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Permalink Reply by BeeAsleep on May 19, 2009 at 11:03am

Jeff,
THANKS. I appreciate your clear, precise answer. I guess you are right, the data will show if things are working for me or not. Until then I will just use the machine and see what happens. It is so relieving to be able to ask the questions on this forum, and not spend days worrying about things. I feel like I have to be 100% on top of every aspect of my care.

j n k said:

The S8 Autoset II is a top-of-the-line autotitrating CPAP machine, or APAP--or as often said in the forums, an "auto."

In order for you to be fully confident about how that machine is set up for you in the long run, you should have copies of your prescription and copies of your sleep studies, including the charts from your titration study. Allow the doc and the RT to explain to you what they do, and take notes on those conversations to keep with your copies of your prescriptions and sleep studies.

The main thing is to get the machine and to use it. It will give you the data to let you know how successful your therapy is at whatever pressures it comes set up with, so I wouldn't worry right now about what those initial pressures are until you see if they work. After a few weeks, you can look at your data and decide if different settings might work best for you or if running the machine in straight CPAP, not as an auto, for nightly therapy might work better. But it is good to have that auto so you can run it in auto mode in a pinch to see what pressures the machine finds for you as a little mini-home-titration study from time to time. It won't be as good as a real PSG, of course, but still, the more information you have over time, the better--for you and your doc.

In summary, I would say: Get your hands on the machine, use it however it comes, and you can figure out later, over time, what pressures and comfort adjustments give you the lowest estimated AI, HI, and AHI most comfortably with the best sleep possible, in cooperation with your medical team.

jeff

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Permalink Reply by Melinda Hertel on May 19, 2009 at 2:07pm

I'm not sure why your pressure range was lowered. But I do know why the Auto Titrate mode might not work for you...I talked to the physician I work with and he explained that the way the autotitrate works can actually cause you to wake up and make it harder to adjust to it. It has to do with the machine responding too quickly to your breathing pattern, just as how the sleep tech changed your pressures too quickly during the study. Responding too quickly doesn't allow your body to adjust to a pressure change and it can arouse you from sleep. We have all been breathing at a constant pressure our whole lives. Then we have to adjust to a slight increase in pressure to alleviate the apneas. Since that new pressure will be constant, we adjust to it and have no problems. However, the autotitrate might respond to external things that are not really apneas (leak in the mask, or even a slight obstruction that fixes itself), raising the pressure rapidly and then waking you because your body has not adjusted to the new pressure yet. It also can take the machine a few minutes to reduce the pressure back to a comfortable setting, therefore not allowing you to go back to sleep as quickly. Realize also that it is normal for "normal" people to have a few apneas. So having your machine respond to every little thing can be disturbing.

Hope that helps! Oh, one more thing....If your machine is autotitrate mode, EPR does not apply. It only works if your machine is in CPAP mode.

Melinda

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Permalink Reply by BeeAsleep on May 19, 2009 at 5:42pm

Thanks for all the great dialog. I seem to be doing really good with actually wearing my CPAP, it is the breathing out against the pressure that is so hard. I have to fight through that each and every night. I just want to find a machine that will be flexible and work for me so I can start to feel better.So far I do not feel better at all. But I am staying positive that eventually i will start to feel less tired. I am excited to have such a nice machine, and I will keep you all posted on how it works for me.

j n k said:

EPR was not available in auto mode in the Vantage, but, in fact, EPR is available in AutoSet mode in the AutoSet II, as stated above the chart on the bottom of page 2 in the pdf at the following link.

http://www.resmed.com/us/assets/documents/product/s8_autoset_ii/fac...

Some patients may find that an auto may disturb their sleep. But I believe that the majority find that they get used to the pressure changes, just as they get used to the other aspects of PAP therapy. Occasionally someone my find that he or she is unrested when using an auto, and that he or she gets better sleep in straight CPAP. But I believe most do get used to using an auto just fine, especially when the auto is set with its minimum within a few cm of their prescribed pressure so that large jumps in pressure are unnecessary and unlikely.

The nice thing about autos is that they all give efficacy data and can all be run in CPAP mode. Running an auto in CPAP mode is not a waste, since the auto mode is available for seeing what pressure the auto lands on most of the night, and that can be valuable information.

If one ever wakes up using an auto, one can simply hit the ramp/settle button or toggle the machine off and back on to engage the ramp/settle feature. And inappropriately high pressure can be prevented by lowering the maximum on the machine.

Some doctors don't like autos because of the older versions. And I agree they are all imperfect and do not always preform quite as well as advertised. The newer autos are quite advanced though. So I would hope doctors keep an open mind about the newer machines and judge how well they work based on experiences with the newly marketed machines.

jeff

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