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Daniel Gagner
Unread post  Post subject: How I decided on my pressure numbers  |  Posted: Wed Dec 06, 2017 11:06 am
User avatar

Joined: Thu Aug 17, 2017 4:23 pm
Posts: 34
Location: Maine
PAP Mask: Respironics Dreamwear nasal
PAP Machine: Respironics Dreamstation 500
Humidifier: respironics
Pressure Setting: 9=13

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I am, as some of you are, a self diagnosed, self purchasing, and self setting, APAP user.

Here is how I experimented and eventually set my own machine settings to get an optimal AHI result for me.

I've made a webpage for this simply so that I could add the pictures and format it the way I wanted to. No advertising on it. Just my personal webspace.

AND, I think it's in english with minimal sleep apnea jargon. It's what a newbie to this needs. I know, I was recently one of them and the apnea jargon in the explanations made it difficult to follow sometimes.

Any comments on this is cool. I'm not trying to break any new ground here. Just trying to assist users in the 'self help' category to get started from my experiences.

This is the webpage:

http://gagnerwebsite.com/Deceiver2/APAP.html


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CobaltSky
Unread post  Post subject: Re: How I decided on my pressure numbers  |  Posted: Wed Dec 06, 2017 4:02 pm

Joined: Thu Nov 16, 2017 1:32 pm
Posts: 13
Location: Peyton, CO
PAP Mask: Aitfit P10
PAP Machine: ResMed s8 Autoset II
Humidifier: H3i
Pressure Setting: 7

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I read through and I think you have APAP and BiPAP a bit confused. Unless you are using EPR OR CFlex, your inhalation and exhalation pressures are the same on straight APAP, and the pressure doesn't auto adjust as soon as you exhale. The algorithm adjusts the pressure in response to obstructive events only and can float back down gradually if it isn't logging any events. You would need a BiPAP machine to actually set inhalation and exhalation pressures.


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Pugsy
Unread post  Post subject: Re: How I decided on my pressure numbers  |  Posted: Wed Dec 06, 2017 4:20 pm

Joined: Wed Aug 02, 2017 8:01 pm
Posts: 329
PAP Mask: ResMed AirFit P10 or DreamWear Gel nasal pillows
PAP Machine: ResMed AirSense 10 AutoSet for Her
Humidifier: ResMed AirSense 10
Pressure Setting: Depends on the machine as I actually have more than one

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Looks like OP is using a Respironics machine with Flex exhale relief turned on and with Flex (or EPR on ResMed) that essentially does create a bilevel pressure situation of sorts.
So you can sort of set inhale and exhale on an apap/cpap machine if someone makes use of the exhale relief offered by either brand.
Fairly easy to do with these 2 brands but not so easy with other brands.

I can see inhale and exhale on the pressure graph...that's why there are 2 different pressure lines. If Flex wasn't used there would only be one pressure line. So he effectively has made his machine function like a bilevel machine....he just can't get as big of a gap between exhale and inhale that a real bilevel machine can offer.
I call it a poor man's bilevel.


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Daniel Gagner
Unread post  Post subject: Re: How I decided on my pressure numbers  |  Posted: Thu Dec 07, 2017 12:11 pm
User avatar

Joined: Thu Aug 17, 2017 4:23 pm
Posts: 34
Location: Maine
PAP Mask: Respironics Dreamwear nasal
PAP Machine: Respironics Dreamstation 500
Humidifier: respironics
Pressure Setting: 9=13

Offline
CobaltSky wrote:
I read through and I think you have APAP and BiPAP a bit confused. Unless you are using EPR OR CFlex, your inhalation and exhalation pressures are the same on straight APAP, and the pressure doesn't auto adjust as soon as you exhale. The algorithm adjusts the pressure in response to obstructive events only and can float back down gradually if it isn't logging any events. You would need a BiPAP machine to actually set inhalation and exhalation pressures.



That's right. I've rewritten parts of it to remove the inhale and exhale examples. I do have flex A turned on. There really is no inhale and exhale pressure. It's actually a minimum/maximum. It's an adjustment the machine makes when it sends a pressure pulse to get an obstructive reading.... I think.


