New Guy here, feeling thrown to the wolves..

[stopdropandlol]

Hey guys, after years of sleeping 14-16 hours every weekend, and exercising every other option that it could be, I decided to undergo a Sleep Study.. I was diagnosed with Obstructive Sleep Apnea having an AHI of 38.

Other than my Father getting a CPAP Machine back in 2003 and it helping him, I had 0 knowledge of what CPAP was, or what it did.

Here in Alberta, CPAP machines aren't covered by healthcare. There's two routes you can take: You can wait in upwards of 6-18 months for a Government funded overnight Sleep Study, or you can go the private route and do a take home study from a clinic. Having an excellent benefits package at my place of Employment, I went the private route.

Private Clinics don't typically charge you for the study, because their Bread and Butter per se is selling you the machine. I was given a brand new Phillips Respironics REMStar System One with A-Flex that includes an attachable Humidifier. Now because they didn't have the correct size of mask for me, I had to wait a day to pick up the machine. Sitting down with my Father, I decided to do some research into my machine, and CPAP in general. I learned things about ramping pressures, prescribed pressure, minimum and maximum pressures and how important these are to effective treatment of Sleep Apnea. This website and CPAPHelpDesk on YouTube were like bibles for a greenhorn like myself. I now HAD questions to ask and wanted concise answers.

The next day when my mask came in, I asked the lady who I had been dealing with at the clinic (a licensed Respiratory Therapist) a few questions about my machine. When asked what my minimum and maximum pressures were set to, she said they were set to 5cm and 20cm respectively, which are the default minimum and maximum of the machine. I then asked what my prescribed pressure was, and she said that the machine would determine that.

Now my question is, if most of what I've been reading says minimum and maximum pressure are medically determined by severity of the sufferer's Apnea and are very different numbers, then why do I feel as if this machine has been programmed in a "set and forget" fashion? I may be wrong and hopefully I can be enlightened by some of you, but I don't think this is a very active approach to managing my Sleep Apnea? I feel as if I'm being thrown to the wolves here.

After a week today of being on my machine, my AHI is 6.6. Will this get better as I adapt to the machine, or do I have to seriously think about experimenting with pressures to find what works best with my body?

Thanks again!!

Michael

[wmcanally]

I just went back for my 40 day followup from being on my CPAP machine. Mine too is set on Auto. Auto means the machine determimes what pressure you need. My initial AHI was 60.0. After titration ( sleep study with CPAP machine i went to 6.0) After 40 days of therapy my AHI averages 1.9 to 2.3. So yes after time that will adjust. Finding the right mask was the key for me. I use the nasal pillows. Those seem to work the best for me. My Doctor decided to leave mine on auto and not set the ramp. The ramp is the range from the low pressure to the highest. Mine starts out at 5 and my average is 10.8. He reason to leave on Auto setting is at times i go to 15 but it doesnt stay there for long and he says he looks at the average. Keep sleeping with the machine. It will adjust and you will adjust to the machine. For me now its like wearing my socks. Wouldnt sleep without the machine.

[snuginarug]

The pressure needed is not based on the severity of your OSA. We all need different pressures to keep our airways open, and that depends on the construction of our bodies, not how many times we experience apneas.

Most people with an auto have a smaller range set. I am not sure whether therapy is more effective with a narrower range, but having such a big range can sometimes be uncomfortable. I would say you really are being thrown to the wolves, UNLESS the idea is that you stay at this wide range for a certain amount of time, and then the doctor evaluates your data and sets a smaller range of pressure. The answer the RT gave you was a non-answer. If the doctor wants to collect data in order to adjust the machine later, she should have said so. If you are going to be left at 5 to 20, well that is not really attentive treatment. Do you have a follow-up appointment soon? Did you have a titration at the sleep study clinic? In the US it is standard to have the titration done in the sleep lab, but other countries it is standard to do a home titration with an auto machine like the one you have. So it depends on when your next follow-up is. If it is soon, the bird brained RT just gave you a silly answer. If it is not soon, I would think about finding a different doctor. Personally.

