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Questionable Titration Study?
#1
One month ago the sleep center doctor who interpreted my titration study prescribed a straight CPAP setting of 4.0. So the provider gave me a S9 ResMed AutoSet with the AutoSet feature disabled.

Thanks to this forum I learned about SleepyHead and found that I had clusters of events that were not offset by the 4.0 pressure setting. The doctor refused to allow the provider to enable the AutoSet feature until I had 90 days usage at the 4.0 setting.

I finally got around the doctor and now have the AutoSet enabled and set at 6.0 min / 16.0 max. My average pressure is 9.11 and my 95% pressure is 14.58. I am thinking of increasing the minimum pressure to 8.0 to lessen the sleep disruption when the machine increases the pressure to overcome an obstruction. Do the experienced users think that is a good idea.

By the way, I don't believe a one-night titration study is valid even though it is interpreted by an expert.
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#2
How long have you used the auto set at 6 to 16?
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#3
How do these doctors manage to keep their job? You need 15 cmH2O and he prescribed CPAP at 4! Can't anybody start suing them?
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#4
Hi JimZZZ,
WELCOME! to the forum.!
What DOOM_NX said.
Hang in there for more suggestions, best of luck and better sleep to you.
trish6hundred
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#5
(12-27-2013, 10:09 AM)me50 Wrote: How long have you used the auto set at 6 to 16?
me50,
I had the AutoSet at 4/16 for a couple of weeks but would wake up when the presssure moved up from 4 to a higher level. I reasoned that a narrower range (6/16) would lessen the disruption.

It worked! Last night was the first time I had it set at 6/16 and I slept much better. So, I'm wondering if reducing the range to 8/16 would be optimal. Since I'm averaging 9.11 it would seem that 8.0 would not be too high.

I feel unqualified to make these changes so am seeking opinions from more experienced users. Thank you for responding.
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#6
If you just changed your settings last night, you need to watch your data for at least 2 weeks to determine how well it is working for you. One night is not enough to change your settings yet. That is my advice to you.
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#7
(12-27-2013, 01:59 PM)JimZZZ Wrote:
(12-27-2013, 10:09 AM)me50 Wrote: How long have you used the auto set at 6 to 16?
me50,
I had the AutoSet at 4/16 for a couple of weeks but would wake up when the presssure moved up from 4 to a higher level. I reasoned that a narrower range (6/16) would lessen the disruption.

It worked! Last night was the first time I had it set at 6/16 and I slept much better. So, I'm wondering if reducing the range to 8/16 would be optimal. Since I'm averaging 9.11 it would seem that 8.0 would not be too high.

I feel unqualified to make these changes so am seeking opinions from more experienced users. Thank you for responding.

Hi JimZZZ,

Because the ResMed AutoSet algorithm always slowly seeks to return to its minimum setting, I think it is usually not good to have the minimum pressure be way too low, like more than 6 lower than the 95% pressure.

I think most who use APAP machines and are closely involved in their therapy prefer their minimum pressure to be set somewhere between 2 to 6 lower than their 95 percentile pressure. A few have reported they feel best (less daytime sleepiness) when their minimum pressure is close to (or even slightly above) where their 95% pressure used to be (when their minimum pressure had previously been set much lower).

If your present minimum pressure setting of 6 is not bothersome to you by being too low (personally, even after just a month of therapy, I would have felt slightly smothered by a low pressure like 6, like I was needing to work a little too hard to take in a breath), then keeping the minimum at 6 for another week or two may be a good idea.

But keep in mind that, on an AutoPAP machine, the setting for minimum pressure is more often than not just a comfort setting which can be raised if a higher minimum would be more comfortable. (That is, unless your individual data shows that central apneas start occurring mostly during the times when the pressure is higher than your median pressure, or something like that.)

Take care,
--- Vaughn

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. The Advisory Member group provides advice and suggestions to Apnea Board administrators and staff on matters concerning Apnea Board operation and administrative policies - not on matters concerning treatment for Sleep Apnea. I think it is now too late to change the name of the group but I think Voting Member group would perhaps have been a more descriptive name for the group.
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#8
(12-27-2013, 01:59 PM)JimZZZ Wrote: I had the AutoSet at 4/16 for a couple of weeks but would wake up when the presssure moved up from 4 to a higher level. I reasoned that a narrower range (6/16) would lessen the disruption.

Hi! Set the RAMP to 5 minutes or off so the pressure change won't happen when you are already asleep. Wink
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#9
Thanks to everyone for the responses. This forum is invaluable for new users! I am going with an autoset pressure range of 8/16, ramp off and leaving it there for at least a month. Thanks to what I've learned here, I feel confident this is a sound decision.
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#10
Oh wait... don't make every change at the same time! Then you won't know what worked for you!

Try changing the RAMP first, see how you go for a few days and then gradually increase your pressure. Pay attention to your pressure graph in ResScan or SleepyHead, to see how low it really goes when you sleep.
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