Advice re: changing CPAP settings

[Perchas]

Enter the Provider mode on your Dreamstation Auto and select 7 days of trial, at the end of that period your machine will be set in fixed mode with the right pressure for you.

Then try a couple of days with that pressure and reset to Auto with a minimum and maximum pressure near the one achieved.

I was diagnosed 8.5 and the dreamstation advised me to 10.5, now I have it adjusted from 9 to 11, nor can you imagine the comfort I feel.

P.S. The doctor who advises you to spend 10,000 on a study night, here in Europe, chopping stone.

A-TRIAL
If Auto-Trial mode is available, this screen displays Days: xx/xx (where xx/xx is the number of accumulated trial days / number of selected trial days). Available on the Pro, Auto, BiPAP Pro, and BiPAP Auto models.

[fyrfyter43]

Sorry I haven't been back in a few days. It was a busy weekend.

After changing to auto, min 6, max 20, I had some slight improvement, but still not as good as it was 3-4 months ago.

One thing I noticed is that sometime during the middle of the night, I become a bit congested. There's very little mucus; I think my nose just becomes a bit dry and restricted. I suspect this congestion corresponds to the increase in hypopnea events later in the night.

In the middle of the night Saturday night I increased humidity from 3 to 4, and also increased the setting for the heated hose to prevent rainout, a problem I've had occasionally since switching to the DreamWear mask. Last night I also switched to the next size larger cushion for the mask as it felt like the cushion was partially blocking my nostrils. Between the added humidity and the larger cushion, it seems like the congestion wasn't as much of a factor. The larger cushion is bigger than recommended, and I have to be careful that I don't inadvertently cause a leak when I move, but it does seem that I can breathe more easily.

Here are screenshots of the last 3 nights.

[Sleeprider]

Fyerfyter, thanks for the new data. I'd like to try fixed pressure at 6.5. This will eliminate the saw-toothed shaped pressure increases, and the increases in pressure that seem to be associated with higher incidence of hypopnea. I think you will find this very comfortable, and it should reduce events. It is one of the variables that can help narrow down the best therapy pressure for you. To implement this stratedgy, increase minimum Auto CPAP pressure to 6.5, and set the maximum pressure to 6.5. We could alternatively set the machine to CPAP mode, but in auto mode we get data regarding flow limitation and RERA.

As you can see from the data, obstructive apnea, flow limitation and snores are not a significant feature, so you may actually have a mild complex apnea situation. This tends to respond best to consistent,low, fixed pressure. Glad to see you sticking with it, and having some better success. If you are finding leaks with the Dreamwear disruptive, I think you would really like the Resmed Airfit P10 pillows mask. The fit kit comes with all 3 sizes of nasal cushion, and it tends to stay in place easier with side-sleeping. It certainly applies pressure in a way that can clear any nasal and sinus congestion.

[fyrfyter43]

Thank you, Sleeprider! I will try that tonight and come back tomorrow with new data.

I was originally using the AirFit P10 pillows, but found that it caused sores inside my nostrils. I may ultimately switch back, though, as the sores also started around the same time my AHI jumped up.

[Marillion]

To combat the sores. Adjust the headband to a loser setting and use a good moisturiser during the day on your nostrils. Make sure to wash off the moisturizer before using the P10 though in the evening. Some have reported success with moving up a size with the pillows to reduce soreness. But I have found that you really do not need to adjust to a very tight setting at all, which is what really helped me.

[xxyzx]

Good morning! I am new to the forum and am looking for some advice regarding changing my CPAP settings.

I started CPAP therapy almost 1.5 years ago. My initial pressure was 13 cmH2O. I did fairly well at that pressure, but still didn't feel quite as good as I should. My average AHI during that time was 2.90, with very rare nights where it went above 10. I also found that I was still up 3-4 times every night.

 After a year of therapy, my doctor ordered another sleep study. My pressure was lowered to 6 cmH2O. Since then my average AHI has been 8.47, with several nights above 30. The majority of events are hypopneas. 

