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Re: CPAP to APAP?
Posted: Mon Jun 22, 2009 12:00 pm
by Muse-Inc
Sleep clinic will loan me an APAP when one comes back in (last one went out the door with the appt before me ). Doc isn't worried about my symptoms and wants to see the numbers sleeping with an APAP (and compare to sleep study results) to make sure what I'm experiencing is really events before we start fiddling with differet xPAPs, settings, masks, etc. He did say that losing 50#s may have changed what pressure I need. Current mask is good because it's pretty much just pillows and soft straps which can be easily tightened as I continue to lose if we can get rid of the exhalation issue. I did tighten the chin support 2 nights ago and have less mouth leaking...maybe that'll continue .
He did give me a sample of Astepro to trial for my congestion (in addition to my nightly Nasonex) and suggested that if that's not working, stop and try the Atrovent spray (some report congestion relief using it even tho it's for runny noses); if that doesn't help, then do all three sprays...at different times of course . And continue with the nasal irrigation.
Thanks all for posting info! It's been helpful. Doc is supportive of my future self-monitoring using a data capable machine. Now, I hafta wait until I try the APAP...we talked about exhalation pressure relief vs APAP for me, that was encouraging, so whichever device turns out to be best choice for now he'll work to get it covered by my insurance. The only good thing is that documented during my last 2 visits is a definite turn for the worse in apnea symptoms using my current equipment...even tho my thinking is less disordered than it was . We talked about the potential for improved fasting-morning BGs that I might find using APAP. All good.
Oh, we also discussed the digeridoo 'practice' (no didge yet I'm still learning how to make the right noises ) -- he said to let him know if it seems to work!
Thanks again.
I like my ResMed...is their APAP a good choice in terms of efficacy, size, ease of use, etc? Is there a better choice?
Re: CPAP to APAP?
Posted: Mon Jun 22, 2009 12:06 pm
by Paul56
Muse-Inc wrote:
I like my ResMed...is their APAP a good choice in terms of efficacy, size, ease of use, etc? Is there a better choice?
The AutoSet has the same form factor but a different set of options.
Consider the Autoset TWO machines in one.
It can function as a CPAP and as an APAP.
How it works depends on how you set the configuration.
Re: CPAP to APAP?
Posted: Wed Jun 24, 2009 8:59 pm
by Muse-Inc
OK, my sleep center doc will loan me an APAP. I pick it up next Thursday and have it for 5 nights. I've also asked for a recording oximeter; the one they loan out only records one night's data but since next Friday everyone is off for the July 4th holiday, I'll turn it in the following Monday...sure wish it'd record more than 1 night so we can really tell if these nightly episodes are events or not & desaturations will tell for sure. The doc's PA thinks he'll OK the oximeter without a prob, BUT and this is interesting...he might want me to use it when I'm using my Escape rather than the loaner APAP. They've scheduled time next Thursday to teach me how to use both.
For my recently developed mouth leaks, Doc suggested we up my pressure which I vetoed because even after nearly 2 yrs exhaling against pressure (mine is 11) is still disconcerting and upping pressure might increase my leaks. That exhalation pressure is so strong that I set a ramp ( reset pressure to 8 ) for 5 mins as I'm usually asleep before full pressure kicks in. I still occasionally get sore around my lower ribcage...I'm wondering if I over-tighten those muscles to exhale...doesn't seem sensible but stranger things have been true. In the mornings, my breathing is weird, sometimes feels like I'm not getting enough air (shallow breathing) and occasionally I'll yawn (deep breaths) like crazy for several minutes, like this morning in particular following 5 episodes in the early morning. After I've been up while, breathing seems to settle again or at least I'm not aware of it.
After he gets the data and a chance to analyze it, compare to sleep study (ideally we'd have done another one but living on unemployment precludes that option), then we'll discuss options.
Doc seems to support my taking an active approach to my apnea therapy...mentioned again that my apnea and its side kicks might all go away when I lose all my excess wt. He seems sincere whenever he says this so I gotta have some faith he might be right...he's been a pulmonologist for a long time. Oh, he did say he wished his two earlier patients took as proactive a stance towards their apnea as I do. I said he had my sympathy, apnea is challenging for patient and doc...what's a doc to do? Scare patients into becoming so anxious they can't sleep or not share enough information letting patients remain ignorant or deny the seriousness of this potentially fatal condition? It's a partnership and a lotta folks want immediate resolution (ain't gonna happen) or just don't want to get educated and tweak equipment, settings, etcetera for optimal treatment.
