CPAP mode vs. AUTO mode general question

[kaiasgram]

I just finished my titration study and am awaiting shipment of my APAP (specs should be listed in my post now). My prescribed CPAP settings are 6-10, but I'm thinking of just staying in Auto Mode. How would these two modes of operation be functionally different, or would they be? Thanks from a still-overwhelmed newbie.

[jen4700]

Welcome to the forum! If your settings are 6/10 then you're probably getting a bilevel machine. ResMed's bilevel is S9 VPAP.

I would recommend leaving the settings as they are until after you get used to wearing the mask and catching up on some sleep. You may not even have to make any adjustments to feel better. See how it goes. Ask questions here. Good luck on your new journey to feeling better!

[nanwilson]

Welcome to the forum! If your settings are 6/10 then you're probably getting a bilevel machine. ResMed's bilevel is S9 VPAP.

I would recommend leaving the settings as they are until after you get used to wearing the mask and catching up on some sleep. You may not even have to make any adjustments to feel better. See how it goes. Ask questions here. Good luck on your new journey to feeling better!

Jen
If I am reading this post right I think she didn't say 6/10 she said 6 - 10 which I read as 6 to 10, not 6 and 10.
A setting of 6 - 10 is a range, of which 6 is rather low.
I would indead leave the setting alone in my opinion until you are used to it. If raising or lower is required, then go for whateverr your doctor prescribes.
To answer the original question...
cpap is a straight setting of say 10, but auto is a range of pressure, say 6 to 10.

[kaiasgram]

nanwilson, that is right -- pressure settings are 6 to 10. I've had so many panic attacks with all this stuff, I almost had another at the thought that I might have just spent a thousand dollars on the wrong kind of machine. (Not your fault Jen, I've just had to rely on Kaiser's sleep medicine department and they have been way less than helpful or forthcoming with support and information. I've had to do everything myself, including diagnosing myself and getting my primary to order the test, figuring out how to get exhalation relief, and on and on... thank goodness for this forum and helpful people.)

So Nan, are you saying that in CPAP mode the machine would always be running at a pressure of 10 (or ramping to 10 and staying there)? Whereas in Auto mode, it would vary between 6 and 10 according to what I need at any given time during the night?

[nanwilson]

nanwilson, that is right -- pressure settings are 6 to 10. I've had so many panic attacks with all this stuff, I almost had another at the thought that I might have just spent a thousand dollars on the wrong kind of machine. (Not your fault Jen, I've just had to rely on Kaiser's sleep medicine department and they have been way less than helpful or forthcoming with support and information. I've had to do everything myself, including diagnosing myself and getting my primary to order the test, figuring out how to get exhalation relief, and on and on... thank goodness for this forum and helpful people.)

So Nan, are you saying that in CPAP mode the machine would always be running at a pressure of 10 (or ramping to 10 and staying there)? Whereas in Auto mode, it would vary between 6 and 10 according to what I need at any given time during the night?

Yes, If you are using ramp, it will ramp up to your pressure of 10. Whatever time you set on your ramp, say 20 minutes, then it would take 20 minutes to get to 10. You can still use ramp in auto mode, but your start range of 6 is so low that it would not make much of a difference. In auto it would stay at 6 and IF you need it to go higher, say if you were having an event, it would go up to catch the event, up to a pressure of 10. I don't use ramp as I find the low end to be too low and can't get enough air to even breath properly. Lots of the patients here are in the same boat as me, they don't use ramp as they find the pressure just too low.
Take me for example, I set my auto from 10 to 15, I usually stay around 11, but it will occasionally go up to 13, but very rarely. I have never seen it go to 15.

[portiemom]

I am curious to know what your pressure was titrated at? If the machine is set 6-10, isn't it possible the titration could be anywhere in that range, and that the doc. or DME is setting the pressures a bit above and below the titrated cms?

[greatunclebill]

if you don't know your exact titrated pressure you'll have to ask your doctor. while lay people in forums generally like to set the range a couple above and a couple below the titrated pressure, my doctor does it differently. he set my 12 at 8-12. he set my wife's 11 at 6-11. both top numbers are directly on the titrated pressure. unless you know how the doc does it you'll have to ask. everybody thinks differently.

[kaiasgram]

greatunclebill, I just submitted a new post about the fact that I don't have a sleep doctor, I have Kaiser. I don't know under what circumstances you ever get access to a doctor in their sleep medicine department, but I never saw or spoke to a sleep doctor and my requests for help and information during the titration week went unresponded to. I am going to try to get a copy of the reports and then maybe I can ask some more intelligent questions but it will likely mean going to a doctor outside of Kaiser. Thanks for responding to my question, I really do appreciate the helpful people on this forum -- y'all have helped me more than anyone in Kaiser's sleep medicine department, even if you're not "real" doctors!

[jen4700]

My bad! So sorry - didn't mean to freak you out!!!

[archangle]

I just finished my titration study and am awaiting shipment of my APAP (specs should be listed in my post now). My prescribed CPAP settings are 6-10, but I'm thinking of just staying in Auto Mode. How would these two modes of operation be functionally different, or would they be? Thanks from a still-overwhelmed newbie.

