I'm sure this is a newbie question.
Why don't I just want to set the APAP pressure to its full range of 4 - 20 and let the machine figure everything out? (my Rx doesn't have any pressures on it, it only dictates an auto-cpap machine)
p.s. tonight will be my first night so I'm trying to figure out an initial setup.
APAP pressure settings
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rested gal
- Posts: 12881
- Joined: Thu Sep 09, 2004 10:14 pm
- Location: Tennessee
Claerwen, it's "ok" to have an autopap set for 4 - 20, but for many people 4 is too low to feel comfortable breathing through a mask. Can feel like you're having to work too hard to breathe in.
20 (or whatever pressure you set for the top) doesn't matter if the machine never has to use it.
However, for a FEW people (note the stress on FEW) an autopap could misinterpret their airflow characteristics and run right up to the top pressure and stay there most of the time -- for no good reason. Runaway pressure. Wouldn't actually harm you if it did that, but could sure be uncomfortable to try to breathe out against a very high pressure, cause more mask leaks, more chance of abdominal bloating from air being inadvertently swallowed or pushing past the esophageal sphincter, etc. A runaway pressure scenario could yield skewed info as to what pressure you actually did need.
I'm not a doctor, but I do think it's a good idea to put a leash on the top pressure for a couple of nights when using any autopap for the first time. Perhaps set it for 5 or 6 as the low and 16 as the top. Look at the data the next morning. If it's not hitting 16 at any time, fine. If it is hitting 16 some of the time, raise the high pressure up a couple of notches. Check the data again.
If an autopap continues to spend a great deal of time up at whatever top pressure you set, you might:
A. actually need that high pressure.
or
B. be using an autopap whose algorithms aren't well suited to your breathing. Example, if a 420E auto keeps a person pegging out up at the top pressure, turning off IFL1 might be all that's needed to make it behave if it was misinterpreting their breathing and they don't really need that high pressure.
Setting an autopap wide open, 4 - 20 is not a great idea, imho. I think it's better to set the low up at least a notch or two more than 4, for a chance at more comfortable breathing with a mask on. Set the high at 15 or 16 until you can look at the overnight data DETAILED results to see what's going on.
Using an autopap for a week or two weeks or a month before a download is done can miss a lot of interesting and useful detailed data. Unfortunately, letting a long time go by before doing a download seems to be the norm for most doctors and DME's. Doing frequent downloads takes time they probably would rather not spend. They aren't generally interested in the detailed data anyway. Usually all they are interested in seeing is:
1. how many hours you're using the machine
and/or
2. what's the 90th or 95th percentile pressure the machine used for you -- if they're using the machine for temporary auto-titrating purposes and plan to put you on straight CPAP after a trial with autopap.
Me, I want to see the nightly detailed data before it gets overwritten by newer data. No one's as interested in optimizing our own treatment as we are ourselves. That's why so many of us have gotten the software so we can look at this stuff ourselves, as frequently as we wish. Just like you've done. Very smart of you!
20 (or whatever pressure you set for the top) doesn't matter if the machine never has to use it.
However, for a FEW people (note the stress on FEW) an autopap could misinterpret their airflow characteristics and run right up to the top pressure and stay there most of the time -- for no good reason. Runaway pressure. Wouldn't actually harm you if it did that, but could sure be uncomfortable to try to breathe out against a very high pressure, cause more mask leaks, more chance of abdominal bloating from air being inadvertently swallowed or pushing past the esophageal sphincter, etc. A runaway pressure scenario could yield skewed info as to what pressure you actually did need.
I'm not a doctor, but I do think it's a good idea to put a leash on the top pressure for a couple of nights when using any autopap for the first time. Perhaps set it for 5 or 6 as the low and 16 as the top. Look at the data the next morning. If it's not hitting 16 at any time, fine. If it is hitting 16 some of the time, raise the high pressure up a couple of notches. Check the data again.
