Advice please

[CPAPcub]

Hi,

I've been on CPAP for about 3 weeks or so now. Luckily my mask is more or less leak free with the just the odd adjustment needed during the night. I have a very low Non Responsive Index, usually 0.25 or below.

I started off on 14 pressure, lowest AHI achived was 6 but most nights were over 10.

I upped it to 16.5, again 6 was the lowest achieved but have hit 7 and 8 a few times. Sometimes it's also over 10, but overall I'm getting better results than at 14 pressure.

So what to do now? My target is 5 or below.

Here a few questions going through my mind:

1. Keep upping the pressure a little at a time and see if that improves things? Although doing that could also bring in the liklihood of leak issues as the pressure inreases? How long should I give each new pressure setting before changing it?

2. Change to APAP - can I use APAP as a diagnostic tool? If so what settings range should I dial in? Maybe 15-20?

3. If I go to APAP mode, am I right in thinking that the machine senses when I am having an apnea or hypopnea and adjusts the pressure accordingly? How quickly does it do this, i.e. would I still be suffering from apneas for a short period while the machine adjusts its pressure?

4. Please can someoner explain to me in laymans terms what the relevance of EPI (exhale puff index) is in my numbers? I have a full face mask and am a mouth breather. Is it good or bad if it records EPIs on my numbers? Why are they there??!!

Thanks for any help or advicde you can give me

[mars]

If a post ever needed a bump, I reckon this one did.

Better people than me will be able to help you with your questions, but you certainly seem to have the right idea and attitude that will get you good results.

cheers

Mars

[dave21]

That's a good bump Mars!

CPAPcub, I can't really comment on your machine as I haven't experienced this machine before. If you have undergone a sleep study both before and after CPAP then that should provide the pressure that you were titrated with to reduce your apnoeas. For me I had a sleep study in the hospital before CPAP and then they gave me a machine and kind of decided from there on the amount of events I had what the pressure rating should be and asked me to see if I could tolerate it. It took a couple of days to tolerate the pressure at home, a week later they wanted the machine back and they checked the stats and said "the stats were looking much better, okay go and buy a machine and this is the pressure setting you should have" - for me that was 10. They warned me away from APAP's because they don't give a constant pressure (the doctor didn't seem to understand that the APAP actually detects as you say when an Apnoea or Hypopnea happens and quickly reacts to stop it from continuing to happen).

For me as the hospital / insurance wasn't paying for the machine I did the research and went with what at the time what seemed to me to be one of the best two machines on the market and purchased an APAP with the understanding that I could return the machine if it didn't work for me and I've been on that machine for 5 years now and it works wonders.

I wouldn't necessarily say you should try to do what I did. I think what you should do is talk to your doctor first before making any changes, as you say upping the pressure could cause more leaks, it could create more irritation in your Ear, Nose, Throat and lungs if you can't tolerate the pressure.

My AHI for 5 years was averaging at 4.5. AHI for me of around 5 I believe is good and you're not far off that at 6, 7 or 8 but others here might disagree with me there. For me I personally believe the lower the AHI the better and for the most part of 5 years the best AHI I could get on an APAP was 4.5.

1) If you don't get any help from your doctor then you could try upping the pressure although I'm already on 10 and I wouldn't be able to support 16.5. Bearing in mind that a lot of machines only go up to 20 and you're already not that far off that at 16.5. Also bear in mind if your doctor is monitoring you they will see the pressure change on any stats they get from the machine.

2) APAP does help for me, it recognises and adapts quickly. For me it's more comfortable than a fixed pressure machine. The pressure remains low (or lower) until it detects an event then ups the pressure quickly to compensate and bring you out of the event more quickly. It keeps the pressure up at that level for a time before reducing it which can stop other events happening. Some doctors (and mine fell into that camp) believe because of this it doesn't keep apnoeas at bay and they still start to happen but happen for less time. That's not necessarily the case. It also makes it easier to fall asleep in addition to the 30 minute ramp function I have set on my machine.

3) Correct, the machine will sense when you are having difficulty and up the pressure between the min and max pressure settings until you respond better.

4) Not sure about EPI in your figures, but others might be able to help you there

I hope that gives you a little more information, I hope others will chime in and provide some advice too!

[mars]

Hi

One thing I have learned in trying to find the best pressure setting is that with both cpap and apap a pressure difference of 0.5 can make a significant difference in the total AHi I end up with.

cheers

Mars

[jweeks]

One thing I have learned in trying to find the best pressure setting is that with both cpap and apap a pressure difference of 0.5 can make a significant difference in the total AHi I end up with.

Hi,

I also found that to be true. One question that I would have is what is the make-up of that AHI? If there are few A events and lots of HI events, then I would be less concerned and base things more on how I feel. But if there are more than a few A events, then the original poster needs to dig in. Running in auto mode to try to find the sweet spot might work. It might also be time for a follow-up sleep study. Something isn't correlating if the poster's titrated number is giving such a high AHI.

-john-

[dave21]

One thing I have learned in trying to find the best pressure setting is that with both cpap and apap a pressure difference of 0.5 can make a significant difference in the total AHi I end up with.

I would agree with you there. The other thing to note is each night is different, so one pressure one night might not be the best pressure another night. Some nights you might have more apnoeas or hypopneas, so sometimes thats where an Auto machine is better.

[CPAPcub]

Hey,

Thanks so much for your replies and to 'Mars' especially for bumping my post up

Dave21 - thanks for your very interesting points, all taken on board.

Mars - facinating that 0.5 could make a difference but doesn't surprise me!! I'll be doing this with baby steps!!

I've started to use APAP mode and am getting weird massages. Read about it here viewtopic/t50195/DeVilbiss-DV54-AutoAdj ... s-out.html

Thanks

[CPAPcub]

Jweeks

I meant to mention in my last post - my machine doesn't break down the AHI into apneas and hypopneas. The only data I get is an AHI number and an 'NRI' number which I understand is 'non responsive events' aka central apneas. Luckily, that number is usually 0 or worst 0.25.