Which auto-pap is best?

[rested gal]

I'm very curious about that too. The only time any machine I've used (not counting what the 420E was doing with me before I turned off IFL1) has gone up above the 10, 11, or 12 that usually keeps my airway open, it's almost certainly been due to mouth air puffs (not wide open leaks, since I tape.) With the air puffs it's been going up to only 13 or 14 (top set for 16, which it's never hit) and comes back down after awhile. The "going-back-down" probably happening when the air puffs waken me enough that I move my tongue into a better sealing position again. I've been aware of consciously surfacing enough to do that from time to time.

I'm not very adept at lining up chicken/egg effects when looking at graphs, so sometimes I find it difficult to see..."hmm, did the leak come first and cause the pressure to go up - or did the fact that the pressure went up some make the mask spring a leak"?

I'd bet on mouth air leaks being responsible for most pressure increases. Even with my lips taped, sometimes the tape loosens along an edge before morning resulting in small puff-type mouth air leaks....and the resulting pressure increases do show up on the overnight data. If the leak has waked me enough to take note of the time, I've seen the correlation on the data. But again, which came first? At any rate, I've not had a single run-up anywhere even close to the top pressure of 16 I had set on both my REMstars. Interesting.

[-SWS]

How do the flow limitations look on your overnight chart, Steve?

I agree that severe nasal impedances can hamper CPAP therapy in general, and AutoPAP algorithms in particular. Interestingly, not all nasal-impedance problems cause this. I have seen each of the three big AutoPAP models do this ramping bit. It's tough to pin point what/why/when an AutoPAP gets fooled into ramping when it shouldn't. Rested Gal posted that her 420e mistakenly ramped until she finally turned IFL1 off. Then she tried both Remstar Autos with no ramping whatsoever. And her very first Remstar Auto model problematically ramped for yet another patient altogether.

Wader and Rested Gal have both given you good advice in this thread IMO.

[-SWS]

You might be able to test your flow limitation hypothesis by trying any OTC spray or medication that is known to reduce your nasal swelling/congestion. If there is none, ask your doctor for a very short-term prescription of something that is guaranteed to reduce the rhinitis/congestion. If your pressure quits ramping, chalk it up to nasal-based flow limitations that need to be permanently addressed. If the pressure continues to ramp, chalk it up to either excessive leaks (which you should be able to discern via data) or simple AutoPAP algorithm incompatibility.

[wading thru the muck!]

rested gal,

I think your suspicions that mouth leaks are to blame are correct. My preliminary guess is that the higher pressure compensates for the leak and that is why the data has 0 min of "Large Leaks." The problem is the ramped up pressure makes the leaks worse. I woke up the other night with the pressure up and my lips ballooned out like Louis Armstrong. several times my wife has woken me saying my mask is blowing on her. This never happened with my PB420E. I'm hoping SWS will help to determine "what's up?"

Glad to hear your's is serving you without a hitch.

[steve7549]

I think that I finally figured out why the Remstar Auto is running away pressure wise. I have a white noise machine that I've used for years on the nigthstand next to my bed. I think that the autopap is intepreting the sound from the white noise machine as snoring! I finally noticed that the snore index for one night was 255!! (I usually don't pay much attention to the snore index because I am not snoring anymore.) DUH! (On the same night, the average flow limitation index was only 1.0.) I didn't realize that the autopap was sensitive enough to pick up ambient room noise as snoring, but that is the only explanation that makes sense.

[-SWS]

Especially if those two machines sit on the same night stand or within close proximity. Yes, the Remstar Auto uses a highly sensitive pneumotach sensor. Let us know if either turning off or relocating your white noise generator has any impact.

Shrewd analysis!!!

[captcpap]

Steve,

I'm very curious too if the "white noise" is interfering with the autopap. I too have white noise running in my bedroom and would like to upgrade to an apap. Let me know if your hypothesis is correct.

Also, you said:

[quote]I was titrated with an Ultra Mirage full face maks and I've tried using it and other full face masks, but have had no luck being able to control the leaks.[/quote]

I have the Ultra Mirage FF Mask and found that with a bit of adjusting I could eventually stop the leaks. On the occasions it does leak it because I was lazy and did not wash my face or the mask where it touches my face for a night or two before I put it on. It almost always leaks then until I clean up.

[captcpap]

Sorry for the quote error above.... still trying to figure out the ins and outs of the forum site... hopefully this quote will work.

[quote="steve7548"]I was titrated with an Ultra Mirage full face maks and I've tried using it and other full face masks, but have had no luck being able to control the leaks.[/quote]

[captcpap]

guess i haven't figured it out yet

[wading thru the muck!]

captcpap,

I cut & pasted what you had into this reply... seems to work for me. It's a mystery.

I was titrated with an Ultra Mirage full face maks and I've tried using it and other full face masks, but have had no luck being able to control the leaks.

[wading thru the muck!]

Captcpap,

Do you have BBCode set to "ON" in your profile? That might be it.