Anything I need to ask about using the APAP? They have several brands, I asked for ResMes as the controls in pics I've seen look like those on my Escape...which I get will depend on what's available next Thursday. I only have 5 nights with it and the goal is twofold: to determine if I'm really having events and to see if my sleep is more refreshing using an APAP and exhalation pressure relief.
Thanks for any suggestions! I'll post any info I can get from the LED for comments-analysis-suggestions so I can make the best of my 5 days...who knows how long it might be until I can afford another machine .
Re: CPAP to APAP?
Posted: Fri Jun 26, 2009 2:27 pm
by mthomtech
Just received my new ResMed AutoSet II. Now I'm just waiting on the software from Australia.
I have to say how awesome cpap.com is. One, the community is fantastic for gaining and sharing knowledge. Two, the website is so thorough, with extremely competitive pricing (I would have easily paid less buying my original machine here w/o including any insurance coverage than what my co-pay was with my DME). I know the ease of use of the site and all the information has certainly encouraged me to take a more active role in managing my cpap therapy. A win-win for me and cpap.com.
Re: CPAP to APAP?
Posted: Tue Jun 30, 2009 3:57 pm
by mthomtech
Well, I got my ResScan software from Australia and started playing around with it.
Quick question to those that use the software. I downloaded the first couple of days of use of my S8 AutoSet II machine, and I noticed that it only had the summary data ... no detailed data was available. Would that be because I'm using the AutoSet in CPAP mode ... and detailed data is only available in APAP mode? Or is there something I'm missing to get detailed data.
Thanks.
Re: CPAP to APAP?
Posted: Tue Jun 30, 2009 4:00 pm
by jdm2857
On the download screen click the Select button next to the Data box.
Then click the All Available Data radio button in the window that opens.
The default, for some Australian reason , is summary data only.
Re: CPAP to APAP?
Posted: Tue Jun 30, 2009 4:15 pm
by Babette
I went from cpap to APAP so I could have the BEST. I wanted a fully data capable machine, that offered me all the posibilities, plus the ability to self-titrate if I thought things needed tweaking.
I go back and forth between modes. Right now I'm running at straight 12 cm cpap, no flex. It seems to be working well for me right now. Things WILL CHANGE FOR NO APPARENT REASON. I've come to accept that. My current machine allows me to tweak the settings to find the optimum CURRENT setting for me.
Good luck!
Barbara
Re: CPAP to APAP?
Posted: Tue Jun 30, 2009 4:45 pm
by Muse-Inc
Babette wrote:Good luck!
Thanks!
I'm excited about getting the APAP loaner (no idea which brand) this Thursday. I get an recording oximeter but it only collects 1 night's data.
I'm hoping someone is around to help get data off the LED Fri morning 'cause I'm clueless! I read the ResMed user guide last night and it's confusing without the actual device .
Re: CPAP to APAP?
Posted: Wed Jul 01, 2009 12:02 am
by Captain_Midnight
Muse asks about experiences switching from those who started on CPAP and went to APAP: why and benefits, please.
First, allow me to agree with those above who extol the virtues of data capability. This is significant if one wants to chart progress v. pressure.
I went from CPAP CFLEX to APAP AFLEX, and for me, the move was priceless.
I've kept my APAP pressure range very narrow (it's now at only 2.5 cm) so if the machine takes off on a wild moose chase, it's not enough of an increase to wake me. I had the lower range set to my titrated pressure, but slowly adjusted it to just a nudge higher than that. (With thanks to those who wrote previously here that AFLEX success sometimes requires a lower pressure slightly above the titrated one.)
Like most apneic patients, my therapeutic pressure range is fairly constant. However, if I have a little seasonal allergy congestion or a cold, or a glass of wine or so, or even if I sleep in an odd position, the auto function compensates quite nicely. I would never go back to straight CPAP
Many experience the opposite, that CPAP is better than APAP. I do wonder, though, how many of the folks with poor APAP experience might have set the pressure range at wide open (e.g. 5-20 cm), which requires AH events for the machine to match pressure with relief. I prefer to start at a high enough lower level to stop events before they start.
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Re: CPAP to APAP?
Posted: Wed Jul 01, 2009 11:15 am
by mthomtech
I just tried my first night on APAP, and I wasn't sure what I'd find.
First, I've only been 4 days on my new ResMed S8 AutoSet II. My previous machine was an F&P HC234, which I was very pleased with ... except for lack of data.
