Need help to find best settings!

My titration pressure was 14. After a month on Auto-PAP, my 95th percentile pressure was around 16. I was prescribed Bi-level Auto PAP for a 2 week trial. My 95th percentile pressure on the VPAP Auto 25 was 19. I don't understand why higher on the Bi-level Auto PAP than on standard Auto PAP (max pressure on both was set at 20).

I'm feeling better, not so exhausted, but still get sleepy during the day. Some days I'm more energetic than others. I don't remember dreaming regularly, but when I do remember dreaming, I typically have a better day (feel more energetic). After mailing my data card to my DME for the 2 week Bi-PAP trial, I started expermenting with the settings. By the way, during the 2 week trial on Bi-PAP, my energy level decreased each day until I was feeling rather exhausted at the end of the 2 weeks. On the Auto-PAP trial, I didn't leave the settings at the 6 min and 20 max the DME set it on, so I was able to improve my therapy.

Here are my thoughts/questions:

1. Why is my 95th percentile pressure higher on Bi-level Auto-Pap than on Standard Auto-PAP (both units were Resmed - same mask)
2. I tried straight C-PAP (with EPR) at my titrated pressure of 14 and experienced lots of apneas. Slowly increased pressure. I have ongoing problems with leaks (some nights not too bad, but some nights, quite bad), I'm sure due to the high pressure. I generally felt more rested on straight C-PAP and remembered dreaming more often. However, leaks are somewhat of a problem.
3. I'm thinking that the changing pressure while the machine is in auto mode are disrupting my sleep without me realizing it at the time. Not sure though.
4. I'm seriously thinking of changing docs from ENT to Pulmonologist. Both docs in the same medical group, so my records are readily available to the Pulmonologist. Reasons for the change are covered in another thread - I don't really want to get into that again.
5. Before going to see my Pulmonologist, I would like some sort of a "game plan". However, I don't know what to try next. I have almost 8 weeks of detail data (I was fortunate to be able to purchase used software and card reader at a decent price shortly after getting my first Auto-PAP). I will go over the data this weekend. Any suggestions what to look for? So far, I have not been able to determine a pattern that helps me decide what I need to do next.

Any suggestions would be GREATLY appreciated! Please share what has worked for you!

Anybody? I'm really dragging today. Need a good night's sleep tonight!

B B G
I am thinking that you may need to try a F/F mask.

Re feeling increasingly tired on bilevel therapy - ask your doc if there is a connection to not clearing out all the CO2 & does he think that may be a cause ?

Good luck

DSM

Bluebonnet_Gal wrote:Anybody? I'm really dragging today. Need a good night's sleep tonight!

I'm not certain I can help you. What machine (generator) do you have that you want to change its settings? Have you used your ResScan software to look at you median pressure and median leak rate? The 95% numbers for pressure and leak rate are, in my humble opinion, not nearly as useful as the medians.

dsm wrote:B B G
I am thinking that you may need to try a F/F mask.

Re feeling increasingly tired on bilevel therapy - ask your doc if there is a connection to not clearing out all the CO2 & does he think that may be a cause ?

Good luck

DSM

I've tried a FF mask - but never made it through the night. Didn't even make it 30 minutes. I've decided it will be okay to use if I ever get stuffed up with a cold or sinus infection and need to breathe through my mouth, but small leaks were irritating me.

What do you mean by not clearing out all the CO2? How would that be different on bi-level?

KengEsq wrote:

Bluebonnet_Gal wrote:Anybody? I'm really dragging today. Need a good night's sleep tonight!

I'm not certain I can help you. What machine (generator) do you have that you want to change its settings? Have you used your ResScan software to look at you median pressure and median leak rate? The 95% numbers for pressure and leak rate are, in my humble opinion, not nearly as useful as the medians.

I'm using the VPAP Auto 25. I think that's a big part of the problem with getting a great deal of advice here. Not many have experience with that type of machine. I view my data daily and I can't seem to establish any pattern at all. For instance, one of my worst nights followed one of my best nights at the exact same settings. My leak was a little worse the night with worse results, but it wasn't terrible or extremely different than the previous night.

I don't understand how the median is very useful. It's merely the middle of where your pressure or leak were all night. You don't necessarily spend any time at all at that level. I think the 95% percentile is much more useful as most of your time is spent at that level.

I guess I should start keeping a sleep log and see if I can establish a pattern that way. I've never been one to keep a journal or diary though and keeping a sleep log seems too much like a journal or diary - just a chore I'd rather avoid!

Bluebonnet_Gal wrote:I think the 95% percentile is much more useful as most of your time is spent at that level.

Actually the 95th percentile number doesn't mean "most of your time" is spent at that pressure. It means that 95% of the time the machine used that pressure AND pressures BELOW that pressure.

It also means the person spent 5% of the time at a pressure (or pressures) above the 95% number.

A person might actually spend the majority of their time at any of the pressures below the 95% pressure number and very little time right AT that pressure. Only way to know what pressure you really spent most of the time at, is to have the software to see percentage of time spent at each pressure.

I do agree, though, that the 95% number gives more useful information than the median number.

BBG. I reread you post twice yesterday, and couldn't figure out what kind of help you're asking for concerning your settings. That kind of post will never get you the help you need in finding the optimal settings.
Here's why:

Bluebonnet_Gal wrote:My titration pressure was 14. After a month on Auto-PAP, my 95th percentile pressure was around 16. I was prescribed Bi-level Auto PAP for a 2 week trial. My 95th percentile pressure on the VPAP Auto 25 was 19. I don't understand why higher on the Bi-level Auto PAP than on standard Auto PAP (max pressure on both was set at 20).

