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[Pressure] Could someone please help with settings?
#1
Could someone please help with settings?
       Hi everyone. New to the board and the wealth of information is great here, but very mind boggling to get a handle on it all.  I'm 52 and I was recently diagnosed with OSA a month ago. I had my sleep study and AHI was 21.  Anyway my pulmonology doc told me that he was going to put me on AutoPAP. Great, I sure hope this helps my EXTREME every day fatigue. 3 weeks later I find out my lovely insurance won't cover my machine. Oh well, buying it myself I guess. Found a System one AFLEX refurbished for 350 with only about 300 hours on it. Yaaaa. And my doc who is the attending on my ventilator unit, (I'm a nurse) told me don't worry about the mask, I got you. Gave me a Airfit F20 for nothing. Love it. 
       I took to the AutoPAP with very little problems the first night. Actually better than expected.  Just told myself to relax you'll be ok.  Your not suffocating.   I didn't really get any good instructions on what pressures to set, other that the resp. therapist telling me "just leave it and 4-20 and you'll be good". We know better though, don't we?.  My AHI's have been in the 1 to 3 range with the occasional sub 1's, which I know is really good enough, but I cant help but think, "How much better COULD I be sleeping."  I've experimented with all minimum pressures from 4 to 10. Leaving each for a few days. The first night is always the best, but every night after my AHI jumps to double or even triple it was on the first night. I've also taken to using a cervical colllar, as I know I snore, which I was under the impression the AutoPAP would help eliminate that. I've also noticed that although there may not be and event, I do have a lot of disturbed, jagged breathing through the night, which means I'm at least slightly waking up. Right? 
        I'm posting a couple of my recent nights of data with Sleepyhead and hopefully somebody on this great board, can point me in the right direction, or at the least tell me to relax, your doing great.  I do feel much better than pre-AutoPAP so that a plus.  I hope I post the screenshots correctly, but the machine settings don't show up in the screen shot, so I'm including them here. Please don't put me on blast for doing the shots wrong. LOL. Hope your all having a great week and getting great sleep. Thanks, guys.

                                                                                                                      Brian 

Machine Settings

PAP ModePAP Device Mode          APAP (Variable)
Pressure Minimum                       9.00 cmH2O
Pressure Maximum                      20.00 cmH2O
AFlex                                         x1
Humidity Level                            x3
Humidifier connected?                 Connected
Ramp Pressure                           (I don't use ramp as I am comfortable without it)
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#2
RE: Could someone please help with settings?
Hi, welcome to the Board.  And I think congratulations are in order for you because you have done very well to learn what you can and to get a grip on your own recovery. Not too shabby.

If you look at your pressure graph, you spend a lot of time up in the 12 cm range on inspiration, and somewhat above 9.5 for exhalation, a decent range.  But you skirt around the edges of excessive leakage, if I am reading your chart correctly.  Those are likely to cause arousals, which are deleterious because they interfere with your natural progression through the various stages of sleep.  If you get excessively tired, you'll snore more.  As you know, position is important, and you say you are addressing that.

