Apap pressure setting plan

General Discussion on any topic relating to CPAP and/or Sleep Apnea.
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Pugsy
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Re: Apap pressure setting plan

Post by Pugsy » Mon Jan 29, 2018 8:58 am

SteveBR wrote:My newest ENT actually gave me a green light to use Afrin. I was shocked.
I'm not. My doc told me that there were a lot worse things in life than being "addicted" to one little squirt of Afrin at bedtime.
He said it's when we start needing it and using it a other times during the day that can lead us down that dark ugly Rebound path.
For myself I can't sleep if my nose is stopped up. Wouldn't matter if I used a full face mask to allow the mouth breathing should I need to...the cold hard fact of life is that if my nose is really badly congested I simply have a horrible time sleeping period.
Since for me getting to sleep and staying asleep really trumps everything else....I do what I have to do to get the sleep and worry about the other stuff later. No I don't always have the most perfect leak line graph...but most of the time it is quite acceptable...but I at least sleep.
I learned a long time ago that a really pretty perfect leak line doesn't mean much if a person wakes up a gazillion times a night fiddling with something that I was using to get that nice pretty leak line. Remember what is said...sometimes we make compromises and I always will choose sleep itself over perfect numbers because without the sleep itself the numbers on anything really don't mean much.

I don't know if your proposed idea to help with definitive answers to the "are those FLs nasal mucosa or not"...I am afraid that you might find that you have to sacrifice sleep quality itself to maybe get that answer. You may end up with a lot of SWJ clouding the results.
It's your body and your sleep that you and if maybe finding the answer is of critical importance to you...then by all means try it. I have tried other less useful experiments for less of a reason than that. Sometimes I learned something useful and sometimes all I learned what what a stupid idea that experiment was...but I always learned something.
It's really the only way to get a maybe answer though in your situation because allowing the machine to do what it wants with a higher maximum we know for sure causes significant problems that we for sure want to avoid. For me...those higher pressures have never disturbed my sleep but I thoroughly understand that it isn't always that way for others and if there is no absolutely critical need for more pressure....don't let the machine go there if it is causing a problem. There's no urgent need in your case. Your AHI is nice and low once the SWJ is removed. You report feeling and sleeping better. Might be a different story if you were reporting no improvement at all and the obstructive component of your AHI was much higher and we couldn't blame enough of it on SWJ.

I avoid the Afrin myself as much as I can because I know how easy it is for me to cross that line where I start to use it too much and can develop the physical dependency that ends up with my using it during the day a LOT. Been there and done that and don't want to go there again.
But I do have a small bottle handy for emergency use and I use only the teeniest tiniest amount and very sparingly when I realize that I am going to have trouble sleeping with the congestion I might have. Fortunately for me it isn't often but I will do it if I have to because given the choice of a tiny bit of Afrin and sleep vs no sleep if no Afrin...I will do the Afrin. Is it ideal? Of course not but neither is not sleeping.

Now I also do the Flonase thing and the Simply Saline thing first before I resort to the tiny Afrin dose...the Afrin is always the last resort and not the first resort. I don't have the seasonal allergy thing much any more.. Did the allergy shot thing some 40 years ago which helped a lot.
Mainly when I end up with any congestion now it is I have caught a cold or something like that.
And like you I often find that I wake up with a clearer nose than when I went to bed because of the humidity in the air coming from the machine.
Think how a hot steamy shower seems to open up the nasal passages...while what we get from the humidifier isn't nearly as much as that hot shower the end result is the same. The moisture helps the nasal mucosa to not swell which is what causes the congestion.

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SteveBR
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Re: Apap pressure setting plan

Post by SteveBR » Sat Apr 21, 2018 2:27 pm

Hi Pugsy,

Just to refresh your memory. I am the one that can not tolerate high pressure settings and have a good amount of flow limitations possibly due to nasal congestion. If pressure is set too high the machine will rev up causing more harm than good.

I have determined that the highest I can go without adverse effects is about 8. So for the last few month my setting has usually been 6-8. However, recently I felt like I have not been getting quality sleep so a few days ago I increased my range to 6-10. With this new setting I felt somewhat worse. So last night I decided to change course. I changed my settings to a very low 4-5. The results were one of my lower AHI scores in months. I think maybe even my flow limitations were slightly better? Still have the peaks but not as consistent. Will you verify that please? Surprisingly, with the lower pressure setting my pressure was not as consistently at the higher end as it was with the higher pressure setting. Why would that occur?

