Are Most People on Auto?

[cpapgirl1318]

Hello everyone. Just wondering if most people are on auto pressure (sorry not sure of exact name) with a range or one fixed pressure. Just wondering why somebody may be on one fixed pressure as opposed to a range. I have the ResMed AirSense 10. My primary care doctor had me on a fixed pressure of 7 but today the sleep doctor changed it to a range from 5-15, which seems like such a big change. I just got my sleep study/titration done within the last 2 months. I know everyone’s situation is different but for the majority, just wondering if a range is the norm.

[chunkyfrog]

Everybody's different--doctors too.
Obviously, you have an auto, even though your equipment line does not specify (see mine)
Welcome to the forum,
You can get the manual, and Oscar--(if you have an appropriate computer) to help fill in the gaps.

[Miss Emerita]

Probably the majority of people with an auto adjusting machine use a range. This means they can get higher pressures when they need them, without being at those high pressure all night. I don't use a range, because my apnea is well controlled at a fixed pressure and I'm very bothered by pressure changes during the night.

I can imagine why you've settings have been changed to raise the maximum, if you're still having a lot of obstructive events, but I'm puzzled by the reduction in your minimum. If it feels OK to you, fine, but for many people a pressure of 5 leaves them feeling a bit air-starved.

[Wulfman...]

Hello everyone. Just wondering if most people are on auto pressure (sorry not sure of exact name) with a range or one fixed pressure. Just wondering why somebody may be on one fixed pressure as opposed to a range. I have the ResMed AirSense 10. My primary care doctor had me on a fixed pressure of 7 but today the sleep doctor changed it to a range from 5-15, which seems like such a big change. I just got my sleep study/titration done within the last 2 months. I know everyone’s situation is different but for the majority, just wondering if a range is the norm.

My advice has always been.......
If you have an APAP machine, try both.......ranges and fixed pressures.
Since APAPs use Flow Limitations and Snores to trigger pressure increases, some people don't have those events or enough of them. So, if they don't have the events and if the minimum pressure isn't sufficient to prevent them, the resulting Hypopneas and Apneas are going to occur anyway. Actually, without a sufficient minimum pressure, the machines usually aren't fast enough to increase pressures to prevent them.
So, in either mode, the minimum or fixed pressure needs to be high enough to prevent almost all Hypopnea and Apnea event.

But, through experimentation, the user needs to try various settings to optimize their own therapy.
Said another way........the users need to take charge of THEIR OWN therapy. The sleep doctors and respiratory therapists don't have enough first-hand experience to adequately advise the users.

It's YOUR therapy and nobody else will care enough about YOUR therapy to provide the optimized settings.


Den

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[cpapgirl1318]

Thank-you Den. I was really worrying about the change for the minimum to 5 as well since it was a fixed 7. I remember during my titration study when I used a cpap for the first time I felt like I couldn’t breathe and that was at a 4 or 5. Any idea why a sleep doctor would even do that?! My sleep report clearly says I was still having events at 5 and 6 and it seems to be “well controlled” with a 7 however I was only on the 7 pressure for 20 minutes before my titration study ended!

[Pugsy]

A poll done here some years back showed that most people with a machine capable of doing auto adjusting pressure mode did use that mode and not fixed mode. I think it was around 80% or in that area.

I have always used auto adjusting mode because I have significant differences in pressure needs during REM stage sleep when compared to the other sleep stages. I see no sense in using 16 cm all night just to deal with the 20% of the night I might need more pressure in REM....the other sleep stages I can get by with 8 cm or so. Now not everyone will have such a difference but if they do...sure is nice to let the machine sort it out and use a lot less for the bulk of the night.

[cpapgirl1318]

Pugsy I literally just sent you a PM! Thanks for your reply. Do you think it’s odd the sleep doc put it down to 5 when my fixed was 7?

[Wulfman...]

Thank-you Den. I was really worrying about the change for the minimum to 5 as well since it was a fixed 7. I remember during my titration study when I used a cpap for the first time I felt like I couldn’t breathe and that was at a 4 or 5. Any idea why a sleep doctor would even do that?! My sleep report clearly says I was still having events at 5 and 6 and it seems to be “well controlled” with a 7 however I was only on the 7 pressure for 20 minutes before my titration study ended!

I repeat........most sleep doctors or respiratory therapists are clueless about how this all works in real life.
That's why I say to try various modes and settings to find the optimal ones for you.

