Help,
I just purchased the IntelliPAP AutoAdjust CPAP Machine with the Mirage Quattro Full Face CPAP Mask with Headgear that was fitted and specifically recommended and sized by my doctor, that was used on my split study sleep test.

My doctor recommended a pressure of 16. I set the auto adjust at 10 on the low end and 20 on the high.

Im on the 2nd night of therapy and I am not doing something right. I go to sleep with the mask on, fall asleep and instantly snore. I sleep about 3 or 4 hours, wake up to a massive leak. I get up and go to the restroom, try to reset my straps go back to bed and at this point im having a hell of a time getting all the leaks to stop. I no longer want to sleep on my back because its starting to hurt from the previous 3 to 4 hours sleeping on it. Fed up.......... the mask comes off !!!!!!!

Key questions

Why am I snoring with the equipment ?? is the auto adjust not working properly, not set properly ??  I know that I was on my back with the mask fitted correctly my wife woke me up to tell me im snoring. There were no leaks at the time.

What am I doing wrong ?????

the IntelliPAP AutoAdjust CPAP Machine has not released there compliance software yet

Please Help

you're probably snoring because your lower pressure is too low.  If the doctor prescribed 16, set your low pressure around 12.   My best titrated pressure was 11.  My biPap is set at 9 and 13 (two under, two over).

You might need to use two pillows or no pillow.  Sleeping on your side will put pressure against the side of the mask, which could result in a leak. My best side-sleeping results happen when I'm actually sleeping on my arm, which holds my hybrid mask off the mattress.

Your mask could be the wrong size.  They come small, med, large.  I use a small size hybrid.  The mask should hit your cheeks just to the outside of your lips.  If it's sealing around the soft part of your cheek, you won't get as good a seal.

I don't use a Quattro, so I'll let someone who does post and offer better suggestions.


_________________
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ResMed VPAP Auto 25 w/heated humidifier
ResMed Mirage Liberty Full Face Mask (nasal pillows and mouth enclosure)
BiPAP pressures: 14/10

rockylinx

Why are you setting your pressure yourself?  You are having problems because it isn't set properly.  We don't recommend people change and/or set pressures themselves exactly for this reason.  If your doctor is that incompetent, then you need a different doctor.  My doctor and I do that together.  Pressures that are too high causes arousals and central apneas, too low and treatment is ineffective as CPAPerRon mentioned.

For an APAP, it is usually set 2 cmH2O above and below your prescribed pressure.

Vicki



Last edited by Vicki on Sun Oct 26, 2008 6:02 pm; edited 1 time in total
_________________
That which does not kill you makes you stronger-Friedrich Nietzsche
Friedrich must of had apnea.

Many people..including me and I am very tolerable with things...have a hard time using auto.  The varying pressure always woke me up..once awake it would be hard to settle back down again.  Also getting the mask seal in the beginning is usually at the lower pressure..and the mask can act differently at a higher pressure.  If there is no reason you need auto then ask the Dr about setting it at your titrated pressure or what ever he scripted as the pressure..that is, if he did not script the auto settings.

There is a poster on here that went ahead and set the machine to a wide range auto function verses the Dr's scripted straight pressure..and has had problems from day one..and the majority of those problems are due to the machine being in Auto Mode...but the poster is/was not enough versed  in SA or the equipment to understand where the problems were coming from.

Keep us posted!


_________________

CLICK HERE FOR MORE INFO~ http://tinyurl.com/69q52a

BiPAP Auto M 13/8 Mirage Nasal Swift. 20 years+ undx'd. RLS/PLMD, Hypersomnia & more.

Hi there,

I really don’t understand the”problem” with the Auto PAP.

Here in Denmark the Auto Pap is standard equipment, and with uncomplicated SA the “windows” is set at the wide range between 4 and 20 cm H2O.

The Auto PAP is an AUTO TITRATION machine; therefore I don’t understand the warnings about that.

Henning

Rocky

I would consider attending to any leaks before I got too creative with the pressure experiments.