Relax. That sounds like they did things right in a lot of ways.

You got an S9 AutoSet machine. (Be sure it says "AutoSet" next to the power button, NOT Escape Auto.) That's an excellent machine. Lots of patients get dumb machines that are much less capable in terms of monitoring your treatment. You're WAY ahead of a lot of patients because you are getting an AutoSet.

It sounds like it's set for 6-10 Auto Pressure (APAP). That's an entirely reasonable pressure range, if you had a sleep study. You do NOT usually want to set an APAP machine on the "wide open" 4-20 pressure range.

The AutoSet will record data on the SD card (or maybe even with a wireless modem to start with.) With this, your doctor/RT can check and adjust your therapy without an office visit and adjust your pressure. Whether they actually do check your data is a crap shoot, but it's possible.

If they're doing things right on their end, they can give you really good settings if they monitor the results and adjust your settings based on the readings. You may feel you're being run through the "CPAP mill," but with a data capable APAP machine like the S9 and proper followup, even a very "mechanical" remote processing system could give you better treatment than I or many other patients got from their doctors.

If the insurance companies were smart, every CPAP user would get a data capable APAP machine, a well run, centralized system would collect the data, have it analyzed by competent doctors and/or technicians, and the machine would get adjusted by them, perhaps working in concert with a local doctor. Done right, this would work enormously better than the care the average CPAP patient gets.

That's the optimistic viewpoint. Many people end up getting poor treatment, but there's nothing inherently wrong with the mechanics of what they're doing.

Many doctors will only check "compliance." i.e. if you don't use it over 4 hours a day, insurance won't pay for it.

If the system doesn't figure out good settings and get you good therapy, you can get free software that will let you look at the data yourself, but start out trying to work with the doctors. It's not a bad idea to get the software anyway.

Check in here often to find help with whatever problems you have. Stay optimistic, but be prepared to take action if things don't work out.

[kaiasgram]

Thanks archangle. I'm getting the Autoset because my Kaiser plan does not cover CPAP equipment (self-employed on an individual plan) and so I had to buy the equipment myself. So I was not at the mercy of a doctor forcing a "dumb" machine on me (though I now can't pay my rent!). I chose the Autoset mainly because that's what they used for my titration study and I became familiar with how it works, and also because of studying this forum for days on end! I've heard nothing from Kaiser about periodic checks or follow-ups, nor have I had any communication or contact with a sleep doctor through this whole process. I've certainly learned that I have to take care of myself and be my own advocate with Kaiser, as do many patients in many other high volume health care settings. But it's sure hard when you're exhausted to have to fight like this. Thanks for posting, and I will try to relax and trust that there's a process that will eventually get me where I need to be with sleep and breathing.

[DoriC]

if you don't know your exact titrated pressure you'll have to ask your doctor. while lay people in forums generally like to set the range a couple above and a couple below the titrated pressure, my doctor does it differently. he set my 12 at 8-12. he set my wife's 11 at 6-11. both top numbers are directly on the titrated pressure. unless you know how the doc does it you'll have to ask. everybody thinks differently.

Bill, I'd be interested in knowing if your Dr gave you his reasons for setting your Apaps that way. By trial and error I found out myself that my husband can't tolerate a higher pressure than 13cms(his titration) so I set his Auto on 10-13. On good nights without any leaks or disturbances his pressure never goes above 11-12. On Cpap I set it to 12cms, same results.

[archangle]

Thanks archangle. I'm getting the Autoset because my Kaiser plan does not cover CPAP equipment (self-employed on an individual plan) and so I had to buy the equipment myself.

That's different. Do you have an idea what machines they dispense instead of APAP? They could still do reasonably good treatment with remote monitoring and adjustment of a data capable CPAP, but it does sound less likely.

For lots of members of the medical mafia, "good treatment" means "wears the machine 4 hours a night," and "followup" means "check the compliance data and blame the patient for failure."

[kaiasgram]

Archangle, Kaiser in this area dispenses a Respironics machine for patients when they're covered by Kaiser, I don't know which model though I think the tech said it can run in Auto mode. I don't know what that means for a Respironics machine in terms of data capability or other features.

Kaiser nevertheless *should* be able to monitor my therapy on my ResMed machine because it's the very machine they use for the take-home titration studies -- so I know they can analyze data from this machine. Whether they will is another question. The tech already told me that they can't help me learn how to operate and care for my new machine because "our class is only for the Respironics machine." So I'm thinkin' the chances of getting ongoing help and monitoring of how my therapy is going are not high with Kaiser.

[archangle]

The tech already told me that they can't help me learn how to operate and care for my new machine because "our class is only for the Respironics machine." So I'm thinkin' the chances of getting ongoing help and monitoring of how my therapy is going are not high with Kaiser.

Take the Respironics course if you can. Much of the info will be useful.

By the way, the Philips Respironics Auto machine does pretty much everything the ResMed does. It calls it's exhale relief "FLEX" instead of "EPR", but it does a similar function. Unlike ResMed, all the PR auto machines do good data collection.