IntelliPap Smartcode questions

Section1 wrote:I guess because I expected it, the machine, to know what was best and do what needed to be done. I thought that's what auto was supposed to do.

Common misconception perpetuated by suppliers who dispense these machines with minimum pressures of 5 and maximums of 20. If someone needs higher pressures to maintain an open airway the machines can't raise quickly enough to get the job done. They can't go from 5 to 15 within a time frame that will prevent obstructions. If they did we would jump up out of bed with the abrupt change.

Auto mode can be useful for some people who randomly seem to need higher pressures for unknown reasons but lower pressures get the job done "most" of the time. I seem to be one of those. I can keep the minimum at 9 or 10 and it rarely will raise the pressure in response to event indicators past 12 BUT every now and then I seem to get some really nasty ones that are stubborn and need pressures up to 18 cm. I also was much, much worse in REM sleep than I was in the other stages of sleep. So I have a choice, keep a lower minimum and be more comfortable 90% of the time and deal with the majority of events or maintain a 15 cm pressure all the time just to get those "rogue" events. I might go a week without needing more than 13 cm so I opted for the lower minimum that prevents the majority of events and I have the max wide open just in case... The pressure changes don't bother me. They bother some people so my way of doing things is not for everyone. Sometimes those rogue events sneak past the defenses because of the way the auto units gradually increase pressure and test things. Those times are rare so I accept them.

If your leak is minimal the difference between one night AHI of 6 and one night of AHI of 8 really is insignificant in the grand scheme of things. We don't sleep the same every night. I have had AHI of less than 1 and the next night seen AHI 4.6. All things seemingly equal... So it happens.

Did you notice any difference in the way you felt with the AHI of 8? Everyone mentions numbers but don't often mention how we feel and how we feel is very, very important. Unfortunately it seems to get lost in the numbers chase.

Are you happy with the way you feel?

I have not been able to notice any difference in the way I feel. I was just looking at the difference in reports. I seem to be able to sleep well no matter what my results show, even when using my other machine. If it wasn't for my sleep study I would doubt I have OSA. The only noticeable difference that jumps out to me since starting CPAP therapy is I seem to dream now and be able to remember them. May not seem like much but to me this has been a very exciting experience and something I now look forward to.

I am finding that if you are experiencing 'runaway pressure', or presures that max out a lot with my IntelliPAP, that it is an indication your minimum pressure is probably set too low. Since I have been increasing my minimum pressure, I have seen a lot fewer of these 'runaway pressure' incidents, and have been sleeping more comfortably. I really don't have a 'titrated pressure' yet, because my results vary all over the place. But as I have increased the minumum pressure, things are coming more under control. Both the doctor and I seem to think that my 'titrated pressure' might be around 14. I am at 13-17 now, but am taking about a month between steps, as it takes that long to see a trend in my AHI. I am definitely feeling better, but am not 'there' yet, as I have had times in my therapy where it has been more effective. It also may be possible that the IntelliPAP is not the best choice for me long-term, and that I may need a machine (like a BiPAP) with a more sophisticated algorithm. And yes, the IntelliPAP does seem to chase apneas at higher pressures, but like many people here, most of my issues now are hypopnas.

Common misconception perpetuated by suppliers who dispense these machines with minimum pressures of 5 and maximums of 20. If someone needs higher pressures to maintain an open airway the machines can't raise quickly enough to get the job done. They can't go from 5 to 15 within a time frame that will prevent obstructions. If they did we would jump up out of bed with the abrupt change.

Auto mode can be useful for some people who randomly seem to need higher pressures for unknown reasons but lower pressures get the job done "most" of the time. I seem to be one of those. I can keep the minimum at 9 or 10 and it rarely will raise the pressure in response to event indicators past 12 BUT every now and then I seem to get some really nasty ones that are stubborn and need pressures up to 18 cm. I also was much, much worse in REM sleep than I was in the other stages of sleep. So I have a choice, keep a lower minimum and be more comfortable 90% of the time and deal with the majority of events or maintain a 15 cm pressure all the time just to get those "rogue" events. I might go a week without needing more than 13 cm so I opted for the lower minimum that prevents the majority of events and I have the max wide open just in case... The pressure changes don't bother me. They bother some people so my way of doing things is not for everyone. Sometimes those rogue events sneak past the defenses because of the way the auto units gradually increase pressure and test things. Those times are rare so I accept them.

