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[Treatment] Self Titration
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TassieJeff Offline

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Joined: Feb 2014

Machine: ResMed S9 Autoset
Mask Type: Nasal pillows
Mask Make & Model: ResMed AirFit P10
Humidifier: H5i and Climate Line Tubing
CPAP Pressure: Auto-CPAP 8.5-12
CPAP Software: ResScan

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Sex: Male
Location: Tasmania Australia

Post: #11
RE: Self Titration
(02-18-2014 12:28 AM)Peter_C Wrote:  I see no point whatsoever in limiting the high end at all, as the machine won't use it unless it is needed. If you need a pressure of (say) 18, why would you want it limited to 15? Set the high limit to max, and set the low limit to 6 or 7 for a week or so, and see how often it hits the low limit if it does, then lower it by ONE wait a week, and check again.

Thank you Pete
Your advice and that of others is giving me confidence to fine tune my APAP.
02-18-2014 12:36 AM
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TassieJeff Offline

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Posts: 26
Joined: Feb 2014

Machine: ResMed S9 Autoset
Mask Type: Nasal pillows
Mask Make & Model: ResMed AirFit P10
Humidifier: H5i and Climate Line Tubing
CPAP Pressure: Auto-CPAP 8.5-12
CPAP Software: ResScan

Other Comments:

Sex: Male
Location: Tasmania Australia

Post: #12
RE: Self Titration
(02-18-2014 12:28 AM)herbm Wrote:  Moving the Max pressure on a CPAP is not the same as changing other things -- within reason, upping the Max gives "headroom" for the MACHINE to do it's thing.

Then you can watch the mean and 95% and max values for a week or so and decide where to make your next move.

I moved my max directly to 16, worked my Min up to 12 and at that point dropped my max back just above the highest values I have seen recently, at 14.

For now, I am on 12-14 and with very few events. 7-Day Avg AHI 0.5

(It's really less since at least some of the events are machine artifacts.)
This forum is just fantastic. Such a wealth of experience and knowledge.
Thanx Herbm
02-18-2014 12:39 AM
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zonk Offline

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Posts: 7,908
Joined: Feb 2012

Machine: A10 AutoSet
Mask Type: Nasal mask
Mask Make & Model: Activa LT
Humidifier: Integrated /ClimateLineAir
CPAP Pressure: 9/13
CPAP Software: ResScan

Other Comments: CPAP since Nov 2010

Sex: Male
Location: Australia

Post: #13
RE: Self Titration
(02-17-2014 10:54 PM)TassieJeff Wrote:  I am CPAP naive and have been self managing my OSA due to necessity.

A recent home based sleep study found my AHI to be 2 (normal) but the report itself indicated it could be a false negative due to a whole range of issues and malfunctions. My wife who is a RN (reg. nurse) said that I did not need a second test, as she has observed enough episodes of snoring, gasps and obstructive breathing to say I needed intervention.

Two weeks on with APAP therapy (ResMed S9 AutoSet) my current results are:
AHI: 4.0
Pmean = 7.0
P95 = 11.5
Pmax = 11.9

Amongst my research, an American Academy of Sleep Medicine Review: Auto-Titrating CPAP (Dr Berry et al) concludes P95 is an adequate choice for fixed CPAP.

I wish to continue with APAP, not with a fixed pressure setting, so my question is what range should I set my S9. Is my current setting of 4-12cmH20 adequate?. Should I reduce my upper range in small increments and if so to what level?.
Whats AHI breakdown category of events
Centrals
Hypopnea
Obstructive

If were me I would ask my GP for a referral to one the sleep clinics, preferably in a public hospital. Sleep study can reveal things home study cannot, things like central sleep apnea or other sleep disorder, home sleep study have its limitation

Here what I find available in Tasmania
Public clinics
North West Regional Hospital ...... 1800 076 673
Hobart Sleep Disorders Unit ........ (03) 6214 3041
North West Regional Hospital ...... 1800 076 673

St Lukes Campus, Calvary Healthcare, Sleep Study Unit (03) 6335 3333
(public and private clinics)
02-18-2014 12:42 AM
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Peter_C Offline

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Machine: System One DS960HS
Mask Type: Full face mask
Mask Make & Model: Mirage Quattro "MED"
Humidifier: Attached
CPAP Pressure: Auto mode-script is:15/3/3
CPAP Software: EncoreBasic Other Software

Other Comments: Severe obstructive sleep apnea 1999/Just got an ASV machine

Sex: Male
Location: Akron, Ohio USA

Post: #14
RE: Self Titration
While no one likes higher pressures, the 'auto-set' feature works well enough to be relied on, so, you set the low limit to just below what your average low pressure is (that way the PAP gets into your comfort zone more quickly), and if you are wanting what is best for you (rather than trying to think this is only temporary, or something you can wean yourself from), you leave the high limit at the max (20) and don't be too quick to change any settings, as in maybe once per week at the most.

