Ramblings about CPAP to APAP?, and stuff.

[Podd]

Hi everyone.
Here in the UK we don't do 'Compliance' which is actually quite scary, my own SleepClinic has me down as an 'SOS' patient.
Actually, all that means is, I contact them if I have a problem !
Any spares are ordered directly from Resmed, then they send the NHS a bill ....
I have been 'Battling' with the NHS for years over my CPAP Machine as I felt, well actually I Knew that my pressure was too low even though it was now at 14CMH2O, after seventeen years of gradual increments. What I needed was an APAP Machine, finally they cracked and I picked up an Resmed S9 Autoset.
I used it last night for the first time and to be honest, I had a terrible nights sleep, my pressure was now up to 17.3CMH2O.
Obviously I am not a 'Newbie' and a sample of one isn't statistically sound but if this keeps up, I'll switch this APAP Machine into CPAP mode!
There isn't enough Data to work out what's happening yet, but I was wondering if there are any others who have made this transition and what their experience was?

[chill]

I am confused.  You say that you knew your pressure was too low.  The APAP increased it from your base of 14 on CPAP to 17.3.  What do you think is wrong?  What did you expect?  The pressure changes during sleep can bother some people leading to lower sleep quality.  Perhaps you need some more nights to get used to it.  If that does not work, then CPAP mode should help.

[OpalRose]

If your are serious about your therapy, then please download the #SleepyHead software.
Use the tutorials in my signature line, and post a screenshot here after a few days on auto cpap.

[Podd]

I had 'Assumed' it was too low but was reluctant to adjust it as at 14Cmh2o, I was already suffering from Tinnitus, constant nasal problems and dry eyes that were not from mask leaks, I had also assumed that these problems would also increase as well.
Here's what I will try tonight:

A start pressure of 6CmH2o
A five minute ramp up to a lower treatment limit of 12CmH20, (My old CPAP was on 14CmH2o, so I can always reduce this later on)
I'll leave the upper limit at 20CmH2o, (Again, I can reduce this later after I actually get some data in ResScan, I think the lower limit is more important anyway)

Mind you, the settings that were made by a 'Qualified' Sleep Clinician were a start pressure of 4CmH2o and a top limit of 20CmH2o were actually the limits of the machine.
When I was first diagnosed many years ago, my max pressure was 9.5CmH20, but during my Titration Study, I experienced 352 Apnoeas, so am classed as a suffering from Severe OSA, caused by an oval throat, obviously things have changed a bit, it was a bit of a shock by how much, that's all.
I have had seventeen years of treatment for OSA and have picked up one or two things on the way, we are all different that's a given.

[Melman]

My initial CPAP setting of a constant pressure of 9 was made by a "qualified" sleep clinician after a sleep study in an accredited lab. It was later increased to 10 by the same clinician. Upon getting a data capable machine I was able, from the data, and with the help of this forum, to determine that a constant pressure 10 didn't provide adequate therapy. I know run my machine in auto mode with lower and upper pressure settings of 8 and 14 respectively. My AHIs have dropped from well above 5 to under 2 and often below 1. Although my average pressure is around 10, it increases to close to 14 several times every night to prevent apnea events.

I have had tinnitus for years and also suffer from dry eye to the extent that I have experienced corneal ulcers. Use of my APAP has not made either worse, unless I have too much leakage at the top of my mask and the effect is usually just temporary. With the use of appropriate treatment for dry eye , it has actually improved in the time I have consistently used my APAP with no recurrence of corneal ulcers.

I'm sorry to hear you have nasal problems as well. I can't address that because, fortunately, I don't.

But don't have a lot of faith in what your clinician prescribed. Get some data on the forum as you've been encouraged to do and you will effective guidance. I'm speaking from experience.

[chill]

I am not aware of any connections between CPAP pressure and "Tinnitus, constant nasal problems and dry eyes that were not from mask leaks".  I have all three too (though I have suspicions that my diagnosed dry eye is actually a failure to drain the tears).  Which is not to say that those connections don't exist.  

If you are normally on 14 and the machine put up above 17, then I would say that a starting pressure of 6 is very low.  That is a looooong way for the machine to have to ramp up the pressure before getting to a level doing anything useful.  In the meantime, you will be having events.  The Resmed machines are more aggressive in this, but I'd say that a starting pressure of 12 or at least 10 is probably a better number.  Given your history, IMO four was just plain silly and reflects a basic ignorance by your 'Qualified' Sleep Clinician in how these machines actually work.

[Sleeprider]

Podd, even at the lower starting pressure, we can learn something about your needs and calibrate later. Something Melman left out of his post was that he arrived here with very high AHI on the machine at his therapy pressure, something like 12 cm at the time I recall. His severe OA was fixed in large part by correcting head and neck alignment to avoid a physical obstruction of the airway that happens when one allows the head to tilt; especially chin to chest. There are factors in addition to pressure that can make a big difference, and avoid the complications of higher pressure. At least for some people that works well.

[Sleepster]

I used it last night for the first time and to be honest, I had a terrible nights sleep, my pressure was now up to 17.3CMH2O.

As others have noted, it could be that the new machine is making pressure changes too quickly and that that is waking you and keeping you from sleeping well.

I'm not clear on your current settings.

Are you using the ramp? If so, what are the settings?

What are the minimum and maximum pressures of your pressure range settings?

The fact that a technician wanted to set your machine at a range of 4-20 for starters is a big red flag. He or she is simply setting the machine at its maximum range and allowing it to figure out everything on its own. That's usually a recipe for failure.

[Melman]

Podd, even at the lower starting pressure, we can learn something about your needs and calibrate later.  Something Melman left out of his post was that he arrived here with very high AHI on the machine at his therapy pressure, something like 12 cm at the time I recall.  His severe OA was fixed in large part by correcting head and neck alignment to avoid a physical obstruction of the airway that happens when one allows the head to tilt; especially chin to chest.  There are factors in addition to pressure that can make a big difference, and avoid the complications of higher pressure.  At least for some people that works well.

My bad. I should have mentioned this. Although, I firmly believe that auto pressure settings have improved my therapy, my first big improvement, which occurred while still using constant pressure CPAP, resulted form getting a buckwheat chaff pillow which could be configured to stabilize my head position and prevent chin tucks while lying on my side.

[Podd]

I get that, as far as I can see the S9 Autoset has three pressure settings, they are a start pressure and two treatment pressures, i.e. upper and lower.
With this in mind the start pressure, set at 6 ramps up over 5 mins to the actual treatment pressure 'Window', so sort of a soft start.
Now, I'm not a big fan of EPR, I have used it but found this setting at 3, I have turned it off, I did attend a Resmed Seminar the other week and their guest speaker Professor John Stradling touched on this point, he wasn't convinced it was effective for everybody, he actually diagnosed me all those years ago BTW.