Self Diagnosis help

Hi everyone,

I am happy to find this site and community that looks after CPAP users.

My name is Anthony from Sydney. Hello

I wish to trial my mothers CPAP machine before investing $1,500 on specialist fees and sleep study.

BACKGROUND
My mother was recently diagnosed with Sleep apnoea and has since purchased an A-Flex CPAP machine. Due to other non-related medical reasons and recent surgery, she is having a break from using the machine.

I feel listening to the symptons of Sleep apnoea that I too might have this. Reasons being:
- sleep apnoea is highly hereditary, so the specialist has said
- i snore
- i've been told I gasp during sleep
- i constantly feel cloudy and tired
- when i was a child/teenager, i was diagnosed with ADHD due to concentration issues. As an adult I am off the drug and feel better for it. Maybe the diagnosis was wrong and I had sleep issues.

QUESTIONS
Given i have a new A-flex machine at my disposal, and the cost involved in sleep study here in Sydney, I wish to trial the machine first to gauge its effectiveness. I understand that the best option is to bite the bullet and fork the money out.... but if you could entertain me and guide me, without recourse, I would kindly appreciate this.

- is there anyway of roughly determining my pressure setting without a sleep study?
- if the pressure is wrong, is it dangerous? ie, can lead to permanent medical issues or even death haha?
- Is there any advise people can provide me before I go ahead and try my mothers CPAP?
- on a separate note, my mother was experiencing migraines after using the machine. the doc advised her that 100% its not due to the machine. does this sound right? the memory card shows she is utilising the machine well and pressure is correct. due to the headaches, she is prone to avoiding the machine now.

Thanks for your time

Anthony

Starting from the end of your note (I take it you're in Sydney, Australia [there's another Sydney in Canada]?) your mother's headaches, if she got them in the morning, were possibly due to apnea, not Cpap, and can signal high blood pressure, which apnea causes, or at least aggravates, and she may just have had a badly fitted mask that leaked air a lot (preventing therapy from working), or else she opens her mouth when asleep, losing the 'therapy' air that way, in which case she would need a 'full face' mask (one that also covers your mouth along with your nose). You will need to know what your mother's machine settings are before you change them to test yourself, so you can change them back for her in future (whatever she's doing now or not). Plus you'd need a mask that's fitted for you, or you won't get accurate information. Yes, we can help you set it up, but I think you need to answer the above issues first, then come back here. Also, register for the forum as you'll be able to get more benefit from it - e.g. someone may well want to PM you, but can't unless you're registered, and you will also be shut out of it.

That's how I got started...purchased a machine and then asked questions at this site. It's certainly not the recommended or ideal way but it's doable.

anko7990 wrote:Hi everyone,

I am happy to find this site and community that looks after CPAP users.

My name is Anthony from Sydney. Hello

Hi Anthony, and welcome.

- is there anyway of roughly determining my pressure setting without a sleep study?

You can use your mother's APAP to do that. It will give you some information about breathing disturbances, and how various pressures affect them.

- if the pressure is wrong, is it dangerous? ie, can lead to permanent medical issues or even death haha?

If you're otherwise healthy - no lung problems etc. too much pressure will be so unpleasant it will make you want to take your mask off. By using the APAP in automatic mode, you have a good chance of not having the pressure go too high. However, sometimes in automatic mode it does go very high unnecessarily.

- Is there any advise people can provide me before I go ahead and try my mothers CPAP?

The mask has to fit comfortably, and leaklessly - I would seriously consider investing in a fitting mask. If your mother's mask does not fit you, the experienc may be very uncomfortable, and the results misleading as well.

If you only want an approximation of the number of time your breathing is interrupted, you can set the machine at a pressure of 4 - the atmospheric pressure - and see what it reports on the next day. Any AHI (Apnea Hypopnea Index) above 5 - and you set up a meeting with a specialist.

A night in a sleep lab will let them see if you have other things disturbing your sleep, in addition to your OSA.

You can also try to self titrate - search for your own pressure. You have a number of ways going about that - the one you choose should be based on comfort.

