Help with a starting point for the clueless

[rockscreation16]

I'm very new to the CPAP world. I bought a respironics REMstar Auto MSERIES 500M and comfort full 2 mask some time back and was never able to sleep well with it. I was never diagnosed with sleep apnea from a sleep lab. I mostly based my findings off of others who had slept around me. They said I gasped for air and stopped breathing occasionally as well as loud snoring. I spoke with a CPAP technician who recommended an auto machine being that I hadn't been to a sleep lab.

My first question would be... Is it possible for me to properly treat sleep apnea without going for a sleep study?

I found myself taking off the mask in my sleep and waking to the sound of the air blowing through the mask. I'm sure that this will give many false indications as to the settings the auto cpap is adjusting to. I also found that the mask fit in a way that I had to tighten it to uncomfortable levels of tension just to make a decent seal, and It would still leak some at that point.

Second question. What is the best way to accurately size the mask?

I typically have bad nasal congestion at night.

Is it possible that a nasal system will work? or should I stick with the full face?

If it is possible for me to find proper adjustments for my CPAP without going to a sleep lab, what levels at minimum and maximum should I set the machine's range to?

[rockscreation16]

I apologize in advance for asking a bunch of questions that can most likely be answered elsewhere. I'm just at a point where I feel discouraged about the CPAP's ability to help me with restful sleep. There was one night where I successfully slept with the machine on for a period of about 2 hours and woke feeling the most rested I can remember. That's the one bit of hope I have in this. Any help is greatly appreciated!

[Pugsy]

M series APAP. I have 2 of them.

Ideally you need the software to have any idea as to effectiveness of the therapy. There is software available that will work but you need a special card reader to transfer files to the computer.
This one
https://www.cpap.com/productpage/Respir ... r-USB.html

Software I can help with. EncoreViewer 1.0 will work with the M series machines. It doesn't appear to be sold anymore but I have it on disc.

EncoreViewer 2.0 will work, it is $99 I do not have it on disc.

Encore Pro 2.4xx will work but PITA sometimes to install and use. Available from the software good fairy.

I wish you had bought the newer model PR System One APAP. So much simpler to get the data and the data is more comprehensive.

Yes it is possible to treat yourself without a formal sleep study but it takes a lot of dedication, hard work and education so that you know what is going on. Software would make things simpler (but it still will take work).

Have you got the clinician manual for your machine? If not, you need it.. Go here and scroll down till you see your machine and get the download. http://www.apneaboard.com/CPAP%20Adjustment.htm

Mask fit and leaks are often the most troublesome part of this therapy. Please go to the equipment page in your Profile and add your equipment in TEXT please, so that members can see at a glance what you are using and help faster and better. I cannot help with mask issue. I use only the nasal pillow type of mask. If you normally can breathe through your nose during the day and can figure out what is causing the nighttime congestion, that type of mask might be easier to get a good seal on but if you HAVE to breathe through your mouth at anytime during the night then full face mask is needed.

Member Rested Gal self titrated and treated herself several years ago. It can be done and I bet she will stop by and point you in the direction of how she did it. I don't have those links handy.

Did you get the humidifier too?

[BlackSpinner]

One start is to read the wiki - the big light bulb on the top right of the screen. It has lots of basic information. I would suggest you print it out and look at it at your leisure. It is a lot of detailed information and you will want to treat it like study material - use a highlighter, make notes on it.
I don't have your machine so I can't help you there, but I suggest you go to the user control panel on the upper left and add your equipment to your profile so that it always shows when ever you post.

Several of our members have self titrated and been very successful.

As you will have noticed, a comfortable well fitting mask is the key to making this therapy work. Many people experiment with several masks before they find The One. Many of us also use mask liners to help our skin. Another point is that tightening your mask too much makes it leak. It works like a hovercraft in that seal need to inflate to work.

[Mary Z]

Do you get any data from the machine you are using, AI, AHI, leaks? Without these numbers you have to go subjectively on how you feel. I am presently titrating myself. I started first in CPAP mode, but moved to auto at a setting of EPAP of 4/IPAP of 8. In the morning I look at my AHI, AI and pressure. I don't make changes any more often than once a week. If I am consistently reaching the IPAP of 8 and feeling sleepy during the day I will increase both numbers by one- to 5/9, spend another week at that pressure, again keeping notes of numbers and how I feel. I continue like this until I feel good or I am not consistenly hitting the IPAP pressure.
Some people set their machines wide open with an EPAP of 4 and an IPAP of 20 and let the machine do the work of finding the right pressure. I think the main thing is to be consistent, give it at least a week between changes, and keep good notes of numbers and subjective feelings of wellness.
Another thing is to be sure you have a well fitting mask. Good luck.

[purple]

If you are short on green, maybe find a teaching hospital, that trains docs, and ask them to give the sleep test as a charity patient. They usually have an allocation for that, although they might want you to fill out all kinds of annoying paperwork, they need that paperwork to justify to the US government that they are giving away services.

I would also bet some other sleep clinics would do the test as well.