Example - I am on a bi-level, and have been for many years. Currently my minimum inhale pressure is '13'. Randomly, perhaps once a week or so, my machine's high leak alarm goes off as my FFM is bypassing (due to high pressure) - so my wife wakes me, I turn my machine off, reset my mask, roll onto my side, and turn my machine back on. Checking the data the next day, I will usually find my pressure had climbed to '18' or higher - my current mask does not work well with high pressures, lucky for me this is not a common event.

*I* am not a DOCTOR or any type of Health Care Professional. My thoughts/suggestions/ideas are strictly only my opinions.

"Only two defining forces have ever offered to die for you. Jesus Christ and the American Soldier. One died for your Soul, the other for your Freedom."
02-18-2014 12:47 AM
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TassieJeff Offline

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Posts: 26
Joined: Feb 2014

Machine: ResMed S9 Autoset
Mask Type: Nasal pillows
Mask Make & Model: ResMed AirFit P10
Humidifier: H5i and Climate Line Tubing
CPAP Pressure: Auto-CPAP 8.5-12
CPAP Software: ResScan

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Sex: Male
Location: Tasmania Australia

Post: #15
RE: Self Titration
(02-18-2014 12:42 AM)zonk Wrote:  Whats AHI breakdown category of events
Centrals
Hypopnea
Obstructive

If were me I would ask my GP for a referral to one the sleep clinics, preferably in a public hospital. Sleep study can reveal things home study cannot, things like central sleep apnea or other sleep disorder, home sleep study have its limitation

Hi Zonk

Central: 0.9
Hypopnea: 1.1
Obstructive: 1.1

A sleep study in a hospital will give me a effective Pressure that will still need a tech to titrate with an APAP so what is there to gain. By the way, I purchased my S9 on-line from a US supplier & now any effort to get clinical advice is stone-walled (naughty boy, you brought one of those dodgy thingys outside of Oz).
02-18-2014 01:01 AM
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comatose Offline

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Machine: ResMed s9 Autoset
Mask Type: Nasal pillows
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CPAP Pressure: 9.8-12.6
CPAP Software: ResScan SleepyHead

Other Comments: Now I am happy coz only some days I'm crappy, thanks to my c pappy :)

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Location: 1 hr from Melbourne, Australia

Post: #16
RE: Self Titration
G/day Tassie, I have been doing the same, I had the in-hospital sleep study on 06/02 and have to wait till 07/04 to see the Mr Sleepy specialist to find out what is going on, I also did the home study but never gleaned anything from it, reason being that I was quite literally brain dead at that time. My internet studies began after I got a hire machine and after 4 weeks of that I bought my own machine and started fiddling with it.
My AHI had crept down, probably because I was able to get the mask to fit better.

My biggest improvement by far though has been over the past 5 nights, I have changed to a nasal pillows mask and chinstrap, my highest AHI over the past 5 nights was 1.23 and the lowest is 0.38, the AHI the night prior to the change in the mask was 8.41 and that was very low for me.

I now consider the full face mask as trainer wheels for CPAP, I did have problems breathing through my nose to start with, but as I have learned from others in here your humidifier may help clear your nose, also I have limited dairy food as this can also give nose breathing problems, I know it does with me anyhow.

I still have a bit fiddling and fine tuning to do but I am very close to as good as it can get, no thanks to the medical professionals and many thanks to everyone in here. Well-done

Keep up the good work mate.
02-18-2014 02:02 AM
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TassieJeff Offline

Preferred Members

Posts: 26
Joined: Feb 2014

Machine: ResMed S9 Autoset
Mask Type: Nasal pillows
Mask Make & Model: ResMed AirFit P10
Humidifier: H5i and Climate Line Tubing
CPAP Pressure: Auto-CPAP 8.5-12
CPAP Software: ResScan

Other Comments:

Sex: Male
Location: Tasmania Australia

Post: #17
RE: Self Titration
(02-18-2014 02:02 AM)comatose Wrote:  G/day Tassie, I have been doing the same, I had the in-hospital sleep study on 06/02 and have to wait till 07/04 to see the Mr Sleepy specialist to find out what is going on, I also did the home study but never gleaned anything from it, reason being that I was quite literally brain dead at that time. My internet studies began after I got a hire machine and after 4 weeks of that I bought my own machine and started fiddling with it.
My AHI had crept down, probably because I was able to get the mask to fit better.

My biggest improvement by far though has been over the past 5 nights, I have changed to a nasal pillows mask and chinstrap, my highest AHI over the past 5 nights was 1.23 and the lowest is 0.38, the AHI the night prior to the change in the mask was 8.41 and that was very low for me.