I know this is only for one night but if I keep getting similar AHI scores and if I feel better should I continue with the low 4-5 setting? Is it reasonable to think that low of a setting is able to adequately treat my sleep apnea?

For some reason SH is showing Min 4 Max 9 for last night but that's not accurate. It was 4-5 as the graph indicates.

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Last edited by SteveBR on Sat Apr 21, 2018 3:31 pm, edited 1 time in total.

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Pugsy
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Re: Apap pressure setting plan

Post by Pugsy » Sat Apr 21, 2018 3:17 pm

Thursday report shows max at 9...Friday report shows max at 5.

You are making yourself more work in terms of screen shots than you need. The first image with Events, Flow rate, pressure, leak and Flow limitations are really all that I need to see.

Yes..the machine wants to use more pressure in an effort to kill those Flow Limitations but if those FLs aren't growing up to earn the OA or hyponea flag then I don't know that I would worry about it since you feel better.
Sometimes we have to make compromises and sleeping good and feeling good is more important than the machine maybe wanting to go killing FLs especially when the AHI is nice and low.

Obviously one night does not a trend make so let's see how you do at these new settings after a few more nights.

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Re: Apap pressure setting plan

Post by SteveBR » Sat Apr 21, 2018 3:38 pm

Thanks for letting me know that because that was a lot of work. :) I edited the unnecessary images out. I will update you in a few days.

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Pugsy
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Re: Apap pressure setting plan

Post by Pugsy » Sat Apr 21, 2018 3:48 pm

Yeah, that's a lot of work and rarely needed.
I prefer to stick with the basics and if I need anything else I ask.

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Re: Apap pressure setting plan

Post by SteveBR » Sat Apr 21, 2018 3:56 pm

Sounds good. You have been very helpful and I appreciate it.

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Re: Apap pressure setting plan

Post by SteveBR » Sat Aug 04, 2018 4:29 pm

Pugsy wrote:
Sat Apr 21, 2018 3:17 pm
Obviously one night does not a trend make so let's see how you do at these new settings after a few more nights.

Hi Pugsy, it's taken me a while to get back to you because I had a third septoplasty and turbinate reduction surgery. I can now breath through my nose throughout the night without the usage of Afrin. My nose breathing is not perfect but definitely better. Please look at the following charts and tell me what you think. Is it possible to be effectively treated with such a low pressure setting? My events are similar, if not lower, than when I had a pressure setting of 6 to 8 and after 8 the higher I go the more events. I still have the flow limitations but I have that, it seems, at any pressure and regardless if I am breathing out of my nose or mouth. I do not understand why that is the case.

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Pugsy
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Re: Apap pressure setting plan

Post by Pugsy » Sat Aug 04, 2018 5:12 pm

Yes it is possible to be effectively treated with a pressure so low. Some people don't need much pressure to hold the airway open..that's why I always tell people that there is therapy value even at 4 cm...assuming people aren't uncomfortable with that low of a pressure and some people are just fine with it.

Would you do me a favor and change the max from 4.2 to 6.0 and let me see what happens just for my own education.
You can be my guinea pig. :lol:

How long since the most recent surgery?

How is your overall sleep quality and how do you feel during the day?

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Re: Apap pressure setting plan

Post by SteveBR » Sat Aug 04, 2018 7:35 pm

Pugsy wrote:
Sat Aug 04, 2018 5:12 pm
Yes it is possible to be effectively treated with a pressure so low. Some people don't need much pressure to hold the airway open..that's why I always tell people that there is therapy value even at 4 cm...assuming people aren't uncomfortable with that low of a pressure and some people are just fine with it.

Would you do me a favor and change the max from 4.2 to 6.0 and let me see what happens just for my own education.
You can be my guinea pig. :lol:

How long since the most recent surgery?

How is your overall sleep quality and how do you feel during the day?
The most recent surgery was almost 3 months ago.

Sure thing. I will do max at 6.0. That means back to taping my mouth. :) Thankfully I don't need tape with the lower pressure.

My sleep quality is better because I don't have to use the tape, no mouth sputtering, and less noise. I feel that I am now very accustomed to cpap at the low pressure. I feel pretty good during the day. Waking up I still feel exhausted though and when it gets to be 4 or 5pm my body craves a nap. I have been napping for years now. I think my body is just used to that.

