Do you need new pressure setting with TAP PAP?

[SleepyCPAP]

I ask because I've experienced a long stretch of "worse" (for me) AHI nights since switching to TAP PAP, but there have been other things which may have affected my night times too. Just going by subjective feel, it seems as if this mask has knocked me off of a balance point. I'm pretty sensitive to changes in my therapy at night, at least I've felt I am, so I gave it about a month to see if things settled down, and still wasn't satisfied with how I was feeling.

I really love the mask, so I contacted my doctor and asked if he would have any objections to me using the "Auto Trial" feature (formerly known as "AutoIQ") set just below and just above my 11cm prescription pressure. No objections. I set it with a low of 8.5 cm and a max of 13.5 cm.

I know, I know -- if I get thrown off balance by a new mask, then this is going to be even worse to be off straight CPAP pressure at night. I dreaded that. In some ways it is. The min pressure feels too low to me and I'm having trouble falling asleep because I'm feeling less pressure support and I'm afraid it isn't going to keep my airway open. RERAs are high, and I'm guessing I'm having other disturbances with all these little pressure adjustments. I'm irritable.

I expected the pressure would climb. But the surprise for me is the machine is staying at 8.5 for most of the night, and except for its "test pressure" spikes the machine isn't getting up to my prescription level -- the 90% pressure has been around 9 to 9.5 cm (SleepyHead tells me 95% has been 8.9 to 9.9 cm). AHI has averaged around .4 over the past few nights, with a high of around .8. Most nights that AHI consists of a few hypopneas, one night I had a CA marked too. There are events not getting flagged, which is another matter, but in general my breath-by-breath patterns look better than the mess that was before this trial.

The machine will soon settle into "CPAP Check" and it looks like I'll be set at 9 cm. I'll notify my doctor.

Is anyone else finding themselves at new pressure levels with TAP PAP?

--SleepyCPAP

[ughwhatname]

I've been using tap pap since April and if anything, my pressures are lower in auto mode than before.

[chunkyfrog]

I have been using Auto mode since early in 2011, and I have lower reported pressure with nasal and nasal pillow masks
than with full face masks. Of course, with APAP I have lower pressure than stated by my titration.
Like I said in another thread, "The dog will not steal."

[Pugsy]

Been using the Tap Pap since it first came out the first of March. My pressures haven't really changed. I see the same pattern of pressures as I did with the Swift FX.

You know the discomfort associated with the new lower minimum pressure may be related to your prior use of the 11 cm fixed pressure. You were used to the air movement and your body may like that amount of air movement and while I would think a month would be long enough to adjust..maybe it isn't.
But maybe the RERAs are your body just not resting well. Lots of mini arousals that you don't remember pointing to fractured sleep cycles and we all know what happens when sleep cycles are messed with....we feel like crap.

Also...maybe the auto changing features of apap mode are disturbing your sleep at some low level. Some people can be really sensitive to even the most minor change in pressures through the night. If you are you sure wouldn't be alone.

If the RERAs are elevated??? how are the Fls? If the FLs are also elevated a bit then you may simply need a little more minimum pressure.

Sometimes is isn't all about what we see on the software reports...sometimes we have to go by how we feel and if our sleep is disturbed then that takes number one priority over what technically gives us good reports.

[SleepyCPAP]

Thanks for the responses,

ughwhatname, I don't remember what mask you were using before. Was it a significantly different category of mask from the TAP PAP? I'm guessing you will tell me what chunkyfrog is saying: that lower pressure comes from switching to nasal pillow type masks.

chunkyfrog, I understand what you are saying in your first two sentences, and it makes sense to me, but I don't understand the part about the dog in this context. I saw that you'd posted it in another person's thread.

Pugsy, I too switched from Swift FX, and thought things would be the same with the TAP PAP. Perhaps it isn't the mask, but it seemed to fit the time period of the change and imbalance of treatment that I'd been having. Flows don't look bad to me -- two nights with zero "FL" marks, and the worst was four. RERAs were up, and Snore2 went way up on my .8 AHI night. I noticed the hypopneas on each of these nights didn't cause pressure increases unless there was also something else marked near it, such as RERA. Not being used to APAP I don't know if that means the machine thinks they are central hypopneas, or if the algorithm ignores them most of the time anyway. I generally get kicked by the pressure pulse (the red dot where the machine tests to see if it is a CA in progress), it seems to reboot my breathing (and I'm guessing boots me out of whatever sleep level I'd been in), so yes, I do think I'm sensitive to pressure changes. I figure I reached REM sleep because I had dreams. I'll see how the CPAP Check mode goes, maybe I will find 9 cm to be just enough pressure to give me confidence to fall asleep. If not, I could manually set the machine to 9.5 or 10. I'm going to check with my doctor about those options. To clarify, I used Auto Trial for just six nights -- the rest of the past month had been the standard CPAP setting, most of it on the new 460 machine but I'd also used my 450 some nights.

In general I'd say the Auto Trial was a good option to have. If I'd tried to do manual adjustments by guessing, I would have guessed going up in pressure. I think that higher pressure jumps increase my Periodic Breathing and my Central Apneas. One advantage to going down is that I could roll to my right side and not be woken by a painful belly of air!

