Switching from standard CPAP to Auto CPAP

[DBBCPAP]

I've been on CPAP now for over 90 days with reasonably good results using Dreamstation Pro in the constant pressure mode (7cmH2O).  I feel the need to try out the auto mode since it sounds like that mode is the most comfortable.  Since the "Pro" model allows me to try it, I thought I would now that I have satisfied Medicare that I am using the machine.

My first attempt was last night when I set the min pressure to 4 and max to 10.  It was not a very satisfying experience.  I had an episode at about 5:15AM that resulted in bad dreams and vocalizations.  In addition, my AHI was elevated. Can you suggest where I should go from here.  

I've first attached the overview.  It shows that I finally got used to my Dreamware mask by August 1st.  Then went on vacation until Sept 6th.  I changed masks to the Fisher & Paykel mask on Sept 13th (the Dreamware had to be too tight to not leak.  The F&P  Brevida is great).  I also attached a previous record when using constant pressure.

Thanks for you help - it is very much appreciated.

[Gary1of2]

5 is often to low for most of us. Try startimg out alittle higher like starting out at 7. It might feel more comfortable.

[Melman]

I'm not the best at reading these charts but 4 is too low. Your median pressure was 6 so that would be a good starting pressure. Auto may not be best for everyone. You seemed to be doing well at a constant pressure of 7 assuming the chart you posted was typical.

[Gideon]

Based on your APAP chart I would set the pressures at 6-10 cmH2O.  See how that works and then adjust in small increments to tweak the result to your optimum.

The PR machines need to be close to your therapeutic pressure to work optimally due to their slower response.  As others have indicated 4 is too low, though it is often in a Rx as a range 4-20 (wide open) where it will quickly indicate a better range, unfortunat6ely the doctors the prescribe this rarely take the stwp of making this adjustment.

[Technopauper]

A very very untrained eye here but pressure seems to bring on CA in some people and certainly seemed to in the 'range' chart you showed.

The overall trend seems to be dominated by hypo apneas, the titration protocol that Sleeprider showed me suggested raising the pressure to knock out hypo apneas - maybe try fixed at 8 instead of a range as you seemed to be doing well on 7 with just a few hypos ?

Rob

[DBBCPAP]

Thanks for the feedback.  I made some changes before I got all of your replies, but I think they were in keeping with the general consensus.  I upped the min to 7cmH2O and the max to 12.  Boy did I get a mess as you can see.  The reason I thought I would try auto mode was that I thought it would be more comfortable with lower pressures some of the time and higher ones only when needed.  But if I need to set the lower at least to 7 then that's what the constant pressure was set to before.  So I do not see any benefit to making the auto function work.  Would you all agree?  Maybe I'll try a constant setting of 8 but it looks like higher pressures may cause more CA's so I may leave well enough alone.

Thanks again for your time!

[Sleeprider]

DBB, do you have a copy of your sleep study, and did you have a titration study? During either of those studies was central apnea noted? Your results show that you have a fair amount of flow limitation and hypopnea normally and AHI is generally under 3.0. Your results on Fixed pressure were pretty good, and that might be what works best for you.

If you want to try some more APAP, I suggest the settings proposed by Bonjour of 7.0 to 10.0, and I think you might need to turn the Flex setting down or off.

[DBBCPAP]

DBB, do you have a copy of your sleep study, and did you have a titration study?  During either of those studies was central apnea noted?   

The sleep study reported:  "There was evidence of moderate sleep disorder breathing manifested by variable origin apnea and hypopneas.....moderate snoring with 2 central apneas, 2 obstructive apneas, 1 mixed apnea and 38 obstructive hyponeas for an AHI of 19.7..."

[Sleeprider]

It's there, so I'm going to suggest we avoid a lot of pressure swings and IPAP/EPAP differential. Nothing serious, but more challenging for CPAP.

[OMyMyOHellYes]

How do you breathe at a setting of 4cm? 8cm is the minimum for me to be able to breathe, and that is sometimes too low for comfort.