My CPAP-to-APAP Experience

[Wulfman]

Hmm. I'm tempted to go there, but I fear it's too soon. I also question why I would want to make the minimum 12cm (notwithstanding the fact that that's been my fixed pressure for so long) if I'm spending a decent portion of the night at 11. Wouldn't it make sense to also set the minimum a little lower? Or am I getting into a range that's too wide to be very effective by doing that?

Your call.

My logic is that if I'm already used to a pressure (and my fixed pressure is 12, too), but then by going to a lower minimum, I might be allowing too many unnecessary events to take place.
The machine will respond to snores and flow limitations (and leaks) before the hypopneas and apneas. By having a little more pressure, it may lessen the number of snores and flow limitations......and thus give an Auto fewer reasons to raise pressures.
In most cases, if given a lower minimum pressure, we'll spend far more time at those lower pressures.....which MAY NOT be "effective" pressures.


Den

[Autopapdude]

IF you make a change (and that is a big 'if"), I would go 9-14. Personally, I have had best results with a wider span in my min/max with an autopap. To me, the ideal spread is 4-5 cm. So, that would give relief and catch events at the same time, since you were running at max. A bit of headroom wouldn't hurt, and I always think the highest "min" setting you can comfortably tolerate in your pressure range makes sense to me.

[BleepingBeauty]

Hmm. I'm tempted to go there, but I fear it's too soon. I also question why I would want to make the minimum 12cm (notwithstanding the fact that that's been my fixed pressure for so long) if I'm spending a decent portion of the night at 11. Wouldn't it make sense to also set the minimum a little lower? Or am I getting into a range that's too wide to be very effective by doing that?

Your call.

My logic is that if I'm already used to a pressure (and my fixed pressure is 12, too), but then by going to a lower minimum, I might be allowing too many unnecessary events to take place.
The machine will respond to snores and flow limitations (and leaks) before the hypopneas and apneas. By having a little more pressure, it may lessen the number of snores and flow limitations......and thus give an Auto fewer reasons to raise pressures.
In most cases, if given a lower minimum pressure, we'll spend far more time at those lower pressures.....which MAY NOT be "effective" pressures.

I believe the object of this therapy is to (drastically) REDUCE the number of events we have......not allow more of them to occur.


Den

As usual, Den, your POV makes a lot of sense to me, and your reasoning is sound.

I just thought that, with such a tight pressure range, if I'm spending a considerable amount of time at the low end, maybe I don't need 12 as often as I think I do. But as you say, I'm certainly used to 12cm and have no problems with that pressure. (And I was at 14 for awhile previously, so I know I can handle a little more than what I'm now accustomed to.) Decisions, decisions... I'll give my current settings a few more nights, just to give myself a full week of data before I adjust the range.

Thanks, Den.

IF you make a change (and that is a big 'if"), I would go 9-14. Personally, I have had best results with a wider span in my min/max with an autopap. To me, the ideal spread is 4-5 cm. So, that would give relief and catch events at the same time, since you were running at max. A bit of headroom wouldn't hurt, and I always think the highest "min" setting you can comfortably tolerate in your pressure range makes sense to me.

Thanks, dude, but I'm puzzled by the statement I bolded above. The highest setting I've ever had (on fixed pressure) was 14cm, and I adjusted to that with little fanfare. Maybe I'm tired (ha!), but I'm confused by your suggestion of 9cm as the min for my next experiment, since my most recent fixed pressure was 12. Care to further enlighten me?

[Autopapdude]

Thanks, dude, but I'm puzzled by the statement I bolded above. The highest setting I've ever had (on fixed pressure) was 14cm, and I adjusted to that with little fanfare. Maybe I'm tired (ha!), but I'm confused by your suggestion of 9cm as the min for my next experiment, since my most recent fixed pressure was 12. Care to further enlighten me?

Yes, I will--that was not what I intended to say. I meant to say "highest reasonably low pressure you can tolerate without suffocating feeling." Some people have the min set to 4 or 5, and that makes the autopap work to hard to avert events, and leaves them with the "choked up" feeling. What I meant to express was to set the low at at least 6 or 7, so as to remove excess C02, and still be effective in treatment. So, something in the 7-9 range would make sense as a start. STUPID ME--must have had my head buried somewhere.