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Daniel Gagner
Unread post  Post subject: Re: How I decided on my pressure numbers  |  Posted: Thu Dec 07, 2017 2:13 pm
User avatar

Joined: Thu Aug 17, 2017 4:23 pm
Posts: 34
Location: Maine
PAP Mask: Respironics Dreamwear nasal
PAP Machine: Respironics Dreamstation 500
Humidifier: respironics
Pressure Setting: 9=13

Offline
Pugsy wrote:
Looks like OP is using a Respironics machine with Flex exhale relief turned on and with Flex (or EPR on ResMed) that essentially does create a bilevel pressure situation of sorts.
So you can sort of set inhale and exhale on an apap/cpap machine if someone makes use of the exhale relief offered by either brand.
Fairly easy to do with these 2 brands but not so easy with other brands.

I can see inhale and exhale on the pressure graph...that's why there are 2 different pressure lines. If Flex wasn't used there would only be one pressure line. So he effectively has made his machine function like a bilevel machine....he just can't get as big of a gap between exhale and inhale that a real bilevel machine can offer.
I call it a poor man's bilevel.


There are two pressure lines with an APAP machine. It doesn't matter if flex is turned off or on. Flex just eases the transition when exhaling.

With an APAP machine you physically set a high and low pressure if you have flex turned off or not. The only way you get one pressure line on the graph is if you put it in CPAP mode which most(all?) APAP machines are capable of. Flex takes those pressure settings and simply eases the exhale pressure depending on what level of flex you have set it to. Displayed on the machine's online screen is the level of pressure that the machine is auto-adjusting to as you breath. So, I'll see a circle with a number in it that may change from say, 9.4 and I'll see it ratchet up or down depending on the machines reading the pressure. Mine sends out a pressure pulse and determines the level of obstruction. It then does just what is needed to open it up. The range between the high and low setting is for one breath. With Bipap you can set a specific inhale and exhale pressure. If someone can't tolerate the APAP machine or a CPAP machine Then the more expensive bipap device is an option.

An APAP machine does cost a lot less than a BIPAP machine. About three times less. But, it's the type that the majority of apnea diagnosed people can do just fine with. With APAP you set two levels of pressure and it Auto titrates between those levels. Most people are starting with APAP machines these days. (some still start with CPAP). A Bilevel machine is often just used when the previous two don't work out well for the user. Usually for people who can't seem to tolerate the auto titrating pressure or if they have congestive heart failure or central apnea.
Usually insurance companies make you start with a cpap or apap device then only move you up to bipap if you have to.


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Pugsy
Unread post  Post subject: Re: How I decided on my pressure numbers  |  Posted: Thu Dec 07, 2017 11:41 pm

Joined: Wed Aug 02, 2017 8:01 pm
Posts: 329
PAP Mask: ResMed AirFit P10 or DreamWear Gel nasal pillows
PAP Machine: ResMed AirSense 10 AutoSet for Her
Humidifier: ResMed AirSense 10
Pressure Setting: Depends on the machine as I actually have more than one

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Hmmm. My Respironics apap only gives me one pressure line with Flex turned off.
Maybe yours is different for some reason.


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diamaunt
Unread post  Post subject: Re: How I decided on my pressure numbers  |  Posted: Fri Dec 08, 2017 8:22 pm
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Joined: Wed Mar 02, 2016 2:26 am
Posts: 1456
Location: Dallas(ish)
PAP Mask: Resmed P10
PAP Machine: Resmed S9 vpap auto
Pressure Setting: 18/13-25/19

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Daniel Gagner wrote:
There are two pressure lines with an APAP machine. It doesn't matter if flex is turned off or on. Flex just eases the transition when exhaling.

This is not correct. Without flex, there's only one pressure line because the pressure doesn't vary during the breath cycle (which is the only time that there are two pressure lines). Perhaps you're confusing the minimum and maximum SETTINGS for the pressure trace in the data.

Daniel Gagner wrote:
With an APAP machine you physically set a high and low pressure if you have flex turned off or not. The only way you get one pressure line on the graph is if you put it in CPAP mode which most(all?)

This is not correct.

Daniel Gagner wrote:
Flex takes those pressure settings and simply eases the exhale pressure depending on what level of flex you have set it to.

Yes, and that pressure variation between inhale and exhale is where the second pressure line in sleepyhead comes from (I used to work with the guy that wrote the program).

Daniel Gagner wrote:
Mine sends out a pressure pulse and determines the level of obstruction. It then does just what is needed to open it up.

This is wrong. The pressure pulse is the machine determining whether your not breathing is because of obstruction or central, nothing more, nothing less. No machine "does just what is needed to open it up", they ALL wait till you start breathing again and then raise pressure if they determined it was an obstructive apnea.