The answer to this question may be interesting - but neither the info nor the question are relevant to finding good settings on your present machine. Was 19 IPAP (I assume) or EPAP? And what was the other (EPAP or IPAP) 95th percentile? And the AHI?

I'm feeling better, not so exhausted, but still get sleepy during the day. Some days I'm more energetic than others. I don't remember dreaming regularly, but when I do remember dreaming, I typically have a better day (feel more energetic).

Sounds like you're inthe right direction. Now, you have to look for a correlation between the better nights and the machine data - and what you were doing the previous day/evening.

After mailing my data card to my DME for the 2 week Bi-PAP trial, I started expermenting with the settings. By the way, during the 2 week trial on Bi-PAP, my energy level decreased each day until I was feeling rather exhausted at the end of the 2 weeks. On the Auto-PAP trial, I didn't leave the settings at the 6 min and 20 max the DME set it on, so I was able to improve my therapy.

But you're not telling us which settings you came up with, and what you are using presently - and why you chose that.

Here are my thoughts/questions:
1. Why is my 95th percentile pressure higher on Bi-level Auto-Pap than on Standard Auto-PAP (both units were Resmed - same mask)

I don't know, but even if I did, why would the answer help you find the optimal settings on your VPAP?

2. I tried straight C-PAP (with EPR) at my titrated pressure of 14 and experienced lots of apneas. Slowly increased pressure.

Was that on straight pressure too? What happened to your apneas at which pressure and how did you feel?

I have ongoing problems with leaks (some nights not too bad, but some nights, quite bad), I'm sure due to the high pressure. I generally felt more rested on straight C-PAP and remembered dreaming more often. However, leaks are somewhat of a problem.

Feeling better at fixed pressure, and more rested - the how are the leaks a problem?

3. I'm thinking that the changing pressure while the machine is in auto mode are disrupting my sleep without me realizing it at the time. Not sure though.

The only thing that can help you be sure about that is the data you have from the changes you've been making. If you haven't been systematic about recording the changes and the data, now is the time to do it. And stick to each setting for a week or two.

4. I'm seriously thinking of changing docs from ENT to Pulmonologist. Both docs in the same medical group, so my records are readily available to the Pulmonologist. Reasons for the change are covered in another thread - I don't really want to get into that again.

This has nothing to do with helping you find the best settings.

5. Before going to see my Pulmonologist, I would like some sort of a "game plan". However, I don't know what to try next. I have almost 8 weeks of detail data

But you haven't shared any of that data with us.

I will go over the data this weekend. Any suggestions what to look for? So far, I have not been able to determine a pattern that helps me decide what I need to do next.

How on earth can anyone else see a pattern if you don't share the data?

I guess I should start keeping a sleep log and see if I can establish a pattern that way. I've never been one to keep a journal or diary though and keeping a sleep log seems too much like a journal or diary - just a chore I'd rather avoid!

Aha! So that's why that first post was so vague!! Machine data - however detailed is useless if you don't know how the setting made you feel.
And you have to note all the many VPAP parameters (IPAP, EPAP, and all the other breathing settings), and share them too if you want our help in making sense of them.
O.

I agree with Ozij - if you want help with the settings and don't give anyone the data, you are leading us up a blind alley without a way to get out.

If you have the real data, the upload it to a photobucket or other account and provide the url to the data.

You need to keep a detailed log and provide data, if you want help from the forum members.

As far as median versus 95 % ile - RG is right on her description of what the 95 % ile means. It sure doesn't mean you spent 95 % of your time at that pressure. Both numbers give insight, however a detailed graph or chart is even more insightful. I can come up with many distributions of data that have given medians and 95 %ile that don't look at all the same.

Hence, again, more DATA is needed.

As far as disruptions of sleep with pressure changes, yep, happens, but by now I would have expected your system to be used to it.

Is there something else going on?


P.S. Many times people who read posts don't go back and read all the posts by the poster. Sometimes people do, so just because you have posted about something else elsewhere, don't assume the readers recalls it. If it is important to the subject of the thread, you can post the url of the old thread in this new one.

Remember, we have Sleep Apnea and don't always remember everything. In fact, some of us don't remember anything.

Here are reports for the time I had the machine set for the 2 week trial (my first 2 weeks on Bi-PAP):

http://www.box.net/shared/66gleoeuak

As you can see, I had some good nights and I had some terrible nights. I wish I had kept a sleep log, but I didn't. I felt better some days, but worse most days and overall felt like I was getting more and more exhausted as the trial went on.

After I mailed my data card to my DME, I switched the machine to straight C-PAP at my titrated pressure of 14 with EPR of 3. Here are a few nights on straight C-PAP:

http://www.box.net/shared/ks8frnl4g7

I think it may be important for me to keep a sleep log at this point. I think generally dream more and feel better on straight C-PAP.

Bump for those who know Resmeds.

Does it make sense for the machine not to report EPAP results?

I noticed sometimes the IPAP went very low - I wonder if that was not because of the low EPAP, and the pressure support of 4.
I also notice the pressure was going down despite apneas - which would indicate the autoset algorithm isn't getting the triggers needed to raise the pressure when its above 10.

O.