It's not clear to me that you adjust only one parameter at a time and then see what happens over several nights.  Do you?  You'll add or subtract pressure on one of the two breathing events....only?
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#3
RE: Could someone please help with settings?
On that chart, if it is your average. I would raise the min pressure to 10, a bit below your 95%. The dreamstation can be slow to respond.
mask fit http://www.apneaboard.com/wiki/index.php...ask_Primer
For auto-cpap, from machine data or software. You can set the min pressure 1 or 2cm below 95%. Or clinicians commonly use the maximum or 95% pressure for fixed pressure CPAP, this can also be used for min pressure.
https://aasm.org/resources/practiceparam...rating.pdf
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#4
RE: Could someone please help with settings?
Thank you so much for replying Mesenteria.  I can all be so mind boggling and frustrating at times to figure this all out.   As far as settings, the only thing that I've changed at times is the Aflex setting and the humidity level.  Sometimes lower, sometimes higher trying to figure this all out.  Other that that it's only the pressure I have adjusted.  I don't know, maybe I'm not giving the particular pressure setting enough time to see if my body adjusts to it.  Ugh, it's so frustrating at times when I wake up, check my data and my AHI is 0.45 and then the next night it's 2.99.  
       As far as leakage, I am using the ResMed Airfit F20 (full face mask).  I was under the impression that the expected leak rate for that mask for my pressure of 9 is around 35.  In my total leaks my 90% is 34.  Are you saying that is still too much leaking?  I always test the mask before and after I lay down and almost never feel any leaking around the mask and the mask fit check always passes on my machine.  Do I try another mask?
       Again, thank you so much for responding.  As I said this can all be so frustrating and at times upsetting, and thinking "Oh, screw it.  Your numbers are under 5, so just live with that."
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#5
RE: Could someone please help with settings?
Thank you so much for replying ajack!!!  This can all be so frustrating to figure out what i'm doing wrong and what I'm doing right.  I actually use the Respironics System One, and not the Dreamstation.  Do you think settting the minimum pressure to 10 is still a good idea?  Is the System One as slow to respond also?
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#6
RE: Could someone please help with settings?
Sorry, I meant the System One. yes, I would use 10 for a week and then review. The Philips machines like to be closer to the 95% than the Resmed
mask fit http://www.apneaboard.com/wiki/index.php...ask_Primer
For auto-cpap, from machine data or software. You can set the min pressure 1 or 2cm below 95%. Or clinicians commonly use the maximum or 95% pressure for fixed pressure CPAP, this can also be used for min pressure.
https://aasm.org/resources/practiceparam...rating.pdf
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#7
RE: Could someone please help with settings?
Your leak rate is fine.  You just had one leak “blip” around 5:30.  Look at the leak graph at that time.  The peak in the leak graph just means you probably moved your mask when turning or bumped it somehow.  The leak rate for the rest of the night is fairly low for a Respironics machine.

As far as setting AFlex, use either a setting of 1 or 2.  A setting of 3 can sometimes feel that the machine is forcing you to inhale or exhale sooner than what feels natural.

I think the setting of 10 that ajack recommended is fine to go with.  See if it makes a difference.

The DreamStation is an upgrade from the current machine you are using.  There is no real difference in many of the features or algorithm.  It just looks better.  Smile
OpalRose
Apnea Board Administrator
www.apneaboard.com

_______________________
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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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#8
RE: Could someone please help with settings?
Ok ajack.  Gonna move the pressure to 10 tonight and leave it at that for the week.  I’ll see you next week, with a whole bunch of charts.  Maybe sooner if I’m doing better.  LOL.  Thanks again!!  You have no idea how good it feels that people like you guys a here to help!!!
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#9
RE: Could someone please help with settings?
Thank you so much OpalRose.  You guys rock!!  So nice to know i’m not alone in this!!!  
      Darn right.  That Dreamstation is one pretty machine.  LOL. We have a couple on my ventilator unit.  Im a nurse on a vent unit, you’d think this would be a breeze for me figuring all this out.  Nope.  LOL
       I’ll take yours and ajack’s suggestions and set pressure to 10 and Aflex to 1.  Just one more question.  Do you think i should keep using the cervical collar?  Do you think it could be restricting my airway somehow?  Just a thought.  
       Again, thank you soooo much!!!
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#10
RE: Could someone please help with settings?
I would use the collar for a couple of nights more, till the new pressure sets. The collar should be reducing and not increasing obstruction, by keeping your airway open. You may have gotten use to the position and be able to adjust your pillow to support your neck. You can remove the collar and see the results. It will be obvious if the obstructive gets worse.
mask fit http://www.apneaboard.com/wiki/index.php...ask_Primer
For auto-cpap, from machine data or software. You can set the min pressure 1 or 2cm below 95%. Or clinicians commonly use the maximum or 95% pressure for fixed pressure CPAP, this can also be used for min pressure.
https://aasm.org/resources/practiceparam...rating.pdf
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