Have an Autoset for Trial....I'm having problems

I have finished my trial with the Resmed Elite. They have now given me a Resmed autoset Vantage to try. When I say my sleep Dr. this past week, he mentioned that it may be to my benefit to have an auto machine as I had more than twice as many apnea's when I was in REM sleep. Since here in Ontario it is very hard to qualify for an auto, I thought it might be helpful to have an auto machine for a couple of weeks to see what it would do. The DME was willing to let me have this machine to try till I see the Dr. again on July 8th. I will be taking the machine back on July 6th and the DME will print off the info from the machine. She set the pressure for a range 5-15.

Well...I have used it for 2 nights so far and I am waking up like I am out of breath and gulping air. I don't know if I am opening my mouth or what...I didn't have any trouble like that with the other machine, I am not a mouth breather. My pressure was only set to 7 on the regular CPAP. I did check the numbers both mornings and it said the pressure was 10 yesterday and 10.2 today. Is this an average for the night or just when I am having an episode? The rest of the numbers were good, no apnea's and .3 hypo. Leak was .23. I feel like I am getting less and less sleep. I don't know what to do.

Marlene

Sounds like maybe the lower setting of 5 is too low. I would think it should set at your previous setting of 7.

What is the EPR setting? Are you using the EPR?

I think the minimum 5 cm is too low. I would feel like I wasn't getting any air movement at all at that setting. Also the pressure changes in response to events may be affecting your sleep. Some people are troubled by the changes others aren't. I am at 10 cm min and maxed out at 20 cm. I have hit 15 rarely but never knew it. The changes don't seem to bother me.

I would think the 7 cm minimum would be a much better starting point and then if you still feel problems with sleep or breathing, re-evaluating the maximum.

Yep, I agree. I think the 5 cms setting is most likely too low too and taking too long to get up to your needed pressure.

Slinky wrote:Yep, I agree. I think the 5 cms setting is most likely too low too and taking too long to get up to your needed pressure.

I completely agree. It is important to get that lower number adjusted right.

No wonder it is so difficult to qualify for an Auto machine in Ontario... they set it up incorrectly. The patient comes back and the numbers are the same or more than likely worse than when on CPAP so they say... sorry, no Auto for you given these numbers.

Well, now, Paul. You gotta admit. 5 cms-15 cms makes more sense than 4 cms to 20 cms. (Does that make the Canadians a shade more smarter than the Americans??)

I don't have EPR set up on it...DME told me it didn't work with this particular machine set to auto. Thanks for the advice about the settings, it sure would make sense as they told me they thought my 7 should go to an 8. I will call the DME in the morning and hopefully she will tell me how to change the settings. I don't want to have to drive to the office just for that when I know it is just a matter of pushing a couple of buttons... I certainly know how to do that.

If you have the S-8 AutoSet Vantage, rather than the "Version II" machine, they are correct that no EPR is available in the Auto mode.

I also agree that a pressure of 5 may be too low for you, but NOT for the reasons mentioned:

-- Not getting enough air? Don't confuse pressure with airflow. The machine increases or decreases airflow to maintain whatever pressure is set. During the day you are breathing with a pressure of zero, and each breath gives you enough air. CPAP is not a ventilator; it does not "push" air volume into your lungs. Pressures well above 30 are needed for that to happen. Your body controls the depth and volume of each breath. The machine will "always" give you enough airflow to maintain a positive pressure. One way the pressure may affect your feeling of air hunger is if the lower pressure doesn't adequately clear carbon dioxide from your mask, which is possible, but unlikely.

-- Takes too long for pressure to increase when needed? ResMed machines are well able to increase pressure at 1cm per minute. An extra 2 minutes to go from 5 to 7 is probably irrelevant. On one hand, if you need 7 to prevent apneas, you may experience apneas which would not have occurred if the pressure were at 7 to begin with. On the other hand, you may not need 7 all the time throughout the night, every night; having a lower minimum reduces the pressure (and potentially reduces the leaks) when higher pressures are not needed. That's one of the advantages of an Auto: in theory it gives you only as much pressure as you need. If your doc is on the ball, (s)he will be able to tell from the data card at what pressures your apneas are occurring. [EDIT: Unfortunately, nightly detail data is available only for the most recent 5 days. Only summary data will be available for the preceding days.]

