Going on the hose without sleepstudy with Intellipap Auto

Hi!
In my country we have only one hospital that offers sleepstudies, so there is a very long waiting list. I have a lot of sleepapnea symptoms, so after reading a bit, I bought a recording pulse oximeter. The reports show frequent drops in spo2, mostly in the 80's but frequently down to low 70's, normally about 25 "events" pr hour. When I showed the reports to my GP, he wrote me a prescription for a CPAP machine without any questions. I now have a DeVilbiss Intellipap Autoadjust with Smartflex and humidifier and a nosemask on the way to me by mail.

What I was wondering, is where to start with the pressures, can I just put the low on the lowest and high on the highest and study the reports? I will not be getting a sleepstudy for quite a while yet, so any advice or links would be very welcome.

Sounds like you have a good GP, and shares your concerns about the possible sleep apnea. The CPAP might just be the right medicine for you.
Your O2 is dropping too low. I don;t know anything about your make of CPAP, but if I were you I would set it up with a bottom of about 6-7 and a top at around 12-13, and then check the daily reports that you get for a couple of days in a row. If your machine gives you a 90 or 95% reading, then that is what I would set the bottom at and then set the top a couple of numbers above. Try to set the spread as close as you can. It is easier to start off with as a beginner. If you start on the bottom, most folks seem to feel that they are not getting any air at all with a setting of 4 or so.

That's good advice. I would also edit your subject line to add "Intellipap Autoadjust" in hopes of catching the attention of other members with the same machine. They will be able to help you with the results and data.

Burkebang wrote:Hi!
In my country we have only one hospital that offers sleepstudies, so there is a very long waiting list. I have a lot of sleepapnea symptoms, so after reading a bit, I bought a recording pulse oximeter. The reports show frequent drops in spo2, mostly in the 80's but frequently down to low 70's, normally about 25 "events" pr hour. When I showed the reports to my GP, he wrote me a prescription for a CPAP machine without any questions. I now have a DeVilbiss Intellipap Autoadjust with Smartflex and humidifier and a nosemask on the way to me by mail.

What I was wondering, is where to start with the pressures, can I just put the low on the lowest and high on the highest and study the reports? I will not be getting a sleepstudy for quite a while yet, so any advice or links would be very welcome.

You may want to purchase the software for your machine. The detailed info may be helpful since you are going to be auto titrating. One of the members who uses the Intellipap is Emilia. She can share info and helpful tips with you. The Devilbiss marketing rep monitors this forum also and can help with questions that may come up, so try to label your posts with Intellipap in the subject. You can PM(private message) back and forth with them. Since you don't have a starting point yet, follow pap4life's advice and see how it goes. I commend you and your doctor for taking care of this so quickly and hope you will see improvement in your health soon.

Thank you all for your advice. Now I feel like I have something to start with and most importantly, a place to seek assistance.

I will try to see how far I can get with the Smartcode data, if nessecary, I will get the Smartlink module.

Burkebang wrote:Thank you all for your advice. Now I feel like I have something to start with and most importantly, a place to seek assistance.
I will try to see how far I can get with the Smartcode data, if nessecary, I will get the Smartlink module.

"Rested gal" did a great series of posts about how she started cpap on her own. Do a search for her links, or maybe send her a PM. She's extremely helpful.

dtsm, I would be very interested in reading rested gals post, but finding that post is not easy, she has a huge amount of posts. Do you remember anything specific I could search for?

I am overwhelmed by the way I have been received here in this forum, I was hoping for some good advice, but feared beeing "spammed" with posts saying that I should not do it without a sleepstudy etc. So far, not a single negative response, that is really great.
I feel like I have an excellent chance of making this work for me. It is also really important that I get my energy back now, as I am about to become a father.

Thank you all again.

Hi Burkebang,

Welcome to the forum!

Below is a link to "my story" that dtsm mentioned. The fifth post down on that page is my post describing how I diagnosed myself and started treating myself:

"not diagnosed yet, many ? brand new here"
topic started by rt3773 (a guest) -- Jan 25, 2005
viewtopic.php?p=5977#p5977

Bear in mind that there can be other sleep disorders (PLMD - periodic limb movement disorder is one of many) besides the various forms of "sleep apnea" that can interfere with getting restful sleep. A full PSG sleep study in a sleep lab is the best way to go. But, for some people, finances and/or lack of insurance, or an understandable concern about having an OSA diagnosis in one's medical record, might put any kind of visit to a doctor or any kind of sleep study or OSA screening out of reach.

If I were going to do it myself with these machines:

Plain CPAP
If it was a CPAP that has C-Flex or C-Flex+ -- I'd set the straight CPAP pressure at 10 cm H2O and use C-Flex or C-Flex+ at whatever "flex" level felt comfortable to me -- or turn "flex" off if I didn't like it.
If it was a ResMed CPAP and I wanted to turn on "EPR" (expiratory pressure relief) "fulltime", I'd set the CPAP pressure this way:
EPR 1 - I'd set the pressure at 11.
EPR 2 - I'd set the pressure at 12.
EPR 3 - I'd set the pressure at 13.

Autopap -- I'd set the range at 7 (minimum pressure) - 15 (maximum pressure.)

Plain bilevel (BiPAP or VPAP) -- I'd set IPAP 14 and EPAP 10

Bilevel Auto (BiPAP Auto or VPAP Auto) with "auto" turned on -- I'd set maximum IPAP at 20 / minimum EPAP at 10. I'd set the maximum "pressure support" (PS) setting at 4.