1. Leave the machine's range wide open - 4 - 20 for one night. The next day the machine will come up with a "90%" pressure, which means it supplied higher pressure for only 10% of the time.
   Take note of this pressure and - after this night, set your minimum 2 cms beneath the 90% recommended. My reason for this is that often, when the minimum is too low you have breathing disruptions and in attempting to respond to them, the machine is driven to higher pressure than would be necessary if min. pressure was higher.
   Run the machine with this new minimum pressure, and look at what it does to the AHI and the 90% recommended.
   If you find yourself woken up by a pressure storm, ("runaway pressure") the machine may be overresponding to your breathing pattern and you would have to drop the maximum pressure.
2. An alternative to using automatic (APAP) mode woul be setting the machine at a static pressure, and changing a bit below it, a bit above it, based on the AHI and how you feel. Probability-wise your best bet for this technique would be starting out at 10, because this is what most people need. However, you may belong to the smaller group that need less or more.

For some people, pressure that is too high will cause pressure induced (non-obstructive) breathing cessation aka "central apneas". More is not necessarily better. If I were to find out that I had a high AHI at 4cms/h2o, I would definitely invest in a sleep study.

Some people do better when their therapy pressure is fixed, not letting the machine do its self-adjusting thing.

I am not a physician, nor anything else in the healthy industry -- please keep that in mind.

- on a separate note, my mother was experiencing migraines after using the machine. the doc advised her that 100% its not due to the machine. does this sound right?

It could be the headgear or the way she holds her head when she uses the mask.
The straps do not have to be very tight.
For me, routing the hose from above my head made a big difference.
A different head pillow could also help a lot.

Please tell your mom about this forum and ask her to join and share her problems with us - we may be able to help her tolerate her treatment better - there are many many hours of successful sleep with the machine under our belts here, and many comfort tips the doctor's office may never have heard of.
O.

Thanks for the prompt and detailed responses

Theres alot of technical discussion here and I think I need to read more on this forum to feel comfortable with the guidance.

I currently have a Respironics M-series A-Flex machine with humidifier.
The mask my mum has is a full faced mask and the fit seems good with no obvious signs of leaking.
We seemed to have covered off on the advise given by the forum regarding her headache. hmmm i will tell her to join this forum.
Julie, when you say register, do you mean sign up? cause I thought I already have by creating an account?
PS I'm in Sydney Aus, not Canada... haha. Though I'm sure it's very nice there, maybe a little colder

i have alot of reading to do to implement the advise given. better start reading and researching.

Sorry, you're right about registering (it was very late here when I posted... must have been the cold :0).

Here are two links from RestedGal that may help you;

http://ajrccm.atsjournals.org/cgi/reprint/167/5/716

http://www.alaccoast.org/pdf/Phillips_0830.pdf

Brenda

Julie wrote:Sorry, you're right about registering (it was very late here when I posted... must have been the cold :0).

haha thanks Julie. we're having the opposite down here... in summer. the heat makes you sleepy... i will blame it on OSA

I'm very eager now and somewhat excited.

I've read your replies and combed through "New Users" and "Our Wisdom" and feel confident and inspired that I can self titrate... with a view to see how I feel from the APAP and if positive, then commit to a proper sleep study.

I have so many questions, so please excuse me if they are commonly covered. I just have a few broad questions for now.... to help me get started on self-titrating.

- The machine I have is a new Respironics M-series A-Flex machine with humidifier. So this is an auto-adjusting model?
- where can I find a soft copy of the manual to learn to change the pressure settings? Sleep doc did not give us the manual.
- if a soft copy is not available, could someone refer me to instructions on this forum for my model?
- Ozij provided 2 options. Auto-pressure and Static-pressure. I like the sound of auto-pressure as a first port of call. So I should set the range wide open to 4 - 20 cms and watch 90% the next morning? then this is my ideal static-pressure?
- how do you obtain the results the next day? does it appear on the little screen?
- do i need the software for self-titration or will the little screen on the machine suffice for now?
- how do i check the current settings assigned for my mum from the sleep doctor?
- how do I change the setting from auto to static and vice versa?

