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New Member Intro: Auto or Set Pressure?
#1
Having just been diagnosed with a supposedly mild case of apnea, tonight will be my first night to sleep with a CPAP. It is a F&P Icon Auto that has been set to 9. I will be using a P10 mask with an XS nasal pillow.

The reason I lobbied for the Icon is because it has a large capacity humidifier. I have recently been diagnosed with Sjogren's Syndrome, which is the condition where moist membranes are too dry.

The reason I lobbied for the Auto is because I am hoping that when I am allowed to use it the automatic feature will help reduce my risk of excessive dryness.

So here's my question. Would it be a good idea to attempt to habituate to the fixed pressure and then switch to Auto later on? Or would it be a better idea to switch to Auto as soon as I get the clinician's manual and let the data tell me what's best to do?

Thanks in advance for sharing your thoughts.

Maud
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#2
(06-02-2015, 10:52 PM)Maudessen Wrote: Having just been diagnosed with a supposedly mild case of apnea, tonight will be my first night to sleep with a CPAP. It is a F&P Icon Auto that has been set to 9. I will be using a P10 mask with an XS nasal pillow.

The reason I lobbied for the Icon is because it has a large capacity humidifier. I have recently been diagnosed with Sjogren's Syndrome, which is the condition where moist membranes are too dry.

The reason I lobbied for the Auto is because I am hoping that when I am allowed to use it the automatic feature will help reduce my risk of excessive dryness.

So here's my question. Would it be a good idea to attempt to habituate to the fixed pressure and then switch to Auto later on? Or would it be a better idea to switch to Auto as soon as I get the clinician's manual and let the data tell me what's best to do?

Thanks in advance for sharing your thoughts.

Maud

Hi Maud,
Welcome to the forum!

I am a fan of Auto mode. In my case, I adapted rapidly to the variable pressures - that never gave me any trouble. My apnea is quite positional, and my events go up dramatically if I roll on my back. At these times, the pressure goes up, and that causes me trouble, both with leaks and aerophasia (air swallowing). Many nights, I might have a few (less than 5) events all night, and my pressure might never go above 12. This is clearly going to lower the average pressure needed compared to a fixed pressure setting. If I were in your position, I would start with Auto mode, and a range of pressure that brackets your prescribed pressure - for example 7 - 14. Then watch your data carefully to see what happens over the next several weeks. You'll find out pretty quickly if you're going to have trouble with leaks, etc. You can always switch to a fixed pressure if you don't seem to tolerate the pressure changes, but I wouldn't give up too quickly on Auto mode, as it has definite benefits. Of course, it is best if you can do this with cooperation from your sleep Dr. (if you have one).

Good luck on your journey.



A.Becker
PAPing in NE Ohio, with a pack of Cairn terriers
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#3
(06-02-2015, 10:52 PM)Maudessen Wrote: So here's my question. Would it be a good idea to attempt to habituate to the fixed pressure and then switch to Auto later on?
Agreed

Coffee

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#4
Hi Maudessen,
WELCOME! to the forum.!
Hang in there for more suggestions and much success to you with your CPAP therapy.
trish6hundred
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#5
Thanks, all! Last night, which was my first night at home with a CPAP, went much better than expected with the pressure set on 9. Several things that I picked up from reading this board and reviews on commercial sites were particularly helpful. I share them in case they can help another newbie.

1. Correctly sized nasal pillow. At the sleep center they put me in a Small, which was too big for me. Maybe they didn't have anything smaller, because they didn't offer an alternative when I pointed it out. Happily, the tech who set up my CPAP recommended the XS that came with the P10, and it worked much better.

2. Correct angle on the nasal pillow. I found some instructions that stated explicitly to make sure the nasal pillow is aimed up the nostril. At the sleep center, in part because the pillow was the wrong size, that hadn't happened. It seems so obvious now, but at the time I didn't realize the angle was part of the problem.

3. Mask not too tight. At the sleep center they really strapped that thing on tightly, and my upper lip really hurt the next day. Last night I tried for less tightness with the correct angle and size of pillow, and what a difference it made in terms of comfort! Because of my Sjogren's, I sleep with a contoured eye shade as a means to maintain a moist microclimate for my eyes. This is especially important with the mask ventilating my CO2 right beneath my eyes. So I first put on my mask, then put on the eye shade, and tucked the bottom edges of the eye shade under the straps for the mask. Thank goodness I can't see what I look like! Anyhow, this approach worked out well for me last night.

4. Nostrils and upper lip lubed with non-petroleum ointment. Yesterday afternoon I tried to take a 45-minute nap with the new CPAP, and the mask chapped my nostrils and upper lip. Because the nasal pillow is silicone, I knew I couldn't use any type of moisturizer or barrier cream that contained petroleum products. I had on hand some all vegetable ointment that worked really well to moisturize my nostrils so they don't crack (Sjogren's again) called Alba Bontanica Un-petroleum Jelly (castor oil, coconut oil, beeswax, and Vitamin E.) The beeswax can make this stuff sticky, but I found a very tiny bit worked very well after I rubbed it in.