It's too bad you don't have the compliance data capability yet,  because that's what you really need in order to make prudent choices.

As Vicki writes, the folks herabouts are militant against us patients modifying our own pressures, so I can't recommend either way on that (I do it, however, with great success to report.)

But, I first used feedback from the data capability of my AFLEX machine, then I made sure that I have no significant leakage, and then made some patient and careful mods to my pressure range.

I look forward to a time when no xPAP machine is sold without complete data capability, and when patients are carefully taught how to eliminate leaks and to optimize pressures and pressure ranges.  Then, we'll see a flood of success stories, as well as phenomenal rates of compliance.

Regards all - -  Woof



.

Many people, including me, are very sensitive to the contant changes in pressure and it causes micro arousals and is disruptive to sleep.  Once a titrated pressure is known, pressures are typically set 2 cmH2O above and below the prescribed pressure.  The algorthms of APAPs are not perfect and they can and do increase pressures erroneously when they think there is an apnea there when there really isn't.  If the pressure is set too high, then the erroneous high spikes that will not only cause arousals but also central apneas.  If the pressure is set too low, then when it erroneously drops low, therapy is ineffectual.

Vicki


_________________
That which does not kill you makes you stronger-Friedrich Nietzsche
Friedrich must of had apnea.

I understand if xPAP users have problems with the varying pressure.

But otherwise I still don’t understand. The pressure can vary a lot between nights. If you have a good dinner with alcohol, or if you have a cold, you maybe need a higher pressure, and the Auto xPAP will take care of this, and if you have a really good night the pressure will be as low as possible.

My average pressure varying more than 4 cm H2O so I think that the Auto PAP in many ways is better than straight CPAP pressure.

I haven’t seen any studies that descript +/- 2 cm H2O for Auto xPAP.

I’m still talking about uncomplicated SA.

Henning

Poster Henning writes...

I haven’t seen any studies that descript +/- 2 cm H2O for Auto xPAP.


Although they quite possibly exist, I have not seen any either, and I scan the scientific literature fairly often.  (Maybe the right key words elude me.)

As nearly as I can determine, the notion of having a narrow pressure range in APAP therapy arises principally from OSA patients empirically determining what pressure range changes improved their individual therapy.

As far as moving the lower pressure up to near the titrated level, the reasoning that I have read is that this gets around the need to actually have apnea events in order for the machine to operate at the correct base pressure level.  (All that fancy algorithm programming apparently doesn't compare with what you know from experience is your minimum.)

Then, the reasons I most often see posted for keeping the upper level within 2 to 4 cm of the lower level (while bracketing the titrated pressure) are to keep the machine from chasing leaks and snores.  I think that the algorithms try to prevent these excursions as well, but once the pressure goes up unnecessarily, the chance of a new leak or a wakeup from too much pressure does too.)  

I suspect that many researchers read this site (and also CPAPTALK.com ) and know that patients claim to have independently determined a higher degree of success with a narrower range of APAP pressures.  And, accordingly, one would hope to see some well-designed and well-controlled studies to put a stamp of scientific evaluation on what might be (in their view) a consensus of self-reported cases from mostly non-scientific patients.

Actually, I would love to help design a study on this topic.  Any interested persons in sleep research capacities are welcome to PM me.

Regards all - -  Tom      (Woof)



.

Mrs Rip Van Winkle wrote:

There is a poster on here that went ahead and set the machine to a wide range auto function verses the Dr's scripted straight pressure..and has had problems from day one..and the majority of those problems are due to the machine being in Auto Mode...but the poster is/was not enough versed  in SA or the equipment to understand where the problems were coming from.

There's a whole lot of things I don't understand about SA or about the equipment, Mrs RVW, and that's why I keep coming here to read and to ask questions. "God" "forbid" I ask my doctor any of these questions.

But I understand the reasons for my being in Auto Mode, I understand why there's a need for a high range, I know that high pressures can lead both to leaks and to centrals but I was set for 19/17 and for 20/4 so then I'm obviously doing something correct by being at a 20/11 pressure setting.

