Please help me fine tune my settings :)

bstrange · Post by **bstrange** » Mon May 01, 2006 5:25 pm

I was directed here from another forum and I am kindof lazy so I will just repost my original posts I made there and hope someone can help me out.

bstrange wrote:Ok, I had been diagnosed with OSA a few years back and had the sleep studies and got my CPAP machine ( a VPAP III). I used it maybe 10 times with my maximum length of tolleration at 5 hours.

I am not sure what most of these people are talking about saying they had restful sleep.
I am a shallow breather the VPAPIII would make my lungs feel like they were going to pop and litterally made me feel as though I had spent the night recovering from the exhaustive panting people experience after running a marathon.

I did have some luck regulating it myself. Fortunately for me, after my Insurance paid for it, I received one final call from the comapny that leased it to me and the tecnician showed me how to get into the clinical menu. Sweet Relief!! I got into the menu and adjusted the rise time and dropped the exhale preasure considerably. This is what allowed me my one night of 5 hours continuous use. That morning, I still felt as though I had worked out all night and at 6 am I tore the mask off, and got 1 hour and 20 minutes of the finest sleep I had in my entire life.

I put the machine away forever, I felt I'd rather die than experience the pain caused by that machine nightly and the sleep deprivation, and lets not forget the painful burn of the nasal cavities that lasted all day long....

Whatever the case, I am now about to have RNY gastric bypass and my surgeons say I need to use this if I don't want to die on the opperating table. I don't want to die so I thought I'd try and use it. I put it on last night and the preasure of the air literally picked the mask off my face. I tightened the straps on the mask and same results... tightened tighter... very very tight. Mask stayed sealed. 1 hours passes and I wake up with the most throbbing headache ever (I am guessing from the straps squeezing into my head like a vice). I take off the mask and go to sleep.

This morning I thought I'd try and reset it, but I forgot the way to access the clinical menu. I called the place I got it from only to find they were out of business. I called the Dr. that did the sleep study. They said "sure we can schedule you for another sleep study and set you up" I call my insurance co to make sure it is covered. Because of the previous study and the fact that they already purchased one PAP machine for me it isn't.

Guess I am going to risk it on the table when the chop me up cause there is no way in *** I am going to try and use it the way it currently sits.

I had one final idea. I have the print out of the sleep study (all 26 pages) and the settings perscribed by the doctor. It lists the in and out preasure (it lists nothing for rise time) and I thought if someone could remind me how to put the VPAPIII into clinical mode, I could reset it to the way I got it and just mess with the rise time to try and get some ability to use it between now and my surgery. I tried what I found on some other people's post and held the 2 rightmost buttons while turning it on. All it did was create a message about the HIGH LEAK LAST SESSION.

Someone please help me, I don't want to die, I don't have time or insurance coverage for another sleep study, I just need the button combo to access clinical mode.

then I got some responses (including the one to post here for help) and I posted the following update :

bstrange wrote:Ok I have modified my vpap and gotten a humidifier for it. You are right, when the humidifier is on it dramatically reduces the nasal burning. I also switch back and forth between the full mask and nasal pillows and I have gotten up to about 4 hours at a pop, though it is a miserable 4 hours, I am still using it. I am going to check out the other forum and see if folks there can help with my min / max, and rise time as well as preasure.

Some info I should have added is from my sleep study, when side sleeping, they controled my apnea at preasure of 16/9 however when back sleeping (I split my time even between back and each side) it took a preasure of 17/11 to control it. At this preasure, I was able to tollerate it for 57 minutes during which time, they recorded 2 apneas without hypopneas, they also recorded 7 arousals.

When I got my machine it was set to 18/11 with min/max and rise at the factory default.

Since finding out how to access the clinical menu, I changed it to 18/6 with rise at 200ms, IPAP Max at 2.20 s, and EPap Min at 0.10 s.

I have been wearing it almost every night (think I missed 2 outa 10 days). The settings still are not right and I had stopped experimenting with it because I have been averaging 4 hours outa 7 hours with the mask on. I am going to post on the other forum and maybe we can get it set perfect so I can wear it all night. I have 17 days till surgery, and the most common result is no more sleep apnea within 6 months post surgery, so I want to get it set and going as I will have to wear it in recovery in the hospital.

Thanks for all the replys and sorry it took me so long to get back.

(BTW... I am a guy )

I am hoping you guys can help me fine tune some of my settings so I can get in a whole night(s) sleep

Thanks in advance,
Brad

another fat dude · Post by **another fat dude** » Mon May 01, 2006 8:54 pm

hey man,

i don't mean to be unkind or rude, but it seems as though you are being a bit of an idiot. why are you f***ing around with trying to adjust your own machine, seeking info on this board, etc -- especially before surgery??? you should be under the supervision of a cardio-pulmonary specialist right now. don't f*** around, bro -- get proper MEDICAL supervision! IMMEDIATELY !!! best of luck, man ...

froger25 · Post by **froger25** » Mon May 01, 2006 9:31 pm

Ok let me try and help a bit. I do not like the VPAP III first off so let me go ahead and put that out there. In fact they are picking it up in the next day or so to replace it with an APAP. Anyway by your post and my little experience with the VPAP III I know what your problem is right off.

