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If one has A10 Autoset Why adjust ranges?
#1
Hi Folks,
So I've gathered that even with an Autoset, there is some advantage to getting to where one get's one's range parameters set a little narrower rather than the wide 4-20. Is that correct?

Why? I have heard that big swings can trigger Centrals....is that so?

What else?

I had my worst night yet on night 23. Felt like I was fighting with the process all ngith long, had highest numbers in time...had been having events stay mostly under 23 seconds and mostly in the low teens, last night had some late 20's and early 30's in seconds. The usual combo of about 2/3 OSA 1/3 Centals.

Woke with Jaw really sore. (nasal pillows, no chin strap, only mild occasional mouth open and am trying to teach self to keep it shut and use tongue seal as well. Maybe I over tried?

I know, you need my charts, I'm still not figuring out the sharing despite the best helpers. I'll get there...

So why narrow numbers once one knows the outliers and range?

Thanks in Advance,
Susan Huh
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#2
the machine reacts to events. if you have it wide open, it will take a while to reach a pressure that tackles the event effectively. it is better to be within range of the most effective pressure when you are rattled with a cluster of events.

it is easier for us to get data, but you can tackle this without charts in the meantime.

so -
what is your prescription pressure setting min and max? (your profile says 5 - 20, is that current?)
what is your starting pressure, median pressure, and your 95% pressure?
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.
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#3
And another aspect that you will discover in time is that when the pressure changes a lot and in a short time, it can actually cause you to wake up. That's kinda counterproductive to the cause at hand. The auto adjusting machines are great for determining what pressure you need to handle your flow limitations but once you know what that is, it's often of great advantage to set the minimum up very close to that figure. I keep mine 1 cm H2O below what it takes to clear the worse case flow limitation before it gets flagged as an OA event.

Best regards, Dude
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#4
Think of it like trying to herd cats.

If you are herding cats in a big room, it will be harder because you have further to go with each cat. You get them all in the box and you relax but one starts to get out of its box. You have so far to go to get to its box, it escapes and you have to herd it into its box again. But then another gets out. And....

But if you are in a smaller room, getting them back in line isn't quite as difficult because they don't have as much room to run around in. And even if you relax, you can stop them from getting out of the boxes quicker because they are all within reach. They may try to get out, and some will still succeed, but it will be easier to herd them back in again.

Oh, and:
The "How Do I..." thread in the Member Help forum:
http://www.apneaboard.com/forums/Thread-How-to-HOW-DO-I

In there you can find the link for how to do an attachment:
http://www.apneaboard.com/forums/Thread-...ttachments

PaulaO2
Apnea Board Moderator
www.ApneaBoard.com


Breathe deeply and count to zen.

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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#5
Wow you all are GREAT! That helped a lot. And Paula I love the hearding cats image. It made me smile after a rough night.

Okay let's see, looking at 30 day setting of Statistics on ResScan it says

212 some hours used, 23 days.

Apnea Index 4.9 Hypopnea Index 1.1 AHI: 6.0 (no time in CSR)
Obstructive 2.4
Central 1.8
Unknown 0.2

Leak L/min Median 0.0 95th 10.8 Max 66.0
Pressure Median 8.3 95th 10.3 Max 13.0

Now those are the stats for the whole period I assume. Shall I go and look for all the outliers low and high, on each day and make note of the highest and lowest or is this sufficient?

What would YOU set pressure to if you were I.
And I have it currently at 5.0-20.00

And I think I am waking from air bursts etc at odd times

Doctors script didn't set a measurement as it was an in home study which determined I had 26.3 AHI and
determined my pulse Ox got down to 76 percent (OUCH) and my event time range went from 14-42 seconds.

SO...it seems like I should set the machine either to 8-13 or a hair hedged say 7.8-13.2 or so? Or should I do 5.0 (what is comfortable to lay down with, I am NOT currently using ramp feature) to 13.2 or so? Or should I do the 7-8-13.2 or so and USE the ramp feature for comfort? I didn't like the long delay to feel fresh air and as soon as I start dozing, I shoot to at least 7 something right away. Please Advise? I know you aren't doctors (-: I also haven't been experiencing any Aerophagia where it's at now.



