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New APAP User
#1
New APAP User
        I have used a CPAP for 12 years, most recently using a Respironics System One machine, and always had my pressure set at 8. I recently purchased a Dreamstation Go APAP machine for travel, and have been trying it out. I'm also new to OSCAR, so I'm looking for some guidance. I have been making some tweaks, but have my Dreamstation Go set to a minimum pressure of 5, with no ramp (I didn't use ramp before). With my old machine, everything was fairly consistent throughout the night. But with the new machine, I've noticed that the first few hours of the night, everything looks good in my limited understanding of the software, but at around 3-4 a.m., everything spikes up a bit, pressures, AHI, etc. Is this anything to concern myself with? I attached screen shots from last night. Thanks for any guidance.
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#2
RE: New APAP User
Welcome

I'm a newbie too, December.  Not understanding everything, but getting there.  You have come to the right place for answers.  I know one of the advisors will be a long shortly to help you.

I see you have RERAs.  I wonder if this might be an issue?  The advisors have eliminated mine with setting tweaks.  This might be something they address.

Best regards,

Plmnb
Huhsign  WARNING: It may take a while to sink in...I tend to get befuddled at times.
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#3
RE: New APAP User
There is nothing unusual about APAP pressures bouncing around during the night.
Peoples breathing changes depending on REM state, sleep position and congestion levels.
I spend the first few hours at about 8 cmH20 and the rest of the night is bouncing between 9 and 11.

Having said that there is probably some room for a tweak or two on the pressure to improve your AHI and minimize the pressure swings that others may recommend.
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#4
RE: New APAP User
Respironics machines are slow to react, so by using a minimum pressure of 5cm, you are limiting your  machines ability to do it's job.  It  just can't be where it needs to be in a timely manner.  It's kind of like pushing a lawn mower up a big hill and running out of gas.  

Just looking at your graphs, I would set the minimum pressure no less than 8cm, possibly needing to move it to 9cm, but wait and see.  

Don't know what Flex setting you are using, but I would try it at 2.

And yes, it's normal to see pressure changes during the night. We go through different stages of sleep and sometimes it can be calm and sometimes not.
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#5
RE: New APAP User
Your pressures rose at 3:20 in response to hypopneas and then an increase in Slow Limitations was enough to prevent a decrease in pressure.  

two options, 

1.  start with an 8 min (that is what the chart is asking,  and what you used previously.

2. start at 7 min,  5 IMHO is too low, 6 min for any PR using Flex, 7 is also OK and is 1 less than what you used on your other machine.

It looks like you are using Flex = 1, I could be wrong.  You have RETAs which are a series of flow limitations ending in arousal, that and seeing the FL event says that you are having some issue with flow limits.  To attempt to treat this try a Flex=2, you can also try Flex=3 and choose which feels best for you. 

Other than numbers, how do you feel?
Fred Bonjour - Project Manager and Lead Tester for OSCAR - Open Source CPAP Analysis Reporter 
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#6
RE: New APAP User
(01-14-2020, 05:42 PM)bonjour Wrote: Your pressures rose at 3:20 in response to hypopneas and then an increase in Slow Limitations was enough to prevent a decrease in pressure.  

two options, 

1.  start with an 8 min (that is what the chart is asking,  and what you used previously.

2. start at 7 min,  5 IMHO is too low, 6 min for any PR using Flex, 7 is also OK and is 1 less than what you used on your other machine.

It looks like you are using Flex = 1, I could be wrong.  You have RETAs which are a series of flow limitations ending in arousal, that and seeing the FL event says that you are having some issue with flow limits.  To attempt to treat this try a Flex=2, you can also try Flex=3 and choose which feels best for you. 

Other than numbers, how do you feel?
Thanks for all the replies. A setting of 8 makes sense, since as you say that's what I used previously. I was thinking of trying that tonight. My Flex is set at 2. 

As for how I feel, I have been a bit more tired the past few days, but not sure if it's my sleep of just this gloomy weather we've been having.

I've also noticed that I use a lot less water in the humidifier than my old machine. Not sure if that is due to the lower pressure setting or just a difference in machines.
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#7
RE: New APAP User
Woke up feeling much better this morning, thanks for the help. Last night's charts attached. I did noticed that the noise level was higher last night, I assume because of the higher pressure. I also tried the night without the humidifier to see how that was before our trip. A little dry nose, but not too bad.


Attached Files Thumbnail(s)
       
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#8
RE: New APAP User
Great results. You still have flow limitations. But I don't think they are that important for you

How you feel is the most important thing now.

Try Flex =3. Many did it too much, and choose which one, flex = 2 or 3, that feels better for you.
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: New APAP User
I always found Flex at 3 was not as comfortable, and it doesn't provide more pressure relief, rather it is more the timing and duration. Flex provides a maximum of 2-cm of pressure relief at settings 2 and 3. My approach with the Philips Dreamstation Auto would be to increase the minimum pressure to 9.0. that will give you 3-cm of pressure fluctuation through the night which should get ahead of the remaining hypopnea, be comfortable and less disruptive. Finally, I would go back to using a humidification scheme that is comfortable to you. Omitting the humidifier will be more noisy as you observed. Manual settings vs auto humidity settings will produce higher humidity in most cases.
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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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#10
RE: New APAP User
(01-15-2020, 10:14 AM)Bonjour Wrote:  "You still have flow limitations." 

SleepriderI always found Flex at 3 was not as comfortable, and it doesn't provide more pressure relief, rather it is more the timing and duration.  Flex provides a maximum of 2-cm of pressure relief at settings 2 and 3.  My approach with the Philips Dreamstation Auto would be to increase the minimum pressure to 9.0.  that will give you 3-cm of pressure fluctuation through the night which should get ahead of the remaining hypopnea, be comfortable and less disruptive.  Finally, I would go back to using a humidification scheme that is comfortable to you.  Omitting the humidifier will be more noisy as you observed.  Manual settings vs auto humidity settings will produce higher humidity in most cases.

Excuse my ignorance, but trying to fully understand, what is meant by "flow limitations"?

If flex is at 2, how does setting the min pressure to 9 give me 3-cm of pressure fluctuation?

I agree on using the humidifier, but wanted to see how I was without it in case i wanted to not bother with it on vacation.
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