New to Dreamstation Auto Cpap

Hi,
I finally got my own machine. I was using (per my doctor advise) a loaner until I get mine. So i had the older Phillips system one with humidification. I used it for 5 weeks.

I found the pressure to work best at 13.5 and used a nasal pillow.

My issues untill now,
Wake up 3am with terrible back pain.
Exhaling again the pressure was a challenge.
Sensational of chest pain. (I did go to a Cariology just to be sure its not the heart)

So... my doctor set it to auto 4 to 18....
I not happy with this local regular MD doctor and scheduled an appointment already with a pulmonologist and sleep doctor. Dr. Steven Feinsilver. But UNTILL my appointment date I need help with my new dreamstation.

After getting into clinical mode. I changed the Auto cpap to min 12.00 max 14.00 and a flex to 1 (humidification to adaptive 5, and set the mask type to 1)

I noticed that this machine blows way stronger! (My loaner had already 700 hours of duration before I began using it)

Also when I take the mask off for a second to adjust or to scratch my nose the pressure would ramp up like crazy.

With the mask on it appears the pressure is barely working. Exhaling was so easy.

I went to sleep....

This setting got me up after an hour with a full blown apnea episode! Scary, dry mouth, pumping heart, grasping for air, etc.

So I decided to ditch the auto, and set my new machine like the old system One.

CPAP (not auto)
Flex OFF!

Now the dreamstation should behave like the system one...
I was wrong!!!

First of all, Comparing both machines without the mask just at the hose end, the new machine blows way stronger at the same pressure setting.

Also I still notice pressure changes when I exhale! I compared it again to the old system one machine, and felt the exhaling resistance, but with the dreamstation exhaling is by far way easier even with flex completely off!

So why is the machine flexing and I told him not to?
And why is the machine changing pressure when I take the mask off? Why is it ramping up like crazy? Its no longer on auto or flex!
And I got up multiple times with a dry mouth. This didn’t happen with the old system one.

Any advice is highly appreciated!

- Yoel

If any any time during the night you would like to reengage the ramp, you can hit the smaller button on top. You can also turn it off and on again.

Your back pain is probably because you're lying in one position for much longer than you're accustomed to. If that's the problem, you'll adjust over time.

If you are having issues exhaling, you can try to engage either C-Flex or A-Flex. If either of those are already engaged, try a higher setting or the "other."

I have the Dreamstation machine and use it successfully.

Regarding the Flex control, the settings you have access to only decrease or increase the flex but do not shut it off - low flex, medium flex, more flex, but always flexing.

Regarding the way that the machine ramps up when you put your finger under the mask - that is what CPAPs do to try to maintain a constant pressure when there is a large leak.

If you have apneas, you may need a higher minimum APAP pressure. You don't want the minimum to be below what you need. You really need the CPAP doc to figure this out.

In the mean time, keep the pressure high enough that you don't have apneas and keep your mask secure with no leaks.

If you are having mouth leaks though, then there is nothing the machine can do to fix it. I had that problem so switched to the full face mask and that fixed it for me.

YoelKlein wrote: ↑

Fri Feb 07, 2020 10:05 am

So why is the machine flexing and I told him not to?
And why is the machine changing pressure when I take the mask off? Why is it ramping up like crazy? Its no longer on auto or flex!
And I got up multiple times with a dry mouth. This didn’t happen with the old system one.

Flow rate of the air isn't the same as the pressure setting. It doesn't increase the pressure....but it might increase the flow rate so that more air moves.

Dry mouth is most likely from mouth breathing more now than before.

As for Flex not being off when you turned it off....use available software and see for sure what the machine is doing.

OSCAR https://www.sleepfiles.com/OSCAR/
http://www.apneaboard.com/wiki/index.ph ... stallation
http://www.apneaboard.com/wiki/index.ph ... rpretation

Thank you so much everyone for your support!

The way I got the cpap was rather unconventional. I spoke with a sleep therapist/coach from Respironics who was able to see all my new machine was doing (it has a modern) and explained me everything and answered all my questions.

I will be more then willing to tell my story so others may learn. Should I?

Hi YoelKlein,

You say you have had conversations with a 'therapist/ coach' from Respironics, and that he or she "explained me everything".

Perhaps not everything.

You say you set the machine to Auto, minimum 12, maximum 14.

My guess is that, in order to do that and think it was a good idea, you had to have the concept in your mind that, on Auto, the pressure goes up gradually, 0.1 of a cm at a time, and continuously.

In fact, when on auto-adjusting, the algorithms 'look' at a moving four-minute window, and on the basis of what the algorithms 'see', the pressure goes up 1.5 cm.

The machine then waits during the next four-minute window to 'see' what effect that increase has. If the pattern of events is still disturbing, the machine goes up by 1.5 cm again. And so on.

So not continuous change, but change that is in discrete steps.

Perhaps, you can see now that your 12 minimum, 14 maximum setting cut right across the logic of the algorithms, and prevented the machine doing what it is designed to do.

Another point: you use the word 'ramp' in a way that is not clear. There is a feature on these machines called 'ramp', but it refers only to the first 5-to-45 minutes of turning the machine on. It doesn't refer to the time after that – the time of main use, the time from the end of that starting option to the time the machine is turned off.