My first thought is to call my doctor and have him change my pressure back to 13 cmH2O. However, I am not very comfortable with this doctor. To my knowledge, he has never reviewed any of the therapy data. I found out that he has an undisclosed financial interest in the sleep center, so I suspect that his answer if I contact him will be to send me for yet another sleep study. Since the sleep center is out of network for my insurance, it has been a fight to get each of the past sleep studies paid for, with the sleep center telling me that the portion of the bill which I am responsible for will be written off once I schedule my next study. I still haven't seen a bill for the most recent study from December, although my insurance is denying it as not medically necessary.

I have found the clinician setup manual for my machine. My only concern is about the compliance data sent to my insurance company. I have read the part in the Wiki about changing your own settings, and the fact that it is not illegal to do so. But I don't know whether or not I could have an issue with my insurance company if I do change the settings, or if they would even know. My thought, since my machine is an auto CPAP, is to set it to auto with minimum pressure at 6 cmH2O. 

Also, is there any reason I need to continue seeing this doctor? What happens as far as my prescription if I were to switch to another doctor?

have they ruled out CSA

you may need a totally automatic ASV type machine

---

Welcome!

If you truly have an Auto machine, I'm dumbfounded that your sleep dr would send you for a 2nd sleep study after you'd already done one that determined the pressure of 13.  If you have an Auto, he could've just set it to Auto and see what it did.  ... which is what I'd be inclined to do, if I were you.  You're on 6 now. It'd be easy enough to switch it to Auto, set the max all the way open to 20, and see where your body takes the machine. (Just my humble opinion.)

if only 

i am fighting the doctor sleep lab and now have to see another doctor to get them to do that

auto seems like it should be the default
one size fits nobody
allergies can change the pressure needed as well as other slower longer  term changes

why dont they just start with auto 

by the time i get them to make a change
my body has changed again

control theory 101 says this delay will ensure that the system oscillates and never matches my needs

[MitchS]

Thank you, Sleeprider! I will try that tonight and come back tomorrow with new data.

I was originally using the AirFit P10 pillows, but found that it caused sores inside my nostrils. I may ultimately switch back, though, as the sores also started around the same time my AHI jumped up.

You might try using a lanolin ointment at night while using your P10. It's used by breastfeeding mothers and is sold in the baby section of most big box retailers and pharmacies. A little bit goes a long way. Apply just before putting on your mask. It will prevent nasal sourness and help nasal sores heal. You will probably be able to discontinue use of the lanolin after you become accustomed to the nasal mask.

As stated above, the P10 needs to be no tighter than it takes to stop leaks. Using the largest size nasal pillow possible seems to work best at preventing soreness as well as delivering air.

[MitchS]

By the way. My data looks exactly the way your last data does when I'm in auto mode with my DreamStation Pro. I do much better on a fixed pressure. My AHI is much lower and I sleep a whole lot better. I think Sleeprider is going in the right direction with your treatment.

[Hydrangea]

---

Welcome!

If you truly have an Auto machine, I'm dumbfounded that your sleep dr would send you for a 2nd sleep study after you'd already done one that determined the pressure of 13.  If you have an Auto, he could've just set it to Auto and see what it did.

if only 

i am fighting the doctor sleep lab and now have to see another doctor to get them to do that

I totally get it.  I told my sleep dr "I cannot breathe. I cannot get a full breath. I'm gasping for air." His response was apathetic - he refused to help me, since my AHI was acceptable.

(That's when I took things into my own hands.)

[Perchas]

Try the pure oil of Argan, here in Spain is purchased for US $ 40.00 a liter, all pneumologists prescribe this oil for irritation of the nostrils and sores.

One of the main reasons that argan oil is so healing, is that it is rich with vitamin A and vitamin E. However, argan oil is also packed with anti-oxidants, Omega-6 fatty acids, and linoleic acid. Research shows that when applied to skin, it eases inflammation while moisturizing the skin.