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CPAP to APAP Transition
#1
CPAP to APAP Transition
Hello all, this is my first post here, and I would appreciate any feedback and advice on my transition from an S9 Elite CPAP to S9 AutoSet APAP. After 7 years the CPAP ran into the "motor life exceeded warning", so I took the opportunity to upgrade to an APAP and keep the CPAP as a backup. My last sleep study was 10 years ago and was my second. (Rx was written for 17.0 cm w/ EPR=3.0cm) I've been using a CPAP for about 16 years or so. I never used SH or Oscar until lurking here, so was happy to find the SD card in my CPAP had been logging my data and stats going back a very long time.  At a fixed pressure of 15.8 cmH2O and EPR of 1, my AHI has averaged below 1.0 over the last 12 months and I still wear a ResMed Activa LT nasal mask.
I've just had the APAP for a week. I started out with a very wide 9-18 setting to allow the machine to find my "floor". That was a rough night and I quickly realized 9.0 was way too low. I am attaching 3 nights with IPAP minimums of 13.6, 13.8, and 14.0 to start with. As I move higher (toward my previous fixed pressure of 15.8) my Indices don't seem to be getting better. Last night min was 14.6 and will use 14.8 tonight thinking I need to get the pressure closer to 15.8. But wonder if I may be going the wrong way.  From the attachments you can see the IPAP curve (and Min/Med) pressures for these three nights indicate the more I go up, the more I am flattening the minimum curve. The pressure curve is flat for many hours without moving. Am I wrong to think this is defeating the purpose of an APAP- that I should have 1-2 cm cushion below the min?  It seems that I'm dreaming more and making less trips to the bathroom the higher I go up, but don't want to waste time iterating another week. I would like to come down on a number and leave things alone and settle for a week. Should I keep going up in increments of 0.2 cm, or drop back to 14.0 and leave there it for a week? Lastly, is it recommended I turn off the EPR (1) while I am titrating? I left it alone so as not to introduce another variable. Thanks for taking a look. I will upload dailies for 14.4, 14.6 later in the thread. Cheers.


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#2
RE: CPAP to APAP Transition
Your numbers look good with only 2 Hypopnea. I think I would leave it alone for a while.
Apnea (80-100%) 10 seconds, Hypopnea (50-80%) 10 seconds, Flow Limits (0-50%) not timed 
Cervical Collar     Dealing w DME     Chart Organizing
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#3
RE: CPAP to APAP Transition
(09-30-2020, 12:51 PM)staceyburke Wrote: Your numbers look good with only 2 Hypopnea.  I think I would leave it alone for a while.

Thank you for your reply Stacey.  The last screenshot with 2 H and zero OA was using min of 14.0.  I am now up to 14.4 and 14.6 (attached). Tonight I was planning 14.8 due to my long time historical CPAP fixed pressure being 15.8. If I don't see/feel an improvement tomorrow, I guess I will dial it back to 14 and try it there for a week or so.  The reason for thinking my optimal level "must" be higher was due to the statistics on the CPAP (attached). That being said I would also like to take advantage of the APAP working at lower pressures.  Thanks again for your input. Much appreciated. Also, anyone else willing to look at the charts please feel free to chime in!


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#4
RE: CPAP to APAP Transition
I don't have the skill to evaluate your charts.

I just made the same choice. My old machine was an S9E; my new machine is an S10 Autosense for Her (or whatever it's called). I'm trying to learn how to be patient! My nature is to rush and make setting changes.

Wonderful people here suggested that I should be more interested in how I feel, than in reacting so quickly to the numbers I see.

It's been about a month now...I feel better! I wish I had an autopap a long time ago.

I'm being careful with sleep hygiene. I'm trying to keep my schedule more regular and get more time asleep.

Good luck with your choice! I feel better working with the wonderful people here.
DaveL
Compliant for about 30 Canadian years

I'm just a cpap user like you. I don't give medical advice. I hope to learn from you, and share my experiences with you. 
Seek the advice of a physician before seeking treatment for medical conditions including sleep apnea. Sleep-well

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#5
RE: CPAP to APAP Transition
I you are experimenting you could the epr to 3. If it does not drive up the centrals it would be more comfortable.
Apnea (80-100%) 10 seconds, Hypopnea (50-80%) 10 seconds, Flow Limits (0-50%) not timed 
Cervical Collar     Dealing w DME     Chart Organizing
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#6
RE: CPAP to APAP Transition
I am curious, why are you not happy with your treatment. From a AHI perspective your treatment is effective. Are you concerned from a comfort basis? Treatment and comfort are equally important, just wondering where your concerns lie.

