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Switching from CPAP to APAP without sleep doctor-Starting settings?

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ReliableCarmineQuetzal8749 -1 point · over 2 years ago Original Poster

I will be switching to a Resmed Airsense 10 Autoset. My CPAP setting was 15 CM H20. I plan to be pretty much a do it yourself-er to avoid more sleep studies or unnecessarily going back to my sleep doctor. I will have my regular doctor prescribe the APAP. What range would people recommend I have the machine set to initially?

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wiredgeorge +0 points · over 2 years ago Sleep Enthusiast

Henry Kett, 1814: ...observed the eminent lawyer, "I hesitate not to pronounce, that every man who is his own lawyer, has a fool for a client."

Seems to me that a strategy of avoiding professional help and seeking medical guidance from amateurs on a message forum may somehow relate to the old saying above?

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UnassumingOrangeRedCormorant9252 +0 points · over 2 years ago

You might want to go to www.cpaptalk.com and post your question there. There are some very knowledgeable members who can help you set the right pressure range.

As far as patients changing their own pressure, many people have come to cpaptalk.com and the other apnea board floundering big time because the pressures weren't set correctly by their doctor and were given the right assistance from forum members. Of course, no one should be changing it without totally understanding the data in Sleepyhead, http://sleepyhead.jedimark.net/, which is a free program.

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ReliableCarmineQuetzal8749 +0 points · over 2 years ago Original Poster

I am a very analytical person and kind of a do it yourselfer and will be monitoring the results closely. None of this looks very much like rocket science. I was not impressed that after my sleep study, the doctor could not give me separate results for the time I spent sleeping on my back versus on my side where I may or may not have events. This forum has been full of posts by people who have been totally unsatisfied with the professional assistance they receive as well as those who go into the provider settings and then monitor the results. I don't feel like I am going out on a limb very far going to an APAP range which surrounds the CPAP setting which has worked for me. I am trying the APAP partially so I can find out if lower pressures are effective for me since a relatively high pressure of 15 requires the mask to be pretty tight which is somewhat problematic. We also know that people's need for pressure can vary from night to night for a variety of reasons so it seems silly to take one night's test as a definitive indication of needed pressure.

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sleeptech +1 point · over 2 years ago Sleep Enthusiast

Well, I can't endorse the idea of proceeding without consulting a health professional, but in theory if you set the max pressure at 15 that should prevent it from going too high for comfort (and you previously prescribed pressure indicates that you don't need more than 15). You can then set the minimum pressure at whatever level is comfortable for you to fall asleep. Start at 4 and bump it up if it is a bit too low. Watch your AHI closely to make sure it's still adequately treating your OSA. Among the data it spits out should be a 90% pressure (or possibly 95%, I can't remember which). This is level which is the equivalent of what a fixed pressure CPAP would need to be set at to produce the same result. If your 90% pressure is significantly lower than 15 after a month or two then your previous pressure may have been a little too high. In theory, as long as the auto does what it is supposed to, you will still be treated adequately.

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ReliableCarmineQuetzal8749 +0 points · over 2 years ago Original Poster

Thanks Sleeptech-I just picked up my new Air sense 10 Autoset and met with a very knowledgeable tech. He thought a range of about 8 around my study number was good and he agreed with the settings I had my GP prescribe range 10-18 vs. my study of 15. He said he was very surprised my number was 15 since i am not overweight and said he would have guessed 9 or 10. I just got my first night's results. Min pressure 10, Max 14.8, 90% was 12.36 and ave was only 10.94. My daily graph shows only 2 brief spikes with the great majority of the time spent below 12. AHI of 1.97 which is what I had been experiencing with the CPAP. If these results continue, I should probably try a range of 8 to 16 to see if less than 10 may be necessary. Mask tightness is an issue for me.

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Bil +0 points · over 2 years ago

If I was on fixed 15, I wouldn't hesitate to go to auto 13-17, As has been said, get sleepyhead. A lot of people are sent home with an auto cpap, with settings of 4-20

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SleepyMommy703 +0 points · over 2 years ago Sleep Commentator

I'll just share my personal experience with the same machine. I required a pressure of 9 in my original CPAP study, and when I took my machine home it was set to a range of 5-16. My average pressure was 9, but it was going as high as 12 at times. It was definitely going far higher than I needed though and I had side effects from it. Difficulty with mouth breathing even with chin strap, dry mouth, bloating, lots of leakage, etc. My more recent study showed I only needed a pressure of 7 to alleviate my apneas and so now my machine is set to 7. No more trouble with leaks, dry mouth or mouth breathing, and so far no bloat.

So I'd be cautious about going too much over what you actually need as it can cause problems.

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wiredgeorge +0 points · over 2 years ago Sleep Enthusiast

The operative idea here is that a sleep study was needed in order for therapy to work without negative side effects. I think the new number was per a prescription by a doc. Hey, its your health and course of therapy and if you think you can do better setting up your own machine, best of luck. To my thinking SleepyMommy 703 approached therapy issues in the most logical and likely to succeed manner.

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ReliableCarmineQuetzal8749 +0 points · over 2 years ago Original Poster

Last night was even better. 1.25 events per hour with range lowered to 8-15.2. Max pressure only 11.1 and average 9.27. Not rocket science to see this working very well at much lower pressure than my sleep study indicated. How many studies, trips to sleep doc, money, time wasted, months going by, etc. would it take to figure this out? A whole lot of people must have low or no deductibles to not want to self manage where it is possible and so easy. One of the reasons health care is insanely expensive for those of us who pay the bill. I think some healthy people would have someone come in to brush their teeth if Medicare paid for it. I can understand for the old or people with complex issues.

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ReliableCarmineQuetzal8749 +0 points · over 2 years ago Original Poster

Here is an update now that I have been using an APAP for nearly a month. FANTASTIC IMPROVEMENT! Despite someone implying I was a fool for doing it myself, it couldn't be easier and has helped tremendously. Versus a fixed factory setting of 15, my range is now set 4 to 15. My typical actual pressure range is 4 to 6 or 8 high with 10 being the absolute highest for an entire week. Events down to about one/hour, leaks way down and I can keep my mask much loser due to lower pressure so comfort is way up. Also, I no longer need to put tape over my mouth or use a chin strap to keep my mouth closed. ANYONE WHO CAN USE A COMPUTER HAS THE CAPABILITY TO DO THIS THEMSELVES IF YOU DON'T HAVE COMPLEX OR RISKY ISSUES! The APAP and sleepyhead software would let you know after one night if you were headed in the wrong direction.

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sleeptech +0 points · over 2 years ago Sleep Enthusiast

It's great to hear that all is going well. What you describe are the potential benefits of auto CPAP - lower pressure for most of the night leading to fewer leaks, mask being less tight and increase in overall comfort. I am also glad that you have been monitoring your own progress to enure that everything is working properly. It is a shame that, where I am from, an auto costs so much more than fixed pressure, or it could be useful for more people. As an aside, a good doctor should be happy to work with you through this process. Either that or they should be able to explain very clearly why they think it's a bad idea. If you find a good doctor, hang on to them.

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