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resetting ResMed pressure range above 95% pressure
#1
Apologize if this has been discussed here before, but I searched and couldn't find any similar threads (but I'm new here). I'll try to keep this short, but include some information as to my current scenario.

BACKGROUND:
I've used a Respronics APAP for 2-3 years, and started to have sleep issues (waking up with palpitations, and trembling in legs - could also be medicine related). AHI was always running 4-8 with the 95% pressure running 9.4. Slept well (up until recently) with the machine. Pressure was set to 9-15 with ramp up starting at 7.5 for 35 minutes (my settings).

I started suspecting the machine (would wake and find machine felt like it was below pressure range). Was able to try a DeVilbis Intellipap. It worked very differently than the Respronics (not as well) and returned it.

Got a ResMed S9 autoset just over a month ago which has been working well for me, but it's 95% pressure rating is higher than the Respronic was (11.2 vs. 9.4). AHI with the ResMed has run between 1.5 and 4.0. I have to assume that the differences in the machines probably accounts for the pressure/AHI differences. The pressure range is 10-15 with the ramp starting at 8.0 for 35 minutes (my settings).

ISSUE
Visited the VA doc yesterday and she wanted the min. pressure raised to 12-15 given the 95% pressure now running @ 11.2. I set it up to 12-15 (ramp starting at 10), but had a bad night (palpitations and leg trembling returned). The machine showed the 95% pressure to now be 12.4 and AHI of 1.5.

Questions:

If I'm using an APAP machine - why would I want to raise the min. pressure above my 95% rate?

Isn't the reason for APAP to allow the machine to determine the best pressure for the patient?

Isn't the new increased ramp up and min. pressure circumventing the reason for having an APAP machine and raising my 95% (average) pressure accordingly?

The doctor wanted me to be on standard CPAP, but I didn't care for it in the past (didn't sleep well), so she raised the min. pressure yesterday. Needless to say, I put it back to the old settings of 10-15 with a ramp up starting at 8 for now. Will try it again shortly just to confirm those settings won't work for me, but need to know why I would want to set an APAP macine above my normal 95% rating (with an AHI of 1.5 to 4)?
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#2
It's been my experience that many doctors do not like (maybe believe?) in the 'autoset' function of the machines. *if* the machine is working properly, it should be able to decide what pressure is needed for you during the night. Even my sleep Doc prefers to control the pressures himself, rather than leave it up to the machine to decide.

Welcome to the forum~! Others will join in shortly with more great info Smile
*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."
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#3
Hi ekim,
WELCOME! to the forum.!
Hang in there for more answers to your questions.
Best of luck.
trish6hundred
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#4
Let me see if I understand this correctly.

Your 95% is 11.2 and she set the minimum number on the APAP to be HIGHER than that?

If that is true, then she is nuts.

The 95% means you were at or LOWER than 11.2 most of the night. Typically, the maximum number is set slightly higher than the 95% and the minimum number is set based on other bits of the data, like where it sat after it settled once you fell asleep or where you feel the most comfortable as you fall asleep.

By setting the minimum that high, she's setting you up to fail. And, quite possibly, inducing central events.

And, since you also think this may be medication related, my suggestion would be to go back to the setting that worked for you then speak to whoever about the medication. You are changing too many variables at once. Get the medication settled first then mess with the CPAP.
PaulaO2
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#5
(11-05-2013, 03:16 PM)PaulaO2 Wrote: Let me see if I understand this correctly.

Your 95% is 11.2 and she set the minimum number on the APAP to be HIGHER than that?

If that is true, then she is nuts.

The 95% means you were at or LOWER than 11.2 most of the night. Typically, the maximum number is set slightly higher than the 95% and the minimum number is set based on other bits of the data, like where it sat after it settled once you fell asleep or where you feel the most comfortable as you fall asleep.

By setting the minimum that high, she's setting you up to fail. And, quite possibly, inducing central events.

And, since you also think this may be medication related, my suggestion would be to go back to the setting that worked for you then speak to whoever about the medication. You are changing too many variables at once. Get the medication settled first then mess with the CPAP.

You are correct in that I avg. 11.2 (95%) on the new ResMed APAP. She prescribed 12-15 as I told her that a standard 12.0 CPAP setting that she recommended would not work great for me sleep wise. I brought along my ResMed chip, and she downloaded the data and reviewed (which I had also reviewed at home thanks to this website info.).

Up until 1 1/2 mos. ago, my old Responiics APAP was 9.2 (95%). She had set it at a standard 10 CPAP 3 mos. ago - which was uncomfortable and couldn't sleep (did give it try a few days before I just gave up). Going back to APAP pressures of 9-15 on the old machine alleviated the extremes immediately. I was concerned that the Respronics was not performing correctly as I would sometimes awake and feel that it was blowing extremely low pressure (below the 9-15 range).

The DeVilbiss Intellipap replacement (less than a week) was originally set up for me at 10 CPAP, but it was a poor performer - even when I changed it to APAP @ 9-15 with a ramp of 7.0. It was very noisy (shrill whistle sound), and it couldn't adequately determine proper point of inhale to exhale (it puffed steadily thinking I stopped breathing).