[Pugsy]

M series machines only offer the usual Respironics 7 and 30 day overall AHI averages and I think the same for leaks if I remember correctly. It isn't the large leak percentage that the PR S1 machines show. Might also show 90 % pressure but since I got the software when I got first machine I quit looking at the on screen data, I just can't remember for sure on that part.

There is a way to reset those 7/30 day averages each day to monitor the data on screen on a nightly basis. Which at least is better than lumping it all in the 7 day average. I did this until I got the software.

==========Resetting LCD Display Data====================

To reset LCD Therapy data (does NOT erase any data from SmartCard):

1. Hold down the (<-) (->) buttons while plugging in the power on the back,
wait for 2 beeps or 5 seconds, release buttons.
2. Press the (->) key and navigate to Therapy screen.
3. Press and HOLD down the (-) minus key for 5 seconds and/or until therapy data is reset to Zero.
4. Press the (->) key to scroll back to main menu, press (+) key to enter Setup or
On/Off button to exit.

[Pugsy]

If it is possible for me to find proper adjustments for my CPAP without going to a sleep lab, what levels at minimum and maximum should I set the machine's range to?

If I were using the machine to "screen" to see if OSA was possible diagnosis I would set the pressure ranges low just to see if any events (AHI) showed up. Say 6 minimum and 10 maximum. I did this for my sister and her husband. I did have the software to see if pressure tried to increase to respond to events. My sister had none, but her husband did and it settled very nicely with that range giving AHI of around 2. The minimum of 4 cm setting was just too stifling for them. Each said not enough air was moving and that is why we came up with minimum of 6.

A person could do this along with reset of onscreen LED numbers to get an idea of what happened during the night. I would do it more than one night to make sure though.
If AHI showed less than 5, then that might be just the right range. If AHI was higher than less than 5, I would raise the minimum to 8 and probably raise maximum also. If leaks are under control the maximum pressure doesn't matter because the machine only goes there if it thinks it should for some reason.
If AHI continued to stay higher than 5, I would just keep increasing that minimum pressure till I got an AHI below 5.
Minimum pressure is the critical key because it gives the machine a running start on dealing with the OSA events.
Too low of a minimum and the machine only rises in slow increments and the event has come and gone before the pressure get to where it needs to be to prevent the event.

One could also do the same sort of titration in cpap mode, especially if pressure variations are disturbing.

Gotta go slow though. Don't go changing things on an every night basis because one night of data can be messed up and we not know why. Most often it is leaks though.

[rockscreation16]

Thanks all for the responses!

I don't have any analysis numbers right now as my machine has erased them from being unplugged I guess. The amount of nights with the blower running while the mask was off would probably make for inaccurate results anyway. I'm seeing the default settings as max at 14 cmH2O and min at 6.0. Is that a good starting point? What exactly is the C Flex setting and of 1,2, and 3 whats a good place for me to start with that? I'll try my setup now for a couple of sessions and see what kind of numbers I'm getting. Is it normal to feel slightly lightheaded after using the machine for a few minutes? Also, I do not have a humidifier as the CPAP tech said I shouldn't need one with the humidity in my area. Is this the case?

[Pugsy]

C Flex is exhale comfort only. Start with 2. If it seems "too fast" start with 1.
6 min and 14 max is a good of a place as any. To be honest with 6 cm minimum, that is such a small amount of pressure you probably won't even miss CFlex if you turned it off.

How come you have CPAP tech and are doing this without sleep study and all that stuff? How come they gave you a discontinued model machine?

Humidifier? I wouldn't be without one. If mine broke I would do without the cpap machine before I tried to use the machine without the humidifier. I forgot to add water twice and it was absolutely miserable without it.
SC is humid but most people will need at least some moisture added to that air.

[rockscreation16]

C Flex is exhale comfort only. Start with 2. If it seems "too fast" start with 1.
6 min and 14 max is a good of a place as any. To be honest with 6 cm minimum, that is such a small amount of pressure you probably won't even miss CFlex if you turned it off.

How come you have CPAP tech and are doing this without sleep study and all that stuff? How come they gave you a discontinued model machine?

Humidifier? I wouldn't be without one. If mine broke I would do without the cpap machine before I tried to use the machine without the humidifier. I forgot to add water twice and it was absolutely miserable without it.
SC is humid but most people will need at least some moisture added to that air.

Most all of the decisions i've made in regards to the CPAP has been funding. Basically in conversation with the CPAP tech that I found through an online store we decided that I certainly had sleep apnea and that I could correctly treat it with this automatic machine. I took his suggestion and bought it. My house generally stays around 55% humidity. Think I still need a humidifier?

[Pugsy]

Think I still need a humidifier?

You can try it without it but be warned, drying out of the nasal mucosa creates some awful "allergy like" symptoms.
Sneezy, runny nose, itchy and profound congestion. Doctors routinely write the RX stating "heated humidifier" for a reason.

Some people can do without it but the majority of people even in your area need at least a small amount of added moisture.

Understand about the funding. Used humidifiers not much though. Keep it in mind.