My "wide span" comment meant wider than 2 cm. Some folks have their autopap set 1 or 2 cm apart, and it really doesn't do much more than a fixed pressure would. I tend for myself to favor a 4-5 cm spread between bottom and top. Man, did I ever blow that post--must have been asleep.

[BleepingBeauty]

Thanks, dude, but I'm puzzled by the statement I bolded above. The highest setting I've ever had (on fixed pressure) was 14cm, and I adjusted to that with little fanfare. Maybe I'm tired (ha!), but I'm confused by your suggestion of 9cm as the min for my next experiment, since my most recent fixed pressure was 12. Care to further enlighten me?

Yes, I will--that was not what I intended to say. I meant to say "highest reasonably low pressure you can tolerate without suffocating feeling." Some people have the min set to 4 or 5, and that makes the autopap work to hard to avert events, and leaves them with the "choked up" feeling. What I meant to express was to set the low at at least 6 or 7, so as to remove excess C02, and still be effective in treatment. So, something in the 7-9 range would make sense as a start. STUPID ME--must have had my head buried somewhere.

No comment!

Thanks for the explanation. I don't know how people are able to handle a really low setting (like 4 or 5). That would definitely feel like suffocation, to me. The lowest fixed pressure I've ever been on was 10cm. I had a rough time with one of the four APAP trials my ex-doctor ordered, which was set from 4-20 ( ).

My "wide span" comment meant wider than 2 cm. Some folks have their autopap set 1 or 2 cm apart, and it really doesn't do much more than a fixed pressure would. I tend for myself to favor a 4-5 cm spread between bottom and top. Man, did I ever blow that post--must have been asleep.

Oh, I fully intend to increase the range a bit. I'm just taking things slow, due to my history of centrals and having become so used to a fixed pressure. Generally, what I see recommended here is 2cm below and 2cm above the titrated pressure.

From the results so far, it's a given that my max needs to be higher. Just not sure where to set the min yet.

Thanks, dude.

[GaryG]

BB and just remember, as you're tempted to play with the settings, the more days you stick to where you are, the more information you are gathering at your current settings.

As has been pointed out, over a few nights the percentage of time you are spending at the lower setting is decreasing and the upper settting is increasing. I'd be curious if this levels off or continues.

[Autopapdude]

Oh, I fully intend to increase the range a bit. I'm just taking things slow, due to my history of centrals and having become so used to a fixed pressure. Generally, what I see recommended here is 2cm below and 2cm above the titrated pressure.

From the results so far, it's a given that my max needs to be higher. Just not sure where to set the min yet.

Thanks, dude.

Ya welcome, beauty! It is just trial and error to see what works for you. From looking at what you wrote, I'd guess at 8 or 9 as a lower, but it is your body, and you have to feel good. Take it slow, and get it right~you will benefit from that. 2 above and 2 below is a good formula. I am very close to that now. Titration was 11, so my low is 8.5, and high is 14 (just cuz I am paranoid about the stray rogue events). I am sure I could go 13 at the top, and might well do that.

ex-doctor

is that like an "ex- husband," or "ex-wife?" lol

[BleepingBeauty]

Here's last night's data:




AHI is going in the wrong direction, but the other numbers are reasonable, and there are still no NR events recorded. I slept straight through the night and feel pretty good today (no worse for wear).

This graph makes it easier to see a correlation of events. Between hours 4 and 5, I see small clusters of events, which seem to have been preceded by an increase in pressure; shortly thereafter, the leak line goes up. And then, at about 2/3 of the way through the sixth hour, my pressure hit the 13cm ceiling again, which seems to have prompted a higher leak rate and then a cluster of OA's. Still, I wish there was more detail in the graphs to make these conclusions easier to reach.

I'm excited to see how I fare with a wider range, because all these little blips on the pressure line make it difficult for me to see exactly what pressures are working best for me. Thus far, I'm spending more time at the higher pressure than I thought I would be. But hey, it is what it is.

