Higher pressures and Apneas with different machine?

I am fairly new to CPAP. Only a month in.

I started off with a F&P icon auto. My pressures averaged 16.5 and AHIs 4.8

I changed to the M series auto for the Cflex function after 2 weeks as i was having muscles pain in my chest from the pressure of breathing out against the machine

Now two weeks later im averaging 18.9 pressure and 7.7 AHI

Any ideas why id have these changes? esp the change in pressure

The difference is a result of the machines' different algorithms: they have different rules for identifying events, and different rules for responding to them. It's not surprsing.

You pressure is pretty high - were you ever tested for Bi-level (i.e. BIPAP) therapy? On bi-level therapy, you get separate pressure for inhale and exhale - and that can make the higher inhale pressure you need easier to tolerate. Sometime doctors won't try you with a bi-level machine because its need won't be approved by insurance unless there' proof you cant tolerate CPAP. Try to complain insistently to your doc -- maybe a bi-level will be easier for you. The exhale relief you can get on a bi-level machine is far greater that you can experience with AFlex or CFlex.

I second Ozij's suggestion that you probably need a Bipap.

Do you feel better or worse with the new machine? The machines will have slight differences in the way they detect events and score the AHI, so I wouldn't take the AHI as the last word on how you are doing...

Are you using software that allows you to see the data? You could try lowering the top limit a bit, to just above what the data shows you need, so that the machine cannot range as high, to see if that would give you better results. With auto machines, it's best not to allow them to range from the top to the bottom, but instead to tighten the range to what the data shows is needed. At the bottom end, you don't want the machine wasting too much time coming up to what is an effective pressure for you, and at the top end, you don't want the machine, for whatever reason, ramping higher than the max you will need.

I can now breathe out comforably against the machine which is good. but there are nights that my pressure is up hitting 20 the whole night and i have more aponeas.

I feel MARKEDLY better with the machine. But then my AHI was 144.3 so its not suprising even avaeraging 7.7 feels good. Right now im borrowing this machine so i cant see the resulkts everyday but i go to the DME once a week and she prints it off.

The range is currently 8 to 20. I upped the bottom range cos i felt like i couldnt breathe at 4 once i got used to the machiney.

I wont be seeing my doc til the end of next month. I will be paying for this machine out of pocket as i live in australia and dont have private health cover (even if i did they only cover about $500) and i am on a high income so the government health doesnt pay for it. I dont mind paying, but if i can avoid a bipap it would be nice given the price haha

ITs good to hear that the machines have different alogrithims., That makes sense.

I do wonder if this is just an old machine and thats the rerason for marked difference in pressures. My DME is going to swap me back to the F&P when she gets on back in stock so i can see if the pressure drops back again lower, but i have to wait a week til someone returns one.

What mask are you using? Are your leaks under control? If you're having excessive leaking that could raise the pressure trying to chase leaks.

using the quattro fx full face mask and my leaks are reasonable most mights. ive had a few nights of high leaks but not many. I dont think thats the reason cos the leaks dont link to the pressure on the graphs

In Philips Respironics' newer machine, a leak actually causes a temporary drop in pressure.

http://www.healthcare.philips.com/main/ ... gement.wpd

Leak Management

Patient leak rate depends upon device pressure. For any given pressure level, the REMstar Auto algorithm compares the measured patient leak rate to an expected amount of leak from the exhalation device in the mask. The robust REMstar Auto algorithm tolerates a wide range of leak fluctuations. If the measured patient leak rate significantly increases above the expected leak for an extended period of time, the enhanced Encore report indicates this large leak by displaying a black bar.

Instead of falsely increasing pressure when a large leak is detected, our novel technology compensates by decreasing pressure in an attempt to re-seal the mask on the patient’s face. It’s safer for the patient and helps to provide uninterrupted sleep.

If you could get a modern Philips Respironics System One (PRS1) Auto or a ResMed S9 AutoSet, you could check your own results, including waveforms and open airway apneas with SleepySead, a free open source program.

I don't know about software/data capability on your F&P machine.

Either of the PRS1/S9 machines will help figure out whether you're having central apneas, which have to be treated differently from normal obstructive apneas.

The M series is obsolete and is hard to read the data from, and doesn't detect open airway apneas.

Different machines will arrive at different AHI numbers and different auto pressures. It's not a black and white "right/wrong" choice to decide what is an apnea and auto pressure. I would not assume the M series is wrong and the F&P was right in their auto pressure.

As someone pointed out, it's easy enough to simply set the M series yourself to not go above the pressure your F&P did.

You might see if you can get the PRS1 or S9 machine.

The F&P is fully data capable.

the M series does in fact show all types of apneas broken into type.

By setting the M series at the pressure the F&P set at wouldnt i be making the damn thing less useful and increase my apneas? Oviously it needs to go to the higher pressure or it wouldnt do so.

IT is a weird anomolie but i guess i figured that at least as far as pressures went they would be standardised across machines.

Oh well. Really its not a huge deal. Right now im working on lowering my AHI with the M series i have by upping the bottom pressure some, esp my start pressure cos im having apneas in the ramp up period.

nichola wrote:I am fairly new to CPAP. Only a month in.

I started off with a F&P icon auto. My pressures averaged 16.5 and AHIs 4.8

I changed to the M series auto for the Cflex function after 2 weeks as i was having muscles pain in my chest from the pressure of breathing out against the machine

Now two weeks later im averaging 18.9 pressure and 7.7 AHI

Any ideas why id have these changes? esp the change in pressure

Perhaps it's the cflex. You could try the new machine for a night or two with it turned off just to find out.

nichola wrote:the M series does in fact show all types of apneas broken into type.

My M series does not distinguish CA (Clear Airway) apneas from obstructive apeneas. Do you have some updated version of M series machine that does?

Distinguishing clear airway from obstructive is valuable because clear airway apneas are probably central apneas, which may require a different form of treatment.

nichola wrote:By setting the M series at the pressure the F&P set at wouldnt i be making the damn thing less useful and increase my apneas? Oviously it needs to go to the higher pressure or it wouldnt do so.

If x cmH2O pressure from the F&P machine is adequately treating your apneas, the M series can give you the same degree of treatment without going over that pressure. If the extra pressure doesn't bother you, or cause central apneas, let the M series do what it wants.

Auto machines don't always get the "right" pressure. If you have one that doesn't get the right pressure, change it's upper or lower limits if that works better. Just because it wants to go higher doesn't mean you "need" a higher pressure. Plenty of people use manual CPAP and get along just fine.

Since the M series can't tell a clear airway apnea from an obstructive apnea, it's a particularly good idea to not give it free reign to run away, since you may be having pressure induced centrals.

nichola wrote:The F&P is fully data capable.

I don't think the free SleepyHead software works with F&P yet. Do you have the F&P software? What's the F&P software's capability? Does it show waveforms? What's it cost? How easy is it to obtain?