When I started out, my sleep doctor prescribed a fixed pressure of 18 cm. That was at least 2 cm. higher than where my sleep study left off.
I actually tried the 18 cm. for about an hour before I reset my (fixed pressure) machine to 10 cm. Actually that setting worked pretty well. It was a sufficient amount of air so I didn't feel like I was suffocating and high enough to prevent most of my Hypopneas and Apneas. My AHI was at around 1.0 or less. I used that pressure for about a year before experimenting further. In hindsight, I should have increased it just a centimeter or two.....sooner. But, hindsight is always 20/20.
About a year after I started, I acquired a lightly used APAP from another forum member and used a range of 10 cm. to 15 cm. as a trial for a week........even though I had already bumped my fixed pressure machine up to 12 cm.
I actually learned quite a bit about my therapy in that week.
First, I had already chosen a pretty good setting at 12 cm.
Next, I didn't like the fluctuating pressures during the night.
I didn't have the precursor events (Flow Limitations and Snores) occurring BEFORE the Hypopneas and Apneas to bump up the pressures in time to prevent them......my Apneas occurred abruptly and out of nowhere......but, there were very few of them, comparatively speaking.

Over the years, I've tried using ranges periodically, but I just never found any advantages to it. So, I do just fine with a fixed pressure.


Den

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[Pugsy]

Pugsy I literally just sent you a PM! Thanks for your reply. Do you think it’s odd the sleep doc put it down to 5 when my fixed was 7?

Actually no I don't think it is odd at all. Most of the time when fixed pressures are prescribed they are a "worst case scenario" pressure to cover all potential bases and when auto mode is used they normally will set the minimum lower and let the machine sort it out because most of the time people can get by with less than the "worst case scenario" pressure.

But in your situation 5 cm simply doesn't move enough air to be comfortable for you and that's quite common also.
Just tell your doctor you feel like you are suffocating at 5 cm...or change it yourself.
It would be a good enough reason no matter what happened to the apnea events at 5 cm...you gotta be comfortable first to ever be able to sleep.

[elsueno]

x

[jimbud]

Because:



YMMV



JPB

[Pugsy]

Hey EL Sueno....lose the fancy bold and huge text.....it's annoying as hell.

Just like your failure to accept the YMMV thing is annoying as hell.

It's your opinion and that's all it is.

Given the outcomes of recent research, why NOT recommend CPAP over APAP for most people?

Because I don't believe you are correct. Simple as that. I don't happen to agree with you. News flash...I get to disagree with you just like you get to disagree with me.

I will tell people to try both modes if they want to try and see what happens. It's always an option. I myself even tried fixed but the results were a disaster because of the high teen pressure I need in REM.

I happen to have a couple of good friends who are RTs....and 3 sleep doctor friends...and 1 RT prefers fixed pressures with NO exhale relief at all and the other is a big fan of auto adjusting. Each has their own opinions and they differ widely.
The 2 sleep doctors actually prefer auto mode for most of their patients unless auto mode causes some sort of problem.
The 3rd sleep doctor prefers fixed mode initially but will entertain auto mode....he's not totally closed to the idea.

Everyone is entitled to their opinion(s)...me, you, joe next door, anyone here.
Most people who really understand this stuff know that there is a big YMMV sticker with everything and the only hard fast rule is there are no hard fast rules.

And I am not going to debate it with you because I don't want to waste my time. I don't want to change your mind and I fail to see why you think it is so important to bring people over to your opinion.

Have a nice day.

[chunkyfrog]

I use auto because it is more comfortable for me.
When I am comfortable, it is easier to sleep.
I don't go to bed to follow rules--I need my beauty sleep.
No telling what I would look like without sleep.
Best not to terrify the tadpoles . . .

[cpapgirl1318]

Well the sleep doctor put in the order for the APAP for 5-15 and I was told it will take 48 hours to set it by the DME so I just changed it myself and wow!!! 5 and even 6 does feel like suffocating. So I just set it 7-15 since 7 has been my fixed pressure. I noticed the suffocating feeling was only when I exhaled, is that how others feel with the suffocating feeling, just on exhale at low pressures? I even have pressure relief 3 turned on like I always have.

[Pugsy]

When you use 5 or 6 minimum you aren't getting the full 3 cm exhale relief reduction. It's no wonder it's harder to exhale.
The machine won't/can't go below 4 cm so at 5 cm starting point it only drops to 4 cm (so 1 cm drop) and with the 6 cm starting point it only drops to 4...so a 2 cm drop. You aren't getting as much of a drop and it's that drop or difference between inhale and exhale that makes it so easy. The bigger the difference...the easier it is to exhale. This is why I use a machine that lets me get a 4 cm drop...I can do a 3 cm drop but I really like a 4 cm drop so much better.