If you could guide me with the above for now... I can get started. I am excited at the prospect of feeling refreshed, less cloudy and less anxious.

PS, my machine has one screen and
4 buttons around the screen; <- -> + -
3 big buttons; Power Flex Volume(i think?)

what do these buttons do?

thanks

Anthony

anko7990 wrote:I'm very eager now and somewhat excited.
I have so many questions, so please excuse me if they are commonly covered. I just have a few broad questions for now.... to help me get started on self-titrating.thanks. Anthony

Welcome to this forum, Anthony .
"ozig" gave you some very handy and accurate information, especially the self titrating part.
Just get comfortable with understanding it all before going further down the lane.
Knowledge is power!
D.

anko7990 wrote: - The machine I have is a new Respironics M-series A-Flex machine with humidifier. So this is an auto-adjusting model?

Yes

- where can I find a soft copy of the manual to learn to change the pressure settings? Sleep doc did not give us the manual.

They usually don't.
- if a soft copy is not available, could someone refer me to instructions on this forum for my model?

Wulfman wrote:
If it's just setup information you're looking for, the following instructions should get you there.
Be sure to write down every screen and existing settings before doing any changes.

Den



Menu for M Series Auto

1. Hold down the <- -> buttons while plugging in the power on the back, wait for 2 beeps, release buttons.
2. Press the + key. <- -> buttons move to next field, -/+ keys decrement/increment
3. Check the following field(s):

-Therapy Mode = (CPAP/Auto)

-Auto:Max = (default=20.0cm)

-Auto:Min = (default=4.0cm)

-C-Flex Setting = 2 (options are off, 1, 2 or 3)

-AutoRamp Time = (options are 05 to 45 min)

-AutoRamp Pressure = cm (4cm->AutoMin)

-Mask Alert Feature = On (On/Off)

-Auto Off Feature = Off (On/off)

-Split Night Time = Off (off, 120, 180, 240)

-Show AHI/Leak Feature = On (On/Off)

Press On/Off button to exit.




==========Resetting LCD Display Data====================

To reset LCD Therapy data (does NOT erase any data from SmartCard):

1. Hold down the (<-) (->) buttons while plugging in the power on the back,
wait for 2 beeps or 5 seconds, release buttons.
2. Press the (->) key and navigate to Therapy screen.
3. Press and HOLD down the (-) minus key for 5 seconds and/or until therapy data is reset to Zero.
4. Press the (->) key to scroll back to main menu, press (+) key to enter Setup or
On/Off button to exit.

Don't make any changes before you list down the present settings.

- Ozij provided 2 options. Auto-pressure and Static-pressure. I like the sound of auto-pressure as a first port of call. So I should set the range wide open to 4 - 20 cms and watch 90% the next morning? then this is my ideal static-pressure?

I would not trust one night's result's from a 4-20 range as my ideal pressure. I would use this as an idicator of whereabouts to put the mimum pressure on the following night.

- how do you obtain the results the next day? does it appear on the little screen?

It should

- do i need the software for self-titration or will the little screen on the machine suffice for now?

The software lets you see when events happen, how they are distributed. If you can afford the software - get it.
[I don't know the machine enough to answer your other questions - but many people do.

O.

Anthony, please PM me your email address. I'll be glad to send you the Provider (clinical) manual for the Auto with A-flex.

You're planning to do exactly what I set out to do for myself about five years ago (with success. )

You'll be using a more comfortable machine (imho) to do it.

My story - why/how I started using "cpap":
viewtopic.php?p=5977#5977

Two years into my self-treatment, I finally had a sleep study:
http://www.apneasupport.org/viewtopic.php?p=7956

Interesting read rested gal. With your encyclopedia of knowledge on cpap, it seems hard to fanthom that you were once a newby too.

Rested Gal, I have sent a PM

Thanks Ozij for the detailed advise.

I will start trialling it this weekend, in case the sleep doesnt turn out restful. Im so busy at work at the moment, i dont want to risk it and struggle throughout the day

good-on-ya and good luck with it. A friend of mine is going to do the same thing with my old spare, Or maybe I'll get to use it again!