I started with wide open settings at 4-20 on a PRS1 60 series Auto, with A-flex set to 3. My AHI quickly fell to consistently < 1.5 everyday after 3 weeks of being on it.
I raised the minimum to 5 and my AHI went below 0.5 on almost every night. I also got 2 perfect 0.0 scores.
Raised it again to 6 and AHI went a bit up to 0.5 - 1.1 range. I was thinking why. The probable answer is in A-flex. A-flex is not triggered below 6. So when I was on 5, my EPAP was 5. But on 6, my EPAP is 4 (since A-flex providers a ~2 cm relief).
Then I raised it again to 7, and it feels like a much better experience. Air flow is ample. I never feel suffocated at any level of ambient temp/humidity. And my AHI is < 0.5 again. Also, my RERAs and FL reading has gone down. I feel much more rested now. This tells me that AHI is not the whole story. RERAs are important too.
So, my algorithm to self-titrate in your case will be:
1) Put the minimum to 8 (since you have experienced this starting pressure before and are comfortable with it).
2) Put the ramp to 0.
3) Keep the upper limit wide open to 20.
4) Evaluate you therapy numbers using sleepyhead for 10+ days.
5) If you see clusters of events (O, C, H) still when pressure shows 8, its time to raise the minimum by 1.
6) If you see Centrals when the pressure is on the high side, you may want to reduce the top limit by 1.
6) Repeat steps 4, 5 & 6 till you feel good consistently.
Started APAP 4-20, Closed range to 7.5-14, then straight 8.0 w/ Aflex 3
RDI always below 1. But sleep much much better at straight pressure.
Started on F10, Tried Quattro Air successfully. Finally settled on P10.
@AshSF - In my short time here, this is one of the best posts I have read on settings. Thanks a bunch.
Dedicated to QALity sleep.
You'll note I am listed as an Advisory Member. I am honored to be listed as such. See the fine print - Advisory Members as a group provide advice and suggestions to Apnea Board administrators and staff concerning Apnea Board operation and administrative policies. Membership in the Advisory Member group should not be understood as in any way implying medical expertise or qualification for advising Sleep Apnea patients concerning their treatment.
12-09-2014, 03:27 PM
(This post was last modified: 12-09-2014, 03:43 PM by Ghost1958.)
I have the same machine. Go into clinical and enable Opti start. Then set the max at about 2cm above your titrated pressure. Then watch software to see if its getting that high or not or getting up to where you capped the max and sitting there with events still happening which would mean raise it a bit.
After thirty hours the machine will start diplaying and starting at your best min pressure. BUT you will need to go into clinical and set your min pressure manually to what Opti start picked. If you dont manually reset the min to the Optistart min pressure the machine will start at the new pressure but lower back to preset pressure if after a short time you have no events.
I use that feature anytime I change masks or think I need to change my max. In thirty hours of use it will recalculate the optium start pressure based on events etc or changes caused by the mask change.
Its never failed to pick a good min pressure that narrows the range to its best spread min to max.
With a simplus FFM with me on my machine and a max of 18 Opti start calculated a starting pressure of 10.5. up from 8. However I seldom went as high as 18.
And as another said AFlex wont engage under a pressure of 6. However set at 3 it will give a 3cmh20 relief "or down to 4cm if 6 is the min" 2 a 2 cm relief and 1 a 1 cm relief.
You can also run Cflex in auto mode which has a different feel that isnt quite as smothery as Aflex for some.