AutoPAP vs CPAP for SDB

Hello everyone! I am new to CPAP, but I've been stalking this forum for the last couple weeks and it seems like everyone is really helpful.

So I have a question. I have sleep disordered breathing, mixed central/obstructive apnea. I had an inhospital sleep study, AHI 27. More central than obstructive apneas, lowest O2 sat at 78%, but many many hypopneas.

Here is my question.

My titration study recommended 10 cwH2O for my pressure, and my DeVilbiss is set for a ramp and flex, however I feel like the pressure starting out is still not right, and it makes it very difficult to fall asleep. Would it be worth while to switch to AutoPAP with a range of 4-15, or keep it as it is? I know too high of a pressure can increase central apneas, so I'm cautious. I purchased my CPAP outright, so I can make any changes I need, both provider and patient. My AHI for the last 2 nights (that's all I used it so far) is still at 6, and I know if should be lower. I also downloaded Sleepy Head, but I'll be honest, I have NO idea if my machine has an SD card, and if it does, where it would be. I don't have an intellilink, but I think I'm going to buy one.

Any help would be greatly appreciated!!

-Martha

marthea007 wrote: ↑

Mon Dec 31, 2018 6:24 pm

SD card, and if it does, where it would be.

The slot for the card is on the back just above the tubing connector. See page 8 - https://www.directhomemedical.com/machi ... or-use.pdf

It has become common for suppliers not to provide a card, but you should check the slot anyway.

The specs say the card is FAT16 (SDHC FAT32 is Not Compatible) - https://www.cpap.com/productpage/devilb ... #specs-tab .

With the FAT16 file system you cannot use a memory card bigger than 2GB. These are cheap. You may have a little trouble finding one because bigger cards are the rule now. https://www.walmart.com/ip/V7-2GB-SD-Ca ... sGEALw_wcB

ChicagoGranny wrote: ↑

Mon Dec 31, 2018 6:52 pm

marthea007 wrote: ↑

Mon Dec 31, 2018 6:24 pm

SD card, and if it does, where it would be.

The slot for the card is on the back just above the tubing connector. See page 8 - https://www.directhomemedical.com/machi ... or-use.pdf

It has become common for suppliers not to provide a card, but you should check the slot anyway.

The specs say the card is FAT16 (SDHC FAT32 is Not Compatible) - https://www.cpap.com/productpage/devilb ... #specs-tab .

With the FAT16 file system you cannot use a memory card bigger than 2GB. These are cheap. You may have a little trouble finding one because bigger cards are the rule now. https://www.walmart.com/ip/V7-2GB-SD-Ca ... sGEALw_wcB

Thank you!!

hi, marthea! welcome to the forum.

it looks like chicago granny is getting you going with the sd card. that's good and soon, you'll be able to use sleepyhead to monitor your progress.

i'm here to address your "cpap vs apap" question. the clear majority here are going to recommend apap. why? it gives you better control over your therapy. each of us is just that slightest bit different from the other. while there are "rules" that pretty much apply to everyone, a lot does not. what is comfortable and effective for me (minimum 11.4 and max of 20) might be neither comfortable nor effective for you.

so please feel free to experiment with your settings. you obviously have no qualms about that, nor should you. however, instead of setting it to a span of 4-15, may i suggest starting at 6 or 7? most find it very hard to breathe with a starting pressure of 4. you could also bump the upper pressure to 20. it won't go that high unless you need it.

that's all i have for now. soon the experts will weigh in with all the stuff i've forgotten.

good luck!

zonker wrote: ↑

Mon Dec 31, 2018 7:35 pm

hi, marthea! welcome to the forum.

it looks like chicago granny is getting you going with the sd card. that's good and soon, you'll be able to use sleepyhead to monitor your progress.

i'm here to address your "cpap vs apap" question. the clear majority here are going to recommend apap. why? it gives you better control over your therapy. each of us is just that slightest bit different from the other. while there are "rules" that pretty much apply to everyone, a lot does not. what is comfortable and effective for me (minimum 11.4 and max of 20) might be neither comfortable nor effective for you.

so please feel free to experiment with your settings. you obviously have no qualms about that, nor should you. however, instead of setting it to a span of 4-15, may i suggest starting at 6 or 7? most find it very hard to breathe with a starting pressure of 4. you could also bump the upper pressure to 20. it won't go that high unless you need it.

that's all i have for now. soon the experts will weigh in with all the stuff i've forgotten.

good luck!