I was advised that 4 was too low a setting, that there was no purpose for me being at a 20/4 setting, that somewhere between 20/8 and 20/11 made more sense and so I listened to that advice.

Henning wrote:

Hi there,

I really don’t understand the”problem” with the Auto PAP.

Here in Denmark the Auto Pap is standard equipment, and with uncomplicated SA the “windows” is set at the wide range between 4 and 20 cm H2O.

The Auto PAP is an AUTO TITRATION machine; therefore I don’t understand the warnings about that.

Henning

Henning,

Problems with APAP usually occur when the setting is at its widest.

APAP uses an algorithim (depending on manufacturer.......some use air flow, others use obstructions) to determine breathing patterns and oncoming apnoea events. Air is then released at a pressure that the machine anticipates is sufficient to clear the individual event.

Assuming the machine is set at 4/20 cmsH2O, titrated pressure is 13 (95th percentile of max pressure requirement) and the algorithim decides that 12cmsH2O is required to clear the event. The APAP machine must then ramp up from 4 to 12, fairly quickly, to clear the event. In quite a few cases the machine may be unable to deliver the required pressure quickly enough..........fail to clear the event and during this period of time the machine is running quite hard, causing increased noise and a greatly increased blast of air...............it then ramps down again. The increased machine activity with a wide range can be uncomfortable for the patient...........and in a lot of cases does not clear all apnoea events, in some cases leaving a severe sufferer with mild or moderate apnoea. This is a fairly typical situation.

On the other hand, taking the same hypothetical case, if the APAP had been set at 11/15, it would have ramped up quicker from 11 to deliver the required pressure with less noise, less activity and delivered the air requirement in time to clear the event. Some APAP users work on tighter ranges.

For titration purposes, APAP is usually set at a wide range..........but for best results, afterwards, should be kept at a narrower range.

Hope this explains it.

Daniel.


_________________
The untreated Sleep Apnoea sufferer died quietly in his sleep.......
Unlike his three passengers who died screaming !!!!!!

(Anon)

Daniel wrote:

Henning,

Problems with APAP usually occur when the setting is at its widest.

APAP uses an algorithim (depending on manufacturer.......some use air flow, others use obstructions) to determine breathing patterns and oncoming apnoea events. Air is then released at a pressure that the machine anticipates is sufficient to clear the individual event.

Assuming the machine is set at 4/20 cmsH2O, titrated pressure is 13 (95th percentile of max pressure requirement) and the algorithim decides that 12cmsH2O is required to clear the event. The APAP machine must then ramp up from 4 to 12, fairly quickly, to clear the event. In quite a few cases the machine may be unable to deliver the required pressure quickly enough..........fail to clear the event and during this period of time the machine is running quite hard, causing increased noise and a greatly increased blast of air...............it then ramps down again. The increased machine activity with a wide range can be uncomfortable for the patient...........and in a lot of cases does not clear all apnoea events, in some cases leaving a severe sufferer with mild or moderate apnoea. This is a fairly typical situation.

On the other hand, taking the same hypothetical case, if the APAP had been set at 11/15, it would have ramped up quicker from 11 to deliver the required pressure with less noise, less activity and delivered the air requirement in time to clear the event. Some APAP users work on tighter ranges.

For titration purposes, APAP is usually set at a wide range..........but for best results, afterwards, should be kept at a narrower range.

Hope this explains it.

Daniel.

Hi Daniel,

This makes sense to me, and sounds logically.

But what not make sense to me is that I never have heard or read about that. And even though I have been at three different sleep centers, no one has ever made any adjustments on my Auto CPAP.

Maybe it's because my average pressure is in the lower end (about 7) and my AHI is about 2.0. (AI=0)

I assume that the average pressures on my display are my “95th percentile pressure” - since my window is wide open.

Thank you for your post.

