Trying to find the right settings.

[VicRob]

I'm having trouble finding the proper settings for my auto cpap machine.

My sleep study was pretty unproductive. They couldn't finish titrating me the first night so I had to go back a second night. I think I slept four hours the second night. Even though the data was scanty, at a pressure of 16 there were no events, so the sleep doctor set my pressure at 16.

The cpap they gave me felt like a wind tunnel so the DME turned it down to 14. I still wasn't getting good sleep so they did a home autopap study and came up with a 90% score of 10. So The DME reset the cpap at 10.

I still wasn't getting much better sleep so I requested that they give me an autopap since my sleep seemed better on it than the straight cpap. The DME set the range at something like 6 to 14 because the data from the home study said there were no events above 14. Even with the auto-pap, I was not getting much better sleep.

I then got on the forum and began the process of self-education. I learned about setting my own pressure. With the help of one of the forum members I have begun the process of re-titrating my pressure. There seems to be an unusual amount of variability in my scores.

Whenever I raise the auto Min my AHI scores dip down below 5 and then within two or three days it begins climbing to something in the 6, 7 or 8 range. My 90% score settles about 2 points higher than the auto min.

(For example, I started at automin 8, 90% at 10 and AHI>5 and am now at automin of 12, 90% at 15 and AHI of 5.2. My auto max is now set at 18.)

I'm trying to get a better understanding of how the pressure settings affect the AHI scores. I know it would be easier if I had software, but being a Mac user has made that more complicated. Has anybody else had this experience of fluctuations in their scores in response to titration?

[Pugsy]

Are you giving us the 7 day average or are you resetting your daily stats to zero each day?
What has your leak rate been?
I increased my minimum and AHI's decreased. The few nights that I had showing significant AHI increases despite the increase in pressure usually also showed significant leaks.
We need leak rate in conjunction with your numbers to be able to give any sort of definitive advice.

[VicRob]

You're right. I should have been posting my leak rate. In general it has been in the acceptable range for my mask - always under 40 - generally in the 32 - 37 range. I started taping my mouth because I hated the chin strap.

I reset the machine every day so these numbers are single night data.

Thank you.

[Pugsy]

One other question. How are you feeling despite the odd progression of numbers?

If you notice, I am a newbie also and I was just sort of asking questions so that someone who has more experience than I do wouldn't have to ask. I use the same machine and mask that you do. Did you happen to see my post from today? Numbers can be very misleading. When I first got the software I compared the daily data on it to the daily (reset to zero) data on the LED of the machine. It was often completely different. BleepingBeauty is in the process of documenting this occurrence on her part also. I quit looking at the machine LED after about 3 days.

But you deal with what you have. Hopefully one of the pros will have some ideas for you. If your leak rate had been high we might could have blamed it but you are correct, it is not bad for your pressure.

[VicRob]

The aching fatigue that I felt before starting treatment has gone away. Some days when my AHI is over 4 or 5 I feel like I'm sleep walking, I struggle to keep my eyes open at work and I feel cloudy. Other days I feel more substantial and have more energy. These tend to be days when my AHI is lower.

[Pugsy]

Have you asked your DME provider if they would download and print off a copy of your data and graphs for you?
It would really be helpful to see what is going on. Some DME's will do this but some will only give you the compliance data which is useless for your needs.

[VicRob]

I haven't been eager to contact the DME because I have begun the process of programming the machine myself and I don't know how he'll respond to that. He wasn't eager to have me learn to do it myself.

What I am most interested in finding out is whether other people have had the experience of bumping up their minimum pressures, getting an initial positive result in terms of their AHI, only to find that in a few days the AHI and the 90% begins climbing again and they need to raise the min again. What causes this pattern to occur?

[Pugsy]

What I am most interested in finding out is whether other people have had the experience of bumping up their minimum pressures, getting an initial positive result in terms of their AHI, only to find that in a few days the AHI and the 90% begins climbing again and they need to raise the min again. What causes this pattern to occur?

