Basic Question about xpap

I use a APAP
Is the point of the machine to give enough pressure to respond to apnias?

Is it to give enough pressure to prevent them?

I’m looking at my date on sh and there are a lot of apnias some qualify as full apnias bc they are the length of time that qualify but some are too short and aren’t flagged by the program but I think still wake me up.

So now I’m adjusting my pressure slowly upward.

So do I now try to prevent the apnias in the first place or just have the machine high enough that it can respond to apnias when they happen?

Read this and post some SH charts and I'm sure someone can help you
viewtopic/t172378/Sticky--Newbies-PLEAS ... STING.html

moo2425 wrote: ↑

Wed Dec 12, 2018 1:25 pm

I’m looking at my date on sh

Why not use the forum's assets? There are members who have assisted in the interpretation of SH graphs for thousands of people. Post a graph of a typical night or two.

moo2425 wrote: ↑

Wed Dec 12, 2018 1:25 pm

I use a APAP
Is the point of the machine to give enough pressure to respond to apnias?

Is it to give enough pressure to prevent them?

I’m looking at my date on sh and there are a lot of apnias some qualify as full apnias bc they are the length of time that qualify but some are too short and aren’t flagged by the program but I think still wake me up.

So now I’m adjusting my pressure slowly upward.

So do I now try to prevent the apnias in the first place or just have the machine high enough that it can respond to apnias when they happen?

You need to set the minimum pressure high enough to where it eliminates almost all of the events to begin with.
APAPs can't or won't respond to events fast enough to stop them. And, in the case of Apneas, the machine won't respond to them when they're in progress.
APAP algorithms primarily respond (increase pressure) on Flow Limitations and/or Snores (then Hypopneas). But, if the pressure is too low, then it can take too long to raise the pressure. Also, not everyone has Flow Limitations or Snores preceding Apneas and the events will take place anyway. With some users, the pressure changes during the night can be disturbing to their sleep.
So, configuring an APAP is similar to configuring a fixed-pressure CPAP. The minimum pressure is the most important.
The user needs to monitor the types of events they have and how they affect what happens to the pressure. Also, if they're having flow limitations and/or snores which send the pressures soaring, but there are no hypopneas or apneas that are occurring, maybe having a higher maximum pressure could be counterproductive to sound sleep.
Anyway, study your reports and learn from what is going on during the night.

I also strongly suggest that all APAP users at least TRY a fixed/straight pressure setting for a period of time to see how it works for them. Same suggestion to users of APAP machines set to fixed pressure.......try a range and see what happens during the night and how the algorithms react to your events and how the pressure changes affect you and your sleep.


Den

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moo2425 wrote: ↑

Wed Dec 12, 2018 1:25 pm

I use a APAP
Is the point of the machine to give enough pressure to respond to apnias?

APAPs *respond* to apneas, by raising pressure afterwards.

moo2425 wrote: ↑

Wed Dec 12, 2018 1:25 pm

Is it to give enough pressure to prevent them?

Eventually, once you get the min pressure high enough to prevent most events, and let the auto handle exceptions.

moo2425 wrote: ↑

Wed Dec 12, 2018 1:25 pm

So now I’m adjusting my pressure slowly upward.

Keep it up.

moo2425 wrote: ↑

Wed Dec 12, 2018 1:25 pm

So do I now try to prevent the apnias in the first place or just have the machine high enough that it can respond to apnias when they happen?

I think I said it above...

It can get complicated to try to explain how the auto-algorithms work and each manufacturer (with the various generations of machines) has their own particular way of approaching and responding to these events.
But, here is an example of what Respironics had with some of their machines in the past:

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Apneas and Hypopneas are determined by establishing a reference that is based on a moving flow signal window that is a few minutes in duration.

Apneas and Hypopneas are detected as a reduction in flow lasting for at least 10 seconds.
Apnea - 80% reduction in flow
Hypopnea - 40% reduction in flow

Response to Apneas and Hypopneas: Ptherapy
While in Ptherapy mode, if 2 apneas/hypopneas are detected within 3 minutes, the algorithm increases pressure by 1 cmH2O.
Re-initiate Ptherapy for 5 minutes.

Response to Apneas and Hypopneas: Poptimum
In Popt search mode, if 2 apneas/hypopneas are detected within 3 minutes, the algorithm increases pressure by 1 cmH2O.
Re-initiate Ptherapy for 5 minutes.

Detection of Non-Responsive Apneas and Hypopneas
Above 8 cmH2O pressure, the pressure increase for sustained apneas/hypopneas is limited to 3 cmH2O above the pressure setting at the onset of the apnea/hypopnea sequence.
The pressure setting at the onset of the sequence is called the "Onset Pressure."
The pressure 3 cmH2O above the "Onset Pressure" is called the "NRAH Threshold."
"NRAH" is an acronym for "Non-Responsive Apnea/Hypopnea."


Detection of Non-Responsive Apneas and Hypopneas
An apnea/hypopnea x2 event detected after reaching the NRAH Threshold is considered to be non-responsive.

Detection of Non-Responsive Apneas and Hypopneas
A special case of Non-Responsive A/H is when the events are hypopneas only, with no apneas.

Detection of Non-Responsive Apneas and Hypopneas
After seeing two Hypopneas, the algorithm increases the pressure by 1 cmH2O, and the Onset Pressure resets to this new pressure level.

Detection of Non-Responsive Apneas and Hypopneas
However, the Onset Pressure can not be raised above 12 cmH2O by a sustained string of Hypopnea-only events.
This does not imply that the Onset Pressure value can not be set above 12 cmH2O. It only states that the Onset Pressure can not be RESET above 12 cmH2O due to a string of Hypopnea-only events.
The maximum NRAH Threshold due to a sustained string of Hypopnea-only events will be 3 cmH2O above 12 cmH2O.

Response to Non-Responsive Apneas and Hypopneas
When the device encounters a non-responsive apnea or hypopnea, it will decrease pressure by 2 cmH2O and hold the pressure for 15 minutes.
During this 15-minute "NRAH-hold" period, the pressure will be changed only in response to detection of a sequence of vibratory snore events.
The reason for this increase in pressure followed by a decrease in pressure when an apnea/hypopnea is not responsive is to allow the device to respond appropriately to an event that is not treatable by increases in pressure, such as a central apnea.

Elevated Leak Levels represent an exception condition
The persistence of large leaks, particularly when the patient's breaths have small tidal volumes, could potentially induce false apnea and hypopnea detection. Therefore, the REMstar Auto monitors the patient's flow over several minutes.
The patient's flow is compared to "expected leak." "Expected leak" is a value that has been determined through testing of various mask and tubing combinations.

Elevated Leak Levels
As the pressure is increased, the "expected leak" also increases.
The algorithm operates normally while the patient's flow is less than two times the "expected leak."

Elevated Leak Levels
This increased flow is considered to be in "large leak" if the threshold is exceeded for more than 1.5 minutes.

Elevated Leak Levels
The REMstar Auto system responds to the "large leak" by dropping the pressure 1 cmH20 every two minutes until the "large leak" condition is cleared.
As the pressure is dropped, the "expected leak" also drops.

Elevated Leak Levels
The "large leak" is cleared when the patient's flow falls below the threshold for more than 1.5 minutes.


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I wouldn't be messing with my pressures early on, especially before you educate yourself on cpap. You could be doing more harm than good. Educate yourself her first.... ask questions.

Sheriff

i appreciate all the answers