If an autopap continues to spend a great deal of time up at whatever top pressure you set, you might:
A. actually need that high pressure.
or
B. be using an autopap whose algorithms aren't well suited to your breathing. Example, if a 420E auto keeps a person pegging out up at the top pressure, turning off IFL1 might be all that's needed to make it behave if it was misinterpreting their breathing and they don't really need that high pressure.
Setting an autopap wide open, 4 - 20 is not a great idea, imho. I think it's better to set the low up at least a notch or two more than 4, for a chance at more comfortable breathing with a mask on. Set the high at 15 or 16 until you can look at the overnight data DETAILED results to see what's going on.
Using an autopap for a week or two weeks or a month before a download is done can miss a lot of interesting and useful detailed data. Unfortunately, letting a long time go by before doing a download seems to be the norm for most doctors and DME's. Doing frequent downloads takes time they probably would rather not spend. They aren't generally interested in the detailed data anyway. Usually all they are interested in seeing is:
1. how many hours you're using the machine
and/or
2. what's the 90th or 95th percentile pressure the machine used for you -- if they're using the machine for temporary auto-titrating purposes and plan to put you on straight CPAP after a trial with autopap.
Me, I want to see the nightly detailed data before it gets overwritten by newer data. No one's as interested in optimizing our own treatment as we are ourselves. That's why so many of us have gotten the software so we can look at this stuff ourselves, as frequently as we wish. Just like you've done. Very smart of you!
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Guest
Thank you Rested Gal! That was exactly the explanation I needed.
As you said, "No one's as interested in optimizing our own treatment as we are ourselves." I will be doing a lot of self-monitoring - I think that's the only way to be when it comes to your health. It amazes me that everyone is not this way.
I've been lurking on this board for the last couple of weeks since my diagnosis and have learned a lot from your many posts. You are a real asset to this community.
As you said, "No one's as interested in optimizing our own treatment as we are ourselves." I will be doing a lot of self-monitoring - I think that's the only way to be when it comes to your health. It amazes me that everyone is not this way.
I've been lurking on this board for the last couple of weeks since my diagnosis and have learned a lot from your many posts. You are a real asset to this community.
apap 4-20
My APAP Rx was for 4-20 and that seemed reasonable, particularly since I had no sleep study. BUT when I first tried the mask, I would have SERIOUS blowouts all through the night. Rested Gal and I tossed this back and forth and she allowed me to realize that, while 4 was a comforatable setting for me (but I have oxygen 5L hooked into above hose so didn't get the "can't get enough air" I am sure I would get without the 02) - Anyway, we talked about my machine going from 4 to whatever highest pressure it went to, (don't have card reader yet) and realized that if I adjusted my mask for comfort and fell asleep at 4, it just wasn't a workable mask adjustment for the higher pressure, so I fought mask leakage ALL NIGHT LONG - wanted to through the thing across the room, but it costs too much money and I need it. Because I bought machine at cpap.com vs DME, I had the manual with instructions how to change the pressure. I changed the minimum to 7 and the maximum to 12 until I can get mask to where it doesn't leak at night. That helped the problem immensely, but then had problems one night when "baffles that puff up against face" (UMFF mask) weren't quite dry AND I was not washing my face before bed where the mask went - H20 + AM moisturizer added up to DRAMATIC mask leakage (scared the dog and kept the husband awake as well as me). Talked to Rested Gal again (she is an absolute life saver!!!!! Very knowledgable and very helpful - and fun to talk to too!!)
She suggested I wash around nose and mouth area with just water (my skin is super sensitive to even the mildest soap) and that has worked well the past few nights. PRAISES TO YOU RESTED GAL!!!!!!!!!
Now, another issue I had is that I got hive bumps under the silicone pads on forehead and where the headgear comes across jaws to attach to mask at corner of mouth. NOW I wash my face in am and apply moisturizer as usual then I apply some healing ointment to sore spots from night before then AT NIGHT BEFORE I GO TO BED I wash the areas the mask seal goes well with water, have applied molefoam to silicone pads for forehead with a cutout for sorest spot. I also apply Diprolene Rx prednisone cream to forehead area and along jaw where hives were starting.
