Number Settings on my new Auto Set?

[Gabby]

First of all, what were your husbands AHI'S an hour? Mine were 18. So they put me on 6 and when I went back after three months they said 6 was controlling AHI'S just fine so would leave me there.
They said I could do with losing weight but never mentioned coming off machine.
My blood pressure has gone from high back to normal and I only go to bathroom once or twice instead of five or six times a night.
They are the only positives for me from CPAP, so far, since February 2014.
I take it your husband isn't using a machine now, because of what Doctor said?
That to me is a ridiculous thing for the Doctor to say.

At the beginning of your quote to Retired guy you said you were going to go with
8-12, then by the end you had changed to 9-13.
I am looking forward to hear how you went. I thought 8-12 sounded good.

Also I am a back sleeper but sleep half sitting up. Cannot sleep on my side and cannot lie flat on my back. That is how I did my sleep tests and they said it was ok.

[becker44a]

What I don't get though, is the bit about sleeping on anything but my back. Ok, yes, I get I will have more sleep apnea events but they are never going away, right? So should i necessarily be uncomfortable on top of it?
Is this a really big issue that i am missing something about?

Hi ShelaghDB,
Yes, this can be a HUGE issue. For me, I discovered after a few weeks that my apnea was fairly positional, and that back-sleeping was a bad idea. Before I started trying to stay off my back, I was having difficulty getting the AHI under 10 - averaging in the 14 - 15 range. After I started to avoid back-sleeping, the AHI began to come down. At this point, the AHI is averaging less than 1. To get the AHI that low, I wear a variety of things on my back, mostly resembling a school backpack loaded with lumpy objects, to discourage rolling onto my back.

I went back to get the data from my sleep study. The initial report gave me an AHI of 36. The detail data showed that the AHI was 58.8 on my back, and 3 on either side, almost a factor of 20.

Apparently, it isn't uncommon for apnea to be significantly positional, which is why people often give advice about avoiding back-sleeping. When you are on your back, gravity is helping pull the upper airway closed, creating the obstruction. The degree of this effect is related to each person's physical throat/airway structure. You may find put that position is not a big factor for you. But the odds are that it is a factor.

Hope this helps.
A.Becker

[Doc J]

Also remember that the pressure that it takes to correct the obstruction does not depend on the number of obstructions you have. It depends on your individual body. You may require 9 and I may need 15 to open the airway but without it we could have a similar number of events. So apple and orange that whole thought and work on dialing in the number that works for you.
I too would notice the change when I first used a Full Face Mask (that I hated) that when I was on my back my machine would crank up the pressure responding to more obstructions. It was bad enough to cause the mask to leak and ruin the whole deal. Now on nasal pillows I don't notice, but I think I have got in the habit of sleeping on my side.
Good Luck and keep working on it.
Doc J

[ShelaghDB]

Here are my scans from last night. I woke up thinking it was easier last night and i do think that it was, initially, although I still suffered from a bit of the pressure feeling but i thought i was doing ok. I remember waking up briefly 2x and going back to sleep but then I remember waking up at what i thought was 6am, noticing that i didnt have much time left to sleep, and taking the mask off thinking id lay there for 10 min before getting up............and the next thing i new it was morning, 8:30 and I had fallen asleep a bit longer than 10 minutes. But when I look at the time I see I only used it for 3+ hours so I must have awakened at about 3am and thought it was early morning.... /sighs






I will read the bit about sleeping in a different position when i get back in....

[Bama Rambler]

I'd just like to amen what Doc J said. I've seen people with an AHI in the hundreds and it only takes 6cmH2O to keep their airway open and my AHI was pretty low and it takes 16cmH2O to keep mine open, so the AHI number really has nothing to do with how much pressure it's going to take to keep the airway patent.

Also to what Becker said. Yes, sleeping on your back can make a huge difference in your AHI. However all that means is that you're just going to have to have a higher pressure to keep the airway patent than you would if you slept completely on your side. That's where the Auto-titrating units (AutoSet) comes into play. For instance, you set your lower pressure to handle the majority of the events and then set your upper pressure to handle the time when you're on your back and it will take care of most all events.

Don't be afraid of higher pressures. It takes what it takes to keep the events down, and you should be willing to do whatever it takes to get used to whatever pressure that is.

My machine is set to 16cmH2O straight CPAP and I don't have any exhale relief or ramp set at all. It's not an issue at all for me to breath into 16cm. I do realize that we are all different, some people need ramp and exhale relief. My point really is that from your reports it looks as if it's going to take somewhere close to 15cmH2O to resolve your events and you need to do whatever you can to get used to that number if that's what it takes.

Having said all that, you have several things going on that may be making your AHI worse. You mentioned medications and you sleep on your back. Both of which could be making things worse. I'd suggest doing what you can about not sleeping on your back as much as you can and changing or discontinuing the medication(s). After all that, realize (and I think you do) that it's probably not something that's going to happen overnight. You may be better lowering your numbers for a while and then bumping them up a little at a time until the great majority of events are dealt with.

