Hello,

I had a sleep study about 3 years ago and have been using a ResMed Elite S8 since then.(Setting of 12)  I have had great results from being on CPAP, but over the last year I've felt that it hasn't been helping me as much as it did at the start.  I have gained about 30 pounds over the past couple of years.  I went to my doctor about this and instead of doing another sleep study, he and I agreed that I would first use a ResMed AutoSet II(EPR) for 30 days and then pull the data off of that and see what it says.  I've been using the AutoSet for about 2 weeks now and I feel like !@#!.   Light headed, dizzy, exhausted, irritable, etc., etc..  I feel better when I go back to the Elite S8.

So, I contacted my doctor and I brought my memory card in for my home health car provider to read.  Below are the results of the 2 weeks I've used the AutoSet, minus 3 days that I went back to my Elite S8.  If anyone could look at the data and give their opinion on how the AutoSet is doing for me I'd greatly appreciate it!  I'm in limbo right now, waiting for my doc to get back to me on the data.  The home health provider person said that there was some problems in the data.  I don't really want to go through another full blown sleep test, but if that is what it takes to feel better I will.

Thank you in advance for any help you can provide!  




I hope this is in the right forum.  If not, I hope a mod will move it.

Well, my first two questions would be:

1] What are the pressure settings, what pressure range?

2] Is the AutoSet II Mask Selection set at the correct selection for the mask you are using?

My 3rd question would be are you still using the same mask? How old is the mask cushion? How old is the headgear?
My 4th question would be was your Elite's pressure output checked by manometer?

5 out of the 11 days you used the AutoSet your Leak rate was too high making the data less than reliable. Part of your problem as far as how you are feeling could be because you are one of those people whom the fluctuating pressure of an APAP disturbs their sleep.

Ask to try a pressure range of 10 cms to 14 cms and see how you do w/that. Leave the EPR setting at whatever it is at now and don't use the Ramp. In fact, if you don't need the EPR don't use it either.

Oooops! I'm breaking my own rule of only one change at a time and for one week at a time before making any other one change.

Leave Ramp and EPR alone and ask only that the pressure range be changed to 10-14 cms and do NOT change your mask either!! That is your one change for one week.

Its not like you are a new CPAP user and need time to acclimate to using a CPAP and wearing a mask. They should be checking your data and making any needed ONE change each week or AT LEAST every two weeks maximum.

Eh, what do I know? I'm just a patient, not a medical or sleep professional.


_________________
Some people are like Slinkies... Not really good for anything, but they still bring a smile to your face when you push them down a flight of stairs.
Resmed VPAP Auto. Humidaire 3i, Simplicity mask, ResScan 3.7, S8 ResLink, Embla oximeter.

It looks like you've given me some questions that I need to get answered.

1)  I'm not sure what the pressure parameters are set at.  I do know that the lower pressure is 4.

2)  The AutoSet II is set for the mask that I am using.

3)  The nasal mask I have been using may have been a bit old, so I replaced it last night.  The head gear is fairly new and is functioning as it should.(maybe)

4)  I don't even know what a manometer is, so that is another question I have for my doc/home health care provider.

Thanks for your insight!  Looks like I need to reduce the amount of leaks that are occurring.  I think that I'll ask to have the parameters set higher and see how I do on that.  Thanks again.

Do you know how to access the Efficady and Usage data on your AutoSet II??? If not, try this. Press the Left and Right buttons and hold for 4-5 seconds. Efficacy Data should pop up on the LCD screen. From then on in it is a matter of Left button to Enter, Right button to Exit, Up button to return to the previous screen and Down button to proceed to the next screen. These xPAPs have an internal, 24 hour, noon to noon clock so you have to check the previous night's data BEFORE noon because at noon it is rolled over into the total averages.

If that button press doesn't bring up the Efficacy Data then you need to ask your DME supplier to turn the SmartData ON. This gives access to what your Users Manual refers to as the detailed patient menu which is the Efficacy and Usage data. You can NOT accidentally or intentionally change your therapy settings from this detailed patient menu.


_________________
Some people are like Slinkies... Not really good for anything, but they still bring a smile to your face when you push them down a flight of stairs.
Resmed VPAP Auto. Humidaire 3i, Simplicity mask, ResScan 3.7, S8 ResLink, Embla oximeter.

I was able to access the Efficacy and User Data.
And as you said, no data for last night because it rolled over at noon.

Here are the settings:
Mode: Autoset
Min Pressure: 4
Max Pressure: 16
Mask: Standard(I have a nasal mask, is this setting correct for that?)
Tube Length: 2m
Humid:  None(which is OK being that I'm don't use humidity in the summer)
Smart Start: Off(what's this?, ramping?)
Leak Alert: Off
EPR: Full Time
EPR: Level 3
EPR Access: On


Also, on the main screen it says: Settling: Off  What is "Settling"?
One more question, what is EPR?

"Eh, what do I know? I'm just a patient, not a medical or sleep professional."
A lot more than my doctor, who is actually a wet behing the ears P.A.!   (he's a nice kid, just needs some experience)

I appreciate the time you've taken to answer my questions.

The Standard Mask Selection is correct for ANY non-Resmed mask. If your mask is a Resmed mask then the Mask Selection should be set for that particular Resmed mask.

