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Switching from CPAP to APAP
#1
My Philips Dreamstation is the auto version, but my prescription is fixed pressure (7cm).

I retired my Devilbiss CPAP about 2-3 months ago. I used to average around 1.8-2 AHI on that machine (at 7cm) and my new Philips generally shows 2.5-3.5 AHI at the same pressure. There may be some differences in the sensing algorithms between the two that can account for the variation.

What I would like to do is enable the auto function of the DreamStation. There are some complications because of my reporting requirements: I can't simply make the changes to see what happens, I have to get my doc to write an explanation and give me a new prescription, otherwise eyebrows will be raised.

If I can convince him to let me change the settings, I'll need a prescription and a report explaining the reason. If he doesn't want to do that, then I would probably need another sleep study. If he WILL do that, what is a reasonable range for an auto setting for a fixed setting of 7cm (6cm - 10 cm, for example?) Is there a way to tell from the current data? My sleep study simply came up with a number that seemed optimal at the time, it was a fixed pressure and not a range. If I were to open up the range, is there a way to know in advance if I could expect lower AHI numbers?
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#2
6 may well feel oppressive since you are accustomed to 7. It does for me... nothing wrong with starting at 7 and giving some headroom - it will not go higher than u need so not so important, but 10 would be a reasonable expectation.

My AHI at straight 7 is in the range you mention above, but my apap is set 8 to 15 and generally hangs around 9 as soon as i am sleeping and spends plenty of time above that. on a good night, my median is 10 ish and max 12 or 13. but some nights i spend a fair bit of time at 14.

All that to say, your pressure needs could be higher than 7 to prevent near events. All I can say is that I feel a heck of a lot better at 8-15 than I did at 7. had a good AHI at 7 but felt untreated.
هههههه هههههه هههههه هههههه هههههه هههههه هههههه هههههه هههههه هههههه هههههه هههههه هههههه هههههه
Tongue Suck Technique for prevention of mouth breathing:
  • Place your tongue behind your front teeth on the roof of your mouth
  • let your tongue fill the space between the upper molars
  • gently suck to form a light vacuum
Practising during the day can help you to keep it at night

هههههه هههههه هههههه هههههه هههههه هههههه هههههه هههههه هههههه هههههه هههههه هههههه هههههه هههههه
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#3
Auto settings are usually based on your 90/95% pressure and aim to bracket it by 1.5 - 2 cmH2O. As your machine is on a fixed pressure, it would bracket that. So a minimum of 5 or 5 and a max of 8.5 or 9. There is no way to know for certain what the result will be in advance.

Do you want to make these adjustments because you are not feeling as well on the new machine, or because you are chasing specific AHI numbers? If you feel as good or better, I'd leave it alone. It could be that the machines detect or score events slightly differently so that the difference you are noticing is just mathematical, not a therapeutic difference. The only thing that matters here is how you feel the next day.
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#4
DreamStation Auto in "Auto mode" is more like having a mini sleep study at home, 6-10 sound reasonable to me
SleepHead will tells us what is going on and if any adjustments needed, as well as how you feel
As for doctors, IMO, once things get dialled in, doctor visits for CPAP/APAP users become redundant but I don't need to prove my compliance to no one, other than to myself which is most important






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#5
Why on Gods green earth would you need a RX to change your own settings?

Insurance doesnt give a hoot except your compliant.
Whose "eyebrows" will raise over you doing something totally lega and that you have every right to do????

Pretty sure I can guess,
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#6
(08-22-2016, 04:44 PM)chill Wrote: Auto settings are usually based on your 90/95% pressure and aim to bracket it by 1.5 - 2 cmH2O. As your machine is on a fixed pressure, it would bracket that. So a minimum of 5 or 5 and a max of 8.5 or 9. There is no way to know for certain what the result will be in advance.

Do you want to make these adjustments because you are not feeling as well on the new machine, or because you are chasing specific AHI numbers? If you feel as good or better, I'd leave it alone. It could be that the machines detect or score events slightly differently so that the difference you are noticing is just mathematical, not a therapeutic difference. The only thing that matters here is how you feel the next day.

I'm chasing AHI numbers, sort of. I'd really like to ensure I'm getting optimum results.

(08-22-2016, 05:46 PM)Ghost1958 Wrote: Why on Gods green earth would you need a RX to change your own settings?

Insurance doesnt give a hoot except your compliant.
Whose "eyebrows" will raise over you doing something totally lega and that you have every right to do????

