Apap pressure setting plan

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

Post by SteveBR » Sun Jan 21, 2018 9:59 pm

Julie wrote:I'd go back to e.g. 8 for a few nights. Has no one told you Cpap for naps is just as important as overnights? Sleep is sleep and without Cpap you can be worse off when you wake up than before you napped.

I am using Cpap during naps. The gap you see on the graph is after my nap and then graph starts up again for overnight.

SteveBR
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Re: Apap pressure setting plan

Post by SteveBR » Sun Jan 21, 2018 10:22 pm

TedVPAP wrote:
SteveBR wrote:Hi, a 2 night at home sleep study indicated that I have a Hyponea Index of 14.4 and 17.4. One treatment option given wass Cpap or Apap with a predicted initial setting of 5 cm H20. I am using a Res-Med AirSense AutoSet 10. I started with a range of 4 cm - 6cm and have worked my way up to 10 cm - 11 cm. I have been using the Apap now for 11 days but didn't start tracking AHI events until the past 6 days. AHI events are as follows. 5.3, 7.7, 6.6, 4.8, 5.9, 7.4. I have the following questions:

Am I increasing the pressure too fast?
As I increase pressure shouldn't I be getting a more steady AHI event improvement instead of the ups and downs?
Should I continue to increase the pressure, as I am currently doing, until my AHI events are near zero or have I plateaued already?
Should I decrease the pressure since lower pressure is showing similar results as higher pressure?

Thanks in advance.
I am confused. The data shows that the machine is set to a minimum pressure of 4 and the maximum pressure has been varied between 6 and 8.4. I don't understand your statement about working your pressure to 10-11. Your maximum pressure should be set much higher (15). Your minimum pressure should be set to 6.

The AHI charts you show are very good; much better than the values you stated in your OP. What changed?
Get a few days of data using 6-15 and then we can evaluate.
As with many first time Cpap users I was going through the adjustment and learning period. I came to the conclusion that raising the pressure too fast and too high exacerbated the issues that were keeping me from getting a good nights sleep including mask leaks, louder breathing noise, harder to breath, etc. I believe these issues were leading to higher AHI events. So I decided to start over with a very low pressure setting and also very slow increases in pressure. That along with changing to pillows, using more Afrin (I know addicting. Only use at night), and taping my mouth shut has led to much better sleep. Also, the 4 minimum to 6 and 8.4 pressure seems in line with the majority of the pressure setting poll taking on this board. That and the good numbers I'm getting made me think I was on the right track. I will try 6-15 and see what happens but do I have much room for improvement?

TedVPAP
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Re: Apap pressure setting plan

Post by TedVPAP » Sun Jan 21, 2018 10:55 pm

SteveBR wrote:
TedVPAP wrote:
SteveBR wrote:Hi, a 2 night at home sleep study indicated that I have a Hyponea Index of 14.4 and 17.4. One treatment option given wass Cpap or Apap with a predicted initial setting of 5 cm H20. I am using a Res-Med AirSense AutoSet 10. I started with a range of 4 cm - 6cm and have worked my way up to 10 cm - 11 cm. I have been using the Apap now for 11 days but didn't start tracking AHI events until the past 6 days. AHI events are as follows. 5.3, 7.7, 6.6, 4.8, 5.9, 7.4. I have the following questions:

Am I increasing the pressure too fast?
As I increase pressure shouldn't I be getting a more steady AHI event improvement instead of the ups and downs?
Should I continue to increase the pressure, as I am currently doing, until my AHI events are near zero or have I plateaued already?
Should I decrease the pressure since lower pressure is showing similar results as higher pressure?

Thanks in advance.
I am confused. The data shows that the machine is set to a minimum pressure of 4 and the maximum pressure has been varied between 6 and 8.4. I don't understand your statement about working your pressure to 10-11. Your maximum pressure should be set much higher (15). Your minimum pressure should be set to 6.