First I do agree with the other poster, don't screw around with whatever your prescribed pressure is before your operation. What I mean by this is your IPAP. I understand changing any other part of it because the rest is comfort settings. Ok the first thing I notices was you mentioned somethign like 18/6. So I am assuming you were prescribed 18 as I was. The high pressure is fine if that is what you need but I don't agree with your EPAP settings which is where it goes to when you exhale. You should be at about 4 or 5 less than your IPAP in my experience. So you should set it for 13 or 14 (I preferred 4 apart). This will keep you from getting punched by the air. THe next thing I saw was your inhallation time was set to 2.20 I would change that to at least 2.5 in case you take a large breath so you don't have to fight the machine. My last piece of advice is to use your RAMP setting for approximately 20-30 minutes which should allow you to fall asleep to gradual increas with pressure. As far as your mask leaks you need to crank down the straps as much as you can stand and make sure you was your face and keep the seal clean. All of that helped me with the VPAP III on 18.

Good luck. I hope that helps you.

bstrange · Post by **bstrange** » Tue May 02, 2006 4:33 am

another fat dude wrote:hey man,

i don't mean to be unkind or rude, but it seems as though you are being a bit of an idiot. why are you f***ing around with trying to adjust your own machine, seeking info on this board, etc -- especially before surgery??? you should be under the supervision of a cardio-pulmonary specialist right now. don't f*** around, bro -- get proper MEDICAL supervision! IMMEDIATELY !!! best of luck, man ...

Wow, I was angry like that too before I turned mine down...

1st incase you didn't notice, the supplier went out of business (not that most have any clue that there are more than just 2 settings anyways)

2nd the folks that worked at that place are now working at home depot (at least 2 of them) so I am taking the term 'professional' lightly.

3rd the doctors that make these perscriptions do so on the assumption that you will be able to exhale against the force of their settings. With the rise, max and min screwed up, exhaling was accomplished only by drastically dropping exhale preasure. If I get help setting min, max, and rise, I am sure the doctors perscribed 18/11 will work just fine.

4th I'd seek another supplier but the 3 I talked to will not adjust 3rd party equipment.

5th I'd have the doctors look into it but seeing how my insurance paid for one sleep study and PAP machine, they refuse to pay for a second shot regardless of how crappy the original provider was.

6th I got the impression from another member that there were people who had been wearing these for years here willing to help. If you are building a spare bedroom who do you consult, the kid that went to college for arcitecture who charges a fortune for an educated guess or the general contractor down the street that deals with this stuff every day...

Turn down your preasure dude, it's makin you cranky...

NightHawkeye · Post by **NightHawkeye** » Tue May 02, 2006 5:07 am

bstrange wrote:1st incase you didn't notice, the supplier went out of business (not that most have any clue that there are more than just 2 settings anyways)

2nd the folks that worked at that place are now working at home depot (at least 2 of them) so I am taking the term 'professional' lightly.

ROTFL.

bstrange wrote:4th I'd seek another supplier but the 3 I talked to will not adjust 3rd party equipment. . ..

6th I got the impression from another member that there were people who had been wearing these for years here willing to help.

Probably. Hopefully one of the folks who know something about the VPAPIII will wander in here before too much longer. The long term users seem not to check in as often as us new folks.

FWIW, it does sound to me like you are taking a reasoned approach to resolving the bad situation which the medical professionals dropped you into. Regardless of how fine tuned you get your equipment beforehand, be sure to take it with you for use in recovery. That's where people die from sleep apnea.

Also, bring a family member or friend with you, not just to sit in the waiting room, but to be with you as soon as you are wheeled out of surgery. Make sure they know how to monitor your breathing and make sure you are hooked up to your machine the whole time in recovery.

Regards,
Bill

brasshopper · Post by **brasshopper** » Wed May 03, 2006 12:01 am

You know, I've been told that I should have a new study every year or two to verify pressures. You need to talk to your insurance - the diagnostic study they don't need to pay for - but they do need to pay for a re-titration.

In many cases, they don't pay for something as a matter of policy but if a doctor says, "X is medically required" then they will pay. Ask them what their exception policy is for medical necessity.

I have not had these compliance problems, in 18 years, but I also have not (yet) had to deal with the pressures you have. Maybe next week.

The people at cpap.com will sell you a water manometer cheaply. That is the one special tool you will need to set the pressure on an old machine like mine or to verify it on yours. They might also let you know what you need to do to get it into the special mode, especially if you were buying a manometer from them. There is also some guy on eBay who sells images of old clinician manuals for various machines.

It occurs to me that one issue you might have is that the internal manometer in the machine might be off. I just can't imagine setting one up and then not checking it with a manometer and not checking your regular manometer with a water column manometer from time to time.

Please help me fine tune my settings :)

Please help me fine tune my settings :)

one study?