Tonight will be night #7 for me and I feel, WITH RESTED GALS HELP, that I am learning more each night and will be able to sleep all night every night before this gig is over.
She suggested trying more than one type of mask to see what works best and then alternating those that do work so your pressure sores have time to heal - GREAT ADVICE RESTED GAL - and I'm waiting for Swift nasal pillows as my next try.
After following this forum, which holds a wealth of information written by people who are new to this and people who have been on cpap for years - all have been through misery we all go through initially - some more than others - but it is people that understand what you're going through and they will support you through this.
I have ordered the smart card reader and software so I can see for myself what my pressures are at during the night. I thought I didn't want to mess with that at first, thinking I could gauge progress by how I feel, but I see now the necessity of incorporating this info to track progress............
Best of luck to you - do you have the info to change the pressures on your machine???
Ellen
She suggested I wash around nose and mouth area with just water (my skin is super sensitive to even the mildest soap) and that has worked well the past few nights. PRAISES TO YOU RESTED GAL!!!!!!!!!
Now, another issue I had is that I got hive bumps under the silicone pads on forehead and where the headgear comes across jaws to attach to mask at corner of mouth. NOW I wash my face in am and apply moisturizer as usual then I apply some healing ointment to sore spots from night before then AT NIGHT BEFORE I GO TO BED I wash the areas the mask seal goes well with water, have applied molefoam to silicone pads for forehead with a cutout for sorest spot. I also apply Diprolene Rx prednisone cream to forehead area and along jaw where hives were starting.
Tonight will be night #7 for me and I feel, WITH RESTED GALS HELP, that I am learning more each night and will be able to sleep all night every night before this gig is over.
She suggested trying more than one type of mask to see what works best and then alternating those that do work so your pressure sores have time to heal - GREAT ADVICE RESTED GAL - and I'm waiting for Swift nasal pillows as my next try.
After following this forum, which holds a wealth of information written by people who are new to this and people who have been on cpap for years - all have been through misery we all go through initially - some more than others - but it is people that understand what you're going through and they will support you through this.
I have ordered the smart card reader and software so I can see for myself what my pressures are at during the night. I thought I didn't want to mess with that at first, thinking I could gauge progress by how I feel, but I see now the necessity of incorporating this info to track progress............
Best of luck to you - do you have the info to change the pressures on your machine???
Ellen
AAP pressure
I see you already have the smart card reader and surely the software - sorry I didn't look at picts at bottom of post. You also have the same machine I have which has CFlex feature also.
I've not got my own pressures, etc. figured out yet (today is day #7 for me) but I can help you reset pressures on machine if you need it. Do you have the CFlex set?
How are you doing with nasal mask - I went to a full face because I knew my mouth would fall open - RESTED GAL can give you some great direction on that - BUT is the mask comfortable???
Ellen
I've not got my own pressures, etc. figured out yet (today is day #7 for me) but I can help you reset pressures on machine if you need it. Do you have the CFlex set?
How are you doing with nasal mask - I went to a full face because I knew my mouth would fall open - RESTED GAL can give you some great direction on that - BUT is the mask comfortable???
Ellen
Tonight will be my first night. T-minus 2.5 hours.
I'll have to see about the Ultra Mirage II - I'm a little worried. It came out #1 in cpap.com's nose fitting program, however the bridge of my nose is wide. I have trouble with sunglasses, etc. I have the mask fitted so I get no/little leaks, but I feel a lot of pressure on my bridge.
I'll try for a few nights and see how it goes - maybe nasal pillows next.
I'll have to see about the Ultra Mirage II - I'm a little worried. It came out #1 in cpap.com's nose fitting program, however the bridge of my nose is wide. I have trouble with sunglasses, etc. I have the mask fitted so I get no/little leaks, but I feel a lot of pressure on my bridge.
I'll try for a few nights and see how it goes - maybe nasal pillows next.
7 posts
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