Regarding your comment about your pressure curve being flat for lengths of time, I see on your charts that your pressure increases match your flow limitations. Do you want the pressure to drop down more in between events? That would possibly results in my flow limitations and events as well as possible less comfort if the pressure were raising and falling numerous times during the night.
Sleep-well
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#7
RE: CPAP to APAP Transition
(09-30-2020, 02:40 PM)staceyburke Wrote: I you are experimenting you could the epr to 3. If it does not drive up the centrals it would be more comfortable.

Hi,  yes optimizing/experimenting. It's probably been 6 years since I have touched settings on my CPAP and now I have a new (to me) machine, so I thought I may as well dial it in. I'm recently unemployed so I have plenty of time now. The historical data (Stats) was so good I almost put it in CPAP mode at the same constant pressure and called it a day... but that's just not me. I thought I may be able to squeeze more out of the APAP. As for EPR, my first thought was to turn it off while titrating to get my "real" pressure but everything I read here suggested not to change two variables at the same time and that made sense. Not really having any comfort issues and leaks seem under control. Thank you very much for your input and once I do come down on what looks like a good pressure and rest there a while, I will definitely be taking a look at EPR. Cheers
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#8
RE: CPAP to APAP Transition
Set EPR = 3
Note how your pressure is spiking almost in perfect sync to the Flow Limit spikes. We need to flatten your pressure. This is one of the rare cases where I want to make significant changes to someone with awesome numbers. By reducing the flow limits the pressure should flatten.
I suspect that we may also be able to reduce pressure going forward. That would be the next step.
Fred Bonjour - Project Manager and Lead Tester for OSCAR - Open Source CPAP Analysis Reporter 
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INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED AS MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEB SITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
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#9
RE: CPAP to APAP Transition
(09-30-2020, 03:04 PM)Cpapian Wrote: I am curious,  why are you not happy with your treatment.   From a AHI perspective your treatment is effective.   Are you concerned from a comfort basis?  Treatment and comfort are equally important,  just wondering where your concerns lie.

Regarding your comment about your pressure curve being flat for lengths of time, I see on your charts that your pressure increases match your flow limitations.  Doso  you want the pressure to drop down more in between events?  That would possibly results in my flow limitations and events as well as p.ossible less comfort if the pressure were raising and falling numerous times during the night.

Hi, please also read my reply to Stacey's post above as a supplement to this. 

Yes, the treatment has been effective recently from a guidelines perspective - thus far AHI <=2. To answer your first question my historical data over the last 500+ days using the CPAP at a fixed pressure of 15.8 cm produced considerably better results than I am getting now, so the numbers can be better even if I have to go back to CPAP mode, but I am totally new to APAP and wanted to take advantage of the technology and try to dial it in. For me, comfort is more related to minimizing bathroom breaks and dream time than mask compliance or leaks. 

As for the second part of your question, I am a complete novice to APAP so don't know what is normal. I was afraid that forcing minimum pressure up was just further flattening my pressure curve into eventually a flat line. I was wanting/expecting the APAP to optimize and regulate pressure so wanted to give it the freedom to do so. Trouble is when I set it low enough to do that (1-2 cm below floor), it seems to wake me up more and I have more bathroom trips. Above min of 14 I have less trips and more dreams. 

Funny thing is I didn't know anything about SH/OSCAR and thought the SD card was just a tool for the doctor! That, and the old CPAP was logging everything for the last year and a half. So at the same time I got the APAP I also learned about OSCAR, popped the CPAP SD card in my PC and WOW! All this data confirms my old fixed pressure (15.8) was working very well for me and I thought I would just work my way up there slowly at 0.2 cm at a time while effectively neutering the APAP algorithm. Sorry for the long post. Cheers.
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#10
RE: CPAP to APAP Transition
(09-30-2020, 04:16 PM)bonjour Wrote: Set EPR = 3
Note how your pressure is spiking almost in perfect sync to the Flow Limit spikes.  We need to flatten your pressure.  This is one of the rare cases where I want to make significant changes to someone with awesome numbers.  By reducing the flow limits the pressure should flatten.
I suspect that we may also be able to reduce pressure going forward.  That would be the next step.

Hi Fred, missed your post earlier. Wow. Two folks suggesting EPR=3 based on an observation I never saw or even considered. Friends with benefits. Guess rather than going further up in pressure tonight I will leave that (currently 4.6) and raise EPR to 3. Will have to study the curves to understand what you two saw. Will report back tomorrow. Cheers, John.
@staceyburke

PS> Hope you guys don't think I'm splitting hairs here trying to refine already low AHI numbers. My numbers were better on the CPAP, I haven't fooled with any settings in well over 5 years, it's a new machine to me... and I'm an engineer so I just can't let things be. THANKS.
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