CPAP Setup help

[jbsix]

So a little background- It's been nearly 2 years since I began seeing a series of doctors for breathing problems while asleep and have been met with nothing but incompetence. I've also performed a single botched sleep study. As my problems worsened I decided to cut out the middleman and get a cpap machine since the logging function would at least aid in the diagnosis/treatment.

To that end I purchased a PR System One Auto and set it for Auto-trial for the first night. 4-16mmH2O. Now I'm sifting through the data and trying to figure out how best to set the pressure, so as to provide both apnea relief and diagnostic utility. Some help would be appreciated for a noob like me. Unfortunately, the botched polysomnography report doesn't show anything that resembles pressure.

Some notes about night 1:
1. I set Auto Trial with A-Flex 3.
2. I woke up in the middle of the night and found the pressure too high for me to exhale comfortably. So i switched the machine off and on again only to run into the same problem after a while. So i shut it off for the night.
3. According to sleepyhead, the max pressure reached was 14.80.
4. According to sleepyhead, 90% pressure was 11.90.
5. AHI was 10.96, OI=3.87, HI=4.51, CAI=2.58, RERAI=3.55

So can anyone offer some insight on what pressure to set? Looking at the stats, something like 9-14? Again, the aim is to manage the apnea while also collecting enough compelling data for the doctor.

Here is a zip of the entire SD Card:
  P-Series.zip (Size: 45.75 KB / Downloads: 41) . Hope I'm not breaking any rules.

[big_dave]

I'm sorry you've been having so much trouble with it. It looks like your machine is chasing leaks. The pressure only increases and never decreases. The machine increases the pressure to try to compensate for a leak, and then the increased pressure makes the leak worse. You should see both increases and decreases in the pressure throughout the night.

Unfortunately, I didn't see anything to suggest what your proper pressure should be. You will need to get the leaks under control first.

[jbsix]

Thanks for the input, dave. I saw it as a problem with me setting such a wide range of 4.0 to 16.0 mmH2O for the A-Trial. I figured it was more of a start at min - end at max kind of thing. Guess I was wrong.

Upon inspection, I did not secure the hosing on both ends all the way to 100% since it seemed snug enough at about 75% . There's also a mask fit check feature which tells me there's a small leak with the way I had the mask on. This improves with a little tightening here and there. Doesn't seem to be any escaping air along the hose. I'll secure the hose and mask properly and try again tonight.

Are the average leak rate (0.07) and 90% leak rate (0.00) inaccurate?

Any suggestions on the pressure range and whether I should try Auto mode rather than A-Trial?

[big_dave]

Are the average leak rate (0.07) and 90% leak rate (0.00) inaccurate?

Those figures were inaccurate. I was looking at the leak graph. The 90% leak rate cannot be smaller than the average leak rate. Unfortunately, Sleepyhead has a few bugs.

I'm afraid I don't have any advice about the pressure settings. I don't think switching from auto trial to full auto mode will make a difference.

[Ghost1958]

First you will need to set auto trial for about 7 days for it to determine a 90% pressure. It has a min number of hours it has to run in that mode.
Second your machine which is the same as mine wont chase leaks. It compensate until it cant keep up with the leak then flag large leak when it cant. But it will only hold the pressure its shooting for unless it cant because the leak is to bad.
Third. When your machine drops out of auto trial it automatically goes into cpap ck mode which is a single pressure mode, until you switch it back to auto manually. If in this one night you set auto trial for it hit 14 as a 90% then cpap ck will be engaged and run single pressure at 14 only changing by one cm every 30 hrs.

Set auto trial for 7 days. It will determine your 90 percent pressure then drop into cpap ck mode to fine tune that single pressure. You can manually skip cpap ck if you want.
Mask fit ck is either pass or fail. It doesnt show you degree if leak though that little bar can make you think it is.

Auto trial and cpap ck together, given a week and a half will get you a more accurate 90 percent pressure single therapy pressure than any sleeb if used correctly.
Also there is no reason to set min at 4 .
Set it 6 to 8 at least. Run auto trial 7 days to get an accurate 90 %.
If you want your best single pressure setting let cpap ck run an additional couple weeks then you can set your min and max around that pressure.
If you are leaking to much the machine will tell you. If it doesnt show large leak your golden.

[jbsix]

Thank you so much for the detailed reply! I'm gonna do just as you advised. Since I woke up last night struggling to exhale at 14.8, I'll keep a range of 6-14.

[sonicboom]

I'm not familiar with your particular machine but if you are having trouble exhaling you should turn up the pressure relief. On Resmed machines it is called EPR. On yours it might be aflex or something like that. Someone with your machine will chime in and provide you with a helpful setting.

[PaytonA]

What is the purpose of 'auto trial" on an auto machine? Just wondering, not at all familiar with this.

Best Regards,

PaytonA

[trish6hundred]

Hi jbsix,
WELCOME! to the forum.!
I wish you much success in getting your CPAP therapy dialed in to work for you.
Hang in there for more responses to your post.

[Ghost1958]

What is the purpose of 'auto trial" on an auto machine? Just wondering, not at all familiar with this.

Best Regards,

PaytonA

PaytonA. Auto trial on a PR auto machine is a modified auto mode.
It can be set to run in that mode up to 30 days.
It will treat events as usual but it will also remember the 90% pressure from night to night over the number of days set and determine the avg 90% pressure over that period of time.

If left alone it will switch to cpap ck mode, using the 90% pressure it determined as the single cpap mode pressure.
Depending on any residual events it will raise od lower the pressure every 30 hours .
At the end of the process you have a very good 90% pressure to work with if you want to run auto mode. Or a very accurate single cpap pressure if you want to run cpap mode.