If your leak is minimal the difference between one night AHI of 6 and one night of AHI of 8 really is insignificant in the grand scheme of things. We don't sleep the same every night. I have had AHI of less than 1 and the next night seen AHI 4.6. All things seemingly equal... So it happens.

Did you notice any difference in the way you felt with the AHI of 8? Everyone mentions numbers but don't often mention how we feel and how we feel is very, very important. Unfortunately it seems to get lost in the numbers chase.

Are you happy with the way you feel?

Pugsy, I am a lot like you in terms of therapy. My sleep study titration was 11 cm. However, for 11 years, I have found that an autopap successfully maintains my therapy at 7-8.5 cm, and does pick up changes. AHI is low, in the 1-2 range during that. Occasionally, and it is very occasional (like once a month or so), I get a spike up to 10, 11, or even 13. Those spikes are rare, and last for a very short duration (about 1% of the time according to my software). In all cases, the machine does respond quickly enough to to a rapid adjustment, and it works just fine. I have a medium span between set pressures--7 low and 14 high, it it works nicely for me with the Intellipap.

Autopapdude wrote:My sleep study titration was 11 cm. However, for 11 years, I have found that an autopap successfully maintains my therapy at 7-8.5 cm, and does pick up changes. AHI is low, in the 1-2 range during that. Occasionally, and it is very occasional (like once a month or so), I get a spike up to 10, 11, or even 13. Those spikes are rare, and last for a very short duration (about 1% of the time according to my software). In all cases, the machine does respond quickly enough to to a rapid adjustment, and it works just fine. I have a medium span between set pressures--7 low and 14 high, it it works nicely for me with the Intellipap.

My titrated pressure was at 8 cm. Auto was initially set at 7 -12. It wasn't quite sufficient to meet my needs. Initial AHI was averaging 8-10 a night at those settings. Got my software and saw that I seem to have cycles with some numerous groups which correspond to REM sleep which I know I was much worse in (53 AHI in REM vs 11 AHI in non REM). I increased my minimum to 10 and the AHI dropped to 3-4 with some less than 1. Noticed I pegged out at 12 often so just changed my max to 20 to see where it went. I could probably lower the max now but the pressure changes don't bother me and I am satisfied to have it wide open for those rare times that I seem to need it.

I have played with up to 12 cm minimum but it didn't really make any difference with the overall picture so I backed it back down to 10. My doctor is aware of what I have done and we discussed the pros and cons and she thinks that what I have come up with suits my needs.

I am only 5 months into this therapy and the only machine that I have used is this Respironics auto, so I don't know if another brand would respond any differently for me. It does seem like those rare higher pressures are coming less often so maybe things are settling in for me.

I am only 5 months into this therapy and the only machine that I have used is this Respironics auto, so I don't know if another brand would respond any differently for me. It does seem like those rare higher pressures are coming less often so maybe things are settling in for me.

Yes, I think you are doing exactly the right thing. Gradual changes, with a consultation with your MD is the smartest possible approach, after watching data trends. Knee jerk responses rarely work, and wildly changing settings makes no logical sense--so you are definitely on the right track for your therapy. The support of your doctor is wonderful, as he clearly wants to be a part of your treatment on an ongoing basis.

In my past experiences with 3 Respironics machines, I find they can be a bit "hair trigger--" that is, they tend to respond and overreact to individual apneas, rather than focusing on the whole therapy portrait over a night, and long term. I have gone away from Respironics as I don't like their algorithm, and am happy with my Intellipap, and average AHI of around 1-2.5.

timbalionguy wrote: And yes, the IntelliPAP does seem to chase apneas at higher pressures, but like many people here, most of my issues now are hypopnas.

That's to be expected. According to the Intellipap's default definitions, the only events defined as aneas are those in which your breathing is reduced between 90% and 95% . Anything less than 90 and more than 70 (not sure of that last number) is a hypopnea by definition. By DeVilbiss's definition, that is. And anything above 95% is a NR.

O.