The AHI charts you show are very good; much better than the values you stated in your OP. What changed?
Get a few days of data using 6-15 and then we can evaluate.
As with many first time Cpap users I was going through the adjustment and learning period. I came to the conclusion that raising the pressure too fast and too high exacerbated the issues that were keeping me from getting a good nights sleep including mask leaks, louder breathing noise, harder to breath, etc. I believe these issues were leading to higher AHI events. So I decided to start over with a very low pressure setting and also very slow increases in pressure. That along with changing to pillows, using more Afrin (I know addicting. Only use at night), and taping my mouth shut has led to much better sleep. Also, the 4 minimum to 6 and 8.4 pressure seems in line with the majority of the pressure setting poll taking on this board. That and the good numbers I'm getting made me think I was on the right track. I will try 6-15 and see what happens but do I have much room for improvement?
It is hard to know if you can get your AHI lower or not - it is worth trying. I am surprised that you need to tape since you are at a relatively low pressure. I would have thought that a standard chin strap was enough at your pressure.
Regardless - once you get settled on your treatment, it is worth going back at some point and trying some of the things that previously didn't work. Our adjustment to treatment can change our perceptions.

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SteveBR
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Re: Apap pressure setting plan

Post by SteveBR » Sun Jan 21, 2018 11:15 pm

TedVPAP wrote:
SteveBR wrote:
TedVPAP wrote:
SteveBR wrote:Hi, a 2 night at home sleep study indicated that I have a Hyponea Index of 14.4 and 17.4. One treatment option given wass Cpap or Apap with a predicted initial setting of 5 cm H20. I am using a Res-Med AirSense AutoSet 10. I started with a range of 4 cm - 6cm and have worked my way up to 10 cm - 11 cm. I have been using the Apap now for 11 days but didn't start tracking AHI events until the past 6 days. AHI events are as follows. 5.3, 7.7, 6.6, 4.8, 5.9, 7.4. I have the following questions:

Am I increasing the pressure too fast?
As I increase pressure shouldn't I be getting a more steady AHI event improvement instead of the ups and downs?
Should I continue to increase the pressure, as I am currently doing, until my AHI events are near zero or have I plateaued already?
Should I decrease the pressure since lower pressure is showing similar results as higher pressure?

Thanks in advance.
I am confused. The data shows that the machine is set to a minimum pressure of 4 and the maximum pressure has been varied between 6 and 8.4. I don't understand your statement about working your pressure to 10-11. Your maximum pressure should be set much higher (15). Your minimum pressure should be set to 6.

The AHI charts you show are very good; much better than the values you stated in your OP. What changed?
Get a few days of data using 6-15 and then we can evaluate.
As with many first time Cpap users I was going through the adjustment and learning period. I came to the conclusion that raising the pressure too fast and too high exacerbated the issues that were keeping me from getting a good nights sleep including mask leaks, louder breathing noise, harder to breath, etc. I believe these issues were leading to higher AHI events. So I decided to start over with a very low pressure setting and also very slow increases in pressure. That along with changing to pillows, using more Afrin (I know addicting. Only use at night), and taping my mouth shut has led to much better sleep. Also, the 4 minimum to 6 and 8.4 pressure seems in line with the majority of the pressure setting poll taking on this board. That and the good numbers I'm getting made me think I was on the right track. I will try 6-15 and see what happens but do I have much room for improvement?
It is hard to know if you can get your AHI lower or not - it is worth trying. I am surprised that you need to tape since you are at a relatively low pressure. I would have thought that a standard chin strap was enough at your pressure.
Regardless - once you get settled on your treatment, it is worth going back at some point and trying some of the things that previously didn't work. Our adjustment to treatment can change our perceptions.
I will definitely give it a try. I have not tried the chin strap. I just went straight to the tape. I am actually thinking about trying without the tape as I already go without tape during naps when I don't have nasal congestion and can use pillows. Sometimes I get through the entire nap without sputtering. Thank you for your input.

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Pugsy
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Re: Apap pressure setting plan

Post by Pugsy » Sun Jan 21, 2018 11:45 pm

Your most recent report with the low and very tight range has produce a respectably low AHI and the very few events shown seem to be mainly at the very end of the sleep/reporting time frame and probably more SWJ (Sleep/Wake/Junk) than real and related to sleep.
But even if there were all real you aren't having very many of them.
And the leak rate seems well managed now.

