Newbie with APAP questions

[kirstena]

Greetings, Folks -

I've got a brand new diagnosis and a practically brand new REMstar Auto M Series with C-Flex, and my doctor doesn't know enough to advise me on how best to use it. I was hoping for a few pointers.

My sleep study came back "mild," and my doctor wanted me to try all the "lifestyle changes" I'd *already* been trying unsuccessfully before the sleep study. When I was given the Remstar, the doctor said I could go ahead and try it. I looked up info online, set it myself to titrate between 4 and 18 cm, got a mask, and went to bed. After twelve nights, I've only ever caught it blowing up to 10.2 (post-nasal drip) and it usually settles around 6, with an average of 8.2. My AHI during the sleep study was 10, but with the machine it's 2.4. I've got the CFlex set on level 2 and find that quite comfortable. I'm using the Opus 360 nasal pillow mask because the nasal one I tried before drove me crazy pressing on my forehead. I like it fine, but the nurse at my doctor's office (who uses CPAP herself and has strong opinions about such things) says I can't use a nasal mask because I'm usually a mouth breather at night. Funny, but after the first night, I stopped waking up going "Ppppppppppppfth," and it seems to be working well for me. The average leak is 24, which is in line with the Opus specs.

Basically what I'm after is validation that I'm not doing something wrong. I have no idea whether an AHI of 2.4 is decent, whether I should set the low end of the auto range higher to get closer to the average pressure, if it's better to have a lower low end to the pressure range or to ramp up to a higher low end at the beginning of the night and take it from there, and whether I can safely ignore the opinionated nurse who insists I should get another, mouth-covering mask.

I'm winging this - how am I doing?

[Emilia]

Welcome! It sounds like you are doing wonderfully..... and AHI below 5 is considered good, but the closer to 0 the better. You will find it will fluctuate nightly as so many things can influence the results. My AHI last night was 1.8 but the night before of 0.4.... Sounds like you have adapted well the the nasal pillows, and with those results and low leak rate, it seems the mouth breathing has stopped. I'd say you have done a remarkable job of self titration and setting your machine for good results. The only suggestion I would make is to tighten up the pressure range now that you have a sense of what you need. I'd say a range of 7 to 11 would put you within the parameters you have seen trending and can always be tweaked from there. Good luck! Keep us posted.....

[dtsm]

Congratulations on a great start....

Besides tightening the band, you might want to work on reducing the leak rate. One thing I noticed, as therapy improves and your REM sleep increases, you might end up leaking more.....so maybe a chinstrap and/or tape can be considered.

Chinstrap: papcap plus 4
Tape: #2080 3M blue painters'

[kirstena]

Emilia - thanks for the info. I think I will bring up the low end of the rate some. I was thinking that, if I started higher, the machine wouldn't need to let me have an apnea in order to turn itself up = lower AHI. Oh, and you have a beautiful cat.

dtsm - I think the leak rate includes what comes out the holes in the front of the mask. From Fisher Paykel's instruction sheet for the mask:

***********************************************
Exhaust Flow
The Opus Nasal Pillows Mask has an air exhaust system that vents the expelled CO2 through a group of fine holes in the front of the Elbow. It is important that these holes are not blocked by any object. This controlled leak ensures exhaled CO2 is expelled from the mask.

(cm H2O:liters/min)
3:17
5:22
7:26
9:30
11:33
13:36
15:39
17:42
19:45
21:48
23:50
25:52

Resistance to Flow
Pressure drop through mask @ 50 l/min = 1.2 cm H2O
Pressure drop through mask @ 100 l/m = 5.4 cm H2O
**********************************************************************
Actually, it might be interesting to figure out what the flow rate of the REMstar is in liters per minute at 8 cm H2O in case I change masks to one with a different pressure drop.... What am I talking about - the machine will take care of it. God, I love this machine.

[roster]

Great start by someone who is self-educated (the best way to do it).


The only thing I would suggest is to start saving your change to purchase a card reader and software https://www.cpap.com/productpage/respir ... eader.html.

I would not be without the "Daily Details" report which you can't get from the display.

[kirstena]

ooooOOOOOOoooooo - you mean it saves *more* data for me to play with?!? I NEED one of those! Fun!

[cflame1]

Just make sure that you have the right kind of reader if you have a "smart" card. Not to be mistaken with an SD card (like what a camera uses)

Respironics used a priopriatory (sp) smart card reader up until you get to the PR S1's. The SD's can use any reader for an SD card.

Smart card reader: MAKO DT35000... labelled as INFINEER (or at least mine is).

[roster]

Below is an example of a Daily Details report. This dude has way too many snores and hypopneas and needs to do some tweaking. Without the report he may not have a clue what is wrong and what to do about it.



See also http://www.cpap-supply.com/Articles.asp?ID=150

[Janknitz]

Kristena,

I'm impressed with your knowledge and what you're doing on your own. Good going!

I'm using the Opus 360 nasal pillow mask because the nasal one I tried before drove me crazy pressing on my forehead. I like it fine, but the nurse at my doctor's office (who uses CPAP herself and has strong opinions about such things) says I can't use a nasal mask because I'm usually a mouth breather at night. Funny, but after the first night, I stopped waking up going "Ppppppppppppfth," and it seems to be working well for me. The average leak is 24, which is in line with the Opus specs

.

The nurse should keep her opinions to herself. Sleep techs in sleep labs who are knowledgeable understand that when you are being treated with optimal pressure, the need to open your mouth to increase air intake diminishes, and . almost everyone can use a nasal mask or a nasal pillow mask. You sound like a case in point, and I bet you know more than that nurse, now.

With the software, you might be able to dial in your pressure a little more, and reduce that AHI rate down even more. I typically run under 1.0. There's a tutorial on my blog to help you understand the data you can get from the software here http://maskarrayed.wordpress.com/2010/0 ... -tutorial/

[rested gal]

kirstena, you chose a perfect avatar picture for the pro-active attitude you're bringing to your own therapy!

Check your private messages.

[kirstena]

Thank you all for your great suggestions. I'm going to get the card reader and study up some more and geek out to my heart's content! My friend David (computer guru) would say that I'm hacking my sleep. As good a description as any, I guess.

Thanks again, everybody!