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Do I need to change my settings?
#1
Question 

Hello everybody.

-After 2 months (AHI around 5), my Dr. changed my machine settings. I got before: 4-15 cms. of water and was using the ramp to reach that pressure. The ramp was way too long (about 20 minutes). She changed the setting and now I don't have ramp and the pressure is 12 cms. of water fixed. This change down almost 1 unit AHI. I was around 4.

I enable the humidifier, enable the EPR to 3 cms. of water, enable the hose temperature to 64.4 ºF changed the minimum pressure to 7 cms. of water and now I am around 1 something in AHI. That's a very good improvement!. I could do this changes because I have learned a lot in this forum and I have asked for advises.

Now I need your help once more:

I am thinking in:
1-Rise up the minimum pressure to 8 cms. Of water.
2-Rise up the maximum pressure to 16 cms. Of water.
3-Enable the ramp with 5 minutes.
What do you think about this new settings?

Machine Settings ( AS of today).
 ModeCPAP Mode CPAP
PressureTherapy Pressure 12.00 cmH2O
Antibacterial FilterAntibacterial Filter No
Climate ControlClimate Contro lAuto
EPRResMed Exhale Pressure Relief Full TimeEPR
LevelExhale Pressure Relief Level 3cmH2O
Humidifier StatusHumidifier Enabled Status On
Humidity LevelHumidity Leve l6
MaskResMed Mask Setting Full Face
Patient AccessPatient Access Yes
Ramp Ramp Enable Off
Smart StartMachine auto starts by breathing Off
TemperatureClimateLine Temperature 18 ºC (64.4 ºF)
Temperature EnableClimateLine Temperature Enable

Ralph.

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#2
So your plan is to change from fixed CPAP to Auto mode, with minimum pressure of 8 and maximum of 16 with ramp at 5-minutes and ?? minimum ramp pressure (assume 4.0). You are of course messing with near perfection with your 12.0/9.0 fixed pressure (assuming EPR of 3.0). You haven't explained why you want to change anything. What is the objective in making this change?

You certainly are free to do whatever you think will be more comfortable and work. I would not cut minimum pressure lower than 9.0 which with EPR is 9.0/6.0. If you do make changes, you should have in mind what the purpose the the change is, and what your objectives are, so you can measure whether the change is successful or not.
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#3
Your AHI search is done and you are doing great. Are you looking for more sleep? more restful? less waking up?
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#4
I can understand the desire to keep seeking lower AHI results.

I am about 10 weeks into treatment. My titration study prescription was for 13cm fixed with EPR of 1.

I bought an Airsense Autoset 10 anyway, because I wanted to have flexibility in my treatment.

I started on 5-18 with my AHI sitting at about 5. I gradually increased the minimum pressure over a number of weeks. I figured if it was close to my prescription pressure, it would catch most events, but allow increases for REM and supine sleeping. I have pretty much ditched the ramp, with a 5 minute ramp starting at 11 cm.

It has pretty much worked to plan. I am now on 12.4 - 17.2
My AHI is averaging below 1.0
Last night I had just one hypopnea for the whole night, with an AHI of just .12.

Oh, and I feel great!
My pre-treatment AHI was 58.9 with low of 60% Oxygen.

Good luck with your treatment.
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#5

sleeprider and everibody.Thanks

The ramp will be 8-15. epr 3. ramp time 5 minutes. I know she never will get the 15 and the 95% of time will be around the 12 fixed that I got now or 13.
About why:
1-I am much better with the last setting, but still @ the beginning I feel a little bit of breath shortness (7 cms.).
2- I think that I must use all the features of my machine. When she detects an apnea she sends an air pulse to find out if is a clear or obstructive one. If it is an obstructive, will be nice that she can rise the pressure a little bit, if the machine is @ 12 fixed she can not do that.
3-The problem that more than 30 years ago I made my master in optimization (actually retired) and I have worked all my life fixing machines and systems (I don't know nothing about medicine), but I know how to solve a problem and find out and reach and objective in a system. The system are the machine and my body and I have been very lucky because I found this forum where are a lot of guys with knowledge and willing to help. I got time to read the forum, and if you read the forum carefully during 2 and a half month in the way that I had done , you get a lot of experiences and now how. Of course we are not equal and what is good for one can be bad for other, I was very lucky, and wait more than 2 month before mess with my settings because I did not know what could be the results.
Any way, if you think that is ask to much, try to lower the 1.89 AHI that I am getting I can stop, because I really don't know when to stop in this system looking for the optimum.
4-I got sinusitis and Tinnitus and I hope that the therapy help me to get rid of these problems or get a lesser impact in my life. Nobody knows really how to treat Tinnitus. I got 1 year with that stuff and I can tell you that it is not funny.
Ralph.

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#6
Sounds good to me. Making minor changes to get things dialed in is pretty harmless, and can be beneficial. I have certainly been there. Good luck with the new settings.
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