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[Treatment] First Machine needs setting.
#1
First Machine needs setting.
Hi everyone Thanks for this creating and contributing to this site!!

I got my diagnosis a few months back, but due to red tape and hulahoops, I only just now have my machine. I bought a dreamstation online from Papsmart (on the list here) unboxed it and had to figure out how to set it. 

I ran into a few confusing things. I have 2 scripts; a script pad scribbled on, and a typed fullpage script. The scribbled script says 2 week auto trial 4-20. but the typed page says APap 4-15 there is a box for auto-trail which isn't even checked off. optistart box also isn't checked

So, I made an appointment to have (i think you would call this place a provider) to set it up for me. First they want to charge me 150$ which i think is a big rip off, second my appointment got cancelled because of covid-19

So, I'm hoping to be able to do this myself and feel comfortable with it. From my research and understanding the important thing in all this is just the 4. The min pressure. High pressure seems to be what scares everyone so I chose the lower of the 2 highs i was given and set my machine to apap min 4 and max 15. Now aflex came on by default and i bought it because i wanted afex and optistart. I was surprised to see that optistart was something that gets prescribed or not, and not just a comfort option the patient can choose. 

The options the doc had to check off was a choice between Cpap, Apap, and Bpap. Apap was picked. 
If I have aflex set to on, does this make my Apap a Bpap? I'm guessing yes, so I should have aflex off? which is a bummer because i also picked the dreamstation because aflex sounded very comfortable. but i don't know because i have yet to take one breath with any machine and i'm the type of person who wants to know everything, so for the last few days Ive even learned how to interpret the blood levels of my sleep study. I'm that person.
Does it sound like i'm missing anything or do I got this?

Thanks
Community is people helping each other overcome some adversity. Sometimes it's a hurricane, other times it's a monopolist industry that benefits from keeping people in the dark about their own medical data or scaring them into thinking they aren't capable of managing their own treatment. Thankfully people will always develop community no mater what the adversity is. 
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#2
RE: First Machine needs setting.
Welcome, rebirth!

It sounds as though your machine is a regular DreamStation APAP machine, not a BiPap. The flex settings give you a bit lower pressure when you exhale; the Aflex setting returns you to your inhale pressure a little more gradually than Cflex. For that reason, people find it more comfortable. (Note: I don't have a PR machine, so what I've written here is what I've gleaned from forum members.)

I would warmly suggest raising that minimum pressure to 6 or 7. Most people feel somewhat air-starved at 4 or 5. It's fine to leave the max at 15 for now, though once you get going, if you find the pressure plastered up at your max, you should raise it.

Have you check whether there's an SD card in your machine? If there isn't do get one. And then download Oscar software to your laptop or desktop. (See banner at the top of the page.) Viewing the data charts will be a key to successful adjustments to your settings. In the meantime, do you have the breakdown of events from your sleep study (obstructive apnea, central apnea, hypopnea, maybe RERA)?

To get off to a good start, I'd suggest setting the machine up outside your bedroom and using it while you read or watch TV during the day. This will speed up your adaptation to the new sensations. Ideally you will do this for at least a few days before you start trying night-time use.
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#3
RE: First Machine needs setting.
A ResMed APAP with EPR of 1-3 can mimic a BPAP, but the EPR-like PS is limited to 3 max. Your DreamStation and A-flex in APAP mode or C-flex in CPAP mode won't get close to mimicking a BPAP.

The script of either 4-15 or 4-20 indicates the doc is just saying he/she does not know what pressure to use and isn't willing to find out. The doc wants the machine to find out and just run between the min and max limits, hoping it gives decent therapy. Hint, it won't. The DreamStation will need optimized AKA you will need OSCAR data to determine what settings you need to get proper therapy that is comfortable and able to produce the lowest apnea related events.

The first thing is a setting of 4 will almost certainly be too low, as you'll feel like you're inhaling through a small straw. Secondly, if you attempt any setting of A or C flex, it cannot go below 4. Say you want A-Flex 3, then your lowest setting on the pressure side can be 7, or the flex setting can't be met. Decide what flex number you want and the pressure setting needs to be 4 plus whatever flex is going to be. That's just to get started. BTW for almost every patient on a DreamStation, you will need the low pressure number very close to what OSCAR shows as your 95% or it will miss addressing some events.