If you are sleeping good and feeling good there's probably no urgent need to do anything other than whatever you are doing.

The only thing that stands on on last nights report is that you maxed out that pressure of 7 some of the night. Your flow limitation graph is a bit active but it isn't horrible looking. I have seen worse. In the absence of flagged OA and hyponea during the times of the higher pressures I suspect that the flow limitations are driving the pressures up a little. I have to say "little" because we a talking a teeny tiny tight range here.
Flow limitations are part of what the auto adjusting algorithm will try to kill. So that doesn't surprise me.

If you are sleeping good and feeling good then the chance of those flow limitations actually being a problems is probably a very small problem if a problem at all. Not all flow limitations need to be killed especially if the higher pressures needed to kill them cause other problems worse than the small flow limitation caused.

So...there's no urgent need to change anything unless you feel that you could still stand some room for improvement in something.
The flagged events you do see at the end of the sleep session or right at the beginning...if those are awake flagged events they are going to happen no matter what pressure you use. So just be aware that if they are SWJ then using more pressure isn't likely going to stop them.

Problems that trying to kill those flow limitations might cause to happen...harder leak control...chipmunk cheek...aerophagia maybe.

So you can try a little more max pressure up from the 7...I don't see you needing to change the minimum to 8 though. That would be way overkill IMHO.
What you are using now is working in terms of reducing the AHI down to acceptable levels and if a bunch of those events are really SWJ the AHI while actually asleep is even low than this already low AHI.

So if this were my report and I was new to understanding all this stuff...I don't know that I would be making any big changes. If I still thought I wasn't feeling as good as the numbers look (and these numbers are very good) then all I would do is increase the max pressure just a little and let the machine kill those FLs a bit. Like maybe set the max to 10 but I don't think it will want to go to 10..

Now IF it does go higher and the going higher creates more problems with leaks, chipmunk cheesk, belly bloating or just disturbing your sleep then back up and stick with these numbers. Sometimes just because we can change something doesn't mean we should if doing the change causes a bigger problem than the problem we were maybe trying to fix then obviously back up.
Your last night's report is actually a very good report. And doubly so since you are doing this all on your own.
Sometimes letting a machine hit the max for part of the night is the lessor of the 2 evils and especially so if we are looking at reports like yours where there is nothing urgently needing better treatment.

And you don't have to be in a rush to do anything either. If you want to get more time under your belt with these settings then that would be fine too because these results are quite respectable.

PLUS...you mention using Afrin for nasal congestion. Those Flow Limitations on that graph they could easily be nasal congestion flow limitations and more pressure won't help those kind of flow limitations. More pressure only helps when the flow limitations are down in the airway below the nose and in the back of the throat area. I have seen some really nasty looking FL graphs (and yours doesn't qualify for nasty in my book) and have seen people try some really high pressures in an effort to clean them up but if it's in the nose...it won't work and just wasting good pressure and maybe causing those other issues I talked about.

So with all that rambling...I don't see the need to urgently change anything if you are now sleeping better and feeling better.
If you have a lot of nasal congestion then that could explain the increased flow limitation activity and chances are no matter what pressures you use you won't be able to kill much of it and if that's the case...not much sense in trying higher pressures.

Now if you aren't feeling so great or sleeping so great...then yeah maybe try a little tweaking to see if it helps or hurts something.
If it were me...maybe 10 max pressure tops. I doubt you will even come near it.
And while I know you are using 4 cm minimum...and a lot of people can't seem to understand how some people are okay with it...people can be okay with 4 and the 4 to 7 range works for you.
But you can always play with small increases in that minimum just to see if anything improves.
Now if something gets worse...by all means go back because it's working for you. If you are comfortable with that 4 cm starting point...hey that's fine.

There's nothing urgent on this most recent report pointing to something that needs to be changed right now.
And you certainly have all the time in the world to make whatever changes you are comfortable making because you want to...
Just because so and so says that they can't breathe at 4 cm doesn't mean anything to you because you are the same as that other person.
Now if you feel a bit stifled and it takes a bit of work to get your mind comfortable at 4...by all means try 5 or 6. We want you comfortable first because it's hard to fall asleep when we aren't comfortable and fighting the "I am having trouble breathing thing".

