Is changing S8 Escape II Auto from CPAP to APAP bad?

[Veridor]

HI all, I'm a newbie to CPAP, having been diagnosed last week with severe obstructive sleep apnea (AHI 175). The DME brought me a ResMed S8 Escape II Auto, but it turns out it was set to CPAP mode at 12 cm. I am thinking about changing it to APAP mode to see if my sore throat in the AM is alleviated. I'm also in the process of trying to have the DME give me an efficacy-data-capable machine, as often suggested on this forum.

My question: is changing it from CPAP mode to APAP mode likely to anger my doc or hurt my therapy?

[kf10]

I believe the S8 Escape II is a CPAP, not a APAP machine. With a APAP, you can go both way. Not with a CPAP. BTW, new comer here also

[Veridor]

I believe the S8 Escape II is a CPAP, not a APAP machine. With a APAP, you can go both way. Not with a CPAP. BTW, new comer here also

The S8 Escape II is CPAP only, but the S8 Escape II Auto is capable of both, apparently. It just doesn't offer user efficacy data from what I can tell, even when going into the clinician menu, only compliance data.

[kf10]

As I learned, for a new user it would be good to able to set in a range of settings as in the APAP, and find out what pressure is ideal for your situation. I was subscribed to set at 8, since I am using APAP, I set it at 5 - 10. Throughout the night, the pressure vary from 6, 8, 9 etc.

[dtsm]

I've referenced two threads which you might interesting to read re apap vs. cpap.

viewtopic.php?f=1&t=48314&st=0&sk=t&sd= ... p&start=15
viewtopic/t50472/viewtopic.php?f=1&t=50 ... ap#p461308

I assume DME set unit to 12 pressure based on the doctor's prescription - did you get a copy of your sleep center study? Assume you did mask titration, thus setting to 12? I would want to make sure to review first, to understand what is your detail diagnosis.

FWIW, I was on apap for almost 3 months and then recently switched over to cpap. It seems cpap might work better for me......it's too early to say which is more effective, as I am also using different masks.

Before going to apap, you might want to articulate your thinking for others to respond here. Keep in mind different strokes for different folks -- it's a marathon and there is no one correct way. And do make sure to get a data capable model....

[ifrimmel]

HI

Welcome..

@AHI 175.. I think you would want to know a little more about efficacy rather than compliance. The Escape is not good enough for that. Tell your doctors you want to be more involved with your treatment and need a machine that can do that for your. CPAP/APAP/BiPAP is a subsequent discussion - once you/your doctor understand more about exactly what is happening.

The most important thing is .. how are you feeling. Is the CPAP @ 12 working for you ?

[ifrimmel]

Another thought .. did they give you a humidifier? If they did? Try turning it up a little. At 12 you DEFINITELY need a humidifier.

[DreamOn]

Welcome to the forum, Veridor. I can't offer any specifics regarding APAP settings since I've never used one myself. But because your ResMed Escape II Auto isn't fully data capable, you're not going to be able to tweak your therapy very easily. It may be best to keep it in CPAP mode until you do have a fully data capable machine and you've been using CPAP longer.

It's quite possible that your morning sore throat may be due to therapy air escaping from your mouth. Our muscles relax during REM sleep, including the throat, jaw and tongue. This can cause the mouth to open, allowing air to escape, which will make your mouth dry. Since you're using a nasal mask, you may need to also use a chin strap to help keep your tongue in a position to block the air from coming out. Some people tape their mouths or use a full-face mask for that reason. You may need to experiment with humidifier settings too.

You're smart to try to get an efficacy-data-capable machine. Without the leak rate information, it's going to be difficult to tell what's going on. If you're leaking too much therapy air, either from mask seal or mouth leaks, your therapy won't be as effective as it could be. And without the data, you really won't know where your pressure's going during the night when the machine is set on Auto. Also, without the data you won't know how effective your therapy is. All you'll be able to go on is how you feel during the day.

Once you get your fully data capable machine, the first thing you need to determine is if you're leaking therapy air from your mouth. That could be happening without you knowing it, while you're deeply asleep. Knowing the leak rate will help to narrow that down. After leaks are under control, then you can work on the other results numbers, such as AHI and AI. It's possible that your prescribed pressure of 12 will be fine if leaks aren't excessive. You should give it a few weeks to determine that. It does take a while for our bodies to adjust.

Best wishes,

DreamOn

[Veridor]

Yes, the machine came set in CPAP mode at 12. Yes, they did include a humidifier, which was set at 2, and I'm bumping to 3 tonight because of the sore throat I had this morning.

Rosie, indeed, my profile has the normal S8 Escape II listed, as the S8 Escape II Auto wasn't an option. Hence the added note at the bottom.

And yes, I was titrated to 12 during my split study. They used an S8 Autoset, I believe. I'm thinking of using APAP to see if that alleviates my sore throat, as well as to lower risk of high pressure-related side effects.

[rosiefrosie]

Yes, the machine came set in CPAP mode at 12. Yes, they did include a humidifier, which was set at 2, and I'm bumping to 3 tonight because of the sore throat I had this morning.