I have only been a member a little over a month and a reader lurking a couple more weeks than that. I did a lot of reading but I do not remember seeing someone post a problem as you are describing. Of course I haven't read everything here. Why this very odd pattern? I have no idea so now we have to wait for the more experienced members to share their ideas. In my mind it makes no sense that is why I would want to see the data if it were me. Something is driving the numbers up. Snores maybe??? Beats the heck out of me. Sorry that I can't be more direct help.

[not so sure]

Your case is very similar to mine , we even have the same equipment. My sleep guy tried me on a steady rate of 10 but i felt iwas being blown away so he put be back on the auto. I was checking my daily ahi it was up around 6.5 so i changed back to a steady pressure of 10 and my ahi dropped down to 2.3 daily. When i went back to the steady pressure it did not seem bad, i guess your body gets used to the machine.
As far as being tired my doctor told it takes about six month to get full benefit ot the treatment

[VicRob]

What I am most interested in finding out is whether other people have had the experience of bumping up their minimum pressures, getting an initial positive result in terms of their AHI, only to find that in a few days the AHI and the 90% begins climbing again and they need to raise the min again. What causes this pattern to occur?

[Wulfman]

What I am most interested in finding out is whether other people have had the experience of bumping up their minimum pressures, getting an initial positive result in terms of their AHI, only to find that in a few days the AHI and the 90% begins climbing again and they need to raise the min again. What causes this pattern to occur?

If you don't have the card reader and software, you'd be better off switching your machine to CPAP mode and setting it to something like a pressure of 10 and working up from there. In fact, most people with Autos would be better off switching to CPAP mode.......mainly because most people (including doctors) don't understand how they really work.

The Autos "respond" to Leaks, Snores, Flow Limitations, Hypopneas and Apneas. In the case of hypopneas and apneas, they respond S L O W L Y. When running in Auto mode, if you can't SEE what's happening, you're "shooting in the dark". The 90% figure is a moving target and isn't necessarily all that useful in setting pressures. If you don't know what's driving your pressure changes, that's the biggest part of the problem.


Den

[mermer40]

I'm really interested in the outcome of this post. Been on autoPAP for about two weeks...I print out my data every day and am trying to make connections. I was titrated at 11...the new machine goes from 4 to 20 and the DME wanted to leave it open at that but I had read somewhere on this forum to set the range two below to two above titration so she did. Seems like when the auto goes up to 13 my AHI is up to 5 or more but at 10 or 11 the AHI stays down around 2 to 3. The more leaks I have (which is usually a lot) the higher the pressure goes on the machine and that seems to raise the OA's and the AHI. My original machine was set at 11 but it didn't give data so I don't really know what my AHI was on it.

The DME told me I couldn't set it myself, but sounds like I can?? My sleep study showed 46 events per hr. so the sleep doc said my SA was severe...scary, huh? Am not feeling rested at all after 4 months of CPAP. What is the AHI I should be trying for? Doc doesn't tell me anything.

Also, my leak rate is not really a good barometer because I have the itchiest nose in the world an am always pulling the mask away to scratch! Anyone else have this problem or am I the only monkey with fleas?

[Wulfman]

I'm really interested in the outcome of this post. Been on autoPAP for about two weeks...I print out my data every day and am trying to make connections. I was titrated at 11...the new machine goes from 4 to 20 and the DME wanted to leave it open at that but I had read somewhere on this forum to set the range two below to two above titration so she did. Seems like when the auto goes up to 13 my AHI is up to 5 or more but at 10 or 11 the AHI stays down around 2 to 3. The more leaks I have (which is usually a lot) the higher the pressure goes on the machine and that seems to raise the OA's and the AHI. My original machine was set at 11 but it didn't give data so I don't really know what my AHI was on it.