Your report last night....actually a damn nice looking report.. I really believe that some of those flagged events are SWJ and if they are that would make the already nice and low AHI even lower.

Most important thing...and I didn't really see an answer to this...
how are you sleep and feeling now? How did you feel today?

Do you need to nap every day? What time do you usually go to bed...and get up...When you take a nap....how long and at what time?
Do you take any medications of any kind...and if so, what?

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SteveBR
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Re: Apap pressure setting plan

Post by SteveBR » Mon Jan 22, 2018 12:35 am

Pugsy wrote:Your most recent report with the low and very tight range has produce a respectably low AHI and the very few events shown seem to be mainly at the very end of the sleep/reporting time frame and probably more SWJ (Sleep/Wake/Junk) than real and related to sleep.
But even if there were all real you aren't having very many of them.
And the leak rate seems well managed now.

If you are sleeping good and feeling good there's probably no urgent need to do anything other than whatever you are doing.

The only thing that stands on on last nights report is that you maxed out that pressure of 7 some of the night. Your flow limitation graph is a bit active but it isn't horrible looking. I have seen worse. In the absence of flagged OA and hyponea during the times of the higher pressures I suspect that the flow limitations are driving the pressures up a little. I have to say "little" because we a talking a teeny tiny tight range here.
Flow limitations are part of what the auto adjusting algorithm will try to kill. So that doesn't surprise me.

If you are sleeping good and feeling good then the chance of those flow limitations actually being a problems is probably a very small problem if a problem at all. Not all flow limitations need to be killed especially if the higher pressures needed to kill them cause other problems worse than the small flow limitation caused.

So...there's no urgent need to change anything unless you feel that you could still stand some room for improvement in something.
The flagged events you do see at the end of the sleep session or right at the beginning...if those are awake flagged events they are going to happen no matter what pressure you use. So just be aware that if they are SWJ then using more pressure isn't likely going to stop them.

Problems that trying to kill those flow limitations might cause to happen...harder leak control...chipmunk cheek...aerophagia maybe.

So you can try a little more max pressure up from the 7...I don't see you needing to change the minimum to 8 though. That would be way overkill IMHO.
What you are using now is working in terms of reducing the AHI down to acceptable levels and if a bunch of those events are really SWJ the AHI while actually asleep is even low than this already low AHI.

So if this were my report and I was new to understanding all this stuff...I don't know that I would be making any big changes. If I still thought I wasn't feeling as good as the numbers look (and these numbers are very good) then all I would do is increase the max pressure just a little and let the machine kill those FLs a bit. Like maybe set the max to 10 but I don't think it will want to go to 10..

Now IF it does go higher and the going higher creates more problems with leaks, chipmunk cheesk, belly bloating or just disturbing your sleep then back up and stick with these numbers. Sometimes just because we can change something doesn't mean we should if doing the change causes a bigger problem than the problem we were maybe trying to fix then obviously back up.
Your last night's report is actually a very good report. And doubly so since you are doing this all on your own.
Sometimes letting a machine hit the max for part of the night is the lessor of the 2 evils and especially so if we are looking at reports like yours where there is nothing urgently needing better treatment.

And you don't have to be in a rush to do anything either. If you want to get more time under your belt with these settings then that would be fine too because these results are quite respectable.

PLUS...you mention using Afrin for nasal congestion. Those Flow Limitations on that graph they could easily be nasal congestion flow limitations and more pressure won't help those kind of flow limitations. More pressure only helps when the flow limitations are down in the airway below the nose and in the back of the throat area. I have seen some really nasty looking FL graphs (and yours doesn't qualify for nasty in my book) and have seen people try some really high pressures in an effort to clean them up but if it's in the nose...it won't work and just wasting good pressure and maybe causing those other issues I talked about.

So with all that rambling...I don't see the need to urgently change anything if you are now sleeping better and feeling better.
If you have a lot of nasal congestion then that could explain the increased flow limitation activity and chances are no matter what pressures you use you won't be able to kill much of it and if that's the case...not much sense in trying higher pressures.

