Setting pressure with S8 autoset II

[rbtgjns]

I have started to use an autoset II and need some advise as to how to maximize the effectiveness. My last sleep study recommended a setting at 13. I have been using an Elite S8 cpap with nearly 6000 hours on the clock. I have not been followed by the plumologist and felt that I was on my own . It seemed reasonable that I needed to get a newer machine. I stumbled onto CPAP AUCTION site and asked my physical to fax in a RX so that I could bid and I now have an Autoset II . A little background--1st sleep study 2003: severe sleep apnea, 20 apnea/40 hyponeas per hour, Ox 71% desaturation. S8 elite for a year (6000 hours) AHI 9.3, AI 2.1, HI 7., leaks 0.18. New autoset: settings min pressure 9.8, max 13.6, 95% pressure 12.2, leaks 0.08, AHI 21.4, AI 2.7, HI 18.7. Th HI is very high when compared to the history with the elite cpap. I need some advice as to the best settings.

[Wulfman]

With pressure requirements above the pressure of 10 cm., the ResMed Autoset's A10 algorithm may not do you any better than straight CPAP pressures. The algorithm will NOT allow the machine to pursue an apnea above the pressure of 10 cm. UNLESS it's preceded by snores or flow limitations.
You would need to set your minimum pressure AT LEAST to what your CPAP (prescribed)......and maybe higher if you want a lower AI/AHI. You should not have limited your maximum pressure so close to your old CPAP pressure if you wanted to see if it'll go higher (which it probably won't, anyway).


Den

[rested gal]

I have started to use an autoset II and need some advise as to how to maximize the effectiveness. My last sleep study recommended a setting at 13.
----
I need some advice as to the best settings.

When you were using your Elite, was the pressure set at 13?

When you were using your Elite, did you have EPR turned on? If so, what did you have EPR set at... 1, 2, or 3?

Do you have EPR turned on with your new Autoset II? If so, what is the EPR set at?

How many sleep study titrations have you had? During a titration, they'd have put a CPAP mask on you during the night.

What was the pressure prescribed from each study?

When was your most recent sleep study titration...the study that recommended a pressure of 13 for you?

[Guest]

Thanks for responding.. I have had three studies. First study I was waken by the tech and was given a mask to wear. When I had the opportunity to read my sleep study I was upset as the Doctor who reviewed the findings guessed that a setting of 10 was appropriate. I asked for a second study based on the "guess" as I wanted a proper setting. Second study indicated that I needed a pressure setting of 15.....the guess was very far off. About two years later I asked for a repeat study as I was unsure that I was getting the results i needed. I questioned hypoxia. This study was the third study and the pressure setting was now recommended at 13. No sleep studies since 2005. All three studies I wore a mask---the first only part of the night. My first CPAP machine was a Responics that had problems with the bearings and made such a racket that I wrapped towel around it so that I could sleep. I took this defective machine to the DME provider and was given the Resmed Elite S8. The ERP was set at two. The autoset EPR is set at two.

[Wulfman]

Thanks for responding.. I have had three studies. First study I was waken by the tech and was given a mask to wear. When I had the opportunity to read my sleep study I was upset as the Doctor who reviewed the findings guessed that a setting of 10 was appropriate. I asked for a second study based on the "guess" as I wanted a proper setting. Second study indicated that I needed a pressure setting of 15.....the guess was very far off. About two years later I asked for a repeat study as I was unsure that I was getting the results i needed. I questioned hypoxia. This study was the third study and the pressure setting was now recommended at 13. No sleep studies since 2005. All three studies I wore a mask---the first only part of the night. My first CPAP machine was a Responics that had problems with the bearings and made such a racket that I wrapped towel around it so that I could sleep. I took this defective machine to the DME provider and was given the Resmed Elite S8. The ERP was set at two. The autoset EPR is set at two.

That means that your pressure is dropping 2 cms. on exhale......when you may need the pressure to prevent apneas. If you're going to use EPR, you would need to compensate (raise) your CPAP or minimum pressure to allow for that.


Den

[Guest]

Ok--based on Den's advise I have set the min at 12 and the max at 18. ERP is set at two. I will try this tonight unless I get additional ideas from others that read this. Thanks to all.

[Wulfman]

Ok--based on Den's advise I have set the min at 12 and the max at 18. ERP is set at two. I will try this tonight unless I get additional ideas from others that read this. Thanks to all.

Bear in mind.....that's going to give you an "effective" pressure of 10 cm. on exhale. If you had your CPAP set to 13 with EPR at 2, then you were getting 11 cm. treatment pressure on exhale.

What I'm saying is that you may STILL need to adjust upward from there, but you'll at least get to see what happens with a few nights at those settings.


Den

[rested gal]

If it were me (and I'm no doctor or anything in the health care field) I'd set the Autoset II this way:

minimum pressure - 16

maximum pressure - 20

EPR - 3


or....

minimum pressure - 15

maximum pressure - 20

EPR - 2

What Den said is exactly right about the lower pressure that's actually been in place at the end of your exhalations when you had EPR turned on. That's why I asked so many questions about what your prescribed pressure was and what EPR level you have been using.

