First Night Using IntelliPap AutoAdjust

[DHC]

I previously reported my experience with the REMstar Plus M Series (viewtopic/t55601/Disappointed-with----E ... -Plus.html) and my craving for DATA (not available with that device). That led me to purchase the DeVilbiss machine which arrived yesterday. Quite a difference - both in the data available from the devices, but more, in the usability and comfort.

I am using the same mask with both machines (waiting on an order to arrive with a new mask to try) - the Respironics ComfortFULL 2. One of the annoyances I had using this mask with the REMstar is that I would awaken several times during the night due to a noise created by a leak and then need to re-position the mask. It probably occurred at least 4 times each night. Last night, using the DeVilbiss machine, I did not have a single leak that awakened me. Some (much?) of this is explained by the very low pressures the DeVilbiss machine used - reporting 95th Percentile Pressure at 5.0 (the sleep study last November had me at 7.0 - and I seem to recall seeing the REMstar with that setting). The AHI reported for the first night seemed quite reasonable at 1.5 even with this lower pressure. I am kind of surprised at the report of such low pressure settings. Since the ACDF surgery, I know *something* has caused a greater need for the CPAP - whether due to a more constricted airway or weakening of the musculature, but something is surely different and I cannot sleep without the CPAP. Since the sleep study was conducted prior to surgery and showed a pressure reading of 7.0, the lower pressures reported (and evident in the improved seal of the mask) seems counter-intuitive - but there they are.

Couple of other observations:

* The DeVilbiss was WAAAYYYYYY quieter than the Respironics machine. I could not hear the machine over the 'whooshing' noise of our ceiling fan.
* The automatic dimming of the backlight in the DeVilbiss was nice. For that matter, the fact the screen was backlit at all was an improvement over the Respironics machine.
* I did not use the humidifier in the DeVilbiss last night - and I stopped using the one in the Respironics machine about a week ago. One night I seemed to 'smell' something slightly off and decided to replace the hose, clean the mask thoroughly, replace the filters, and remove the possibility of the humidifier introducing anything into the breathable air. I now have some bacterial filters, so may add the humidifier back into the mix, though I do not seem to miss it right now.

I am somewhat confused about something with the APAP. It seems like all the APAP machines have the same available range of pressures from 4 to 20 cm H2O. I have seen several posts about the DeVilbiss in which the suggestion is made to set the range differently - to something within the overall capability of the device. I do not understand why someone would do that? If the machine is designed to automatically adjust pressure to optimize therapy - presumably by reducing AHI count - then why would there be any need to manually restrict the machine's full capability?

Overall experience - based on a single datapoint (so it is FAR from substantial) - is the DeVilbiss is a dramatic improvement over the REMstar Plus machine I used previously - in every aspect, as far as I can tell now.

Will report further as I try other masks and have more datapoints to report.

[ozij]

I am somewhat confused about something with the APAP. It seems like all the APAP machines have the same available range of pressures from 4 to 20 cm H2O. I have seen several posts about the DeVilbiss in which the suggestion is made to set the range differently - to something within the overall capability of the device. I do not understand why someone would do that? If the machine is designed to automatically adjust pressure to optimize therapy - presumably by reducing AHI count - then why would there be any need to manually restrict the machine's full capability?

Generally, APAP will wait for an event before raising pressure, the go gradually down as far as you let them. Which means they may bring you down to non-optimal pressure, in which another event will occure, causing the pressure to rise. And some APAP's, for some people, zoom uncontrollably up to intolerable pressures. So, to low, and too high are good reasons to raise the minimum and put a ceiling on the maximum.
Added to that, some people are bothered by pressure changes and a narrower range makes their sleep more restful.

[KatieW]

Did you see this post by ozij? viewtopic/t55680/APAP-webinars--new-wit ... tml#unread

The Webinars explain how apap's work, and specifically how DeVelbiss apap's work. Really excellent presentation and information.