Now if you aren't feeling so great or sleeping so great...then yeah maybe try a little tweaking to see if it helps or hurts something.
If it were me...maybe 10 max pressure tops. I doubt you will even come near it.
And while I know you are using 4 cm minimum...and a lot of people can't seem to understand how some people are okay with it...people can be okay with 4 and the 4 to 7 range works for you.
But you can always play with small increases in that minimum just to see if anything improves.
Now if something gets worse...by all means go back because it's working for you. If you are comfortable with that 4 cm starting point...hey that's fine.

There's nothing urgent on this most recent report pointing to something that needs to be changed right now.
And you certainly have all the time in the world to make whatever changes you are comfortable making because you want to...
Just because so and so says that they can't breathe at 4 cm doesn't mean anything to you because you are the same as that other person.
Now if you feel a bit stifled and it takes a bit of work to get your mind comfortable at 4...by all means try 5 or 6. We want you comfortable first because it's hard to fall asleep when we aren't comfortable and fighting the "I am having trouble breathing thing".

Your report last night....actually a damn nice looking report.. I really believe that some of those flagged events are SWJ and if they are that would make the already nice and low AHI even lower.

Most important thing...and I didn't really see an answer to this...
how are you sleep and feeling now? How did you feel today?

Do you need to nap every day? What time do you usually go to bed...and get up...When you take a nap....how long and at what time?
Do you take any medications of any kind...and if so, what?
I think you make a lot of excellent points. Last night I went to sleep around 3am and woke up around 11am to use the bathroom. At 11am I looked at my AHI and it was .8. I got back in bed for another hour and when I woke up AHI was 1.9. That last hour included little, if any, sleep. Sleep/Wake/Junk that you mention is spot on. I believe I also get the SWJ affect during naps too and this also raises my AHI.

My sleep is pretty good. I think I need to get more though or probably cut out the naps and get to bed earlier. During the week I get roughly 6.5 hours of sleep plus a 1 to 1.5 hour nap per day.
M - F 2am to 8:30am
Sat 2am to 10am
Sun 3am to noon.
Nap most days 5pm to 6:30pm (Sundays 7pm to 8pm)

I've been taking naps for years so it's very hard to break that habit especially when they feel great! As I get acclimated to Cpap my naps are longer and consist of deeper sleep than before Cpap. I sleep in on the weekends which is probably not a good thing. I do feel like my overall energy level has improved modestly since getting my AHI score lower with Cpap. I also feel less irritable. It's still hard to get out of bed in morning but once I do and get going I feel better than I did before Cpap. I take Zoloft which probably makes me a little tired and more likely to nap.

Do you think going back to a full face mask may help my flow limitation that may be caused by my nasal congestion? I do believe as long as I use Afrin I' don't breath out of my mouth.

I appreciate your thoughts and for taking the time to post them. I think you make a lot of good points. Thank you.

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wm_hess
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Re: Apap pressure setting plan

Post by wm_hess » Mon Jan 22, 2018 4:54 am

Steve

I am no expert on treating apneas, but I still look at peoples graphs and see if what I think is what the experts are saying. Looking at your first chart (yearly summary I believe), I noticed that I now know your email address, name & birthdate. That might be considered a little too much personally identifying information to have floating out there. You may want to obscure that stuff.

Good luck with your treatment too.

-Bill

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Pugsy
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Re: Apap pressure setting plan

Post by Pugsy » Mon Jan 22, 2018 9:06 am

The Zoloft is notorious for making people drowsy and need to sleep and also for causing people to be less than maybe as energetic as they would like when they wake up.
Look up the side effects and also potential ways it can actually affect sleep architecture itself. SSRI & SNRI effects on sleep..google it.
Something to maybe talk over with your doctor.