I now consider the full face mask as trainer wheels for CPAP, I did have problems breathing through my nose to start with, but as I have learned from others in here your humidifier may help clear your nose, also I have limited dairy food as this can also give nose breathing problems, I know it does with me anyhow.

I still have a bit fiddling and fine tuning to do but I am very close to as good as it can get, no thanks to the medical professionals and many thanks to everyone in here. Well-done

Keep up the good work mate.


Well done yourself Comatose!.

Yeah, my full face mask is good but not perfect. Still farts a little. I'm going to stick with it for some time longer & see if I can flick the training wheels off for a proper run. What I'm concerned about is when I dial my pressure limits up. I'm not sure how the full face mask is going to handle it.

Please let me know how you fair with your nasal pillow and chin strap. I'm a bit of a mouth breather as well and may trial it if there is good feed back.
02-18-2014 03:30 AM
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PaytonA Offline
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CPAP Pressure: VAuto MinE14.0 MaxI 20.6 PS4.0
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Location: Orange County,California

Post: #18
RE: Self Titration
(02-18-2014 12:28 AM)herbm Wrote:  Moving the Max pressure on a CPAP is not the same as changing other things -- within reason, upping the Max gives "headroom" for the MACHINE to do it's thing.

Then you can watch the mean and 95% and max values for a week or so and decide where to make your next move.

I moved my max directly to 16, worked my Min up to 12 and at that point dropped my max back just above the highest values I have seen recently, at 14.

For now, I am on 12-14 and with very few events. 7-Day Avg AHI 0.5

(It's really less since at least some of the events are machine artifacts.)

I am being curious here not critical. How do you discern machine artifacts?

Best Regards,

PaytonA
02-18-2014 12:11 PM
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herbm Offline

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Machine: ResMed AutoSet S9
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CPAP Pressure: 11-16
CPAP Software: ResScan SleepyHead

Other Comments: Backup Mask: Innomed Hybrid FFM -- Oral+Nasal Pillows

Sex: Male
Location: Austin, TX

Post: #19
RE: Self Titration
(02-18-2014 12:11 PM)PaytonA Wrote:  
(02-18-2014 12:28 AM)herbm Wrote:  Moving the Max pressure on a CPAP is not the same as changing other things -- within reason, upping the Max gives "headroom" for the MACHINE to do it's thing.

Then you can watch the mean and 95% and max values for a week or so and decide where to make your next move.

I moved my max directly to 16, worked my Min up to 12 and at that point dropped my max back just above the highest values I have seen recently, at 14.

For now, I am on 12-14 and with very few events. 7-Day Avg AHI 0.5

(It's really less since at least some of the events are machine artifacts.)

I am being curious here not critical. How do you discern machine artifacts?

Best Regards,

PaytonA

Mostly two types that I see regularly are EASY to find:

1) Events while you know you were awake (of course you should also subtract out the time if you want a "Fair Value")

2) Looking at the flow rate to see if the events are really there -- sometimes they are missing, sometimes they are "judgement calls".

Also: An event or two while you are falling asleep is pretty normal as control of your breathing switches over.

A 'hypopnea' that appears to have sufficient, but reduced, breathing can be scored by the machine algorithms which work at least partially off 'reduction' in flow.

Another interesting thing to consider is "marginal events" -- an 11 second hypopnea is not nearly the same as a 27 second event.

You might view the YouTube videos by TheLankyLefty27 on interpreting SleepyHead results.

Sweet Dreams,

HerbM
Sleep study AHI: 49 RDI: 60 -- APAP 10-11 w/AHI: 1.5 avg for 7-days (up due likely to hip replacement recovery)

"We can all breathe together or we will all suffocate alone."
02-18-2014 12:42 PM
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SuperSleeper Offline

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Machine: PR System One REMstar Auto (DS560)
Mask Type: Nasal pillows
Mask Make & Model: ResMed Mirage Swift II
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CPAP Pressure: 12.5 - 18.5 cmH20 (auto range)
CPAP Software: SleepyHead

Other Comments: Have diabetes Type II

Sex: Male
Location: Illinois, USA

Post: #20
RE: Self Titration
The reason some like to adjust the upper pressure limit is to minimize AHI overall. It takes quite a bit of tweaking over time of both lower & upper limits on an Auto-CPAP to do that. For instance, many times a patient with a 95% pressure of 12 might set their pressure range at something like 9-20, which seems adequate, but later they've found that by lowering the upper limit to something like 15 or 16, it will actually cause a reduction in overall AHI. Sometimes it works, sometimes not... depends upon the individual, and other settings as well. But it can't be discounted that sometimes lowering the upper limit helps AHI. I don't pretend to know all the technical reasons for that, but it does work for some.

Coffee

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02-18-2014 01:19 PM
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