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Pugsy wrote:Remember that having a few centrals get flagged is normal...like a sleep onset central..those are normal and not cause for alarm.
Sleep stage transition centrals..it's normal to wake up after REM stage. Now we may or may not (usually not) remember waking up but we do and when you do you go back to sleep and another chance for a sleep onset central to happen. We have multiple REM stages during the night so multiple chances for a sleep onset central.

Also we have Sleep/Wake/Junk centrals...or centrals getting flagged during an arousal. Turn over in bed and hold your breath central...quite common but we don't realize we are pausing our breathing but the machine might flag it because it only measures air flow.

So don't get all in a panic over a few centrals here or there....it's normal for one thing and another is a few might be SWJ and those don't count anyway.

Now if you started seeing 4 or 5 centrals every hour...every night all night long...then we have a talk about centrals but the number you are having...even if every one of them were real...isn't enough for concern.

That's good to know, Pugsy, thanks! Generally my centrals are in the middle and end of the night. But as you say they could be sleep/wake/junk centrals.

AMK wrote:If the machine goes to 20 and wakes me up, that's fine, I can just turn the machine off and back on since this happens so infrequently. I would rather wake up than go for an hour with severe OA.

Do you use your ramp feature to get to sleep?

I don't need to use mine for that reason. I have a DreamStation, I don't know about your machine but on the DreamStation the ramp is a separate button. My min pressure is 8 and I set my ramp to start at 8, with a duration of 5 minutes.

So when I want to quickly reduce pressure, I don't need to turn the machine off and on. I simply hit the ramp button. Machine goes back to 8. It's actually preferable to do it that way, for two reasons:

1) the obvious one is that it's one button push instead of two pushes (off and on).

2) the less obvious and more important for me is that the ramp button changes the pressure immediately. In my machine it's not possible to turn off then on quickly. The machine takes a few seconds to turn off during which time it doesn't recognize the second press to turn back on. And I swear, sometimes it even seems to ignore the turn off press for a few seconds.

At least on the DreamStation, there is no harm in pushing the ramp button. It doesn't lock the machine to the lower pressure if the machine thinks it needs to increase it immediately. The whole concept of "ramp" is more a "suggestion" than an imperative.

Anyway, that's what works for me. Your machine may behave much differently.

Yeah, I use the ramp. It's not a separate button, though. I have to hit the power button twice.

the obvious one is that it's one button push instead of two pushes (off and on)

If you use SmartStart (recommended) on the ResMed AirSense 10, you only have to hit the button to turn off. SmartStart will turn the blower on as soon as it detects one or two breaths.

ChicagoGranny wrote:If you use SmartStart (recommended) on the ResMed AirSense 10, you only have to hit the button to turn off. SmartStart will turn the blower on as soon as it detects one or two breaths.

SmartStart (or the equivalent in the Respironics world) is a very good idea.

When my DME tech demonstrated my DreamStation for me, he threw away the clinicians manual. I asked him for it and he fished it out of the trash and gave it to me. So, of course, I was ignorant and dangerous.

Fortunately I restrained myself from turning off autostart. "Chesterton's fence" explains this: if you don't know why something is done, then don't just blindly change it, try to understand it first.

Well, guess what happens with a short power outage or glitch? Simple: The CPAP machine resets itself. With autostart, you might not even know anything happened. The machine simply starts working again. Without autostart, you'll need to wake up to restart your machine.

It's obvious when someone explains it, but I actually figured this out the hard way. One morning, my wife got up before me. When I got up and saw the blinking clocks, she confirmed that we had a short power outage. But I slept right thru it! My DreamStation started working again as if nothing ever happened. The only indication was a short gap in the SleepyHead data.

Pugsy wrote: The thing is though...it's the minimum pressure that is the most critical pressure setting. It does the bulk of the job holding the airway open and the maximum is reserved for the special cases...like REM needs or supine needs.
Often when the minimum is more optimal the maximum pressure reached will actually reduce because the machine doesn't have to go trying to fix something after it has happened...it prevents it in the first place with a more optimal minimum where the machine can go a bot higher more quickly and better prevent the airway from collapsing and thus maybe not need as much on the higher end.

This is so true for me. I have an APAP and when I had my minimum set to 7 and max set to 20, my machine had to go up to 16-17 to correct apnea issues. I upped my minimum pressure to 8 and reduced my max to 18 and now my machine's average maximum pressure is in the 10's and I have no OA or CA apneas at all and about 3-5 hyponeas on average and now, almost no VS's or RERA's. Just that simple change made a huge difference. I know we are all very different in our needs, but this worked beautifully for me.

AMK, I hope you find a good working solution for yourself. All of this can be daunting!

