Switched my machine to Auto

[brentm77]

Hello everyone. I am new to the group (and CPAP) and I am glad I found this great resource.

I did a sleep study about two weeks ago. It was a follow up study after avoiding CPAP for the last seven years after the first study showed I had sleep apnea. Accordingly, the study was to determine the appropriate pressure to prescribe.

I was never shown the results for the study, but my primary care physician prescribed CPAP at 9. After about five days I looked at the data on my machine and found that my AHI was at about a 7. I read online that it should be under five. So I got into the physician settings on the machine (they left in the pamphlet that said how to do it - and also said not to give this pamphlet to the patient). I changed the machine to "auto" instead of the plain "cpap" and put in a range of 8.5 to 11.

My thinking was that I didn't have anything to loose by allowing the machine to go a bit higher if it determined it was necessary. This morning, the AHI was 2.8. I feel good and woke up rested for the first time in a long time.

My question is - what is the thinking of the physician not using the auto feature? What is the best way to determine an appropriate range? What other information should I be looking at on the machine?

Thanks,
Brent

[tektrek68]

Typically if you have a good sleep study with sound data, a static pressure that worked well for you may be chosen for the device. I just switched to an auto one as your body changes with weight and age so can you need for pressure, more or less. Under the auto method you can monitor the data over weeks to get your best results, you want to try to find the sweet spot that will give you the least amount of AHI but not be higher pressure than necessary. Also dont adjust your min an max that they are so close together that you miss the benefit of auto

[Hawthorne]

Brent - some people do better on a range of auto settings and some do better on a straight cpap setting. Your doctor may think that most do better on a straight cpap setting. After 5 nights, it appears you may do better on an auto range.

I do better on a range of auto settings and it sounds like you do as well. In setting the range for an auto, you should set your minimum pressure at or up to 2 cm below your titrated pressure. With a titrated pressure of 9 cm, setting your minimum pressure at 8.5 cm is good. You don't want the minimum set so low that it takes too long to get to a pressure that begins to be effective therapy for you.

Setting a narrow range (you have set it at 8.5 to 11 - a good narrow range) is also a good idea as far as I am concerned. If there is a wide range you could be setting yourself up for runaway centrals and maybe a lot of pressure changes that can disturb your sleep. It appears that you need about 9 cm for effective therapy. As you said, this is an approximate therapy setting for you. I don't believe that 1 night in a sleep lab (strange surroundings, etc) can reveal the EXACT pressure for you. Yours seems to have been pretty good but there are times during the night or on some nights when you may need a little more. That's why I like and auto range but narrow. What was your 90% (95%) pressure? Whatever it is, you spend 90% of your night at that pressure or below and 10% of your night at a higher pressure.

Watching the stability of your 90% and your AHI will tell you if you need to make any changes in that pressure range. Right now, it looks like you hit it right the very first time! You will have some nights you will do well (maybe even lower than your AHI of 2. and some nights it may be a little higher. You want to keep the AHI below 5. This may not happen evey night but you certainly want it to be almost all nights. You may even get an AHI lower than that.

I wouldn't make any more changes in your pressure setting for now unless you get an AHI above 5 for several nights in a row. Then you may have to do a little more tweaking.

I am not a medical person at all, just someone who has been on cpap for quite a while and done a lot of reading on this forum!

You should watch your Apnea Index as well and see how it is. Software is available for many auto and fully data capable machines. With the software you can get very detailed data on your computer showing you all your events, whether or not you are have leak problems with your mask, and your 90(95)% and average nightly pressure. You may want to look into that.

Sounds like you are doing very well. Welcome to the forum! Hope you stick around! There are a lot of people here willing and able to help you a lot!

[Hawthorne]

Forgot to mention that you should list your equipment in your profile (in text not pictures) so that people know exactly what machine and mask you have. That can help us help you. It will appear every time you post if you put it in your profile.

You can see what it says at the bottom of people's posts.

[jmelby]

Welcome to the forum brentm77, and good for you for taking control of your own treatment! I too, find that I have better AHI and sleep better using APAP instead of CPAP. You'll want to get the software, which will depend on what machine you have... so be sure to fill in that info in your profile and you'll find many willing to help you find the right software.

As Hawthorne already mentioned, the important data is:
- AHI (as you know)
- Leak (to know if your mask is effective for you)
- Pressure graphs... with APAP, you'll want to monitor what the pressure actually stays at most of the night--that will help determine the best range.
- For some machines, you can also get data on Central vs. Obstructive apneas. If you have centrals, too high of a pressure can be problematic and possibly indicate a need for BiLevel treatment instead.