Thoughts?
Thanks,
Susan

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#6
If it was my cute little body, and precious little machine, I'd set min 8, max 13... I'd also set the EPR to 3 and see if that makes me happier than the usually happy camper I am. Then I'd really watch the stats for a few days. If they did not drop to say 1 or 2, then I'd figure something needs adjusting further. Keep an eye on the leakage as that can cause results to be goofy as well.

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#7
I also agree that you need to raise the minimum setting some. An 8 setting will probably be comfortable if you also set the EPR value to #3. That way you'll be exhaling into a mere 5 cm H2O, just like you are now but you will be inhaling with 8 cm H2O pressure which gives you a better hole shot on the Flow Limitations and a better chance at stopping them from being full grown OA events. The 5 ~ 13 as suggested should give you better results but don't expect instant improvement. It's amazing how the body can adjust to breathing under pressure but it does take time, more for some people, less for others. In time you may choose to back off on the EPR but not right away. Most old timer shut it off completely but it's great relief for newbies.

I had to start at 6 cm H2O and swore I'd never be able to stand anything higher. Presently I start with a minimum of 12 cm H2O and it feels fine. If I could tell you one thing that helped the most in getting that acceptance, it would be wearing the mask while watching TV during the day for short periods and increasing the pressure each day by small amounts. It took me a couple of weeks to get it done but it sure beats laying in bed and struggling with some new pressure setting. Familiarity breed contempt and it can allow you to disregard all the fears you have of being blown up like a balloon and all that jazz.
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#8
The strategy that I employed to go from a 4-20 range to a 7-18 range is to raise the minimum pressure by 1cm. Keep it there for 10+ days. Then raise it by 1cm and repeat. It helped me get used to breathing against a higher pressure. I have had my A-flex set to 3cm so its roughly equal to 3 setting on EPR on Resmed. You can also try raising it by 0.5cm every 5-10 days.

When I went from a 5 start to a 6 start, I felt like the machine was trying to inflate me like a balloon. I had to consciously not think about the machine and my breathing and I could fall asleep. Didn't happen at any other start pressure change.

I also observed that my Average Pressure actually went down from 8+ to ~7.5 when I gradually raised my minimum pressure. My 95% pressure value also went down.

YMMV.
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.
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#9
Thanks Guys! I've had my 5.0 and last night I tried 6.0 for a while but I only had the EPR set to 1.

For now, I've gone and set my bottom Pressure to 8.0 and my top to 13.6 (okay I'm a chicken, just in case I go over somehow)

I have set my EPR to 3 and it is at full time.

I did give myself a 5 min ramp time for this new trial in case I felt overwhelmed during the night or while I lay here and try it while faffing about. If I do well enough on awake trial, I may dump the 5 min ramp but I have it set to start at 5.0 cause that is my "familiar" that said I expect it will feel less than because of the EPR now set to 3.

In the early days I'd find self pulling mask off, feeling disoriented, but I've tried to train myself to hit the reset button with mask staying on, instead to give me thinking time and then return to breathing as I have it on smart start.

I will stay put for a few days and let ya'll know how it goes!
Thanks.
Susan in San Francisco,
Itching to get out of the crib and into the toddler hosehead room where I can forget about the machine for a bit and just play enjoy the land o'nod.
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#10
It's not the wide range that causes centrals. For SOME people, a higher pressure cause centrals. It probably doesn't matter whether you got there by auto or by manual CPAP.

If your starting pressure is too low, you may suffer from discomfort or inadequate treatment until the machine adjusts up to the right pressure. Most auto machines only adjust pressure upwards 1 unit per minute or so.

Sometimes, an auto machine will "run away" and go to too high of a pressure unless you lower the max pressure. Even if the higher pressure is "right," it may cause discomfort and a lower pressure works better.

Changing pressure makes mask fitting harder. If you fit it at your starting pressure, it may leak after you go to sleep and the pressure goes up.

I find that I feel better if I set my minimum pressure a bit above where my AHI is basically zero anyway. I presume this is something a little more subtle like UARS or restricted breathing of some kind.
Get the free SleepyHead software here.
Useful links.
Click here for information on the main alternative to CPAP.
If it's midnight and a DME tells you it's dark outside, go and check it yourself.
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