Rosie, indeed, my profile has the normal S8 Escape II listed, as the S8 Escape II Auto wasn't an option. Hence the added note at the bottom.

And yes, I was titrated to 12 during my split study. They used an S8 Autoset, I believe. I'm thinking of using APAP to see if that alleviates my sore throat, as well as to lower risk of high pressure-related side effects.

I did some digging and did find the ResMed Escape 11 Auto on the ResMed website.

I do use an ResMed Autoset 11. You could try setting it from 10 to 13 and see if this helps. Are you mouth breathing and maybe this is why your throat is sore?

rosie

[DreamOn]

Yes, the machine came set in CPAP mode at 12. Yes, they did include a humidifier, which was set at 2, and I'm bumping to 3 tonight because of the sore throat I had this morning.

Rosie, indeed, my profile has the normal S8 Escape II listed, as the S8 Escape II Auto wasn't an option. Hence the added note at the bottom.

And yes, I was titrated to 12 during my split study. They used an S8 Autoset, I believe. I'm thinking of using APAP to see if that alleviates my sore throat, as well as to lower risk of high pressure-related side effects.

You can certainly try to raise the humidifier from 2 to 3, but just be aware that you may get "rainout" (condensation) inside the tubing. Not only is it unpleasant to have water up your nose, but rainout can also decrease the pressure delivered to the mask. A good hose cover can sometimes minimize rainout, but the temperature in your bedroom also plays a role.

Like I said, your sore throat is very likely due to leaking therapy air from your mouth, especially if your mouth is also dry. So you may need to figure out if that's happening and solve it with a chin strap and/or mouth taping or a full-face mask in order to get optimal results.

[Veridor]

Y'all make good points. Titrated to 12 in my split study, I went from AHI 175 to AHI of 5, so I'll leave it in CPAP mode at 12 and call the doc tomorrow.

I considered that I might be mouth leaking, especially since I was a mouth breather prior to CPAP, but honestly if I mouth leak it must happen in deep sleep, as if I lower my tongue from the roof of my mouth, I get chipmunk cheeks and air going in nose and out mouth is an interesting sensation, to say the least. I wear a dental bite guard for bruxism as well at night to complicate matters. They didn't say anything about mouth leak in my study though and didn't recommend a chin strap, but I might need to try that.

[ifrimmel]

Yes, the machine came set in CPAP mode at 12. Yes, they did include a humidifier, which was set at 2, and I'm bumping to 3 tonight because of the sore throat I had this morning.

Rosie, indeed, my profile has the normal S8 Escape II listed, as the S8 Escape II Auto wasn't an option. Hence the added note at the bottom.

And yes, I was titrated to 12 during my split study. They used an S8 Autoset, I believe. I'm thinking of using APAP to see if that alleviates my sore throat, as well as to lower risk of high pressure-related side effects.

APAP will not fix ANY problems - it will certainly introduce PLENTY of variables that will make your situation far more complex than it needs to be.

I believe there are potentially 3 problems :
1) Adoption ( Get used to it .. a few days .. things will be different )
2) Leaks - MASK FIT!!!
3) Humidification - push it up a bit.

[DreamOn]

They didn't say anything about mouth leak in my study though and didn't recommend a chin strap, but I might need to try that.

They didn't say anything about mouth-leaking in my study either. I don't think it really began until a few weeks after starting CPAP. I discovered through the machine data that it was happening while asleep, although I did occasionally encounter it while still awake (chipmunk cheeks, puffs of air, hurricane when my tongue dropped down).

It will be much easier for you to determine if leaks are a factor once you can see the leak data on a fully data capable machine. And it'll be possible to check AHI and other results numbers. With the Escape, you can only go by how you feel, which is fine if you feel good, but not helpful if you're having problems.

Did you get a copy of your sleep study report? If not, be sure to get that so you can see if there were any other sleep-related issues. Did you have central apneas, or were they obstructive apneas? Your AHI of 175 was very high!

I hope that the DME doesn't give you problems in switching your machine. Let us know what happens.

[rosiefrosie]

Y'all make good points. Titrated to 12 in my split study, I went from AHI 175 to AHI of 5, so I'll leave it in CPAP mode at 12 and call the doc tomorrow.

I considered that I might be mouth leaking, especially since I was a mouth breather prior to CPAP, but honestly if I mouth leak it must happen in deep sleep, as if I lower my tongue from the roof of my mouth, I get chipmunk cheeks and air going in nose and out mouth is an interesting sensation, to say the least. I wear a dental bite guard for bruxism as well at night to complicate matters. They didn't say anything about mouth leak in my study though and didn't recommend a chin strap, but I might need to try that.

Do you have EPR on your machine and if so are you using it? This may help if you are mouth breathing,

You won't always know if you are mouth breathing while sleeping and sometimes the only way to know is if you wake with a very dry mouth. I love my nasal pillows and will mouth breath at times, so I tape my mouth as a chin strap does not work for me, but does for some. You may want to consider a full face mask. It all takes time to get everything worked out.

It will be great if you can trade your machine in for a data capable machine. It makes it so much eaiser if you can see whats going on.

rosie