Initial AutoPAP Range for Beginner

General Discussion on any topic relating to CPAP and/or Sleep Apnea.
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opus49
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Initial AutoPAP Range for Beginner

Post by opus49 » Tue Jun 28, 2022 2:39 pm

Hello. I was diagnosed with moderate sleep apnea about 15 years ago and briefly tried CPAP. It was a disaster. As I slept, the mask seal would break and the pressure would increase so much it would wake me up. I would repeat this process several times per night. After a week of misery, I gave up. I understand this was a mistake, but it is what it is. I'm now in my 40s and with a fresh sleep study (AHI 30.2) my sleep doctor recommended an AutoPAP set to 6-20cm. The DME company said it would be at least three months to acquire a machine so I just paid out of pocket and bought one from cpap.com which should be arriving Thursday.

I've looked through the forum here and watched videos discussing Oscar and SleepHQ and I am more than willing to adjust as I go based on the data. I am very committed to successful treatment.

My question is, should I start with the 6-20 cm suggestion (I was not titrated during my study) or should start with a lower max setting to give myself time to adjust to the machine? Something like 6-10 or 6-15?

Thank you.

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zonker
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Re: Initial AutoPAP Range for Beginner

Post by zonker » Tue Jun 28, 2022 5:28 pm

opus49 wrote:
Tue Jun 28, 2022 2:39 pm


My question is, should I start with the 6-20 cm suggestion (I was not titrated during my study) or should start with a lower max setting to give myself time to adjust to the machine? Something like 6-10 or 6-15?

Thank you.
welcome to the zoo! yes, by all means, start at 6-20. you may never need the pressure to go up to 20, but if it does, you'll be ready.

once you've got some oscar data to post, post it right here, it what is now your therapy thread. then the knowledgeable folk will take a look and advise.

good luck!
why folks don't like it when asked to clarify their statements?
We can't take this journey for you, but there is a forum full of people here who will gladly take it with you.-jnk

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Julie
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Re: Initial AutoPAP Range for Beginner

Post by Julie » Tue Jun 28, 2022 5:28 pm

Lower max is not the issue (until you find out that for some unusual reason it might be). Most leave it at 20 or not a lot lower. It's the min. setting that does the work so, yes, 6 is a place to start (4 is the machine's default low) so while it's a bit hard to breathe at there, 6 is fine to start with again until you have some reason to change it (higher), but don't just do it for... whatever, but use Oscar to judge what to do when and give things - one at a time - a few nights each to get a good idea of how they're working.

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ozij
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Re: Initial AutoPAP Range for Beginner

Post by ozij » Tue Jun 28, 2022 7:51 pm

Here's the voice of the minority:
There are cases in which an autopap will push pressure up more and more, because of how it analyses and misidentifies your breathing pattern.

By all means, try a wide open upper limit, but don't be discouraged if this time around you find pressure rising and bothering you. Share your results, and we'll chip in with suggestions.
I know that for me, as a beginner, the mere presence of pressure - and low pressure at that - made exhale feel difficult - and that caused anxiety.

It's easier for some people, more difficult for others. Some of us really have to train their mind and body to this new way of breathing a sleeping - and training takes time and perseverance.
And now here is my secret, a very simple secret; it is only with the heart that one can see rightly, what is essential is invisible to the eye.

Antoine de Saint-Exupery

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Pugsy
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Re: Initial AutoPAP Range for Beginner

Post by Pugsy » Tue Jun 28, 2022 7:59 pm

ozij wrote:
Tue Jun 28, 2022 7:51 pm
Here's the voice of the minority:
Another minority voice here. Given this situation and the history I would be just fine with limiting that max the first couple of nights until someone can report that they got good solid blocks of sleep so we can do the best job evaluating.
Will he need higher??? Maybe and maybe not but just worrying about it could mess with sleep and we gotta get the sleep first and foremost.

Maybe a nice max of around 12 and see if the machine even goes there.
Worry about getting the sleep first and THEN worry about tweaks if it is proven they are needed.

I am okay with the minimum of 6 though as long as a person is comfortable with it.
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opus49
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Re: Initial AutoPAP Range for Beginner

Post by opus49 » Wed Jun 29, 2022 3:54 am

Thank you to everyone who replied!