The idea of 'ramp start' is to start at a lower pressure than minimum, and gradually built up to that minimum. With the idea that the patient can fall asleep before the machine gets to full minimum pressure.

And you can switch this feature on and off. It is optional. And some people, once they have used the machine for a few months and get used to the pressure, do not bother with it.

So in order not to confuse others, it is better not to use the 'ramp' word to refer to the main-activity auto-adjusting process.

Something else that your 'therapist/ coach' seems not to have told you is that new users of CPAP and APAP often report an ache in the chest muscles, the muscles between the ribs. This is because breathing out against the pressure takes a little more work, a little more effort.

But after a few weeks, the muscles develop and get stronger, and the ache goes away.

Perhaps your 'therapist/ coach' is not themself a patient, and so only knows things as information and not as direct, slept experience.

RB.

Wow, great info. So basically what the Therapist told me, since I have a double issue, 1) I need pap therapy, 2) my “NOSE” is a barrier, stuffing up and blocking the air, and it takes a pressure of 13.5 to UNBLOCK my nose. So his advice was to set the auto min on 13.5 because that’s the pressure I worked out on the previous machine that will overcome my stuffed nose resistance issues, and set the max to a couple numbers higher, so “IF” for some reason the dreamstation decides that 13.5 is not sufficient during an event of air blockage somewhere, the machine will up the pressure to try to overcome it.

So let me repeat what you said, and please tell me if I understood you correctly.

1) the algorithm will start at the min pressure, and then after 4 minutes increase with 1.5 regardless if its needed or not.

2) the algorithm will always increase in 1.5 increments, So I have to make sure that the max pressure is set at least 1.5 or 3 number above. Otherwise the algorithm won’t be able to work and it won’t be on “auto”

Regarding the ramp up: Thank you for making me aware. What I meant to say, the fan ramps up - oops, cannot use ramp. I don’t have another word to explain it.

Hello again.

1. The interruption in breathing these machines are designed to prevent is in the tongue and windpipe area.

Here's a video which many people have found helpful.

https://www.youtube.com/watch?v=-gie2dhqP2c

2. Pressure increases in an auto-adjusting machine depend on what the algorithms 'see' in that four-minute time window.

Can be apneas, hypopneas, snoring, respiratory-effort-related-arousals (RERAs for short), and centrals. Any of these. And if 'enough' of them.

If none of these events happens, and the airway is clear, there is no change in pressure. Except ...

.. with the Philips Respironics machines: even if nothing detrimental is happening, every 20 minutes or so the algorithms raise the pressure by 1.5 cm just to see if that makes any difference. If it doesn't make any difference, the pressure quickly comes back down (by 1.5 cm).

This is a kind of double-checking, built into the design. A 'just in case' prevention measure.

3. Settings. Most people will tell you that leaving the maximum at 20 is best. If the machine's algorithms 'think' they they need to go there, fine. And if they don't 'think' they need to go there, nothing is lost ...

.. unless you/ the patient needs higher pressures AND has bad air-swallowing. And then there might have to be a bit of a trade off – between accepting a few more apneas than optimal in return for a bit less air-swallowing.

4. Back to the topic of blocked nose – I'm one of those people one who don't breathe very well through the nose. AFAIK, the best solution is to use a 'full-face' mask, and not to use sprays more than a few weeks.

BTW, that name – 'full-face' – is a bit of an exaggeration. With one exception, 'full-face' doesn't mean 'covers the whole face'. It means 'covers the nose and mouth'.

Thank you again.

Now I understand why I see a brief pressure increase here and there. See screenshot.

Since I have a beard, I have tried 2 different full face, - or rather month breathing masks, The hair is interfering and cannot seal it right.
Interestingly though, I had a fever last night together with a runny then stuffed nose, coughing, etc. The pressure set to 13.5 was sufficient to push in the air successfully, Man was I worried, but it worked out.

On the Dreamstation LCD it said I showed on average 14.5 (up from min 13.5 and went with a full number increase, not 1.5) but on the chart, It shows mainly on 13.5. I'm still new, so I might not know how to read this Oscar chart.

I would also want to know on what data to focus the most.

Thanks.

Hello again,

Can I direct you to the top of the Home page – where it says 'Announcements'?

Read those next – especially the first two – if you haven't read them before now.

Lots of information – and stuff every APAP user should know.

And the answer to 'Which bits of OSCAR/ Sleepyhead should I post, and in what order?'

I sure will read the top announcements.

Oscar is showing so much data, my question was, What's the most important data I should focus on? all of them? or only the important ones, like, pressure and leaks.

YoelKlein wrote: ↑

Sun Feb 09, 2020 9:59 am

On the Dreamstation LCD it said I showed on average 14.5 (up from min 13.5 and went with a full number increase, not 1.5) but on the chart, It shows mainly on 13.5. I'm still new, so I might not know how to read this Oscar chart.

You need to know what the machine is showing on that LCD screen...
It's what we call a 90% number and all that means is the machine was AT OR BELOW that number for 90% of the night.
It's not an average number at all and the "or below" part of the definition is real important.

You might want to go here and request the provider/clinical manual for your machine .....and read it....as I think it may help you understand your machine better and what it does and why.
https://www.apneaboard.com/adjust-cpap- ... tup-manual

Ohhh, at or below, that makes sense.
Thank you! And thank you again for the link