In the Standard Mask Selection the Resmeds automatically SUBTRACT 0.4 L/s (24 L/M) from the reported Leak rate. So using a non-Resmed mask and correctly the Standard Mask Selection you must look to the literature that came w/your mask for the table showing the allowed vent rate at your reported Pressure. ADD the the 0.4 L/s (24 L/M) to the reported pressure and compare that to the allowed vent rate at your reported Pressure to figure your TRUE Leak rate. (All the mask allowed vent rate tables I've seen are in L/M).

SmartStart is the option that if turned ON allows your AutoSet to automatically turn itself on when it sense you have your mask on - usually w/in the first to second exhalation - and it will automatically turn itself off when it senses you've taken your mask off OR if it senses an EXTREMELY high leak for any length of time. You can NOT have Leak Alert and SmartStart both on at the same time, you can only have one or the other on - or both turned OFF.

EPR is Resmed's expiration pressure relief. Each setting equals 1 cm of pressure. So EPR = 3 means you will receive 3 cms lower pressure on expiration.

Settling means the AutoSet will not respond to breathing "events" (apneas or hypopneas) during that time period. It is usually set for the length of time it normally takes you to get to sleep.

Don't be too hard on your sleep doctor/PA. The actual use of these xPAPs is not their field of endeavor. You really can't expect them to know the various "comfort options" of the many brands and models of xPAPs on the market. That is the local DME supplier's RRT's "job" and supposed field of expertise (snort!). Far too many of them don't know diddley-squat about the xPAPs they provide to their clients beyond the Quick SetUp Guide. For whatever reason, they don't bother to READ the Clinicians Manuals. Duh!

You did notice to, that the Efficacy Data WAS availabe for the previous week, month, six months and one year (if you have been using it that long)??


_________________
Some people are like Slinkies... Not really good for anything, but they still bring a smile to your face when you push them down a flight of stairs.
Resmed VPAP Auto. Humidaire 3i, Simplicity mask, ResScan 3.7, S8 ResLink, Embla oximeter.

Wow, tons of info.  I should have edumacated myself about this a long time ago!  
I was just joking about my PA.  He's not a sleep specialist, just my GP.  A nice guy who genuinely wants to help.  I do get a little frustrated with my DME supplier.  One gal there is a lot of help, but one other is a bit "opnionated", yet doesn't know that much about OSA and the machines.

Anyway, I got some Efficacy Data.  This is from my Elite S8 as I haven't used the AutoSet II long enough.(I'm not using it at all now)

Last night's readings:
Press:  11
Leak: 0.12L/s
AHI:  8.6
AI:  0.1
HI:  8.5

6 Months:
Press:  11.2
Leak:  0.24L/s
AHI:  6.1
AI:  0.2
HI:  5.8

Year:
Press:  11.2
Leak:  .26
AHI:  4.6
AI:  0.1
HI: 4.4

How do these readings look?  Are the within acceptable parameters?  My pressure setting for the Elite S8 is 12.  Why does it show that it is running at 11-11.2?

I don't mean to hog all of your time!  Thanks a lot for all the help!

No problem.

Are you using EPR or Ramp w/your S8 Elite? EPR = expiration pressure relief. If you are using EPR you have to remember, you are inhaling roughly half the night and exhaling roughly half the night.

If you are using Ramp, then there is a portion of every night where you are starting out at a lower pressure and then Ramping up over the set amount of minutes before reaching your set pressure.

Actually, your data for the year looks better than your data for the last six months, and your data for the last six months looks better than your data from last night. But one night doesn't tell much of a story. You really need AT LEAST a week's data to truly assess the situation.

We prefer to see the AHI less than 5.0 (5.0 is considered "normal" sleep). We prefer to see the AHI made up mostly of hypopneas which yours is so that is good. Resmeds tend to score hypopneas a little more aggressively than other brands. We really like seeing the AI less than 1.0 so you're dong good there. We like to see the Leak rate less than 0.4 L/s so you are doing good there too.


_________________
Some people are like Slinkies... Not really good for anything, but they still bring a smile to your face when you push them down a flight of stairs.
Resmed VPAP Auto. Humidaire 3i, Simplicity mask, ResScan 3.7, S8 ResLink, Embla oximeter.

My Elite S8 is set at a 20 minute ramp.  Thanks for the explanation about that.

Well, it looks like my Elite S8 is doing a pretty good job.  I'll have to keep an eye on the data over the next week to see how I'm doing on the AHI's, etc.

I'm still planning on hearing from my PA on what he suggest to do with the AutoSet.  If they tweak the settings on that I am willing to give it another shot.

Thanks again for all the help.  I feel much more prepared to work with my DME and PA to get the best results form my CPAP as possible.

General rule of thumb with an APAP is setting the pressure range 1-2 cms below the titrated pressure and 1-2 cms above the titrated pressure. Then work from there, since you gained weight you might want to work your way UP in pressure, rather than down. Or you can start the pressure range 1-2 cms below your titrated pressure and set the top of the range at 16 cms. Ask your sleep professionals about this type of pressure range w/the AutoSet.

4 cms is too low a pressure for almost anyone to breathe comfortably at w/a mask on for any length of time. Especially w/EPR turned on in auto mode a low pressure of 8 cms w/EPR at 3 or even 2 is a much better starting pressure.


_________________
Some people are like Slinkies... Not really good for anything, but they still bring a smile to your face when you push them down a flight of stairs.
Resmed VPAP Auto. Humidaire 3i, Simplicity mask, ResScan 3.7, S8 ResLink, Embla oximeter.