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Re: Apap pressure setting plan

Post by zoocrewphoto » Sun Aug 05, 2018 5:03 am

SteveBR wrote:
Tue Jan 23, 2018 2:33 pm
I don't think the low 6 setting is too much for me. I think the high setting of 15 is too high for me. There is definitely a misunderstanding. Can someone else maybe explain this to me in a different way? As I mentioned previously the pressure was at over 13 when I looked at it last night as I was trying to sleep. The pressure at 6 is okay. It was when the machine reved up to over 13 that I could not tolerate. Does that sound illogical?
When your machine is set for 6-15, and you see that it is at 13, that means that the pressure of 6 wasn't enough to prevent events. The machine went higher because it needed to.

Now, if 13 is too much for you right now, you can lower it a bit and realize that it won't be able to help you as much until you get used to it. In order to get successful treatment, you will need to be able to tolerate the 13. And if goes there frequently, then you really need a higher minimum.

The purpose of the minimum is to prevent most events. For example, My pressure is 11-17. My pressure rarely goes above 12, because that is enough to prevent most of my events. If my starting pressure were only 6, my machine would be going up and down all night and letting events happen. My machine has short spikes to 15 and rarely above that.

Have you posted any graphs of a typical night? That would help us tell you what you need. And we could also help you get used to the pressures you need.

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Re: Apap pressure setting plan

Post by Pugsy » Sun Aug 05, 2018 5:35 am

zoocrewphoto wrote:
Sun Aug 05, 2018 5:03 am
Have you posted any graphs of a typical night? That would help us tell you what you need. And we could also help you get used to the pressures you need.
You are responding to the Jan post and since then a lot has happened and changed including septoplasty surgery and he just posted a new report from just a few nights ago and his pressure needs are significantly lower now.
You may have missed the new posts which are at the end of page 4.

Just last night he said this.
it's taken me a while to get back to you because I had a third septoplasty and turbinate reduction surgery. I can now breath through my nose throughout the night without the usage of Afrin.

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Re: Apap pressure setting plan

Post by zoocrewphoto » Sun Aug 05, 2018 5:45 am

Pugsy wrote:
Sun Aug 05, 2018 5:35 am
zoocrewphoto wrote:
Sun Aug 05, 2018 5:03 am
Have you posted any graphs of a typical night? That would help us tell you what you need. And we could also help you get used to the pressures you need.
You are responding to the Jan post and since then a lot has happened and changed including septoplasty surgery and he just posted a new report from just a few nights ago and his pressure needs are significantly lower now.
You may have missed the new posts which are at the end of page 4.
Thanks. I thought I was looking at the last page of the thread. Guess I need to go to bed early (for me). I did have a really hard work day.

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Re: Apap pressure setting plan

Post by SteveBR » Sun Aug 05, 2018 2:24 pm

Pugsy wrote:
Sat Aug 04, 2018 5:12 pm
Would you do me a favor and change the max from 4.2 to 6.0 and let me see what happens just for my own education.
You can be my guinea pig.
Here you go. I'm going to try the max at 6.0 again tonight but without tape.

I have done all types of experimentation. I have tried a max of 20 for a short nap where I am certain I did not fall asleep. The pressure went as high as 14, I had tons of events, and my flow limit was even worse than at lower pressure. If pressure is rising due to flow limitation then why is it worse? This was before my most recent surgery. Please see nap data in second image below.

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Re: Apap pressure setting plan

Post by palerider » Sun Aug 05, 2018 2:45 pm

SteveBR wrote:
Sun Aug 05, 2018 2:24 pm
Pugsy wrote:
Sat Aug 04, 2018 5:12 pm
Would you do me a favor and change the max from 4.2 to 6.0 and let me see what happens just for my own education.
You can be my guinea pig.
Here you go. I'm going to try the max at 6.0 again tonight but without tape.

I have done all types of experimentation. I have tried a max of 20 for a short nap where I am certain I did not fall asleep. The pressure went as high as 14, I had tons of events, and my flow limit was even worse than at lower pressure. If pressure is rising due to flow limitation then why is it worse?
Because your awake breathing is irregular and confuses the machine.

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Re: Apap pressure setting plan

Post by Pugsy » Sun Aug 05, 2018 2:53 pm

Your machine thinks the Flow Limitations are bad and need to be killed and that's a big reason why you see the machine want to go a lot higher and max out for a prolonged period of time.
Sometimes nasal congestion can show up as ugly FLs but we really can't fix FLs that are caused by nasal congestion with more pressure.

If you are sleeping good now and feeling good...then I don't know that I would let the machine go so high trying to kill the FLs.
It might end up wanting to go so high that the higher pressures disturb sleep more than the FLs do.

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