Good luck with this adventure called CPAP!

[nanwilson]

Hi Michael
Welcome to the forum from another Albertan
If you have the solftware for your machine you will be able to track your progress. I know that a setting of 5 to 20 is a "fishing" setting and once you can see via the reports where you are 90 % of the time you can reset your pressures. For example, My 90% is at 11, so I set my machine at 10 to 15. We usually use a range of approx 2 or 3 below our normal and 2 or 3 above. If you do not have the clinicians instructions to unlock your settings go to apneaboard.com and you can download them........they are free. Good luck with your therapy, having your Dad there with his cpap experience you are one step ahead of other newbies...you will do fine.
Cheers
Nan

[carbonman]

or do I have to seriously think about experimenting
with pressures to find what works best with my body? Thanks again!! Michael

Don't seriously think about it.....
seriously do it.
It's your life.


.....or enjoy the wolves.

[jamiswolf]

Michael,
Just to reassured you a bit, that's how it's done when you have a home sleep study. That's what happened to me. Since you don't have a pressure titration during the home study, they use an auto machine in "titration mode" meaning wide open pressures. Then, after awhile...a month at my Drs. office, the machine pressures are evaluated. So perhaps you didn't get a good explanation of what was happening, but it was fairly typical when a home study is done.

NanWilson summed things up nicely for you...so follow her instructions which will get you on your way.
J

PS: I edited my comment about titration usually lasting a month. That's just how my Doc did it. Combined it with the compliance visit. I really don't know how it's done elsewhere.

[ameriken]

Will this get better as I adapt to the machine, or do I have to seriously think about experimenting with pressures to find what works best with my body?

This may get better as you adapt to the machine, and yet it may not. And yes, you may have to experiment with pressures to find what works. After 4 months on my machine, my AHI's (which never really made it to a consistent <5) started increasing this past September/Oct. They even climbed into the teens.

I finally tweaked my pressures and since I did that in October, I've never once had over 5.

Remember, IMO, a sleep study only gets a small snapshot of our sleeping. They have just a few hours to narrow down our pressures. We could be a having a good night during the study and needed less pressure. Or we could have been having a bad night and needed more pressure. Either way, I think the titrated pressures are a starting point that may need to be adjusted later.

If you feel more comfortable about it....talk to your doctor about adjusting your pressures. Or, like carbonman said above....this is your life. Take charge of it.

[BlackSpinner]

Now my question is, if most of what I've been reading says minimum and maximum pressure are medically determined by severity of the sufferer's Apnea and are very different numbers, then why do I feel as if this machine has been programmed in a "set and forget" fashion? I may be wrong and hopefully I can be enlightened by some of you, but I don't think this is a very active approach to managing my Sleep Apnea? I feel as if I'm being thrown to the wolves here.

After a week today of being on my machine, my AHI is 6.6. Will this get better as I adapt to the machine, or do I have to seriously think about experimenting with pressures to find what works best with my body?

First - the pressure you need has nothing to do with the severity. You can be extreme severe and only need 7cm to reduce it to next to nothing and vice versa.

Hunt up UncleBob member and find the software for your machine and get a copy of the clinicians manual.An AHI of 6.6 is too high.

You are the only one who can deal with this. As you noticed the RT is more ignorant then you are. Treat the whole thing like diabetes, check your results and adjust accordingly. It is your health, your life, your brains that are affected. Do you wait for a mechanic to say your car needs an oil change or a check up?

[carbonman]

Now, can you imagine one person,
walking into their DME, sitt'n down, and resetting their cpap....
and walk'n out....
....they'd just think he was really sick.

Two people, can you imagine two people,
walking into their DME, sitt'n down, and resetting their cpap's....in sync....
and walk'n out....
...they'd just think they were crazy.

Now, three people.....three people...
walking into their DME, sitt'n down, and resetting their cpap's....
and walk'n out....
....they'd think it was an organization.......

....50...can you imagine 50 people a day...yea, I said 50 people a day,
walking into their DME, sitt'n down, and resetting their cpap's....
and walk'n out....
...they'd think it was a movement.....

and my friends, that's what it is......

