Always at max pressure

[Caterdm]

Hoping someone has some insight. I have Resmed S9, and machine always runs at max high pressure. Still feeling tired after months of use. AH I very low .5 to 1.5 bipap provider said max needed to be turned up because should not run at max. But I questioned what raising high would help if API is already good. Anyway I raised high from 13 to 14 and now machine runs always at 14. Should I keep raising max until machine runs under max pressure? How can API be that low but I am still so tired? Thanks for any ideas.



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[JimP]

I'm not familiar with the S9 machine as I'm on a Phillips Respironics machine.

On my Respironics machine, you do have the option to change the settings from Auto to fixed CPAP. Is it possible that your machine got changed to fixed? That would account for it running at max all the time.

Also download sleepyhead and take a look at what your pressures are doing.

In my case which may not be at all what yours is, the sleep tech had me cranked up to 16 and 10 fix bipap pressures. I struggled for the first 3 weeks trying to stop air leaks and having inconsistant results as far as feeling rested.

After reading this forum, I changed the settings on the machine to auto bipap. Last night for example my 90% pressures ran 8.5 and 5.5. That's about half of what the tech had perscribed. I also feel more rested than before.

Last week I had my first visit with the sleep doctor and after explaining what I had done (fully expecting to be chewed out) he commended on being proactive and suggested I get a job as a sleep tech. He went on to say that the techs try to eliminate the last little bit of AHI and what happens is they get the pressures cranked up so high that people aren't getting their rest.

So for what its worth, higher pressures don't mean better. In my case and apparently many others, it can actually prevent you from getting good night's sleep with no real improvement in AHI.

Now in my case, I didn't have the type of sleep disorder where my brain isn't telling me to breathe. That's something else for which a different type of machine is required. One that detects the lack of you taking a breath and initiates the breath on its own.

Let us know about your machine setting. That'd be the first place I'd look.

[englandsf]

Agreed we need to know what mode and pressure settings you're at.

14 is not that high a pressure, my S9 is set at 10-20 APAP but often hits 14-15 briefly but my pressure is below 12 for 95% of the night.

How is your mask comfort? What type do you use and what do you feel when you wake?

[kaiasgram]

Hoping someone has some insight. I have Resmed S9, and machine always runs at max high pressure. Still feeling tired after months of use. AH I very low .5 to 1.5 bipap provider said max needed to be turned up because should not run at max. But I questioned what raising high would help if API is already good. Anyway I raised high from 13 to 14 and now machine runs always at 14. Should I keep raising max until machine runs under max pressure? How can API be that low but I am still so tired? Thanks for any ideas.

First thing -- which S9 machine? The model name is right above the Start/Stop button
Then, tell us the IPAP and EPAP settings and whether the machine is set in Auto mode, CPAP mode, or other...

[Caterdm]

Thanks everyone I will try to answer questions best I can. Machine is Resmed S9 Autoset. Mode is on auto set. Choices for mode are autoset or CPAP only. I dont see anything that says IPAP or EPAP so Im not sure, but Min pressure is 8 and max is 14. Mask is Quatro full face, very comfortable and doesn't leak much I think, 8L/min over 1 month don't know if this is good or not. AH I over 1 month at 0.5, AI 0.1, central AI 0.0. Thanks for all your help!

[Pugsy]

IPAP is inhale pressure
EPAP is exhale pressure
and with the AutoSet you won't see a specific setting for those names. If you use EPR you will have EPAP and IPAP as a byproduct of EPR reduction during exhale but there's not a specific setting area for EPAP and IPAP on the AutoSet machine (in either mode)

Minimum of 8 cm pressure means in auto mode it starts out at 8 cm...and the max of 14 means it can go up to 14 if the machine thinks it needs to go there. But it starts out at 8 cm inhale and 8 cm exhale unless you are using EPR exhale reduction and if you are then exhale is reduced by the setting choses...example setting of EPR of 3 will reduce the pressure 3 cm upon exhale so while awake you would have 8 cm inhale and 5 cm exhale. During the night if the machine goes to 14 and if using EPR at 3...that means exhale would be 11 cm.... SleepyHead will report the difference as EPAP and IPAP but you won't see it specifically in the settings that are available on the machine.

8L/min is a good leak rate...the machine can compensate for leaks up to 24 L/min and do a decent job. Above that and it gets iffy and the farther it goes over 24 the iffier it gets.

At this point with your AHI so low....if your machine is wanting to stay up around 14 cm it doesn't necessarily mean that anything needs adjusting. Your AHI is low...your leaks are low...and unless you are having issues with the changing pressures themselves there is no urgent need to change anything.
If you are seeing a 14 as a 95% number (that's what shows on the machine's LCD screen) that doesn't mean you were up there all night...95% number just means you were at OR BELOW that number for 95% of the night. People forget the "or below" part of the definition and think that is where they are at all night and it isn't necessarily so.

Unless you are having problems....I see no reason to change anything based on what you have reported so far.
Potential problems....aerophagia at higher pressures...disturbed sleep due to changing pressures.
You say you are still tired...Is it fatigue or sleepiness? They aren't the same thing.
How many hours of sleep are you averaging?
Are those hours fragmented with a lot of wake up for any reason and if so, any idea what reason?
And do you take any meds of any kind? If so, what?
There's a lot more to feeling the good numbers than just getting them...unfortunately.

[Wulfman...]

Hoping someone has some insight. I have Resmed S9, and machine always runs at max high pressure. Still feeling tired after months of use. AH I very low .5 to 1.5 bipap provider said max needed to be turned up because should not run at max. But I questioned what raising high would help if API is already good. Anyway I raised high from 13 to 14 and now machine runs always at 14. Should I keep raising max until machine runs under max pressure? How can API be that low but I am still so tired? Thanks for any ideas.



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When you get tired of being tired........try switching your machine to straight pressure (CPAP mode) instead of a range of pressures. Your tiredness is quite possibly the result of you being bumped out of your needed sleep stages by the changing pressures. As you enter deep sleep stages or REM, your breathing changes and the machine may interpret that as a need to increase pressures. The pressure bumps may be bumping you out of those sleep stages and into lighter ones. It's a very common problem with people using APAPs in ranges of pressures.


Den

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[kaiasgram]

I dont see anything that says IPAP or EPAP

Sorry 'bout that -- you referred to your "bipap provider" so I assumed you had a bilevel machine.