5. No ramp-up. At the sleep center I actually got panicky at the beginning of ramp-up because I felt air-deprived. I now know this was caused in great part by an ill-fitting mask where one nostril was collapsed and getting no air. So last night I decided to try starting without a ramp-up, and it worked well for me. I think the fact that the mask fit properly made all the difference in eliminating the need to do this.

6. The heated hose and humidifier. I don't know how this is going to work in warm weather, but last night was cool and I was glad that the Icon has a heated hose and the high capacity humidifier. The humidifier on the Icon can be set from 1 to 7, and I decided to try 4. It worked very well and there was still water in the tank this morning! Tonight I may try setting the humidity to 3 to see if it's enough. The ambient humidity is not exactly low, so I want to figure out the least amount of humidity I need when the weather is not dry.

So my next step is to download Sleepyhead and become familiar with the terms and the data. I also need to find out more of what the sleep center data revealed. For example, I have no idea what my AHI was on my original home study or when I spent the night at the sleep center.

I think I'm going to keep my setting at 9 until I am habituated to sleeping with the mask, and then attempt to reset the Icon to Auto (having already received the clinician's manual!). I now believe it's likely that 9 is higher than it needs to be because I was basically breathing through one nostril at the sleep center because the mask was the wrong size.

Thanks again for your help and support!

Maud
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#6
Different strokes. I started out with an auto bi-level machine and love it.
Knowledge is power. Lots of power here to be had. If you can conatct the sleep center tell them you want the study. All of it. Do not take no for an answer. By law they gotta give it to you. Get your Rx too!
I use my PAP machine nightly and I feel great!
Updated: Philips Respironics System One (60 Series)
RemStar BiPAP Auto with Bi-FlexModel 760P -
Rise Time x3 Fixed Bi-Level EPAP 9.0 IPAP 11.5 (cmH2O)
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#7
(06-03-2015, 10:26 AM)Mark Douglas Wrote: If you can contact the sleep center tell them you want the study. All of it. Do not take no for an answer. By law they gotta give it to you. Get your Rx too!

Done! She promised to mail it. We shall see!

Maud

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#8
Whether you should be auto or fixed is primarily determined by one factor, which is how involved you sleep doc is in the decision for your fixed pressure. If this is based on a PSG and titration, then it is probably a good starting point. But it may be that the doc just collected the fee for the PSG, did not review the results for more than 5 seconds (you were probably not there to see whether he did or not), and then just threw a dart. 9 is a good round number, so lets use 9. OK, 9 it is.

Another way the therapy happens is to go full auto wide open for a couple weeks, then review that data, and make a decision about how to tighten the range for best effect. You may notice that I did not mention the sleep doc in this approach, because they might not be involved in this. But you can do this yourself if you want.

But were I given a fixed 9, I would try that for a while, and then slowly expand the range while monitoring results. Go 9 for a couple weeks, parse the data, go 8-10 for a couple weeks, parse that data, and so on. Look for the APAP to not top out, and use that for your top limit, or if CAs increase, stop opening up the top limit. If AHI goes up, the lower limit may be set too low.

Marathon, not a sprint.

My oersonal, non-medical opinion is that fixed is never the best thing for a typical OSA sufferer, because a fixed pressure is a legacy holdover from CPAP, which is a machine not capable of anything other than a fixed pressure. And that number is based often on what is the best AVERAGE pressure you should have. But your requirements change with sleeping position and with sleep stages, so your best therapeutic pressure changes dynamically throughout the night, meaning that the fixed pressure is often wrong for a good part of the night. APAP solves this problem completely, but it works best only if tweaked properly.
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#9
(06-02-2015, 10:52 PM)Maudessen Wrote: So here's my question. Would it be a good idea to attempt to habituate to the fixed pressure and then switch to Auto later on? Or would it be a better idea to switch to Auto as soon as I get the clinician's manual and let the data tell me what's best to do?

Thanks in advance for sharing your thoughts.

Maud

Maud, I can't answer your question (newbie that I am), but did you ask your doctor why s/he set you with a single pressure? What is the goal? Why is this better than using the auto features?

What I'm getting from reading is that a lot of doctors simply continue to prescribe as though auto machines don't exist. If they are using a single pressure, why is that better than just letting the machine do its job? I will be bombarding my sleep doc with those questions tomorrow should I be prescribed a single pressure, because frankly, I've been doing well on the auto machine I bought used.
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#10
If your titrated pressure is 9 and it is well tolerated by you AND sleepyhead shows your AHI to be acceptable then:
There is no reason to go Auto.

Auto is not a magic bullet. Their algorithms are still a heuristics based work in progress and so they don't work for everyone. Also, some people have pressure change induced microarousals which disrupt sleep quality and make you feel crap in the morning even though AHI looks really good.

If your needed fixed pressure is not tolerable, then Auto is a trade off you can make.
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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