Sometimes a slight adjustment does it!

I've been using the Intellipap for 2 1/2 months, after using Respironics products for 10 1/2 years (The venerable Solo, and the Virtuoso Autopap). Treatment has been going extremely well, but we all strive for the best possible (at least, most of us do so). Being that I fall into the "tweaker" category, and have been accused of being deliberately negative to DME and RT "professionals" who come here, I wanted to just relate a procedural minor change for the newbies who do want their own input into fine tuning their own therapy (whether or not they have good DME follow up, or are just interested in actively monitoring, that is their business). At any rate here is what was happening and what I did:

With the Intellipap, I'd been doing really well, and wanted to see if I could get my numbers even better. My AHI had been hovering around 1.5 for the better part of a month, and had a few scattered NRI events (probably centrals, or just blips on the Intellipap software--who knows)? At any rate, the pressure was set for 8-14, after an original set of 4-16 as delivered ( 4 was immediately changed the day I got the machine, as I find starting pressures that low on an autopap to be suffocating, and non-therapy productive( for me). So, it was at 7-15 for a while. Then, I GRADUALLY gave the bottom a tweak to 8 over a 4 day period--going 7, 7.5, 8, in nightly stages. Looking at my numbers, I could see that 16 was unnecessary, as my titrated pressure is 11, and it was never going close to that--topped out occasionally at 13 on an "odd night--restless night" SO, I went for 8-14, and had an AHI of 1.5 for a month.

Being one who "tries to get it right," I decided to give a MINOR tweak to the lower, and upped it to 8.5 5 days ago. VOILA! That gave me the sweet spot of an AHI of 0-.8 for the last 5 nights, and NO NRI events or leaks, or any other incidents. So, sometimes, minor changes can get a good situation to be even better, and make therapy change quite productive. When I called my doctor about it, he said "excellent, you clearly are doing things the right way." So, this wasn't random, or unsupervised, (to answer the DMEs who say that they don'd dare adjust pressure). I got a doctor's approval and endorsement in an hour, and feel even better.

Way to go, Autopapdude! Fantastic results! Thanks for sharing your experience.

~ DreamOn

Autopapdude, thanks for sharing. I've been at 6-12 for a few weeks myself, just gathering numbers. Mine are pretty good too, AHI around 3-4, and AI around 0.8 or so, but we all want to find the sweet spot. So after a bit, I know I'll be itching to move my lower # up a little at a time. Interesting to me that you increased it every day by 0.5 for those few days instead of keeping at the interval for a little while longer.

Autopapdude, thanks for sharing. I've been at 6-12 for a few weeks myself, just gathering numbers. Mine are pretty good too, AHI around 3-4, and AI around 0.8 or so, but we all want to find the sweet spot. So after a bit, I know I'll be itching to move my lower # up a little at a time. Interesting to me that you increased it every day by 0.5 for those few days instead of keeping at the interval for a little while longer.

__

Excellent point, Gary. NORMALLY, I would have kept it at each .5 increment for 4-5 days to a week on each step, but in my case, I saw that the numbers were unchanged each night. I wanted to get the "bottom limit" as close to my titration as I could, but have some "lower" foot room for comfort relief. It is a trade-off, and I would advise people who are not that experienced in xpap therapy to STAY at a given pressure for a while. My Internal Medicine doc advised me to get "up to 8" as quickly as I could do so, as he wanted me near the titration, but 2 to 2 1/2 cm below. So, that is where I am at now, and you're right....as few changes as possible. I am now going to keep it right where it is for approximately 2-3 months, and then I am due to meet with my doctor for a 6 month check up--let's see what he thinks. He's pleased with the results.

Autopap,Thanks for the informative update. What is your average pressure on most nights? I was also interested in your Dr's comment about wanting you about 2cms below your titration. Did he give you a reason for that? My goal is to keep hubby's pressure setting as low as possible and still get a good AHI. His titration was 13cms and he does well on auto at 11-13cms(rarely goes to max except for a few minutes) or straight cpap at 12cms with AHI between 0.8 -1.9. (Last night was an unusual 2.2). I found out pretty soon that he was sensitive to wide pressure ranges. So can I do any better?

Autopap,Thanks for the informative update. What is your average pressure on most nights? I was also interested in your Dr's comment about wanting you about 2cms below your titration. Did he give you a reason for that? My goal is to keep hubby's pressure setting as low as possible and still get a good AHI. His titration was 13cms and he does well on auto at 11-13cms(rarely goes to max except for a few minutes) or straight cpap at 12cms with AHI between 0.8 -1.9. (Last night was an unusual 2.2). I found out pretty soon that he was sensitive to wide pressure ranges. So can I do any better?

My doctor (and I) share the opinion that the really low pressures (4-6 cm) are not sufficient to alleviate the suffocating feeling, and to ventilate C02. His point is that the autopap does allow for a more comfortable than prescribed titration, but the closer one can get to titration, the less the machine will have to make big jumps. That allows for the machine to rectify events, but at the same time, prevent a lot of them from happening. In addition, he (and I) feel that the "wide open" settings above 15 are unnecessary, unless one has a high titration to keep the airway open. So, that was the rationale. Sounds like your hubby is doing just fine as his AHI is consistently excellent. The goal is to find the "sweet spot," where the machine doesn't jump up and down a lot, and still deliver a good AHI, but comfort for one to fall and stay asleep.

Congrats! Another testament to what a good doctor-patient relationship can achieve!

Congrats! Another testament to what a good doctor-patient relationship can achieve!

Thanks, Link. Yes, I am fortunate to have an excellent Internal Med. doctor, who is very well informed and empathetic in/re OSA. He also believes highly in "patient involvement" in his/her own treatment. I find this doctor far superior to my original sleep MD, and consult him with plans for therapy improvement during my 4-6 month checkups (for controlled Hypertension, as well).

Nothing useful to add, just Congratulations, and an amen to the "It's great you've got a good doc" chorus.

Congratulations and thanks for sharing that Autopapdude!

My own excellent doctor happens to be an internal medicine specialist as well as GP. Glad you two make such a great team!

This is my first post on this forum, I have been reading your post about great doctor/ patient relations and it all seems odd to me. I had a sleep study in early 2000 went back for my follow up to pick up my CPAP, I asked the nurse as she was handing me my machine. What is next, when do I come back she looked at me and said I was done, go home and use your CPAP. So for the last 9 years I have pretty much been on my own trying new headsets learning about humidifiers, yes I used my CPAP for 5 years before I ever knew what a humidifier was. I have been having trouble for the last year or so so I started researching, on this site the new APAP machines. I decided to call the Hospital where I had my original study, I told the nurse what I was thinking and the first thing that she said to me was that APAP was not for me and my response was how do you know that. She said quote, your insurance company probably will now cover it. I told her that I was really not interested in what my insurance would cover all that I really care about is getting a good night sleep. She then wanted to schedule me in for another sleep study but I feel I am way past that. So I ordered an new Intellipap and feel like I am starting over. I am reading through the posts and trying to learn all that I can about the proper set up for me. When I was tested in 2000 they sent me home with a setting of 13 on my Goodnight 420e so that is where I started on my settings for the INtellipap. First night I had a AHI of 5.5 with my settings 5 low 15 high which turned out to be a nightmare. Second night I set my low range at 10 and my high range at 16, AHI went down to 3.5. Kept it there today we will see how I do tonight.

[quote="erictnjc"]This is my first post on this forum...quote]
Welcome! Great info and folks here. You'll likely get more comments creating a new thread with a title something like "Need IntelliPap Setup Help."