The ResMed S9 Auto works great right from the getgo.

As for the medicine issue. I had an allergic reaction to my thyroid medication (levothyroxide - swelling). One of my blood pressure medicines (diltiazem 360mg) was too high according to the heart specialist and discontinued - replaced by lisinopril 10mg. I do not take any thyroid medication currently, but waiting to see a specialist as to whether or not I should take natural replacement thyroid medication.

The issue was that around 4mos. ago - I started abruptly waking up with varying intensity heart palpitations and sometimes my legs would be trembling - even though (both) APAP machine(s) show they are controlling apnea properly. I tried to get the VA to redo a sleep test as this is only when it occurs, but they have spent almost $10K in stress testing the heart and monitors (futilely billed to BCBS - $0 paid). All tests show I have a normal 62 year old heart - I'm in relatively good physical shape (swim 3X/wk, bike/walk and they know this).

FYI - VA is only coverage I can currently get on thyroid issues - Blue Cross Blue Shield permently won't cover (preexisting condition - until 2014).

It's good to know that my feelings of doubt about her 12-15 recommended setting being dangerous are valid. I'll ask for another Pulmonary Doc for the next visit in 6mos.

How do most here who take control of their CPAP machine interact with their doctors when it comes to these issues?
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#6
I would be interested to know when you had a sleep study and what the results of that sleep study is.
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#7
(11-05-2013, 06:29 PM)me50 Wrote: I would be interested to know when you had a sleep study and what the results of that sleep study is.

It was 2-3 years ago and done by the VA. Never got any info from the test and was given the Respironics machine set up with 8-15 APAP (believe the ramp up was 4 or 5 initially). The VA tester came into the room after about an hour that night and told me that I needed to use the CPAP machine with a full face mask. Said that I stopped breathing better than once a minute, that I had obstructive sleep apnea, and needed to sleep on my side from now on. I usually slept on my stomach or back. I had a rough night (couldn't sleep) using the CPAP machine. I am a nighttime mouth breather as my nose plugs up when I lay down. Nose is clear during the day.
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#8
An auto CPAP may not necessarily find "THE" right pressure.

Sometimes, it just doesn't find it.

Sometimes, you need a lot more pressure for short time periods, such as when you change sleep stage, REM, or just shift position. The APAP will eventually adjust, but your sleep is disturbed while it catches up.

Sometimes, you may not have actual apneas, but you may be having some degree of collapse of the airway. You may have an apnea, but it's less than 10 seconds and doesn't register.

I find I feel better if I raise my minimum pressure.

Usually, 95% is good enough, but sometimes a little experimentation will show that a higher number works for you.
Get the free SleepyHead software here.
Useful links.
Click here for information on the main alternative to CPAP.
If it's midnight and a DME tells you it's dark outside, go and check it yourself.
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#9
(11-06-2013, 06:35 PM)archangle Wrote: An auto CPAP may not necessarily find "THE" right pressure.

Sometimes, it just doesn't find it.

Sometimes, you need a lot more pressure for short time periods, such as when you change sleep stage, REM, or just shift position. The APAP will eventually adjust, but your sleep is disturbed while it catches up.

Sometimes, you may not have actual apneas, but you may be having some degree of collapse of the airway. You may have an apnea, but it's less than 10 seconds and doesn't register.

I find I feel better if I raise my minimum pressure.

Usually, 95% is good enough, but sometimes a little experimentation will show that a higher number works for you.

I set the ResMed back to 10-15 with a ramp up of 8 for 35min last night. I slept "much better" than the night before - 7.6 hrs with an AHI of 3 and a 95% pressure of 11.2. Did wake up a couple of times, but mild (barely noticeable) palpitations and no leg trembling (fell back to sleep quickly).

As menitoned - the night before with raising the min to 12, had me waking with palpitations and leg trembling. The AHI was only 1.5, but the 95% pressure was up to 12.4 and only registered 6 hrs sleep (but was awake for more than an hour upon awakening with issues around 2:00am and again around 5:00am until I just got up for the day).

I will try increasing the minimum again in the near future (in increments) to see if it was just me, but I have to tell you that sleep appeared to go back to normal when I put it back to where I was before. My logic (simple math) is telling me that the higher I go, the higher the 95% will be and (so far) not allow a decent nights sleep.

I have to tell you - not very happy with the lack of support I get at the VA with my apnea and the machine's system settings. I found this site when searching for machine info when the VA failed to properly set the machine settings 3 months ago (I live just under an hour away from the VA hospital). I'm very happy to have found this website and learned to maximize my sleep quality by self-managing the settings on the machine.

How do others here handle taking control of their apnea machine's settings and "discussing" settings with their Pulmonary doc?
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#10
phew!! just read this and need to edit b/c I was replying from my phone and it doesn't make a lot of sense.

glad you had better results last night.

I told my sleep doctor that I know how to change my settings. because I was not getting cooperation from him, I will pick up my medical records tomorrow and I will be going to a new doctor and hopefully get the answers and the medical assistance I need. If not I will find someone that will answer my questions and act like they care about my treatment
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