My initial impressions of the ResMed were mixed. Even though it's supposed to be much quieter, and the HC234 was already pretty silent, I felt like I could hear the machine with every breath. However, I really think it is likely do to the machine being SO quiet, that you can hear more ... if that makes sense. I'm going to try them side by side one night. That being said ... the S8 is very very quiet, just different. I also noticed that it seemed like I could hear more in APAP than CPAP ... so I'm probably just picking up the variability and pressue movements. I have not tried EPR yet, as I haven't been uncomfortable with exhalation. But I'll try it soon to see how it effects the numbers.
First 3 days in CPAP mode w/ 8.0 cm of pressure. This is what my prescription is for, and the I did very well. My AHI was 2.1, 2.8 and 2.1 for the 3 days. AI was 0.2, 0.3, 0.3. My leak rate was almost negligible, just slight leaks occasionally, but median was 0 for all but one day. I just started a new mask/headgear, and I always think the headgear relaxes a bit after some use, so I have to adjust the first few days. I've been VERY impressed with the F&P Zest mask, it must fit my face well, because I've been able to really eliminate leaks with it. All in all ... I think very good results in the CPAP mode.
Last night in APAP. I left the settings wide open at 4 - 20. I agree that narrowing it would be good because it is strange going through the range. But then again, I don't really like the ramp mode either ... I only used it for 2 days when I started therapy. But with a prescribed pressure of 8.0 ... it's not hard to get used to. If I had a higher pressure, I'm sure I'd appreciate it more. Anyway ... I thought I would do worse on APAP, and I did wake up a couple of times, but I think it was external to the PAP (dog, wife, etc). Looking at the data, I was pleasently surprised. AHI of 1.8, AI of 0.1 ... only one event late in the morning. The hypopneas were only around every 2 hours, probably defining my sleep cycles or something. Anyway, solid sleep according to the numbers. The leak rate was 0 through almost all of the night. What I was really interested in was the pressure. I was at a median of 6.8, 95th percentile of 9.4 and max of 10.4. Those extra nudges above 8 looked like they took care of 2 or 3 apneas from straight CPAP.
The moral of the story ... having this data is awesome!
Re: CPAP to APAP?
Posted: Wed Jul 01, 2009 7:42 pm
by Muse-Inc
Thanks all of you who posted!! Tomorrow I pick up my APAP to collect 5 nights of data and the 1 night of oximeter data -- I'm excited!
Re: CPAP to APAP?
Posted: Wed Jul 01, 2009 9:15 pm
by mthomtech
Good Luck!
Re: CPAP to APAP?
Posted: Wed Jul 01, 2009 9:59 pm
by socalmonkey
Captain_Midnight wrote:Muse asks about experiences switching from those who started on CPAP and went to APAP: why and benefits, please.
I've kept my APAP pressure range very narrow (it's now at only 2.5 cm) so if the machine takes off on a wild moose chase, it's not enough of an increase to wake me. I had the lower range set to my titrated pressure, but slowly adjusted it to just a nudge higher than that. (With thanks to those who wrote previously here that AFLEX success sometimes requires a lower pressure slightly above the titrated one.)
.
I am making the switch to this machine, so your comments are nice to hear.
But my question is where are the instructions for setting the pressure range? I downloaded the .pdf manual, but it looks rather generic (just like the instruction for my current machine).
Are there any instructions on this site (or somewhere else) that deal with setting the pressure range, specifically on the REMstar Auto M Series with C-Flex with SmartCard?
Update: I just found the correct version of the manual. It looks pretty straight forward. But I can't find where to set the pressure range. I'm guessing I do that in the clinician's setup mode?
Re: CPAP to APAP?
Posted: Thu Jul 02, 2009 12:01 am
by jdm2857
The manufacturer's don't want you to have access to the Clinical Menu, so they have the DME remove that before delivering the machine to the patient.
Someone here should be able to send you a pdf version. I have them for the ResMed S8 II series, but not for Respironics.
Re: CPAP to APAP?
Posted: Thu Jul 02, 2009 9:15 am
by Pugsy
socalmonkey wrote:Are there any instructions on this site (or somewhere else) that deal with setting the pressure range, specifically on the REMstar Auto M Series with C-Flex with SmartCard?
Update: I just found the correct version of the manual. It looks pretty straight forward. But I can't find where to set the pressure range. I'm guessing I do that in the clinician's setup mode?
Yes, you change the pressure range by increasing or decreasing the minimum pressure and the maximum pressures in the clinician menu.
Scroll through menu till you find minimum pressure setting, then use either the plus or minus button to increase or decrease pressure leaving it at your desired choice and then move on to Maximum pressure setting and do the same with it.