Using APAP with no improvment

kasali · Post by **kasali** » Tue Jun 06, 2006 2:15 pm

I've been using the APAP (420E with humidifier) set for the range 4-10cm H2O for more than 2 months but unfortunately still not feeling good as expected. What do you think is the reason?
I use the ComfortClassic Mask with Headgear correctly. Also, when I did the sleep test, the nurse used to adjust the cpap manually during my sleep. That is mean she did adjust the pressure as per the instant chart result that appears during the study. When I woke up that day I felt it was the best sleep ever got.

Wulfman · Post by **Wulfman** » Tue Jun 06, 2006 2:39 pm

What was your titrated pressure?
It's possible your pressure (range) isn't working properly for you (or there's something in your machine that needs to be set differently).
There are quite a few here that use that machine and may be able to give you some ideas.

It's also possible your body is still trying to pay back the "sleep debt" (or, more specifically, your body is still trying to recouperate from the lack of good sleep).
That's one of those things that varies with each person.

Best wishes,

Den

Moogy · Post by **Moogy** » Tue Jun 06, 2006 2:41 pm

I recommend that you do one of the following:

1. Call your prescribing doctor or your provider and tell him/her that you are not having good results. I suspect the lower level of your pressure is too low. (I can hardly breathe at that level!) Often they will change your pressure a few cm without another titration study.

2. Change the pressure a LITTLE bit higher yourself, maybe changing it to 5-11 instead of 4-10. If you don't know how, someone on the forum can tell you. Research has shown that it is safe and effective for patients to titrate their own pressure based on their results. If you are going to experiment like this, be sure to give yourself a few days to a week or so on the new pressure to evaluate the results before you go any higher.

Moogy

littlebaddow · Post by **littlebaddow** » Tue Jun 06, 2006 2:47 pm

Hi Kasali

Well, there could be a number of reasons, or a combination of them, but it really is worth persevering until you do start to feel better. Surely, this is not something you'll want to leave untreated?

First off, you are not alone in this. It seems to be the lucky few that get instant improvement and many of us take several months before noticing a gradual improvement.

There are also many variables on the treatment. I don't know your machine and I'm sure someone who does will pipe up, but does it have software so that you (or your doc) can monitor the results? Talking to the doc would of course be an essential starting point in any case.

Otherwise, can you tell us more so that someone in here might be able to suggest someting more specific?

ozij · Post by **ozij** » Tue Jun 06, 2006 10:31 pm

The 420E has software to help you monitor your therapy, and control your machine. The software is called SilverLining, and can be bought at cpap.com - the kind hosts of this forum.

If you haven't got it yet, and can afford it, I suggest you do so - it will help you know what is going on in your treatment while you're asleep.

Theoretically the machine should be doing the adjusting that the nurse did during the study.

O.

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Guest · Post by **Guest** » Tue Jun 06, 2006 11:43 pm

First of all, I would like to thank all of you for passing by.

To answer Wulfman; The titrated pressure during the lab study was as follow:
The nurse put the initial pressure at 4cm H2O and then increased manually, by her, to 5 cm H2O then to 6 cm H2O. I don’t remember if she raised it to 7 cm H2O or not. So it was in this range till waking up. The nurse judged the right pressure based on the instant chart results during the sleep lab.

To answer Moogy; Yes I tried changing the pressure setting of APAP sometimes ago and succeeded. however it is still on the range of 4-10 cm H2O.

FYI, there was some little improvement in the last 3 weeks after changing the old mask with new one. However, this improvement does not reach my satisfaction and expectation yet. What do you think?

kasali · Post by **kasali** » Tue Jun 06, 2006 11:47 pm

First of all, I would like to thank all of you for passing by.

To answer Wulfman; The titrated pressure during the lab study was as follow:
The nurse put the initial pressure at 4cm H2O and then increased manually, by her, to 5 cm H2O then to 6 cm H2O. I don’t remember if she raised it to 7 cm H2O or not. So it was in this range till waking up. The nurse judged the right pressure based on the instant chart results during the sleep lab.

To answer Moogy; Yes I tried changing the pressure setting of APAP sometimes ago and succeeded. however it is still on the range of 4-10 cm H2O.

FYI, there was some little improvement in the last 3 weeks after changing the old mask with new one. However, this improvement does not reach my satisfaction and expectation yet. What do you think?

Kasali

Snoredog · Post by **Snoredog** » Wed Jun 07, 2006 3:08 am

You should try:

Set your low pressure to 5cm.
Set your high pressure to 10cm.

Look in the manual, try flipping the special FL1 feature on/off, think it comes by default set to 0 or off, change it to 1 or on, then try it a few nights and see how you feel. There are more discussions on that feature here, search for it using 420E +FL1

Check the delivery pressure on that machine with an external manometer, it has been know to be off...way off, there is an adjustment in the manual (if the machine doesn't go south trying to correct it).

ozij · Post by **ozij** » Wed Jun 07, 2006 5:59 am

The company default for flow limitation (FL1) is 1, on.
When FL1 is on, the machine reacts to flow limitations by rasing the pressure - which is good for most people.

For some people, this reaction to flom limitation cause the pressure to go up to the limit, down, buck up to to limit, or else hang at the top limit, no matter what the range given. Thas is a reason to turn FL1 to off (0). For other cases, turning FL1 off is the equivalent of tying the machined hands.

Kasali, you have to give clearer info about why the range is back at 4-10 if you've already changed it, and if you use, or do not use, the software. Otherwise we're all guessing in the dark.

O.

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