Pressure too low and can’t change it

[PHugger]

I am a long time, happy CPAP user. I had been using the same machine for the past 15+ years. I thought maybe it was time for a refresh. I went through the frustrating process of getting a new prescription. No changes needed, just a machine refresh with the same settings.
 
I got my new Phillips Respironics Dreamstation Auto CPAP recently. Of course I tried it out at nap time.
No Bueno – the pressure was only 5cm. I am prescribed 10cm of pressure. I thought it was the Ramp feature, so I turned it off (Ramp Time zero). Still it was stuck on 5cm of pressure when it ran. The ramp feature has 3 choices for initial pressure – 4, 4.5 and 5cm. This was a bit confusing, but I determined that the Ramp function was Off and I should be getting whatever was prescribed for me. I called my provider. They checked the machine and re-downloaded the settings. They confirmed that the machine was set for 10cm. They also told me that the pressure shown on the screen didn’t matter – it was the Ramp initial pressure. I read in the User Guide that this was not correct. The Pressure shown (when it’s running) is in fact the working Therapy pressure. It was still at 5cm and not changing. I headed to the Internet and found out how to go into the Clinician Settings. I confirmed that the machine was set for 10cm. I tried to understand what each setting did.
 
I played with the Auto CPAP settings and was able to get it to start at whatever pressure I wanted. I noticed that Auto CPAP switches the EZ-Start function Off. I turned off Auto CPAP and left EZ-Start Off. The Therapy pressure was now correct (at 10cm for me). What does EZ-Start do you may ask.
 
Eventually came across this –
EZ-Start
Reduces the therapy pressure for the first few days of operation and the device automatically gradually increases this setting until the prescription therapy
pressure is reached. On/Off
 
And after some further searching -
If the EZ-Start is engaged, it will start at 50% of the prescribed pressure (but the minimum pressure must at least be 5cmH20). Now every time that person can successfully sleep more than 4 hours a night with their CPAP at ½ pressure…the CPAP machine will on the next night start at 1cmH20 higher. It will continue to do so until the prescription setting is achieved. Previously, doctors would have the medical equipment company increase the pressure by 1cmH20 every week. Now the machine will do it automatically. Fantastic feature.
 
Fantastic indeed! You are air-starved for in my case at least 5 days (well maybe 8 or 9cm would be OK). It was set to initially give only one half of my prescribed pressure.
 
The answer –
Switch Off the EZ-Start Function
 
Lesson learned –
Your provider probably has no clue. Don’t simply trust what they say. Figure it out yourself. Get a copy of the Clinician Settings Guide. Understand what your machine is doing.
 
Mini Review -
The new machine is now working very well. It’s very quiet and I like the heated hose. The Air Filtering is much improved. It has a lot of Wiz Bang features – built-in cellular modem and Bluetooth. Be aware that your provider can get the machine to automatically Phone Home which allows them to change settings and monitor compliance. I just needed to make sure that my provider won’t try to reset the EZ-Start ever.
 
I used a nasal pillow for many years (Swift II), but I decided to try the newer ResMed AirFit P10. It’s smaller, lighter, and quieter. The headgear is an improvement and much more comfortable. The fit was good. I had no leakage right from the start. It’s a clear winner.
 
I purchased a new SoClean unit. Hopefully the improved filtering on the Dreamstation and the Ozone disinfection of the SoClean will also be a positive experience for me. The SoClean machine is pretty noisy. It buzzes quite loudly during the 7 minute cleaning cycle and then runs silently for the 2 hour purge cycle. Hopefully it works better than it sounds. I can’t believe an engineer couldn’t get it any quieter. There is a slight hint of Ozone when you use the CPAP after cleaning, but I didn’t find it to be too bad. I’m used to a hint of detergent after washing these parts so it’s just a new “fragrance”.

I hope this helps.

Best Regards,
PCH

[upsman]

What made you feel you needed to purchase the SoClean machine?

[PHugger]

Lately I'm liking the idea of having a CPAP machine that has nothing growing in it. The SoClean even kills viruses (I know viruses aren't truly alive). My old machine had a musty smell that was impossible to wash out completely. As I understand how it works, it pumps Ozone into the water reservoir and back out through the hose and mask. Now I can be fairly assured that these parts are free from anything that might want to grow there. Warmth and moisture are two important factors for the growth of microbes. Distilled water has some antibacterial effect, but many species can survive in it. Relying on distilled water alone is a weak approach IMHO. I'm interested to see over time if it helps to reduce my incidence of colds and the flu.