Henning

Henning wrote:

Daniel wrote:

Henning,

Problems with APAP usually occur when the setting is at its widest.

APAP uses an algorithim (depending on manufacturer.......some use air flow, others use obstructions) to determine breathing patterns and oncoming apnoea events. Air is then released at a pressure that the machine anticipates is sufficient to clear the individual event.

Assuming the machine is set at 4/20 cmsH2O, titrated pressure is 13 (95th percentile of max pressure requirement) and the algorithim decides that 12cmsH2O is required to clear the event. The APAP machine must then ramp up from 4 to 12, fairly quickly, to clear the event. In quite a few cases the machine may be unable to deliver the required pressure quickly enough..........fail to clear the event and during this period of time the machine is running quite hard, causing increased noise and a greatly increased blast of air...............it then ramps down again. The increased machine activity with a wide range can be uncomfortable for the patient...........and in a lot of cases does not clear all apnoea events, in some cases leaving a severe sufferer with mild or moderate apnoea. This is a fairly typical situation.

On the other hand, taking the same hypothetical case, if the APAP had been set at 11/15, it would have ramped up quicker from 11 to deliver the required pressure with less noise, less activity and delivered the air requirement in time to clear the event. Some APAP users work on tighter ranges.

For titration purposes, APAP is usually set at a wide range..........but for best results, afterwards, should be kept at a narrower range.

Hope this explains it.

Daniel.

Hi Daniel,

This makes sense to me, and sounds logically.

But what not make sense to me is that I never have heard or read about that. And even though I have been at three different sleep centers, no one has ever made any adjustments on my Auto CPAP.

Maybe it's because my average pressure is in the lower end (about 7) and my AHI is about 2.0. (AI=0)

I assume that the average pressures on my display are my “95th percentile pressure” - since my window is wide open.

Thank you for your post.

Henning

Henning,

I think the answer is in your average pressure of 7. Your machine is ramping up from 4 to 'average 7'...........not too far away from your average pressure.

I suspect that a tighter range of say 5/9 might eliminate your AHI of 2.

A higher pressure requirement might not give as  good a result.

As for no talk about APAP problems....... IMHO, most sleep clinics just want their patients on XPAP, regardless................at a recent talk to OSA sufferers I met an RT who had worked in the US and Europe and she really didn't seem to be too well informed on patient problems with XPAP. I was somewhat disappointed at her replies to some queries. On the other side, DME companies would love to have all patients on top end machines........and they never mention potential problems with them. Even now, there is still no resolution as to which algorithim works best and there appears to be no moves towards the introduction of an industry standard.

A very large number of sleep specialists still refuse to prescribe APAPs..............or do so under duress, as they are still not satisfied that they provide reliable treatment therapy.

I can see the benefits of APAP usage, particularly where compliance is at issue...............but the main players in the market (ResMed and Respironics) should try and come up with an industry standard.

Just my thoughts.

Kind regards,

Daniel.


_________________
The untreated Sleep Apnoea sufferer died quietly in his sleep.......
Unlike his three passengers who died screaming !!!!!!

(Anon)

From personal experience I would say that a very narrow window of auto adjustment also can cause problems. I need more pressure when I have gained a couple of pounds, and more when I sleep early. On the otehr hand I often use very low pressure when just taking a nap. When a new machine was adjusted to a narrow range my AHI went up and my AI was 4 or 5 times my normal results, as soon as it was adjusted to a wider range things got down to normal. We humans vary, some have different needs, so lets encourage new users to find what works for them not give doctrinaire answers.


_________________
Arthur
Sleeping with a curvaceous blonde autoPAP (Resmed autoset). Hope springs eternal.....

Hi Daniel,

I've thought about it, and maybe it is just a lack of information to me.

The low pressure due to the fact that I sleep on my left side. If I sleep on my back I need a minimum pressure of 8 and an average pressure of 12.

Some nights it goes wrong, and my average pressure increases dramatically. So perhaps there is an explanation for my APAP settings here.

Thank you again.

Henning