Sisters & Brothers of the Yahoo Hoserhood

[Perrybucsdad]

Michael, welcome to the group. My doc didn't do a titration study but had me use the autoset at home with a range of 4 - 14 to start. What you need to realize is that this is just a starter range. When I was on the FFM, I found that I almost needed 20cm of pressure to keep my airway open, but when I switched to nasal pillows, this decreased for me considerably.

What you will want to do is get your software for your unit. You can then analyze what is going on and see what your statistics are. Post some of those here and we can give you suggestions on what we might do if faced with that data. What you will find is most of the time, the bottom number in your pressure range needs to come up as the auto PAP will take some time to reach the level necessary to keep you airway open.

Also, after sometime, I switched out of APAP to CPAP and found it was actually easier to sleep with a constant level of pressure and my AHI didn't suffer.

John

[Janknitz]

You are the only one who can deal with this. As you noticed the RT is more ignorant then you are.

Blackspinner, I respectfully disagree. The OP is undergoing a home titration with an automatic machine. They start out at a wide open pressure to get some idea of where to narrow the range. I don't think an entire month of wide open pressure is necessary (probably has more to do with the clinician's schedule than the OP's need) but that is how it starts out. Once they have some idea of range, they can start to narrow in the range to see what OP's response is and then eventually refine it for him.

If he decides to take matters in his own hands by educating himself he can certainly do his own titration, but my point is that these settings do not automatically indicate the RT is ignorant. This is standard operating procedure for a home titration.

That's how it was done for me, but I got to go back after a week to refine the settings, instead of waiting a month with sub-optimal settings.

[Mary Z]

Michael, you've gotten plenty of replies, so I'll just say welcome and good luck. Please keep us posted on your progress.

[BlackSpinner]

You are the only one who can deal with this. As you noticed the RT is more ignorant then you are.

Blackspinner, I respectfully disagree. The OP is undergoing a home titration with an automatic machine. They start out at a wide open pressure to get some idea of where to narrow the range. I don't think an entire month of wide open pressure is necessary (probably has more to do with the clinician's schedule than the OP's need) but that is how it starts out. Once they have some idea of range, they can start to narrow in the range to see what OP's response is and then eventually refine it for him.

If he decides to take matters in his own hands by educating himself he can certainly do his own titration, but my point is that these settings do not automatically indicate the RT is ignorant. This is standard operating procedure for a home titration.

That's how it was done for me, but I got to go back after a week to refine the settings, instead of waiting a month with sub-optimal settings.

I had a home titration also - one night of it with oxymeter and other monitors. The RT at the hospital spent 45 minutes with me explaining in detail what was happening and how. (and also gave me some guides for my asthma) That was what an real RT does. Of course they don't sell equipment so they don't have to be sales staff too as well as doing the billing so they can actually focus on the patients needs. My doctor gave me the option, come and see these RT's every 6 months or learn how to do it myself.

[rocklin]

.

Hi Michael;

I had the exact same set-up: same machine, same range, and it was unacceptable for me.

The pressure was too high and I gave up after 2 nights.

Then I tried another sleep lab, and they prescribed a flat 10.4 for me.

That was vastly more comfortable.

.
_____________________________________________________________________________________________________
.

My recommendation is to:

1. Switch to a ResMed S9, with a climate-line hose and a cleanable tank

2. Download and install ResScan.

3. Using the included data card, check your results on a computer each morning.

4. If you like, after a few days, you can gradually increase or decrease the pressure. No more than .2 at a time.

5. Keep a written record.

6. Post you results here. You make want to switch to a range, say 10.0 to 13.0. For me, the smaller the range, the better.

7. For me (and others) proper mask fit is 90% of the work.

8. While I don't sleep much (an hour or two each night), my AHI is near 0.0 during those times.
This was the result of constantly experimenting with the APAP, the mask, and my body position.

Please keep us posted,

michael

.

[indy5]

recently started on S9, can somebody please tell me where to get the software from to download the data
Thanks