Thank you for the input! I thought the overall consensus would be for the Autopap, given what I’ve read on here. I just wasn’t sure where to set the numbers. Also, I don’t think I’m completely technologically inept, but pretty sure I don’t have an SD card slot on my DV54D. I went ahead and ordered the SmartLink to make it easier to get my data.

It's hard to have an idea what apap settings to use without knowing what kind of results you are getting now.
The minimum pressure setting is going to be your most critical setting though. None of these apap machines can go from 4 to 10 in the blink of an eye....often we have to give them a decent head start. The idea is to use a minimum that does a good baseline holding open the airway and can increase as needed for the times when the baseline isn't enough to keep the airway from collapsing.
Sometimes more pressure is needed when we are on our backs or during REM.

Often titration studies where a fixed pressure is suggested that is a worst case scenario pressure...something to cover the more difficult times so you use a higher pressure all night just to cover the maybe short periods of time when more pressure is needed.
I need 14 to 18 cm when in REM sleep...but the rest of the night I do quite well at 9 or so.
So I use a 7 cm minimum and the machine goes up to around 9 for the bulk of the night and if I happen to need more pressure during REM it might go to the 14 to 16 range. If I used a 4 cm minimum it couldn't make the trip from 4 or 5 to 14 quickly enough to prevent the airway collapsing. From the 8 or 9 I am at most of the night it can get to 14 or so quickly enough.

I think I would maybe try 3 cm below that fixed pressure as a minimum pressure in apap mode....you gotta start somewhere.
Watch the software reports and if you see very many OAs or hyponeas then increase that minimum a bit.
If you don't see any events flagged...drop the minimum a little and see what happens.
The maximum setting isn't really going to matter much unless going higher (if it does) happens to cause a problem. The machine won't go anywhere without a good reason. So I would set it to 15 or even 20 and if you have a problem pop up then re-evaluate the maximum depending on how high it went and what the problem might be.
Problem being...maybe some aerophagia or higher pressures disturbing sleep or making leaks worse....centrals always a possibility but if you are using 11 now and not having a problem with centrals it is unlikely they will pop up at 12 or 14 should you go there.
It's not nearly as common to have higher pressures trigger centrals as people might think.

Pugsy wrote: ↑

Mon Dec 31, 2018 9:23 pm

It's hard to have an idea what apap settings to use without knowing what kind of results you are getting now.
The minimum pressure setting is going to be your most critical setting though. None of these apap machines can go from 4 to 10 in the blink of an eye....often we have to give them a decent head start. The idea is to use a minimum that does a good baseline holding open the airway and can increase as needed for the times when the baseline isn't enough to keep the airway from collapsing.
Problem being...maybe some aerophagia or higher pressures disturbing sleep or making leaks worse....centrals always a possibility but if you are using 11 now and not having a problem with centrals it is unlikely they will pop up at 12 or 14 should you go there.
It's not nearly as common to have higher pressures trigger centrals as people might think.

Thank you! I will definitely try setting the lower at 7. I think i'll wait making the change though until I have a weeks worth of info, so I have more to go on.

marthea007 wrote: ↑

Mon Dec 31, 2018 9:09 pm

my DV54D

OK, that is the DeVilbiss IntelliPAP 2 AutoAdjust Auto CPAP Machine. You can change the model in your profile equipment profile.

https://www.directhomemedical.com/machi ... or-use.pdf

marthea007 wrote: ↑

Mon Dec 31, 2018 9:09 pm

Thank you for the input! I thought the overall consensus would be for the Autopap, given what I’ve read on here. I just wasn’t sure where to set the numbers. Also, I don’t think I’m completely technologically inept, but pretty sure I don’t have an SD card slot on my DV54D. I went ahead and ordered the SmartLink to make it easier to get my data.

oh! (derp) i believe that the module your getting hooks in the back there and that's where the sd card will reside.

i started my therapy with that machine, i should have remembered that!

okay, so once you've got the module and sd card, then you can acquire sleepyhead and start tracking your therapy. meanwhile, you can at least get started on your pressure spread and see how it works for you.