The DME told me I couldn't set it myself, but sounds like I can?? My sleep study showed 46 events per hr. so the sleep doc said my SA was severe...scary, huh? Am not feeling rested at all after 4 months of CPAP. What is the AHI I should be trying for? Doc doesn't tell me anything.

Also, my leak rate is not really a good barometer because I have the itchiest nose in the world an am always pulling the mask away to scratch! Anyone else have this problem or am I the only monkey with fleas?

If you'll set your current (data-capable) machine to your original prescribed pressure, you'll find out how accurate it was.
I ALWAYS advise new Auto users to set their machines to their original titrated/prescribed pressure before experimenting with a range of pressures.
That "two up - two down" may or may not work. It depends on how accurate the original titration was. In most cases, with an Auto, the minimum pressure needs to be set to where it eliminates almost all of the events.....leaving the upper limit to try to address other events.

Far too often, new users have too many problems with mask leaks (and other issues) to make an Auto function properly.

As far as those nose itches go, try rubbing your nose and the area where your mask will sit, vigorously, before strapping the mask on. That helps to desensitize that area and probably will give you time to get to sleep. Once you're asleep, it usually won't be noticeable. This is a very common situation to us full face mask users.

With regard to what your DME told you.......they're full of it! It's going to be YOUR therapy.....not theirs. THEY are legally obligated to set your machine as per your prescription.......that doesn't apply to YOU. If you can find a better setting (like most of us have), then so much the better.


Den

[mermer40]

Thanks, Wulfman
With four years experience I think you're much more knowledgeable than my DME and maybe even my sleep Doc!
I do get up several time a night (for bathroom break...4-6 times) and I have found that if I wipe my face with a damp cloth and dry before remasking I get a better seal. I've tried not taking the mask off, but claustrophobia sets in too quick, I have to try to get to sleep quickly after remasking or I'm yanking the mask off and staying up for an hour or so to get really tired again.
I'm going to read my manual now and see if I can figure out how to reset the pressure to my original setting. Thanks again for the advice. MM

[Wulfman]

Thanks, Wulfman
With four years experience I think you're much more knowledgeable than my DME and maybe even my sleep Doc!
I do get up several time a night (for bathroom break...4-6 times) and I have found that if I wipe my face with a damp cloth and dry before remasking I get a better seal. I've tried not taking the mask off, but claustrophobia sets in too quick, I have to try to get to sleep quickly after remasking or I'm yanking the mask off and staying up for an hour or so to get really tired again.
I'm going to read my manual now and see if I can figure out how to reset the pressure to my original setting. Thanks again for the advice. MM

I'll save you the reading. And, if you don't have the "Provider Setup Manual", it won't be in there (User manual).
Copy this to a file on your computer.

Den

Menu for M Series Auto

1. Hold down the <- -> buttons while plugging in the power on the back, wait for 2 beeps, release buttons.
2. Press the + key. <- -> buttons move to next field, -/+ keys decrement/increment
3. Check the following field(s):

-Therapy Mode = (CPAP/Auto)

-Auto:Max = (default=20.0cm)

-Auto:Min = (default=4.0cm)

-C-Flex Setting = (options are off, 1, 2 or 3)

-AutoRamp Time = (options are 05 to 45 min)

-AutoRamp Pressure = cm (4cm->AutoMin)

-Mask Alert Feature = On (On/Off)

-Auto Off Feature = Off (On/off)

-Split Night Time = Off (off, 120, 180, 240)

-Show AHI/Leak Feature = On (On/Off)

Press On/Off button to exit.




==========Resetting LCD Display Data====================

To reset LCD Therapy data (does NOT erase any data from SmartCard):

1. Hold down the (<-) (->) buttons while plugging in the power on the back,
wait for 2 beeps or 5 seconds, release buttons.
2. Press the (->) key and navigate to Therapy screen.
3. Press and HOLD down the (-) minus key for 5 seconds and/or until therapy data is reset to Zero.
4. Press the (->) key to scroll back to main menu, press (+) key to enter Setup or
On/Off button to exit.