If that lower pressure (the 2 cm drop for exhalations you've had with EPR set at "2") has not been enough to keep your airway open "enough" to get the next inhalation STARTED.... well, you can imagine. ResMed does have a safety measure built in -- that if a person doesn't being to inhale within 15 seconds or so, EPR operation is suspended and the regular higher pressure comes in. I wouldn't particularly want to wait for that many times during a night.

My thoughts (just opinion..I'm not a doctor) about EPR:

Nov 2008
viewtopic.php?p=310021#p310021

Aug 2008
viewtopic.php?p=289264#p289264

Oct 2006
viewtopic.php?p=121621#p121621

Oct 2006
viewtopic.php?p=121625#p121625

Dec 2007
viewtopic.php?p=231782#p231782
______________________________________________

April 2008 - "Resmed vs. Respironics - Help"
topic started by Needsdecaf
On page 22 split_city and -SWS discussing apneas
viewtopic.php?p=260224#p260224

[Robert J]

THANK YOU ---this is what I hoped. I have set the Min to 15 , max at 20 ERP at 2. I will post results.

[Guest]

First night with settings at
MIN 15.0
MAX 20.0
PRESS 15.0
LEAKS 0.26
AHI15.7
AI 3.6
HI 12.1
USAGE 6.33HRS

SLEEP QUALITY FAIRLY RESTED

MASK-- MIRAGE ACTIVIA

IMPROVEMENT IN HI ONLY BUT NOT MATCHING PREVIOUS HISTORY.

[rjones]

After the last night with poor results, I have contacted a sleep clinic to see a MD certified in sleep studies. I expect that I will need a new over-night study as the last one was in 2005. I have not been followed since then. On my own and now becoming aware that this, although not uncommon, should not be tolerated. I will continue to try to find the best level according to the advise I get from the forum and the results from my efficiency read outs.

Let me know if this seems a good course.

[rested gal]

After the last night with poor results, I have contacted a sleep clinic to see a MD certified in sleep studies.

Good idea.

In the meantime, while waiting to see that doctor, since the machine stayed down on 15 for 95% of the time last night, I'd try this setting for several days:

Min 12
Max 20
EPR 2

And this setting for another week or so:

CPAP mode - pressure 14 - EPR 2

Be sure EPR is set for "full time."


I'd check my results in the LCD window every morning and keep an ongoing written record, just like you've been doing.

[Wulfman]

After the last night with poor results, I have contacted a sleep clinic to see a MD certified in sleep studies. I expect that I will need a new over-night study as the last one was in 2005. I have not been followed since then. On my own and now becoming aware that this, although not uncommon, should not be tolerated. I will continue to try to find the best level according to the advise I get from the forum and the results from my efficiency read outs.

Let me know if this seems a good course.

I won't say that it's a "bad" idea.......but maybe a little premature, under the circumstances. You've just scratched the surface of your machine's options.

Do you have any copies of your previous sleep studies and titrations? If not, I'd suggest seeing if you can get them and see what's in them......also looking for evidence of Central Apneas.

You MAY just need a little more pressure. If you bump up your minimum pressure (or switch to CPAP mode) and keep moving it up after several nights at each setting.......and the results get worse, then you know you may be going in the wrong direction or there's something else that needs to be addressed.

Do you happen to have GERD? (if you don't know what it is, you can Google it)

Positional sleeping(?)......especially on one's back......is the worst position for OSA and will result in higher AHI counts.


Den

[rbtgjns]

I dont remember seeing central apneas on the sleep study but will request copies to look more closely at the findings.

I have recently become aware of the maintenance schedule as I had a severe mask leak that I couldn't resolve- Googled for ideas and found that I should have been replacing equipment---I was using the original tube from my 2003 first study and a mask from my 2005 repeat study. Knowing something about sleep apnea and seeing this as a life long disorder I have become anxious to get the appropriate treatment etc.

I bought the APAP thinking that it would work as a replacement for additional sleep study. I had a dismal relationship with the pluminolgist that I was referred to. This Dr. said that I didnt have sleep apnea and that sleep studies were very expensive----. After the study he prescribed a CPAP machine without followup. I had to write to him to get a humidifier...

Now I have bought a APAP with the RX coming fro my General Practitioner that works well with my requests. I was hoping that the APAP would provide setting ETC. Now I am trying to get this all straightened out. I have several new masks and an Aussi hose.

As is apparent, I am very angry at the way this has happened. I will try different settings to see if I can get better results.

[rbtgjns]

night two...settings min. 12.0 max 20.0

results..pressure 13.4, leaks .22l/s...AHI 18.5....AI 6.5...HI 12.0...

sleep 6.08 hrs.

Awake at 3am feeling tried---not a good nights sleep... better yesterday.

Mask--mirage activa--very comfortable

Plan...boost min setting up and try different mask--- mirage ultra II

Aussi heated hose works well---had humidifier setting at 3 and no condensation/rain out...room temp in the low 60's.

ERP set at 2---may reduce this to setting at one???? or turn it off.