[Hawthorne]

You say you are spending more time at the higher pressures than you thought you would. That's why I suggested raising the maximum by just 1 or maybe 2 cm and see what happens then.

I know you want to take it slowly and are watching for centrals which is the way to go, but I still think it may be time to make a change. I think it is 5 nights of data you have now, which tells pretty much the same story, as I read it.

As Den said, "Your call"!

[BleepingBeauty]

BB and just remember, as you're tempted to play with the settings, the more days you stick to where you are, the more information you are gathering at your current settings.

As has been pointed out, over a few nights the percentage of time you are spending at the lower setting is decreasing and the upper settting is increasing. I'd be curious if this levels off or continues.

I'm curious, too, Gary. I know I've been saying I'm going to give each experiment a full week, but with the little patience I have (and the pressure pattern that's pretty obvious from this run at 11-13cms), I think five nights' worth of data is enough to go on to take the next step.

ex-doctor

is that like an "ex- husband," or "ex-wife?" lol

There was a lot of animosity at the end of our relationship, so yeah. If you have the time (or the inclination), you can read all about the "divorce" in this thread, which concerns the last AutoPAP trial my ex-doofus ordered for me in April of this year: viewtopic.php?p=359741#p359741 Fair warning: It's a long thread.

You say you are spending more time at the higher pressures than you thought you would. That's why I suggested raising the maximum by just 1 or maybe 2 cm and see what happens then.

I know you want to take it slowly and are watching for centrals which is the way to go, but I still think it may be time to make a change. I think it is 5 nights of data you have now, which tells pretty much the same story, as I read it.

Thanks, Hawthorne. I agree, so I'll up the max tonight and run from 11-15 for my next test to see how I fare with those settings. I handled 14cms fixed pressure with no problem, so if I actually do get up to 15 occasionally, I should be okay with that (provided that centrals aren't triggered).

Thanks, everyone.

[Hawthorne]

I think you are ready and I think your data indicates you should do that!

I think you will be fine. After 5 days at that setting (11-15), I am hopeful that your 90% will not be your maximum pressure every night.

After 5 days with that setting, you may be looking at another change. That change could be upping the maximum again or upping the minimum! Time and data will tell.

[BleepingBeauty]

Last night was my first night running the machine from 11-15cms. It wasn't my best night, sleep-quality wise (several brief awakenings to adjust for small leaks), but it wasn't terrible, either. I am yawning this morning, though, after ten hours of sleep.




I find it interesting that I'm spending similar amounts of time at the low and high ends of the pressure range. Not sure what, if anything, to make of that. Most of my events seem to be happening at the higher pressures, from what I can tell, and the snoring is all but eliminated. Still no NR events being recorded, which is a relief.

It's just one night of data at these settings, so I'm not drawing any conclusions just yet. But I confess I am a little freaked out about the potential need to raise the max pressure even higher, considering how much time I spent at 15 last night. I hope things even out a bit over the next few nights with these settings.

[Hawthorne]

I've been hoping you would post last night's data!

I am surprised that your 90% went up to 15 cm. However, it is just the first night at this setting so it may be a case of, time will tell. Things look great for the first while during the night (almost 1/3 of the night). It seems that a leak issue set in at that time and that may be what raised the pressure after that. You had a failry nice "zipper" line for that 1/3 fo the night.

Things did even out at your last settings so it may be a wait and see.

I am also now thinking about raising that minimum pressure but I 'm not ready to make any suggestions yet!!

[Wulfman]

Got any idea what happened at the 2 1/2 hour mark that started the pressure increases in motion? Or, another way would be to ask what did NOT happen during the first 2 1/2 hours?
Part of the answer appears to be in the increased leakage at about that point in time. As you noted, the number of events increased during your higher pressures. I'm wondering about my thought the other night......if it doesn't have room to make three more pressure increases on an apnea before backing off, does it then not flag the event as "NR"?


Den

[KatieW]

BB, thanks for posting. I hope things settle down for you, after a few nights.