CPAP pressure too high but already 30% below average

RomanDelta · Post by **RomanDelta** » Tue Sep 10, 2019 5:43 am

Hi All,

I am really struggling with my CPAP. My pressure is set to 7, and my ramp is 4. When I have the ramp on, it feels comfortable, but to be honest I don't notice much difference between 4 and not wearing the mask at all. With 7 I noticed a difference, but I get symptoms ranging from annoying to painful to dangerous. Let's start from the worst and end with the best:

1. Central Sleep Apnea: At some point during the night, my mouth opens and I start mouth breathing (I wear FFM due to this, and I cannot use Nasal only due to cartilage problems). When this happens, I can feel in my sleep that my entire throat airway is "open" but I am not breathing. If I am dreaming, the dream usually turns into something like I'm being possessed and have no control over my body (because in real life I'm not breathing), and I wake up gasping for air. Take the mask off and go back to sleep, and I don't get that sensation anymore. I've read that basically that is Central Sleep Apnea, and it can be caused if your pressure is too high.

2. Swallowing air: No matter how many preventative measures I take, once my mouth drops open, I start swallowing air, and when I wake up in the morning, I am in a lot of pain for the first two hours because of it. I've tried all of the usual tricks people here say to do to reduce aerophagia, but nothing helps. I've read this is also a symptom of your pressure being too high.

3. Mouth open. Not dangerous or painful, but leads to the other issues. Also a symptom of pressure being too high.

I also have all the other symptoms, like dry mouth and sore throat despite humidification. But, again, were talking a pressure of 7, and a pressure of 4 for ramp feels like nothing. So is 5 or 6 really going to make that much of a difference or should I seek other therapy?

realshelby · Post by **realshelby** » Tue Sep 10, 2019 6:10 am

RomanDelta wrote: ↑
Tue Sep 10, 2019 5:43 am
Central Sleep Apnea: At some point during the night, my mouth opens and I start mouth breathing (I wear FFM due to this, and I cannot use Nasal only due to cartilage problems). When this happens, I can feel in my sleep that my entire throat airway is "open" but I am not breathing. If I am dreaming, the dream usually turns into something like I'm being possessed and have no control over my body (because in real life I'm not breathing), and I wake up gasping for air. Take the mask off and go back to sleep, and I don't get that sensation anymore. I've read that basically that is Central Sleep Apnea, and it can be caused if your pressure is too high.

Not sure what you mean by "start mouth breathing"? If you can breathe through your nose at first, why can you not use a nasal style mask? The slight pressure the cpap gives actually allows you to breathe through your nose easier than without it.

Lot of stuff going on, and people with better knowledge will chime in. But 7 is not very much pressure and likely not nearly enough to hold your airways open....which I suspect is what is leading you to wake up gasping.

There are things you can do to keep from or help with mouth breathing, but you are going to need to be using a nasal mask for them to help. You can buy tape strips for your lips, chin straps to hold your jaw closed, and the cervical collars seem to help too.

RomanDelta · Post by **RomanDelta** » Tue Sep 10, 2019 6:38 am

I have a deviated septum. When I fall asleep, my nose is pretty clear, but throughout the night it gets plugged up with mucus and I can no longer breathe through it. This is with a breathe right strip on, and with the wing inserts that flare your nostrils.

roadcycler · Post by **roadcycler** » Tue Sep 10, 2019 7:16 am

I usually had a fixed pressure of 6 for the last year with an AHI between 3 and 8 mostly centrals and waking up in the middle of the night sweating. For the last week I have reduced the pressure from 6 to 5.6 and my AHI has dropped to 1 to 1.5 and most of the centrals have disappeared. So as the experts come on line they will tell you that small changes can have a major effect even at lower pressures.

TropicalDiver · Post by **TropicalDiver** » Tue Sep 10, 2019 8:25 pm

RomanDelta wrote: ↑
Tue Sep 10, 2019 5:43 am
Hi All,

I am really struggling with my CPAP. My pressure is set to 7, and my ramp is 4. When I have the ramp on, it feels comfortable, but to be honest I don't notice much difference between 4 and not wearing the mask at all. With 7 I noticed a difference, but I get symptoms ranging from annoying to painful to dangerous. Let's start from the worst and end with the best:

1. Central Sleep Apnea: At some point during the night, my mouth opens and I start mouth breathing (I wear FFM due to this, and I cannot use Nasal only due to cartilage problems). When this happens, I can feel in my sleep that my entire throat airway is "open" but I am not breathing. If I am dreaming, the dream usually turns into something like I'm being possessed and have no control over my body (because in real life I'm not breathing), and I wake up gasping for air. Take the mask off and go back to sleep, and I don't get that sensation anymore. I've read that basically that is Central Sleep Apnea, and it can be caused if your pressure is too high.

2. Swallowing air: No matter how many preventative measures I take, once my mouth drops open, I start swallowing air, and when I wake up in the morning, I am in a lot of pain for the first two hours because of it. I've tried all of the usual tricks people here say to do to reduce aerophagia, but nothing helps. I've read this is also a symptom of your pressure being too high.

3. Mouth open. Not dangerous or painful, but leads to the other issues. Also a symptom of pressure being too high.

I also have all the other symptoms, like dry mouth and sore throat despite humidification. But, again, were talking a pressure of 7, and a pressure of 4 for ramp feels like nothing. So is 5 or 6 really going to make that much of a difference or should I seek other therapy?

Can we start by talking a bit about pressure? Bi-level machines typically support pressures up to 25 while "regular" machines support pressures up to 20. 4 is the very lowest they will go. There is no objective analysis that would classify 7 as high pressure. That is not to say that your treatment isn't making you very uncomfortable. It is. And we (and by that I really mean you) should work to fix that.

BTW, how much pressure is 7? The pressure of air at sea level is 14.7 PSI. A pressure of 7 cm of water is less than 0.1 PSI. It feels like a lot but....

So, how do you feel better? Address the mouth breathing in some manner other than lowering pressure. There are entire threads on the topic. Ideas that have worked for folks here include: a) Using a full face mask; b) chin straps; c) soft cervical collar; d) mouth taping; e) hair scrunchies (yep); f) training your tongue to be in a certain position; g) pillow arrangement. I am certain there are many more.

Your premise was that your pressure is too high, that is causing centrals, air swallowing, and discomfort. And the only solution is to lower the pressure. This is not all caused by pressure being too high. But there is a real problem to be addressed and that is mouth breathing.

palerider · Post by **palerider** » Tue Sep 10, 2019 8:51 pm

RomanDelta wrote: ↑
Tue Sep 10, 2019 5:43 am
to dangerous.

Drop it on your foot? did you? still wouldn't call that 'dangerous".

palerider · Post by **palerider** » Tue Sep 10, 2019 8:54 pm

TropicalDiver wrote: ↑
Tue Sep 10, 2019 8:25 pm
BTW, how much pressure is 7? The pressure of air at sea level is 14.7 PSI. A pressure of 7 cm of water is less than 0.1 PSI. It feels like a lot but....

I think I saw something about it taking more than 40cmh2o to even start blowing up a balloon.

CPAP pressure too high but already 30% below average

CPAP pressure too high but already 30% below average

Re: CPAP pressure too high but already 30% below average

Re: CPAP pressure too high but already 30% below average

Re: CPAP pressure too high but already 30% below average

Re: CPAP pressure too high but already 30% below average

Re: CPAP pressure too high but already 30% below average

Re: CPAP pressure too high but already 30% below average