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opus49
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Re: Initial AutoPAP Range for Beginner

Post by opus49 » Fri Jul 01, 2022 5:40 am

My first night: https://sleephq.com/public/a809afee-bcf ... fb505bfd34

I left it at 6-20. I did not have the runaway mask pressure like I did years ago, but I felt like I woke up often during the night.

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Pugsy
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Re: Initial AutoPAP Range for Beginner

Post by Pugsy » Fri Jul 01, 2022 5:59 am

You probably did wake up several times during the night. Most people do when first starting cpap and even though you tried this years ago you are really starting all over at step one.
Just from the "newness" or "difference" in everything if nothing else. The brain saying "hey dude, you got an alien plastered on your nose blowing air up it" "that's weird dude". :lol: :lol: I know it took my brain about 3 months to quit doing that and I had zero problems with anything cpap related. I was happy with my mask and had no problems with the pressure or anything. I was quite comfortable yet my brain felt the need to alert me.

The CAs/centrals flagged are most likely associated with the wake ups for the most part. For sure the last little cluster of CAs/centrals is related to wake up because they happen so close to when you turned the machine back on and I doubt you were sound asleep. At least 2 breaks in therapy are shown where we know for sure you woke up. Highly probable that there were a few others. It's a normal part of the adjustment process.

These settings are working well at this time. I would continue with them and see if any trends or patterns develop.

Do you really need ramp???? The machine doesn't flag anything during ramp. Is it set to Auto Ramp or just regular timed ramp?
That looks sort of like an Auto Ramp response with the pressure.

Why are you not using EPR full time? Any special reason?
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opus49
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Re: Initial AutoPAP Range for Beginner

Post by opus49 » Fri Jul 01, 2022 6:06 am

Pugsy wrote:
Fri Jul 01, 2022 5:59 am
Do you really need ramp???? The machine doesn't flag anything during ramp. Is it set to Auto Ramp or just regular timed ramp?
That looks sort of like an Auto Ramp response with the pressure.
It's set to auto ramp. I'm not convinced I need the ramp at all at these settings because I don't feel like 6 is any less uncomfortable than 4. Even when I would wake up and it was at 10 I still felt reasonably comfortable.
Why are you not using EPR full time?
It's how the machine came configured. I debated on changing EPR but ultimately left it.

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Re: Initial AutoPAP Range for Beginner

Post by Pugsy » Fri Jul 01, 2022 6:22 am

I don't know how important EPR is to things to you. You aren't really getting to try it.
When at 4 cm starting ramp point there simply isn't anywhere for EPR to go so it's essentially not doing anything at all.
The machine can't ever go below 4 cm and in Auto ramp it doesn't do a linear increase in pressure so EPR essentially isn't even happening. EPR gives you a 1 cm drop during exhale per the machine setting (setting of 1 is 1 cm drop, setting of 2 is a 2 cm drop and the setting of 3 is a 3 cm drop) but if the machine is at 4 cm...there can be no drop.
And since EPR ends when ramp ends...you are never actually using EPR. You don't know if you would do well with it or not.
I happen to like what EPR does and I feel that the natural breathing feeling it offers helps my sleep.
Other people don't like it and think it hurts their sleep. I have no idea how it will be for you but I do think it is one thing you will want to at least try at some point.....just so you know...especially if you continue with the random wake ups and you can't explain why.

Auto ramp means the machine will use the 4 cm (or you can set it to something else) until 1 of 2 things happen.
1...it thinks you are asleep and ends ramp
2...after 30 minutes it ends ramp whether it thinks you are asleep or not

My personal thoughts about the machine's ability to predict sleep....I am not yet convinced that it is as good as ResMed wants us to believe. :lol: If they were so good at predicting sleep based on breathing patterns then why can't they not flag awake irregularities in breathing patterns. Would make evaluating these reports so much easier.
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opus49
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Re: Initial AutoPAP Range for Beginner

Post by opus49 » Tue Jul 05, 2022 11:03 am

I know it took my brain about 3 months to quit doing that
Three months?! Oof. I'm still struggling with staying asleep, but it hasn't even been a week yet, so I understand I need to be patient.