That's just how I'd go about starting out with one of those types of machines, if I had not had a sleep study at all or had not had a titration PSG. But I'm not a doctor, and I'm in excellent health other than mild OSA. If a person had other serious health issues, particularly COPD (chronic obstructive pulmonary disease) or CHF (congestive heart failure) it would certainly be important to consult his/her doctor beforehand.

Treating oneself can be done effectively even without having software to do downloads from the machine... just going by some AHI and leak info in the window on the machine. It can even be done effectively (by some people) without being able to see any data at all in the machine window, if the CPAP is what we often refer to as a "brick" that gives no info beyond "compliance" (hours used.)

Of course it's easier to figure out what settings work best with a machine that provides AHI and leak information, and with the data software can provide -- especially getting to see detailed leak data via software.
A recording pulse oximeter to use at home would be a helpful tool, too.

Here are a couple of links you might find interesting, Burke:

Link to a study that concluded, "yes."
"Can Patients with Obstructive Sleep Apnea Titrate Their Own Continuous Positive Airway Pressure?"
http://www.tnlc.com/Lara/laura/osa/CanP ... wnCPAP.pdf

Link to a Powerpoint presentation by board certified pulmonolgist/sleep doctor (Dr. Barbara Phillips) at a meeting of the American Lung Association of the Central Coast - November 2004:
"Not Every Patient Needs to Go to the Sleep Lab"
http://www.tnlc.com/Lara/laura/osa/Barb ... t_0830.pdf

As apneawho mentioned, the cpaptalk member nicknamed Emilia can be of great help to you with the brand/model machine you have...the DeVilbiss.

Good luck, and do please let us know how things go for you.

Congratulations on becoming a new father soon!

rested gal wrote:Hi Burkebang,
Welcome to the forum!
Below is a link to "my story" that dtsm mentioned.

You're the BEST

I have now received my CPAP equipment and have slept with it for the first time. I had a great nights sleep, really great. I cannot remember the last time I slept like this I had one awakening during the night, but that's not abnormal for me. What IS abnormal, is that after 3 hours of sleep, I felt so good that I had problems going back to sleep:D

Thanks to the very VERY much appreciated help and advice from Emilia and rested gal, setting up the machine was streight forward and no problem.

I set up my machine with a pressure range of 6-14. The Smartflex settings I got from Emilia worked very good for me. When I woke up, my CPAP was working at a range from 12-13,7. I guess this means I need to adjust my pressures up. Any further advice with interpreting my Smartcode report would be very much appreciated
Smartcode report

Btw. The report from my pulseoximeter shows an adjusted hourly eventindex of 3,5. This is very low for me. I have never been lower than 15 and normally in the 20's and up to 30. I did however have one dip to 82% but the entire rest of the night, I was above 95%
I am extremely happy with my results so far and I know that they can and will become even better with some tweaking.

Not familiar with your unit and how to read the data; others will be more helpful. It 'appears' you leaks are negligible; that's good. That means you can probably adjust your pressure range to 11-15 and if the average pressure remains as posted, can tighten the range after a week or so.

Give it time but looks like a GREAT start, congrats!

dtsm wrote:Not familiar with your unit and how to read the data; others will be more helpful. It 'appears' you leaks are negligible; that's good. That means you can probably adjust your pressure range to 11-15 and if the average pressure remains as posted, can tighten the range after a week or so.

Give it time but looks like a GREAT start, congrats!

Thank you very much I think it's a great start also, I actually feel rested this morning.

Generally speaking, is it good to have a tight pressure range? I vary a lot from night to night (15-30 SPO2 events an hour), so I would have thought that an automatic machine with a quite wide range, like 9-18, would make up for that and give me the pressure I need that day. But what I think and what works in practice is not allways the same

What would you consider a good AHI result? I hope to get lower than 7, but is 0 a reasonable goal?

No reason not to try and get the AHI as low as possible, but less than 5 is considered normal. By following Rested Gals and other's advice I have my AI down to 0 and I have about 10 to 12 HI's total for the night now. Downloading the detailed data really helps as well.

When using the xPAP in auto mode the minimum pressure is more important than max. My 95% pressure was around 11 in auto mode. With the min set lower than 11 I was still having AI's. Set the min to 11 and my AI's went down. I have since switched to CPAP mode but that's another discussion.

I think I'm starting to get an understanding of what the numbers in the report means.
I adjusted my pressures to 9-18 this night and my AHI went down to 5,5. If I was to set my low pressure to 15 (or switch to CPAP mode), I would have a 0 AHI. But beeing an automatic machine, I think it "needs" some events to make it's adjustments. The AHI number are after all just a messure of machine interventions pr hour. My pulseoximeter shows that allthough I had some events, they where dealt with quickly and without significant or worrysome drop in O2 saturation.

This night, when I had my pressures at 9-18, the 90% and 95% pressures where lower, 10 and 10,5. But comfort was seriously compromised. I could not sleep without using the delayfeature. I think from now on, I will try reducing my lowpressure to a very comfortable 6 again and keep my high at 18 and just let the machine do its job while I monitor both the Smartcode and saturation reports. This will give me the pressures I need each individual night. Do you think this is a good plan? Or is it better to try to avoid events at all by upping the pressures?

Give yourself time to adjust to the machine and mask. Don't make changes too quickly. When you change a pressure, give yourself time to get used to it. You'll find that after a few nights you will get used to higher pressures. You may also find that after a few nights your AHI will settle down and be a bit lower. We usually recommend one change at a time and wait a few nights(a week is better) before changing anything else.



Brenda