[DHC]

Did you see this post by ozij? viewtopic/t55680/APAP-webinars--new-wit ... tml#unread

The Webinars explain how apap's work, and specifically how DeVelbiss apap's work. Really excellent presentation and information.

Saw the topic - tried to register - still waiting on the 'email' to complete registration.

[Emilia]

I registered for the webinars yesterday and instantly got my email to verify my registration. I haven't watched one of the webinars yet, though..... I will soon. My IntelliPAP is the only machine I've used as I am a newbie. I've had it almost 4 weeks now. I agree it is very quiet. My doctor wanted me to set it in auto mode with a pressure range of 6-10. So, far that has been good for me with my 90th %tile pressure usually between 6.5-7-5. I have had some events need a spike up to 9.7, but that only happened a couple of times. My AHI has averaged 1.6 for the month so far.

What was your titrated pressure? Mine was an 8 which is why we went with a range of 6-10. The general rule is to set it a couple of notches below and above the titrated pressure.

[Sillyme]

[/quote]Saw the topic - tried to register - still waiting on the 'email' to complete registration.[/quote]

Check your JUNK email. That's where it was on mine.

[DHC]

I registered for the webinars yesterday and instantly got my email to verify my registration. I haven't watched one of the webinars yet, though..... I will soon. My IntelliPAP is the only machine I've used as I am a newbie. I've had it almost 4 weeks now. I agree it is very quiet. My doctor wanted me to set it in auto mode with a pressure range of 6-10. So, far that has been good for me with my 90th %tile pressure usually between 6.5-7-5. I have had some events need a spike up to 9.7, but that only happened a couple of times. My AHI has averaged 1.6 for the month so far.

What was your titrated pressure? Mine was an 8 which is why we went with a range of 6-10. The general rule is to set it a couple of notches below and above the titrated pressure.

I guess I am not sure what you mean by "titrated pressure." I have a single-page sleep study that indicates the pressure to use as 7.0 - I guess this is the "titrated pressure" you mean?

Check your JUNK email. That's where it was on mine.

Yep - been checking there as well. Still no joy.

[Emilia]

Yes, your titrated pressure is what they set it at during your study to sufficiently stop events from occurring. If yours is 7, your auto settings would be well suited at 6-10. Going as low as 5 would seem difficult to breathe with, I would think. You could use the Delay (ramp) for 10 minutes starting at 5 or 5.5. Do you also have your SmartFlex set to ON? If so, what are the settings for that?

[DHC]

Yes, your titrated pressure is what they set it at during your study to sufficiently stop events from occurring. If yours is 7, your auto settings would be well suited at 6-10. Going as low as 5 would seem difficult to breathe with, I would think. You could use the Delay (ramp) for 10 minutes starting at 5 or 5.5. Do you also have your SmartFlex set to ON? If so, what are the settings for that?

Why would settings at 5 (or even 4) make it difficult to breathe? It would still be a positive pressure - correct?

For the one night I have metrics, it shows:

95th Percentile Pressure at 5.0
90th Percentile Pressure at 4.5

So pretty low pressure figures compared to most I see posted.

Taking your advice, I established the low end of the APAP to 4.0 and the high end to 10.0. I do have the Delay set to 4.0 for 10 minutes - and the SmartFlex settings are:

Full-Time
IRnd - 3
ERnd - 3

Out of curiosity, do I need to do anything special to get the SmartLink to record all detailed data? I do not find any settings anywhere in the menu. To move the data from the device to my PC, I simply remove the SD card and plug it into the PC and download the data - correct? Reason I ask is the data seems to be incomplete - but that may simply be due to only recording one night's usage.

Thanks for the suggestions.

[timbalionguy]

If you are indeed comfortable at 5 cm, as you seem to report, a pressure range of 5-9 would not be a bad range. (Many people are not comfortable with a pressure of 5 cm. They experience a suffocating feeling. 6 or 7 cm is the usual low end for most people.) You are one of the lucky ones for whom a wide-open APAP machine gives good therapy!