Anyways, after all these years it seemed like it was worth a try. It's does seem a bit expensive, but I was blessed to have enough to purchase it.



Best regards,
PCH

[upsman]

Hopefully, you haven't spent your hard-earned money yet. I know it's very enticing to just be able to plug your machine into one of these devices and voila...everything is spotless. Be aware that absolutely NONE of the CPAP manufacturers recommend using any type of "sanitizing" device. Every single one recommends only using soap and water. You have to clean with soap and water before using a "sanitizing" device, so why further complicate things.

Take a look at this information to get some of the facts regarding this device. You can save the $300 and use it to buy tons of soap and water. 

Do You Need a CPAP Cleaner Like SoClean or Lumin?

FDA Reminds Patients that Devices Claiming to Clean, Disinfect or Sanitize CPAP Machines Using Ozone Gas or UV Light Have Not Been FDA Authorized | FDA

Additionally, ResMed has issued a statement that they will not honor their warranty if the use of an ozone cleaner is determined to cause a defect.  
Microsoft Word - Ozone Policy Initiative - Patient Letter AMER Eng_FrC.docx

If you need more information about why not to bother with these devices, post back here. There's tons of data and facts available.

[PHugger]

Please excuse me. That was my very first post in this forum.
I thought you were asking an honest question.
What you really wanted was to tell me how dumb I am.

I won't bother to respond to your tons of data and facts. They are weak and not worth it.
I now realize I am unworthy to continue contributing to this group.
I won't bother anyone in this forum ever again.

[upsman]

No reason to get all defensive. I was asking an honest question. If you could have given an answer that proved my assertions wrong, I would happily entertain it. 

I simply intended to give you some information to base your decision on. That's all. 
I apologize if I came across as condescending. That was not my intention.

You are more than welcome to participate here. Just be aware that you may not always like the responses to your questions.

[Jeff8356]

@PHugger, you are correct. Many (if not most) practitioners really have no clue about these machines. The see "Auto" and assume the machine will do everything all by itself. And the machine can change according to your conditions as it's supposed to. But they usually only look at your AHI then tell you you'r doing great and the treatment is working. They never bother to look at the wild swings in pressure and the subsequent poor nights sleep as a result. Or the flow limitations, or the CA's, etc. The industry as a whole is long overdue for a major overhaul.

Thankfully there are places like this forum that have many knowledgable users, with years of experience, that can help guide you towards getting the proper xPAP therapy. I learned more here in my first few month's than I did in 6 years of seeing specialists!

If you download/install OSCAR you will be able to take screenshots of your data and post them here. Others may be able to help you get your settings adjusted just right. Never hurts to ask.....

[SarcasticDave94]

OK as I have been viewing the posts so far, the OP has a DreamStation, he needs to access the clinical menu to change settings. First, as was suggested get the CPAP Setup Manual with the button above to learn about the settings, what they do for therapy. To access the clinical menu on DreamStations, push and hold both the Ramp and Dial for about 5 seconds. There, you can set the machine as you see fit. Here in the US the DME or doctor needs updated scripts to edit the settings, however you the patient do not need a revised script. You can change these settings every day if you choose to do so. Get OSCAR to view your charts with an SD card to store data.

A few other things: This is not to belittle or be confrontational, but SoClean may not work as advertised and the manufacturers warranty is in jeopardy by using it. You will still need to wash the PAP parts in soap and water even if using SoCLean. I myself use Dawn dish soap with very warm water to soak the mask cushion, hose, and humidifier tub. Then I rinse these off in very warm water. And finally set it aside to dry.

Finally, note that your doctor is like most sleep doctors, he's lacking in knowledge of the settings and what they do. So to fix this, do it yourself. The RT that set my ASV had to guess at settings, so that is proof the "pros" don't know what they're doing.

You are going to hear other things here at AB that you're not going to like, such as if you'd joined sooner, we'd recommend the ResMed instead of the Respironics as ResMed is a better machine for therapy, for comfort, and by way of comments in build quality.

So officially, note that we are civil in tongue around here. Bickering has a short leash. We can disagree about anything posted, but if you voice that disagreement, you will be kind and the conversation will be civil. You will not throw personal attacks for any reason. So settle down children, relax and learn from posts.