Your OSCAR chart will tell if you need higher than that by event counts. This has yet to address the high pressure number. 20 be sufficient to start off due to you need OSCAR to show what your highest pressure needed for therapy. It can be lowered if you never reach that high limit. All this action is a self-titration you do at home yourself for free with advice from AB members.

So having said all that, you will have to get your clinical manual to understand what the settings are. Visit the CPAP Setup Manual section at the top of the Apnea Board screen and get your exact model of APAP's manual. You will need OSCAR to monitor the therapy results.

You will need to access the clinical setup menu and plug in the settings, likely starting with date/time, then to pressure settings, operation mode, flex, and then to comfort settings like humidifier. This may seem like a lot of actions and hard work, but be assured it's easier than it sounds.
INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEBSITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
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#4
RE: First Machine needs setting.
Thanks Guys. This is exactly the info i'm looking for. 
Yes, i have a sd card, but it doesn't have any data for oscar yet. I'm very excited to get my first night's data. My dreamstation came with all the manuals and it was super easy to set the pressure myself, i'm more concerned that I missed something important and with all the scare tatics the cpap cops are using to make sure we are all dependant on them and keep forking over the dough.. well.. i didn't want to over oxigenate my lungs and have a heart attack. However, it seems that happening are on the scale of: only if you have a rare heart condition to none. 
However, I don't know if i'm one of the special people whos brain decides they no longer need to breath if the machine is doing it. Maybe i am. Better to not find out. lol. So, it's good to know my afex will not act like a bipap. 

I like this idea of trying it out awake. I'm going to do that now. 
If the pressure is too low can you get too much co2 in your blood?
And my big fear that I do something wrong with the mask or the power goes out and i end up breathing into a plastic tube like a bag over my head until the sleeping me passes out. everyone, including my doc, said that i would wake up first. but it's still there in the back of my head as a rare and scary possiblity. 

Downloading oscar now. Hope to get this thing going. 

As for sleep study i had only 1 apnea, 91 hypos, and 11 rera's Which i'm told is good. I'm not a critical situation which is why my apt got bumped i guess. Maybe also why the doc put me on such a low pressure? idk. i don't like the idea of breathing though a straw. That sounds very bad and painful.
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#5
RE: First Machine needs setting.
According to your left sidebar, you're using a nasal mask. Your body would wake you or you'd open your mouth to get air if the machine were off and not pressurizing the mask. If it were a full face mask, there's a built-in anti-asphyxiation valve near the hose elbow that allows air circulation in the event of power failure.
INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEBSITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
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#6
RE: First Machine needs setting.
I do have a nasel pillow and I might open my mouth at night. I just tried it with my mouth open.  Too-funny Wow, that's a different sensation. And got my first oscar data. All appears well. Very glad i didn't by a brick, because i had no idea when i bought it. Got lucky.
After using it a bit while awake i feel a little light headed. I think because i'm focused on my breathing, i'm breathing more and deeper. It's going to take some getting used to.
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#7
RE: First Machine needs setting.
Yes, it does take some getting used to, and now you're off and running!

Sometimes higher pressures will lead to a bit of disruption in the neurochemical system that keeps us breathing regularly. If this happened to be the case with you, nothing at all dire would happen. You would just see a bunch of central apneas when you looked at your Oscar data, and we could advise you how to adjust your settings.

I have put a little circuit alarm in a plug on the same circuit as my machine because I tape my mouth. (Otherwise my lips would part and then with that break in the dam, I'd have air blasting out of my mouth in no time.) That way I can be completely certain I'd wake up and remove the tape if the electricity went off in the night. If you are at all anxious, despite Dave's reassurances, you can get one too.
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#8
RE: First Machine needs setting.
Thanks Dormaro, I will get one of these. Or a battery back up. I'm not at all confident in my ability to wake up during the night. I've had few situtation where I should wake up and in my dream i'm telling myself to GET THE BLANK UP! but my body just doesn't wanna listen. I do fear this could happen so I definatly want some kinda back up.
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#9
RE: First Machine needs setting.
I just looked: my alarm is made by Reliance Control Corporation. The sound of the alarm is comparable to that of an alarm clock rather than a smoke detector.
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#10
RE: First Machine needs setting.
Thanks I'll check it out.
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