That said...I am still not a morning person...I hate mornings but it's just me. Not meds related...not sleep apnea related...not even related to how many hours of sleep I get but definitely worse when I only get 4 hours of sleep because of the damn dog.
The best cpap therapy in the world won't make me a morning person because I have never in my life been a morning person. It's not going to make me into something I never was to start with no matter how much I might want it to.
SteveBR wrote: Do you think going back to a full face mask may help my flow limitation that may be caused by my nasal congestion? I do believe as long as I use Afrin I' don't breath out of my mouth.
No...doubt it will help the flow limitation graph and in fact might make it worse if the FLs are down in the airway and not in the nasal mucosa area.
Sometimes with a full face mask people actually need more pressure to get the same results as they get with a nasal mask. Not sure why but I suspect it is related to what the full face mask does to the position of the jaw.
But you could try it and see what happens.
Most people who have nasal congestion say that using the nasal interface mask actually helps the congestion more because of the more direct pressure.
I suggest using the mask that lets you sleep the best in terms of sleep quality first...gotta get the sleep first before any of this other stuff matters.
So use the one that you like the best in terms of comfort and least annoying during the night.

Here's an example of what a clean Flow Limitation graph looks like. Now please don't think that this is something you have to see on your reports.
I show it just so you can compare what I mean by active. Yours isn't horribly active...and trust me I have seen much worse than yours and why I am wishy washy about letting the machine try to kill the FLs with more pressure in your case. I am not so sure that yours need to be nuked with more pressure but eventually you may want to try to kill them just to see if it changes anything.
Image

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SteveBR
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Re: Apap pressure setting plan

Post by SteveBR » Mon Jan 22, 2018 9:32 pm

wm_hess wrote:Steve

I am no expert on treating apneas, but I still look at peoples graphs and see if what I think is what the experts are saying. Looking at your first chart (yearly summary I believe), I noticed that I now know your email address, name & birthdate. That might be considered a little too much personally identifying information to have floating out there. You may want to obscure that stuff.

Good luck with your treatment too.

-Bill
Thank you for the heads up.

SteveBR
Posts: 31
Joined: Fri Dec 15, 2017 10:31 am

Re: Apap pressure setting plan

Post by SteveBR » Mon Jan 22, 2018 9:56 pm

Pugsy wrote:The Zoloft is notorious for making people drowsy and need to sleep and also for causing people to be less than maybe as energetic as they would like when they wake up.
Look up the side effects and also potential ways it can actually affect sleep architecture itself. SSRI & SNRI effects on sleep..google it.
Something to maybe talk over with your doctor.

That said...I am still not a morning person...I hate mornings but it's just me. Not meds related...not sleep apnea related...not even related to how many hours of sleep I get but definitely worse when I only get 4 hours of sleep because of the damn dog.
The best cpap therapy in the world won't make me a morning person because I have never in my life been a morning person. It's not going to make me into something I never was to start with no matter how much I might want it to.
SteveBR wrote: Do you think going back to a full face mask may help my flow limitation that may be caused by my nasal congestion? I do believe as long as I use Afrin I' don't breath out of my mouth.
No...doubt it will help the flow limitation graph and in fact might make it worse if the FLs are down in the airway and not in the nasal mucosa area.
Sometimes with a full face mask people actually need more pressure to get the same results as they get with a nasal mask. Not sure why but I suspect it is related to what the full face mask does to the position of the jaw.
But you could try it and see what happens.
Most people who have nasal congestion say that using the nasal interface mask actually helps the congestion more because of the more direct pressure.
I suggest using the mask that lets you sleep the best in terms of sleep quality first...gotta get the sleep first before any of this other stuff matters.
So use the one that you like the best in terms of comfort and least annoying during the night.

Here's an example of what a clean Flow Limitation graph looks like. Now please don't think that this is something you have to see on your reports.
I show it just so you can compare what I mean by active. Yours isn't horribly active...and trust me I have seen much worse than yours and why I am wishy washy about letting the machine try to kill the FLs with more pressure in your case. I am not so sure that yours need to be nuked with more pressure but eventually you may want to try to kill them just to see if it changes anything.
Image
This is last night with 4 to 10 setting. I had very restless sleep which I believe is due to the higher pressure. I realize that this is just one night and not a trend and more time is needed to come to a conclusion.

Image


This is my 1.5 hr nap today with 4 to 10 setting. Slept very well. No events!

