Need some advice on APAP Range settings

[chill]

I was on an machine on AutoTest to determine what an appropriate pressure was. 9.5 was the result. That machine had problems and I switched to a loner CPAP set at 9.5. My AHI was mostly low, in the 1-2 range most nights but up above four some days. Two nights ago I got my replacement APAP machine and the sleep tech set up on on Auto with a range of 8 - 12. In the two nights since, my AHI has been over 5 and I can feel it. The max pressure was 11.5 one night and 12 the other. My 95% was previously 9.5 and now it is at 10.5. On the bright side, I did not wake up in the middle of the night either night!

My guess is that 8 is too low for me and a range of 9 - 12 might have better results. Does that seem right? Do anyone have any advice for me? I have Sleepyhead if graphs from that would help.

Thanks
Chuck

[PoolQ]

yep graphs would help. I would guess that your max is too low and the graphs will tell if that's right or not. I stay just below my max and never hit it. On the low end I usually see people saying 2 below your 95% (maybe median) so I think that with a 95% of 9.5, 8 seems good.

[FrankNichols]

Posting some Sleepyhead reports would help get answers. I guess my first step would be to put the Autoset machine into CPAP mode and run it at 9.5 a couple nights to a week to see if that reverts you back to where things were working. Also, you might want to look at things like EPR and RAMP. I had to turn both of those off to get my AHI to settle down, but my case if different - I got the Autoset instead of an Elite even though I was supposed to be on CPAP and not auto. (It's a long story). So, when I started my AHI was up in the 30's with the new machine. I got the AHI down to 3 by turning off everything automatic, shaving my beard off to get leaks under control, and fiddling with the fit of my FFM. Now, I will let it run like the for a week or so, and then slowly start adding things back into the mix going for stability and repeatability foremost.

[chill]

I am attaching some of the graphs, I am not sure which are the most useful so I guessed. These are from the two nights after changing to APAP.

[attachment=2340]
[attachment=2339]

[palerider]

http://www.apneaboard.com/wiki/index.php...ganization <- do it that way instead.

[sdb7802]

my $0.02:

min = 9.5
max = 14
flex = 1 or off

[chill]

Thank you palerider. It is getting worse. My AHI last night was over 7 after I'd turned the EPR down to 1. I see Flow Limitation on the left hand summary but I don't have a graph for it and it the list of graphs in the lower right popup does not show it either. It might be a bug in this beta version.

I think the 9.5 cm/H2O was my 90% pressure and the higher numbers are the 95% which would explain some or all of the differences. Sleepyhead show 95% on the Daily tab and 90% on the summary.

I am also wondering if it might be something wrong with the machine. This is my third DreamStation in a month and the other two produced much better results. The first was set to 6 - 16, the second locked in at 9.5.

Some of the higher AHI may be attributed to my laziness to get out of bed when I wake up. I hate getting up in the morning, always have. So I roll over and doze for one or more hours. So sleep/wake junk might be affecting the later numbers.

Chuck

[attachment=2345]
[attachment=2345]

[palerider]

EPR down to 1. I see Flow Limitation on the left hand summary but I don't have a graph for it...

I think the 9.5 cm/H2O was my 90% pressure and the higher numbers are the 95% which would explain some or all of the differences. Sleepyhead show 95% on the Daily tab and 90% on the summary.

I am also wondering if it might be something wrong with the machine. This is my third DreamStation in a month and the other two produced much better results. The first was set to 6 - 16, the second locked in at 9.5

your machine doesn't *have* EPR, you're using a respironics machine, only resmeds have EPR.

respironics machines don't generate a flow limitation graph, so don't worry about that.

I see hypos throughout the night. I'd suggest bumping your min pressure to 9, maybe 9.5, and raising the max, though you're not *quite* hitting it. your min pressure of 5 is *way* too low. 6 would be way too low for you.

[0rangebear]

Posting some Sleepyhead reports would help get answers. I guess my first step would be to put the Autoset machine into CPAP mode and run it at 9.5 a couple nights to a week to see if that reverts you back to where things were working. Also, you might want to look at things like EPR and RAMP. I had to turn both of those off to get my AHI to settle down, but my case if different - I got the Autoset instead of an Elite even though I was supposed to be on CPAP and not auto. (It's a long story). So, when I started my AHI was up in the 30's with the new machine. I got the AHI down to 3 by turning off everything automatic, shaving my beard off to get leaks under control, and fiddling with the fit of my FFM. Now, I will let it run like the for a week or so, and then slowly start adding things back into the mix going for stability and repeatability foremost.

SHAVING OFF YOUR BEARD

[chill]

The DreamStations have Flex which I think is EPR with a less clear name: "This allows you to adjust the level of air pressure relief that you feel when you exhale during therapy. Your home care provider can enable or disable this feature when your provider enables flex a level will already be set for you on the device. You can increase or decrease the setting from 1 to 3. The setting of 1 provides a small amount of pressure relief with higher numbers providing additional relief."

The 5 pressure is because I used the Ramp Up feature that night: (8 min - 3 ramp).

Thanks for the input, I am debating changing the settings vs waiting to hear from my sleep tech -- should be Monday at the latest.

Cheers!
Chuck