I don't worry about insurance for my CPAP, I pay out of pocket so I don't need to show compliance to them.

To maintain my pilot's license medical requirements, I need to report to FAA with an annual report showing compliance (6hr/night for >75% nights for the previous 365 days) and efficacy. If I change my settings, the questions I have to answer are, "Why? Your scrip says 7 cm, what made you think you needed to change it? Wasn't it effective? If it wasn't, then you need a new sleep study ($$) and you are grounded until then. Have a nice day."

But if my doc writes a note that says something like, "Setting of 7 cm shows OSA fully controlled, and patient shows full compliance. For patient convenience a setting of 7-12 (or whatever) has been prescribed", then I can avoid a new sleep study and have the ability to play around without worrying about the Feds.


(08-22-2016, 05:46 PM)Ghost1958 Wrote: Pretty sure I can guess,

Was that your guess?
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#7
(08-22-2016, 09:55 PM)KSMatthew Wrote:
(08-22-2016, 04:44 PM)chill Wrote: Auto settings are usually based on your 90/95% pressure and aim to bracket it by 1.5 - 2 cmH2O. As your machine is on a fixed pressure, it would bracket that. So a minimum of 5 or 5 and a max of 8.5 or 9. There is no way to know for certain what the result will be in advance.

Do you want to make these adjustments because you are not feeling as well on the new machine, or because you are chasing specific AHI numbers? If you feel as good or better, I'd leave it alone. It could be that the machines detect or score events slightly differently so that the difference you are noticing is just mathematical, not a therapeutic difference. The only thing that matters here is how you feel the next day.

I'm chasing AHI numbers, sort of. I'd really like to ensure I'm getting optimum results.

(08-22-2016, 05:46 PM)Ghost1958 Wrote: Why on Gods green earth would you need a RX to change your own settings?

Insurance doesnt give a hoot except your compliant.
Whose "eyebrows" will raise over you doing something totally lega and that you have every right to do????

I don't worry about insurance for my CPAP, I pay out of pocket so I don't need to show compliance to them.

To maintain my pilot's license medical requirements, I need to report to FAA with an annual report showing compliance (6hr/night for >75% nights for the previous 365 days) and efficacy. If I change my settings, the questions I have to answer are, "Why? Your scrip says 7 cm, what made you think you needed to change it? Wasn't it effective? If it wasn't, then you need a new sleep study ($$) and you are grounded until then. Have a nice day."

But if my doc writes a note that says something like, "Setting of 7 cm shows OSA fully controlled, and patient shows full compliance. For patient convenience a setting of 7-12 (or whatever) has been prescribed", then I can avoid a new sleep study and have the ability to play around without worrying about the Feds.


(08-22-2016, 05:46 PM)Ghost1958 Wrote: Pretty sure I can guess,

Was that your guess?

No LOL. Your in sort of a special situation,

My guess was the Dr gettin his shorts in a knot or a DME,
Got me good on this one LOL
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#8
I was told early on -- chasing the numbers is often a fool's game as there are too many variables that play out in a short period of time. I was told by my mentor, "you treat the patient, not the machine." Just as long as you feel good and the numbers are within tolerance AHI < 5, you should consider looking at longer periods and keep a diary to note possible causative issues like drinking, eating a full meal, being stressed, etc. Best of luck.
"The object in life is not to be on the side of the majority, but to escape finding oneself in the ranks of the insane." -- Marcus Aurelius
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#9
(08-22-2016, 09:55 PM)KSMatthew Wrote: I'm chasing AHI numbers, sort of. I'd really like to ensure I'm getting optimum results.

I fully understand the desire to get optimum results, but watching AHI is not the way to do it. The AHI is a good first order rough estimate. If your AHI is 5 then you probably feel better than if it is 10. The AHI does not indicate event duration, so 10 seconds of not breathing and three minutes score the same AHI. It does not directly reflect oxygen desaturations, full or partial wakings, etc. All of which can have a real life, bottom line effect on how you feel and function.

All of which is not an argument against getting on an auto setting and adjusting your flex and whatever else won't upset the FAA and keeping an eye on things in SleepyHead and a diary of how you feel. But AHI is too coarse a measurement to use as your main focus.
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#10
Since my pressures are the same over 2 different machines, and I'm getting slightly different AHI numbers, I've been assuming the differences were due to internal sensing algorithms. So, yes I've been fixated on that. I can see a direct correlation between how I feel on a given day and my AHI score of the night before. I can look at my score in the morning and tell if I will have a good day or not.

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