--SleepyCPAP

[ughwhatname]

Thanks for the responses,

ughwhatname, I don't remember what mask you were using before. Was it a significantly different category of mask from the TAP PAP? I'm guessing you will tell me what chunkyfrog is saying: that lower pressure comes from switching to nasal pillow type masks.

--SleepyCPAP

I was using the Swift FX prior to the Tap Pap. I've only used nasal pillow masks. Prior to that, I used the Swift LT for a short time (my first mask.)

[chunkyfrog]

What I meant by the dog won't steal is that I can trust the machine further than I can the operator (lab tech, DME, doctor).
People who bet at dog tracks often believe the races are more honest than horse races, as no dog has a jockey.

[SleepyCPAP]

Good Morning, although I'm quite tired. There was about an hour in the night when I was just laying there. Wife had been up, and a child too, and that was enough to put me on alert and to have kept me awake for a bit, even as I kept breathing into the mask hoping to slide back into sleep. This was the first night of the CPAP-Check mode (9 cm straight pressure). Interesting that SleepyHead lists it as APAP mode with the 6 cm to 12 cm range, but there are no pressure checks at this point, just a flat pressure line (we'll see at 30 hours what happens). No leaks either -- it makes me wonder if my mouth leaking before this adjustment was my body telling me "let off some of this pressure!"

Numbers were good: one hypopnea, 1 snore, but 10 RERAs. "FL" isn't being scored anymore. My quick scan through the breath-by-breath waveform didn't show anything ugly, although perhaps evidence this pressure is just a tiny bit too low based on the tips of the curves, and there may have been an hypopnea that didn't get flagged. There was some moderate waxing and waning but it must not have been enough to be marked as PB.

ughwhatname wrote:
I was using the Swift FX prior to the Tap Pap. I've only used nasal pillow masks. Prior to that, I used the Swift LT for a short time (my first mask.)

OK, ughwhatname, you and I then have a similar experience of a pressure drop going from Swift FX to TAP PAP. So far we're the only ones to notice or say something about it.

chunkyfrog wrote:
What I meant by the dog won't steal is that I can trust the machine further than I can the operator (lab tech, DME, doctor).
People who bet at dog tracks often believe the races are more honest than horse races, as no dog has a jockey.

Thanks chunkyfrog. That makes sense now. Sometimes I need the dots connected to understand. I'm glad I trusted the machine's Auto Trial, because you are right, with me or my doctor in charge we would have been racing the opposite direction, following an imaginary high pressure rabbit.

--SleepyCPAP

[SleepyCPAP]

Just an update. Still using the TAP PAP, and my pressure is still lower. CPAP Check has (after the most recent 30-hours cycle) bumped it up to 10cm though. RERAs are running around 10 or 11 per night at this pressure, which is more than I want but is considerably better than the 16-19 (and even up to 24) per night I was experiencing a week ago at 9 cm.

I can't do as much side sleeping at 10 cm, due to air in the belly. Too bad, as this is one of the reasons I so love this mask -- I'm not laying on any straps when I turn my head, and it never dislodges.

I did have my first experience of rainout in the mask. I was on my side and awoke to tweeting noises. It was condensation getting into the vent holes in the downward position on that side. I did the same solution as I'd done with the Swift FX -- I rubbed my finger over the holes, and it got rid of some moisture. I also rolled another way. It was an unusually humid and cooler summer night, with rain outside and the fresh air due to open windows.

--SleepyCPAP

[SleepyCPAP]

Update with SleepyHead reports for the past month, showing RDI. First I'll show 2013 (TAP PAP) and then similar chart for 2012 (Swift FX).

After a few days at 10cm at the end of July, the CPAP-Check went back down to 9cm. This mask is sooo quiet, especially at this pressure. I was getting some CA's showing up with the TAP PAP at 11cm (in June and early July, before the Auto-Trial), and since then the only two on this 30-day period happened to be nights when pressure went to 10cm or more. Notice that the Periodic Breathing went up on the days it was at 10cm too (if you are a display-watcher, not software reader, then double the SleepyHead number to estimate what the machine's display says PB % was for the night). For me it works better to have it low pressure.



I'm getting pretty close to where I was with the Swift FX during the same 30 day period last year, even with this pressure. My prescribed pressure is 11cm, and that is what I used with the Swift FX, ending up with pretty low AHI and even some zero AHI nights. Not quite there with the TAP PAP at 9cm, but I'm amazed at the numbers at this significantly lower pressure, and that I can turn onto my right side.



Yes, there were CA's at 11cm with the Swift, but overall I was pretty pleased with where the numbers were. But I had to tape my lips at this 11cm pressure, and stay on my back -- I'm beginning to learn to keep my lips closed without tape now that I'm on the TAP PAP at lower pressure.

Summary:
Last Year (2012) / This Year (2013)
Mask Used : Swift FX / TAP PAP
CPAP Pressure: 11 cm / varied, but mostly 9 cm
Compliant Use: all nights 100% / all nights 100%
Average AHI for the month: 0.24 / 0.42
CA: 0.17, OA: 0.04, H: 0.18 / CA: 0.11, OA: 0.04, H: 0.37
Number of “0.0 AHI” nights: 8 / none
Average hours of use/night: 7:18 / 7:40
Average RDI for the month: 1.71 / 2.01
RERA: 1.46 / RERA: 1.60