Sorry if I'm making this overly complex, but overly simplistic answers don't really help in the long run, either.
Velbor

Slinky wrote:Well, now, Paul. You gotta admit. 5 cms-15 cms makes more sense than 4 cms to 20 cms. (Does that make the Canadians a shade more smarter than the Americans??)

It means the Canadians don't like pushing the upper limits too far.

I was able to get my DME to let ME change the pressure range over the phone. (I feel so empowered now I can do it myself ) I will see how I make out tonight. Last night wasn't a good night either, woke a lot, so I am really tired now after 3 nights of this. From a lot of posts that I have been reading about auto's and regular CPAP, maybe I really only need the CPAP and this will tell me what the pressure I really need is. If the changes are going to wake me all the time I think the Auto is defeating the purpose for me, I want some quality sleep from whatever means I can get it. We are leaving on vacation on Thursday so hope I can get things sorted out better by then.

Now, that's a great DME! Hope s/he doesn't get picked up by the "CPAP Police" for sharing sensitive clinician's info with a patient :<)

Hi windmill,
I'm waiting for approval for a new auto cpap from Ontario Assistive Devices (OHIP). The DME sent my application on March 25th, and still have not been approved!
I called last month and they told me that there is a backlog of 2 months. I called the technician of the sleep lab where I was diagnosed with severe sleep apnea, to call OHIP but she has not heard from them. In the meantime, I have an old Remstar Auto CPAP machine that my DME rented to me. I've been having some occasional problems with it, such as the suffocation feeling when I wear it with my Quattro mask. My min. setting is: 7cm and the max is set to 16. I ordered the Resmed S8 Autoset II and will have a new Quattro mask, it seems that this machine is specifically designed to work better with the Resmed masks and if you have another mask like a Respironics or other brand, the sleep technician has to modify the pressure settings so you get maximum benefit. I agree with paul56, many DME's don't know how to set up these machines correctly. Every case is different, I still get the occasional bloating, since I've been also diagnosed with GERD, sleep apnea is deadly if left untreated, but also frustrating to deal with at times!!!
I hope that you will get approval soon of your new auto CPAP!

Windmill,

Your DME is sticking you with an outdated piece of equipment. They will bill and receive compensation from the Ontario ADP the same amount whether you have the older unit or the version II. If it turns out that you need higher pressures to get a decent night's sleep, you would be better off with the newer ResMed Autoset II APAP machine that allows EPR if you need assistance exhaling against greater pressures. Don't settle for less.

The sleep lab should have provided a titrated pressure for the original cpap prescription. If you can't find it, your DME certainly should be able to provide you with the information. If for instance you had been titrated by the lab at 12, then a good rule of thumb for your minimum apap settings would be no less than 10. The upper is less important unless you have a tendency to develop severe leaking problems when moving around while you're asleep. Reducing that from the highest setting of 20 may inhibit the impact of "runaway" pressures associated with air leaks.

Once you get your titrated info, you can always come back here for suggestions and instructions on how to set your machine if your DME is reluctant to increase the minimum setting within a couple of points of your prescription.

Paul

Slinky wrote:Well, now, Paul. You gotta admit. 5 cms-15 cms makes more sense than 4 cms to 20 cms. (Does that make the Canadians a shade more smarter than the Americans??)

No Silly, living that close to the border, I would have thought by now you'd be familiar with the Canadian rate of exchange. A Canadian setting of "5" is comparable to the US setting of "4". It's kind of like the metric system.

Yeah, you'd think so since we always go thru Ontario and Quebec, at least as far as Montreal, before dropping down into Vermont and then across New Hampshire to Maine. Hubby is a Maine-iac. But, why spend "my" money when I can coast along on "our" money that he handles? So I let him pay for the gas and meals, etc.