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Dream Station Settings
My doctor ordered me a sleep study which revealed severe sleep apnea. I now have a Philips Dream Station and the clinician said, probably because I had an at-home sleep study done, that it was set on automatic between 4 and 20. I have not slept well since I got this machine nearly a month ago. The #4 setting seems too low and the 20 is like gale force winds that keep me up. When I asked the clinician to change it he said it was a prescription and the doctor had to change it. Now my doctor says I have to go a chest specialist to have the prescription changed??? My husband researched online and it said the ramp is supposed to adjust to when I need more air or not, but all it seems to do is start at 4 and go up to 20 and stays there which is much too high and even wakes my husband up with the machine humming at full force. It stays at that level until I hit the ramp button which starts the process all over again. This means I'm up every 2-3 hours hitting the ramp button when it reaches too high of a state. Isn't it supposed to adjust up AND down? Someone please advise us as to what we can do. BTW I have a full face mask as I am a mouth breather.
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First, we must identify exactly which DreamStation you have. There are specific models that operate differently.
Your description seems to indicate you have a their Auto machine. The models are: (DreamStation Auto BiPAP, DreamStation BiPAP Pro, DreamStation Auto CPAP, DreamStation CPAP Pro, & DreamStation CPAP).

A pressure of 4 cm-water is too low for many people. The machine should not go to 20 unless it senses you need it.
I want to make sure you do not have a CPAP machine set to fixed pressure of 20; and all you get is a ramp up from 4 to 20.

Yes, the auto machine should adjust both up and down as needed.

I suggest this path:
1) Identify the exact Dream Station.
2) Learn how to enter the clinical menu can check the pressure settings. (For now, don't change anything)
3) Get SleepyHead software and post some screenshots -- let's see why it would think you need 20 cm-water pressure.
4) Get a copy of your prescription and your sleepstudy -- they belong to you. And, they are essential to determining if the machine you were issued fits that prescription. And what type of apnea was found in you sleep study. If you had a home study, it may be limited in its information -- but the conclusion is important.

FYI, the ramp is a comfort feature that raises pressure at the beginning of the night. It's not THE auto adjusting feature.
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I just looked and I do have a Dream Station Auto CPAP. My husband did find out how to go into the clinical menu but so far the tweaks did not help. Interesting you said about the adjusting feature. I will have to ask my husband about that. My doctor had said my sleep apnea was one of the worse he had seen (he said over 400 incidents per night??) but I will get a copy of it for myself. But even if it needed to go all the way up to 20 (though anything over 10 or 11 seems to wake me up), it does not seem to go back down even when I am awake and start breathing normally. Could there be something wrong with the machine?
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Occasionally (but rarely) is a machine defective in its pressure algorithm.

IIRC, the Dream Station Auto CPAP can be set to CPAP mode or Auto mode. In the menus, make sure it's set to Auto. What is the min and max pressure set to?
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I know the minimum and maximum pressure is 4 to 20. I will have my husband take a look when he gets home to see if Auto is on. Thank you so much for helping us start to figure this thing out. I'm pretty desperate to get a good nights sleep.
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It will take a while. Your obstructive sleep apnea may be positional. For many they have fewer events and require less pressure if they sleep on their side. This requires getting pillow just right so it doesn't put side pressure on the mask.

Many who require higher pressures are put on a BiPAP machine -- higher pressure for inhalation and lower pressure for exhalation. That may be in your future. As you see in my profile, I am on a BiLevel Auto with a max pressure of 18. I side sleep with a full face mask. My AHI was 0.5 last night; and I slept over 7 hours. It can be done.

Tracking therapy by looking at the pressure, flow, event, and leak graphs may lead to you having a choice to change pressure.
I can see no immediate solution in the absence of data. But, do try side sleeping.
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The machine does not know if you are awake or asleep. It takes quite a while for the pressure to go back down. The pressure is raised after an event has happened, the machine will not attempt to address a problem as it is happening. So after it raises the pressure, it will wait for a period of time (I don't know how long, probably between 15 and 45 minutes) and if there are no further problems it will start to reduce the pressure.

You said that the noise wakes your husband. That suggests to me that you have a leak, probably around the mask where it touches your face. Otherwise, there should be very little noise even at 20. If this is a vibratory leak, the machine can think that it is snoring and raise the pressure or keep it up. My DreamStation did that sometimes with my F&P Simplus full-face mask. When the leaks (face farts!) were just right, it would record it as a snore and increase the pressure. Which, of course, made the leak worse and so on and so on until I awoke. Google for the name of your mask and "fitting" or "stop leaks" to see if someone out there has specific suggestions. Also, please fill out your profile fully. As you can see, we can provide more exact advice if we know what we are advising on.

400 events a night over a eight hour sleeping period equates to an AHI of 50. High but not insanely severe. My guess is that they set it at 4-20 as they have no idea what pressure you need as you did not have a titration study done in a sleep lab. I guess it makes sense to them, but very few people find this to be a useful/helpful range of settings. You really need to download SleepyHead (link at top) and let us see what is going on before we can give any useful advice on what settings might be better or, as JustMongo suggested, you really need a different kind of machine.
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Thank you so much for the information. I do sleep on my side as well as on my back. Chill, that is exactly what is happening. I am getting "face farts" when the pressure amps up, though Dream Mapper says the full face mask is fitting 100%, and that is what is waking me up. I have downloaded Sleepyhead and will update my profile to give you all more information. Here's the other thing. My understanding is that I have to use this nightly for 90 days and then send a modem into the insurance company. Are they going to be able to tell if we have gone into settings we technically aren't supposed to or are they just looking to see if has been used for at least 4 hours per night for 90 days?
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Interesting that Dream Mapper says my mask fit 100% with no leaks but when I uploaded info to Sleepyhead it says "your mask is leaking way too much. Talk to your CPAP advisor." All info is in Sleephead. How do I get it so you all can see it?
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Leaks can do exactly as Chill said. Find a way to stay off your back. Some people put something behind their back to prevent rolling on their back.

Here's Robysue's beginner's guide to sleepyhead:

You do a screen capture to get an image of the sleepyhead display -- it's the F12 key.

Best way to share them is by uploading to a sharing site like Imgur; then putting the link to them between IMG tags in your post.

The link for showing postings to imgur will look like:

The machine likely sends usage reports via cellular modem to your provider who may send those reports to your insurance. They are usually only interested in hours used so they get paid for the machine. You may have to let them read your SD card; but that's sort of old fashioned with the latest model machines that have cellular modems. I believe your provider, on physician's order, can make a remote settings change to your therapy.

Yes, they can tell if you have changed a setting if they want to.
Read the apneaboard Admin's treatise on changing your own pressure: http://www.apneaboard.com/adjust-cpap-pr...tup-manual
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