Under Preasure

[Sparticus]

During my my hospital visits I was given a cpap machine which I used for a while before changing back to an apap. My preasure was set at 10 through out this time. Last night on my apap I checked my readings and my preasure level was up at 11.6. Surely this give more reason for the set preasure machines to be replaced by autosets. if I had stayed on cpap I may not have got any benefit. It just goes to show that things can change very quickly

[silvercarper]

I have been using APAP,s for 20 months now and I dont think they are that wonderful.

The way APAPS work can vary and I had problems a while back when my machine was changed and I had to try several machines before I found one I was happy with. They were all the same make of machines but were running different software to my original one and also the one I finally choose.

Also as you can see from my other post the APAP I am using is causing me to over breath and is taking over control. The fact that switching off and back on cleared the problem makes me think that its processing is getting a bit screwed up.

Finally my hospital only supply APAP,s but I beleve they can be set to run as a CPAP and Im thinking about getting this done.

[symmit]

My sleep tech is gradually increasing the min pressure of mine so it doesn't vary so much and my sleep is better for it. Nice though an "open" APAP is to get used to set at min 4 to max 20 I'm sleeping much better and the stats are better too set at 8 to 20.

I'm forming the opinion that it'll be useful to set it wide open every few weeks to see if weightloss or other stuff has affected the need for pressure but for now I'm following instructions and going up until it gets the AHI and ODI down a bit more.

There's a response time setting in the clinical menus of mine (very well hidden and only accessible from an attached PC) which we've increased a notch and that makes it far more responsive to "events".

[James @ Intus]

Gradual narrowing of the APAP range often quickly leads to increased comfort. And rather than occasionally widening it back open, we ask APAP users to send in their data (especially easy with the SleepCube) so we can check the stats and graphs. If a machine is set between 8 and 15 and the 95% pressure is 14 and plateau time high, then obviously the 15 needs to go up. The stats will quickly confirm this.

[Sparticus]

My APAP is set at 4 and Im not sure what it goes too. I was told that my preasure ceiling on a Cpap machine I had was 10 yet my readings are saying that Im up at 11.6, why would narrowing the band help, if you needed more than the max then surely you will start to have problems.

[James @ Intus]

Yes, but some find 4 too low, so that quite often goes up. A higher low-pressure usually also lowers AHI, we find. As it works more preventatively. If 4 becomes 8, chances of apnoeas and hypopnoeas to happen in the first place often reduce.

Lowering the upper limit often helps avoid the extreme pressure peaks that the machine sometimes reaches which wakes people up. You then have to consider what's worse. A possible apnoea event or the patient waking up in a tornado, uncomfortable, mask leaking, disturbing the partner etc. And APAP are algorithm based so ultimately, they won't always be right. It's a computer model after all and you only have to look at the weather forecast to know what computer models can do for you.

So many people do benefit form lowering the upper pressure too. But as you say, you just have to make sure you don't consistently miss out on pressure you should have had. That's why data monitoring is important if you do narrow the range.

It's a balance, a trade-off and you have to be aware of the pro's and cons.

[Sparticus]

...and thats why there is no set rules because god (Another issue) made us all different, I think I will try that and up my baseline to 8. Also your so right about the Tornado, its the one thing for me that upsets my sleep. Thanks for the imput James

[James @ Intus]

And that point is indeed key. We're all different. That's why some are morbidly obese with a neck of 25 inch and have mild OSA whereas others are technically in a healthy BMI range and have severe OSA.

And that's why some have severe OSA and a low CPAP pressure and others have mild OSA and a high CPAP pressure.

It's because we're all different.

And that's also why you can't go and read on a forum like this and think "That sounds like me, I'm going to copy that" as you are a different case.

It's also why Auto-CPAP algorithms pan out differently for different people. A computer model is based on an average behaviour yet you are never average. So it all has to be held against the light of you as an individual, not compared to anybody else. If you plan to make any changes, always keep a detailed log of before, during and after the period of change so you have an accurate reference. A simple Excel spreadsheet or old school paper notepad does the job here perfectly.

[Sparticus]

Surely then my point that I made in another thread about the NHS handing out cpap is them handing out more work for themselves? Surely it's common sense that most who can handle it should be on APAP?

[Tigers Fan]

Not so.

My APAP is in the cupboard and the NHS CPAP I use every night is set at a constant pressure, no exhalation relief. Suits me best that way.

THe APAP will come into use again when I get my new oximeter and I go stats chasing again.

TF

[Sparticus]

My APAP is in the cupboard and the NHS CPAP I use every night is set at a constant pressure, no exhalation relief. Suits me best that way.

THe APAP will come into use again when I get my new oximeter and I go stats chasing again.

TF

Ive been looking at these things, what kind of data can you get other than O2's and pulse or am I looking at the cheap ones?

[Tigers Fan]

You need to talk to symmit and Solphist - they have experience. There's a thread about this.

TF

[symmit]

My APAP is in the cupboard and the NHS CPAP I use every night is set at a constant pressure, no exhalation relief. Suits me best that way.

THe APAP will come into use again when I get my new oximeter and I go stats chasing again.

TF

Nice thing about the APAP is that it can be set up as a CPAP if that suits, surely economies of scale and the use of it for diagnostic and titration purposes would make more sense for the NHS to stock APAP only and not send an APAP for a week or two, get it back and issue a CPAP, and have the equipment then to clean, sterilise, retest and certify, inspect and then reissue.

[symmit]

My APAP is in the cupboard and the NHS CPAP I use every night is set at a constant pressure, no exhalation relief. Suits me best that way.

By the way - 17cmH2O and no exhalation relief - that's hardcore!

[Tigers Fan]

But I still have to wave my hand in front of the vent to make sure the machine is running. Hardy types, we Tigers Fans!