I spent a few nights at Auto 8-16 and it never went above 10.5, and even when it went up, it seemed to be in response to me waking up and it flagging false apneas. Last night I started off on a fixed level of 9cm and woke up with my heart pounding at 2am. I thought maybe the pressure was too low so I increased it to 10cm and went back to bed.

I guess my question is, based on the attached charts, should I feel comfortable leaving it at 9 cm for a while? I know we're not supposed to fiddle with it every night, but I'm just trying to get to a point where I'm not waking up every hour and getting false pressure increases. I don't see anything obvious on the graph at 2am and it seems pretty clean at 9cm.

Last night: https://i.imgur.com/gu95WYA.png
2am wake-up: https://imgur.com/oUbk59D.png

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Re: Initial AutoPAP Range for Beginner

Post by Pugsy » Tue Jul 05, 2022 11:25 am

opus49 wrote:
Tue Jul 05, 2022 11:03 am
I don't see anything obvious on the graph at 2am and it seems pretty clean at 9cm.
I don't see anything either.

I have no idea why you woke up. Maybe it was nothing but the normally to be expected end of REM stage sleep wake up.
Did you know that it is normal to wake up after a REM stage sleep cycle has completed? Google "sleep stages" and look at the normal hypnograms and you will see what I mean. Most of the time when we wake after REM it is so brief we don't form a memory of the wake up but sometimes we just are awake longer.
Those wee hours of the morning is when we can expect to have more REM.

Add in that "normal" wake up to just the newness of all this cpap stuff and maybe it was nothing more than a normal wake up.

Have you considered maybe trying a little OTC sleep aid???? Or if they don't help maybe have a chat with your doctor about getting some RX short term help?
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opus49
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Re: Initial AutoPAP Range for Beginner

Post by opus49 » Tue Jul 05, 2022 11:31 am

Pugsy wrote:
Tue Jul 05, 2022 11:25 am
I have no idea why you woke up. Maybe it was nothing but the normally to be expected end of REM stage sleep wake up.
Did you know that it is normal to wake up after a REM stage sleep cycle has completed? Google "sleep stages" and look at the normal hypnograms and you will see what I mean. Most of the time when we wake after REM it is so brief we don't form a memory of the wake up but sometimes we just are awake longer.
Those wee hours of the morning is when we can expect to have more REM.
First, thanks for the response and your responsiveness in general. I feel a bit alone going through all of this and I really appreciate your comments and suggestions. I hadn't really considered sleep cycles but that makes sense.
Have you considered maybe trying a little OTC sleep aid???? Or if they don't help maybe have a chat with your doctor about getting some RX short term help?
Another good suggestion, thank you!

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Re: Initial AutoPAP Range for Beginner

Post by Pugsy » Tue Jul 05, 2022 11:41 am

There is nothing to be ashamed of if we need a little help.
Been there and one that and got the T shirt myself.
I still have to take something to help my sleep....and I am not ashamed of it.
I have had long chats with my doctor about it and we weigh the pros and cons to all my options.
We ended up with several options from OTC Benadryl (main component of OTC sleep aids) to pain meds (since pain is one of my causes of wake ups) to sometimes a RX sleeping pill which I can safely take with pain meds as well and it helps me sleep just a little longer and more soundly.

Since I have multiple options I don't get stuck using the same thing each and every night.

I am not a huge fan of melatonin....while it helps a person fall asleep fairly well it doesn't do such a good job of helping someone stay asleep unless someone take the controlled release version and it helps.
Never helped me but did cause extreme vertigo in my situation so I couldn't ever try the controlled release version.
Too scared to.

Just be aware....everything we take (down to the lowly aspirin) has the potential to come with some baggage that we might not like. This is where you evaluate just how important any side effect is or how much that baggage matters.
Yes...I might have a little "hangover" the next day after taking something but for me that "hangover" is not nearly as bad as how I might feel with crappy sleep all night. Damned if you do and damned if you don't kind of thing.
I just opt for the less damning.
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opus49
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Re: Initial AutoPAP Range for Beginner

Post by opus49 » Tue Jul 05, 2022 12:16 pm

Your suggestion led me to this: https://www.aafp.org/pubs/afp/issues/20 ... p1156.html

I have some experience with Lunesta so this feel promising to me. I sent a message to my doc inquiring about a short-term rx. Fingers crossed!