Daniel Gagner wrote:
The range between the high and low setting is for one breath.

This too is wrong. The pressures change over a period of minutes with auto machines, NOT within one breath.

Daniel Gagner wrote:
A Bilevel machine is often just used when the previous two don't work out well for the user. Usually for people who can't seem to tolerate the auto titrating pressure or if they have congestive heart failure or central apnea.

Where ever do you get your "information"??? so much of it is wrong. I've got a bilevel machine, and guess what, it auto adjusts, just like the apaps you're talking about.

Here's a piece of wisdom... Pugsy has *years* of experience.... if she says something you don't think is right, you'd be much better off if you went and did some research before disagreeing with her.

_________________
https://sleep.tnet.com/resources/sleepyhead
how to post:
https://sleep.tnet.com/resources/sleepyhead/shorganize
https://sleep.tnet.com/reference/tips/imgur


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diamaunt
Unread post  Post subject: Re: How I decided on my pressure numbers  |  Posted: Fri Dec 08, 2017 8:24 pm
User avatar

Joined: Wed Mar 02, 2016 2:26 am
Posts: 1456
Location: Dallas(ish)
PAP Mask: Resmed P10
PAP Machine: Resmed S9 vpap auto
Pressure Setting: 18/13-25/19

Offline
Daniel Gagner wrote:
CobaltSky wrote:
I read through and I think you have APAP and BiPAP a bit confused. Unless you are using EPR OR CFlex, your inhalation and exhalation pressures are the same on straight APAP, and the pressure doesn't auto adjust as soon as you exhale. The algorithm adjusts the pressure in response to obstructive events only and can float back down gradually if it isn't logging any events. You would need a BiPAP machine to actually set inhalation and exhalation pressures.



That's right. I've rewritten parts of it to remove the inhale and exhale examples. I do have flex A turned on. There really is no inhale and exhale pressure. It's actually a minimum/maximum. It's an adjustment the machine makes when it sends a pressure pulse to get an obstructive reading.... I think.

You're wrong about that.

There IS a separate and distinct inhale and exhale pressure if you're using aflex.

Buy, or build, a manometer and *see for yourself*.

_________________
https://sleep.tnet.com/resources/sleepyhead
how to post:
https://sleep.tnet.com/resources/sleepyhead/shorganize
https://sleep.tnet.com/reference/tips/imgur


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diamaunt
Unread post  Post subject: Re: How I decided on my pressure numbers  |  Posted: Fri Dec 08, 2017 8:34 pm
User avatar

Joined: Wed Mar 02, 2016 2:26 am
Posts: 1456
Location: Dallas(ish)
PAP Mask: Resmed P10
PAP Machine: Resmed S9 vpap auto
Pressure Setting: 18/13-25/19

Offline
Daniel Gagner wrote:
I am, as some of you are, a self diagnosed, self purchasing, and self setting, APAP user.

Here is how I experimented and eventually set my own machine settings to get an optimal AHI result for me.

I've made a webpage for this simply so that I could add the pictures and format it the way I wanted to. No advertising on it. Just my personal webspace.

AND, I think it's in english with minimal sleep apnea jargon. It's what a newbie to this needs. I know, I was recently one of them and the apnea jargon in the explanations made it difficult to follow sometimes.

Any comments on this is cool. I'm not trying to break any new ground here. Just trying to assist users in the 'self help' category to get started from my experiences.

This is the webpage:

http://gagnerwebsite.com/Deceiver2/APAP.html

You've basically got the process backwards.

The high pressure is typically immaterial. There's no reason whatsoever to keep the numbers close.

Start out with 6 and 20, ignore the high pressure unless you *have* to lower it. (Mine's at 25, my machine never gets there, it's an irrelevant setting the vast majority of the time, like driving a yugo on the autobahn, doens't MATTER what the speed limit is, you're not getting there.)

Set the lower pressure high enough to prevent the majority of events, this takes a few days and looking at the pressure graph to see where pressures go up when events occur.

The low pressure isn't the "relaxing" pressure. It's just the pressure the machine starts a session at, and tries to get back down to when events stop.

You're not completely off base, but you're not that close to it.

_________________
https://sleep.tnet.com/resources/sleepyhead
how to post:
https://sleep.tnet.com/resources/sleepyhead/shorganize
https://sleep.tnet.com/reference/tips/imgur


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