Sleeping Ugly wrote:This is so true for me. I have an APAP and when I had my minimum set to 7 and max set to 20, my machine had to go up to 16-17 to correct apnea issues. I upped my minimum pressure to 8 and reduced my max to 18 and now my machine's average maximum pressure is in the 10's and I have no OA or CA apneas at all and about 3-5 hyponeas on average and now, almost no VS's or RERA's. Just that simple change made a huge difference. I know we are all very different in our needs, but this worked beautifully for me.

You know as often as I mention the "minimum pressure is critical and when it's more optimal sometimes the machine won't need to go so high" thing....it wasn't that for me at least every night. I have done various experiments over the years and no matter what my minimum is I will still see the pressure go to 16 to 18 occasionally when using apap mode occasionally...not every night and not all night long but still occasionally. I had it happen with a minimum of 13 experiment that I did for a week. So now I use a much lower minimum and accept the fact that the machine will on occasion want to go higher and I sleep through it all so I don't care.

I always mention it though because I have seen some rather dramatic max reached changes happen from just a little minimum pressure change.
I saw one person who we thought was going to be needing bilevel because the machine was going to 17 and pretty much staying there all night and that was a problem.
But once we got the minimum pressure doing a better job the machine never went over 12 and time spent at 12 was really minimal anyway.

Pugsy: You know as often as I mention the "minimum pressure is critical and when it's more optimal sometimes the machine won't need to go so high" thing....it wasn't that for me at least every night. I have done various experiments over the years and no matter what my minimum is I will still see the pressure go to 16 to 18 occasionally when using apap mode occasionally...not every night and not all night long but still occasionally. I had it happen with a minimum of 13 experiment that I did for a week. So now I use a much lower minimum and accept the fact that the machine will on occasion want to go higher and I sleep through it all so I don't care.

I always mention it though because I have seen some rather dramatic max reached changes happen from just a little minimum pressure change.
I saw one person who we thought was going to be needing bilevel because the machine was going to 17 and pretty much staying there all night and that was a problem.
But once we got the minimum pressure doing a better job the machine never went over 12 and time spent at 12 was really minimal anyway.

I think it's your theory about gremlins coming in the night to mess with our sleep. Just when you think you have it alllllll figured out--you don't.

I am astonished by what I am learning in this thread. I just now went and turned SmartStart on. It's been off all this time ("off" is the default I guess), and maybe a year and a half ago I had a night where the power went out briefly and I didn't wake up until I had spent over an hour breathing into an "off" machine. I thought my only option was to get a battery or set up a big UPS or something which I'd never gotten around to. And now I find out that I could have had SmartStart on. My DME explained nothing to me and so now here I am 2.5 years later....but better late than never, for sure.

I do have experimenting with min pressure on my list. Thanks for all the info everyone has shared here. Very grateful.

SnoringInOregon wrote:
Fortunately I restrained myself from turning off autostart. "Chesterton's fence" explains this: if you don't know why something is done, then don't just blindly change it, try to understand it first.

huh! thank you for introducing this maxim into my lexicon. very useful!

AMK wrote:I am astonished by what I am learning in this thread. I just now went and turned SmartStart on. It's been off all this time ("off" is the default I guess), and maybe a year and a half ago I had a night where the power went out briefly and I didn't wake up until I had spent over an hour breathing into an "off" machine. I thought my only option was to get a battery or set up a big UPS or something which I'd never gotten around to. And now I find out that I could have had SmartStart on. My DME explained nothing to me and so now here I am 2.5 years later....but better late than never, for sure.

SmartStart is one of my favorite resmed features... It starts up and shuts off so quickly.. and my machine is in a spot where reaching the power button is inconvenient... so I never touch it... just put on the mask and take a breath.

it's another of the nitpicky things I like better about Resmeds than Respironics. The two Respironics machines I've had, one with 'auto start' only, one with both auto start and auto stop, were like trying to suck start an engine.. several strong inhales ... and back then I was using a full face mask, and I'd have to cover the AA vent.. or the thing would ignore me.... the Resmed fires right up.

And when I'd take my mask off, with the Respironics, it'd keep blowing for a minute or more, before shutting off... the Resmed, just a few seconds.

Much smarter machine.

SnoringInOregon wrote:
Well, guess what happens with a short power outage or glitch? Simple: The CPAP machine resets itself. With autostart, you might not even know anything happened. The machine simply starts working again. Without autostart, you'll need to wake up to restart your machine.

Yes, there is also another point. Someone once wrote in here that they had not been using AutoStart. One night they were very tired, put the mask on, got in the bed and hooked the hose to the CPAP. Being dead tired, they immediately fell asleep without remembering to turn the machine on. They woke up a couple of hours later feeling like they had experienced a bunch of apneas.