Image

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Julie
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Re: Apap pressure setting plan

Post by Julie » Mon Jan 22, 2018 10:37 pm

I still feel you're misunderstanding that the low setting matters to how well therapy goes... and 4 is as low as it gets. You need to try a higher one, e.g. 6 or 7, and let the high setting go at 15 or 20 instead of keeping the range so narrow... isn't helping anything. Also, get rid of the calendar - it'll allow more info below to show up.

SteveBR
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Re: Apap pressure setting plan

Post by SteveBR » Tue Jan 23, 2018 1:48 pm

Julie wrote:I still feel you're misunderstanding that the low setting matters to how well therapy goes... and 4 is as low as it gets. You need to try a higher one, e.g. 6 or 7, and let the high setting go at 15 or 20 instead of keeping the range so narrow... isn't helping anything. Also, get rid of the calendar - it'll allow more info below to show up.
Last night I tried 6/15 and could not tolerate the high pressure. My cheeks were blowing up like a chipmunk and the air noise level was not allowing me to fall asleep. I was curious to see what the pressure was showing on the screen and it was over 13. Why did the pressure increase this high before I even fell asleep? I was not having and occurrences because I was wide awake. During the night I decreased pressure down 2 more times and finally fell asleep.

Do you agree that my stats are good? If so, why should I jeopardize my quality of sleep by raising the pressure by such a large amount? Tonight I'm going to try 6/10 and see if I can tolerate that. If so I will gradually increase the pressure if stats indicate I should. Does that sound like a reasonable plan?

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Julie
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Re: Apap pressure setting plan

Post by Julie » Tue Jan 23, 2018 2:08 pm

I think if your sleep was so terrific you wouldn't be here... I'm obviously missing something but I don't know what. I don't know anyone who's low setting of 6 is too much for them. If your high setting is at 15 (or 12 or 20) it is not going to affect the low (therapeutic) setting and someone else will have to jump in as I think there's a basic misunderstanding going on. Lowering the high setting does NOT mean you get more pressure (to blow up your cheeks), if anything, it means your low pressure's too low and needs to be raised even a bit, but that won't affect the high setting that by your setting it too low is blocking the low setting from (when needed) going higher. Really.

SteveBR
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Re: Apap pressure setting plan

Post by SteveBR » Tue Jan 23, 2018 2:33 pm

Julie wrote:I think if your sleep was so terrific you wouldn't be here... I'm obviously missing something but I don't know what. I don't know anyone who's low setting of 6 is too much for them. If your high setting is at 15 (or 12 or 20) it is not going to affect the low (therapeutic) setting and someone else will have to jump in as I think there's a basic misunderstanding going on. Lowering the high setting does NOT mean you get more pressure (to blow up your cheeks), if anything, it means your low pressure's too low and needs to be raised even a bit, but that won't affect the high setting that by your setting it too low is blocking the low setting from (when needed) going higher. Really.
I'm new to Cpap. I started coming here recently because my family practitioner that prescribed my in home sleep study doesn't know very much about Cpap therapy. I was having a hard time adjusting to therapy and also wanted to make sure I was setting my pressure correctly. I came here to learn. I never said my sleep was terrific. It's better and I believe my scores indicate that. I've had some success with Cpap and I want to make sure that I'm maximizing the benefits of therapy.

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?

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Julie
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Re: Apap pressure setting plan

Post by Julie » Tue Jan 23, 2018 2:43 pm

Not at all. I think for the moment just pretend the high setting doesn't exist and that it's all about the low one. The thing is that you'll likely get better therapy (and AHI's if it matters) with a slightly higher low setting, one that can address apneas that occasionally hit high spots overnight, because e.g. 4 (machine's default low) is too low (and probably 6 is too) to get to those high points when they occur... takes too long to reach the high ones. But if you set the high # too low, and events can't express themselves (having been effectively capped) that's when you'll get chipmunk cheeks. So let the low one be a bit higher (very many of us are at e.g. 10) for now, maybe 7 for 1-2 nites, and let the high setting BE high, e.g. 20. It won't cause your problems and may help the low setting do its job.