[ShelaghDB]

I feel like an idiot to be honest. I am fairly intelligent person yet I don't seem to be grasping these settings and understanding of SA as quickly as i think I should have.........it might also be partly due to the fact that i can't just accept things verbatim and need to understand everything little detail down to the smallest one.

1) for me is to go read up on all the terms and finally get a f ill understanding of what everything means ;-)

2) I need to understand what some of the settings are that i am changing and why I am


My 1st sleep study was ignored for i slept on my back the whole time. No one ever came into wake me up to turn me on my side

My 2nd was, I believe, flawed, as I slept on my back for about 2 hours and then the rest of the night we had a fight with masks that we leaking strongly. The DME would put one on, leave the room and within 3 mins have to come in, tape it down, leave the room 10 mins later, come in and try a new mask, this went on all night and i never really got any sleep after that first 2 hours. She began to tape them down so much my head hurt.
She came in at one point and pleaded with me to try and sleep as she needed one more hour in order to get a study for the night but it wasn't my fault that none of their FF masks fit me.
Anyhow she asked me to get on my side and i did and then got hit in the eye with tons of air so she came in and did something else, at which point i gave up and pretended to sleep for a bit......maybe i fell asleep for 10 mins, I don't know but she finally came in, had her hour and we gave up.

My point being, that whatever tests they got from me were from being entirely on my back.


I will read the rest of the posts later and figure out what i should be changing tonight on the machine and why.

[retired_guy]

Actually, you did much better last night!

Your obstructives were a mere 7! Rock on girl!

Your CA's are way high yet. It is possible you should have a different type of machine to address that, but it's too early to know. Often CA's are caused when changes are made, so if you just leave things alone now they very well might start downward.

The biggest thing now is for you to get some sleep. I see you only masked up for a bit over 3 hours last night. Hopefully you can improve on that.

Whatever you're doing, just keep doing it for at least another day so you can see what happens when the dust settles.

Good job!!

I just noticed: You turned EPR back on? That can cause CA's too..... So at this point, I think I'd leave it on since that's where it is, but that might explain why your OA's came down nicely but your CA's did not. Leave everything alone, mask up and get 8 hours tonight!

[PaulaO2]

Okay, if you can tolerate yet another bit of advice?

Stop. Just stop. Stand in place and just stop. Take a deep breath. Let it out. Repeat as necessary.

Now, you have an Autoset. Let it auto-set.

We know now that your previous setting was really 10. We also know that your pressure that one night went to 14.5.

So my suggestion is this: (you can move now, by the way)

- Pretend you never had the Escape. It had no data to go by, only the pressure it was set to so, bleep, gone.
- Set the range from 10 to 15. Perhaps 8 -15.
- Turn EPR off as long as you are comfortable with that.
- Decide if you want your ramp on or not. If you leave it on, only set it for as long as it takes you to normally fall asleep. I'd say no longer than 10 minutes, perhaps as short as 5.
- Then leave it alone for two nights. Seriously. Leave it alone. Look at the data. See how it is going. But leave all the settings alone.
- After two nights, let's look at the numbers. If you are constantly hitting that max number, you can raise it a tad. That 'tad' depends on how much you are hitting the max. A little, raise it to 15.5. A lot, raise it to 16.

Meanwhile, I read that you are sleeping on your back. Consider raising the head of your bed some. Either putting something under the footboard or under the mattress or under you. The idea is to get gravity to stop helping to cause apnea events.

And contact whoever did your sleep test and ask for a copy of your report. Be calm, even act kinda stupid if you feel like it. They may tell you it is umpteen pages long and you won't understand it. Tell them that is fine, you want it anyway. That you want it for your own records or whatever. Suddenly they will remember there is a summary report. If you have a good relationship with your regular doctor, you can ask that office to get it for you. We are curious as to if there were any reports of central events during your sleep study.

[vsheline]

If were me, have to start somewhere, as a starting point, I would set the machine in CPAP mode as the the old machine at 13 and monitor the results for a while
Keep an eye on leak rates, AHI and type of events, snoring, flow limitation and of course 'how you feel'

My advice:

1) Go back to your S-9 Escape and find out what the settings were on that machine. I would change your new S-9 Autoset to CPAP mode at exactly the same settings you were on on your S-9 Escape.

The goal here is to get you back to getting decent sleep.

I agree with Jaycee. Changing too many things at once isn't good for your sleep.

Changing to CPAP Mode at exact same settings as were used on Escape makes perfect sense.

Anyhow off to bed soon to see how it works and i did set it between 9 = 13 so if that causes me problems tonight i will go right back to 10 tomorrow and start over from the beginning

Hi ShelaghDB,

If your sleep quality was better when you were using the Escape, then it still makes sense to set everything the same as the Escape, as you were intending last night to do next:

Mode: CPAP

Pressure: 10 (if that is what it was)

EPR mode: Ramp Only (because you said this is what it was on The Escape)

EPR level: Whatever it was on the Escape, but it won't matter much in any case, because as long as EPR is set to Ramp Only, EPR will be OFF after the Ramp ends.

(The big difference will be that the AutoSet in CPAP mode will record lots of data, unlike the Escape.)

Take care,
--- Vaughn