machine switch advice?

First, thanks for all the patient advice re data collection. I managed to produce first, and quite revealing, report just in time for appointment with sleep doc.

After starting with cpap @ 16, which proved awful, I switched to apap @ 4-15 range. First report, covering 12 days w apap, revealed that pressure of 9 was keeping AHI at around 1.3 and lower. In addition, doc concluded titration report was inaccurately inflated . (for newbies, I strongly recommend getting a copy of your T. report!) I told doc that while I liked the apap overall, I was experiencing some trouble with "runaway" pressure jumps in early morning, which was keeping me awake sometimes after waking up for bathroom call. So he wrote me up a "my choice" Rx of the following:

* switch back to cpap, with 9 pressure.
0r
* stay with apap but with range narrowed to 4-10.

I couldn't decide on the spot, so he's happy to have me experiment with both, and switch around as needed (a most accommodating fellow!).

So, I'm wondering what might be the comparative advantages / disadvantages of these two options? Given that we've found a pressure that appears to work, does the mode of delivery really matter? If I'm splitting mechanical hairs here, please say so.

thanks,
tom

I don't think that it's very important if you choose CPAP or APAP. The difference that I've found is that with APAP you need the high pressure only during AHI events. The rest of the time you're at a lower pressure, breathing easy. As long as your high pressure is 10 you won't get your head blown off with mask leaks. (Think about if it was 20 and you had a leak! )

Tom,

Many people report that they are uncomfortable with the lower pressure at 4. Originally my old brick would ramp from 4 to my set at 10 over 10 minutes after about 1 week I never used the ramp since I felt that I was not getting enough air. I would think that the APAP set to a pressure range would give more information about the optimum pressure for you.

Rolf

Try it at 9cm CPAP first so you know. I wouldn't start at 4 - that will allow for too many events and inflate your ahi more. But do try like 7 or 8 to 12 or 15. Compare both ways to see how it feels for you.

IF you think you will still need ramp, bump it up to 6 or 7 but don't press ramp unless you need it. In time you will get used to your normal pressure.

Try both. People respond differenly -- as do machines. It's like shoes - my boon may be your curse, and vice versa.

O.

msla wrote:Many people report that they are uncomfortable with the lower pressure at 4. Originally my old brick would ramp from 4 to my set at 10 over 10 minutes after about 1 week I never used the ramp since I felt that I was not getting enough air. I would think that the APAP set to a pressure range would give more information about the optimum pressure for you.

Hi,

I think this is spot on. Most folks feel uncomfortable (like they are suffocating) on a pressure of less than 7 or 8, though some people run at low pressures just fine. I agree that running in auto mode will give more useful information over time. So, unless the original poster reacts badly to the APAP pressure changes, I think APAP might be the way to go. The rule of thumb that I have been repeating recently is to keep the pressure +/- 2 or 3 cm from the target pressure. Since 9 seemed like a good number, I'd consider running at 7 to 12. If he bumps up against the 12, then raise the upper number a bit. If the machine doesn't spend much time at 7, then raise the lower number a bit.

-john-

Two observations:

Your APAP range is pretty wide. Common wisdom leans toward a range of -1 to +2 of your 90% pressure.

Some of us find we get better results on CPAP, instead of bouncing up and down all night on APAP. I usually run CPAP @ my 90%, but every couple of minths I do a couple of nights on APAP to ensure my 90% hasn't changed.

Untreated my AHI was 92. Now, running CPAP, it's rarely above .2. I was averaging .6 on APAP.

Thanks for all the good advice!

I gather from comments that some folks changes their pressure themselves; S9 allows that, correct?
I know that technically it's illegal to change w/o Rx, but my doc is quite flexible and accommodating and respects my input, so I don't think he'd mind if I fiddled with his new Rx. And I'd prefer not to have to call DME every time to want to experiment with adjusting pressure.

Tom

This is indeed a difficult problem. I am just starting out, and I had a doctor who was very inflexible, fortunately I found another who gave a couple of suggestions and suggested I experiment to find what worked. It might be best not to assume that your doc is happy with you fiddling around.

As I just described here viewtopic/t57561/breathing-and-sleeping ... toset.html my doctor suggested fixed CPAP but I got the Autoset, which however is not working well so far. It seems the range is too wide for me as well.

Good luck!

Changing your pressure is not "illegal" with or without a RX. It is your therapy, not the RT's or the doctors. RT's tell you its illegal, only because they want you to come back in to their office to change it....then they can charge you or your insurance more $$$$$.
Remember its YOUR therapy, do what you need to do.
Cheers
N

Roger that, Nan. Will do.
(and if they haul me into court, I will recite your declaration of patient independence from the docket!) t

nanwilson wrote:Changing your pressure is not "illegal" with or without a RX. It is your therapy, not the RT's or the doctors. RT's tell you its illegal, only because they want you to come back in to their office to change it....then they can charge you or your insurance more $$$$$.
Remember its YOUR therapy, do what you need to do.
Cheers
N

I wish my doctor was as reasonable as the folks on this forum. . .