat so that you can belch (sorry about that) some of the air out. This worked for me when I was on CPAP of 15.

Wulfman · Post by **Wulfman** » Mon Sep 05, 2005 4:27 pm

barbyann,

I think your DME had the statement backwards.....
Instead of:
"....the APAP machines are constantly challenging your airway to then adjust the pressures...." should be:

"....the APAP machines are constantly being challenged by your airway to then adjust the pressures...."

The machine tries to adjust to your breathing to give you a good night's sleep.

Lori,

Some of us probably do just fine on a single pressure.
Speaking of my own situation, I believe that my CPAP is "training" my airway (body) to adjust to that particular setting while it's allowing my nightly breathing to be "normal". My snoring and other things would probably have driven an APAP "berserk" trying to adjust and would have probably pegged the needle on pressure......which would not have been very comfortable for me.

Take care.

Den

Machine	Mask

Why Not Auto?

Why Not Auto?

I was told