Examples of how minimum pressure affects report "clutter"

[Pugsy]

For the past couple of weeks I have been using my PR S1 750 machine at 9 cm EPAP with max open to 20 (sometimes I have been known to need almost 20). This setting worked well for me in the past and I have lots of really "pretty" and boring reports to show for it but I for some reason not working so great right now. At first I thought it was a fluke but they have been pretty consistently "ugly" with a lot more snores than I normally see and a lot more of what I call "clutter" on the reports. AHI in the 3 to 5 range instead of my usual 1 to 2 range (or even less than 1.0) with snores, FLs and maybe a few RERAs along with pressures roaming all over the place.

So this is what I have been seeing for the past couple of weeks and last night I decided to do something about it.
Now that I was having any real problems..still slept well and felt the same during the day but just in general didn't care for the overall appearance. It remains to be seen if this change will affect how I feel now during the day.
It's rather hard to me to be subjective about my sleep or how I feel since I have other issues that affect how I feel. I have been doing lots of yard work the past couple of weeks and I at first thought maybe what I was seeing was just "poor sleep" or "restless" sleep from overdoing things and my back telling me I was a stupid old woman...like when I built a retaining wall with 25 pound pavers...yep, dumb ass did that. Not only built the wall but had to unload them from the truck bed all by myself.

Anyway...this is what I have been seeing for the past 2 weeks or so. Some a little less ugly but some more ugly and it isn't normally what I have seen in the past at the same settings.
EPAP 9 cm...too many snores and just general ugly look to it even though the AHI wasn't horrible. Look at that pressure line going all over the place trying to kill those snores.



So last night I decided at the last minute to increase my EPAP to 10 cm...just a 1 cm increase with no other changes and no...I wasn't a lazy butt yesterday.....I did a good bit of brush hogging using my riding lawn mower and even got it stuck and had to get it unstuck using the truck...so I worked hard yesterday too.



So see how the pressure stabilized? See how there is minimal "clutter"...see the nice low AHI?
This is why I mention that the minimum pressure is sometimes so critical. If I have a more optimal minimum pressure then the maximum really doesn't come into play does it?
This is Bilevel machine in auto mode...same principle applies to APAP mode on a regular cpap machine. When I was using the APAP machine...my minimum was 10 cm with 20 max. Same sort of results and that is why I used 10 cm instead of 9 cm when using APAP machine. A little more pressure did/does a better job of preventing stuff from happening and thus the machine doesn't always have to play "catch up" and try to fix things after the fact.

In the past my BiPap did well with 9 cm EPAP...for some reason things are different right now. I don't know what it is but I won't worry about it and choose to just go with the flow and use what works well now.

Some of you might wonder...why don't I just use a fixed pressure....well sometimes even with a nice stable pressure line I have been known to on occasion need much higher pressures and I would have to use something around 13 or 14 all night and I just don't want to do that. Besides...it wouldn't get them all because sometimes I really do need almost 20 cm for a brief period of time.
I have tried it...too many "clusters" of OAs to my liking. Since changing pressures have never disturbed my sleep and I don't have issues with centrals or aerophagia with the higher pressures I choose to let the machine do its job. If I had those sort of issues then maybe I would make some sort of compromise but since I don't...no need to compromise.

I just thought I would share these reports because it offers a good comparison showing what just a little change will do in terms of cleaning up "clutter". Clutter isn't necessarily bad..and I don't panic over one night of clutter every now and then but 2 weeks of such clutter got me to thinking maybe it needs cleaning up.
BTW...my doctor is okay with me making such adjustments and evaluations. Original RX was for straight cpap at 8 cm but that was based on poor titration study where I didn't have but a handful of minutes in REM sleep and REM sleep is where my OSA kicks butt. Follow up visit to doctor with proof of higher pressure needs ended up with APAP RX 10 min and 20 max.
He doesn't know about the BiPap... That was entirely on my own but I imagine if I explained why it was done...he wouldn't have a problem. That's a different story that I have talked about in the past.

I am going to update my SH understanding your data tutorial to include today's examples. I figure it's just another example of something we can use to help understand what we see on our reports. If anyone wants Encore reports from these nights just let me know and I can get them.

[jdm2857]

That change is results is dramatic for a 1 cm H2O pressure increase.

But there's one thing that I don't understand. What triggered all of those sawtooth
pressure increases? I don't see any sort of events that would have triggered them.

[DoriC]

And why the double line in the first pressure graph and the single sawtooth line in the second? Very helpful reports, thanks.

[jdm2857]

Dori --

In the second pressure graph, the lower pressure (EPAP) blue line is at 0 -- on top
of the baseline -- until about 6:45 am. Then it bumps up a bit.

[patrick_a]

If we keep in mind, xpap is nothing more than an air splint, it only makes sense that the min pressure setting would be most critical because it effects the stabillity of the walls in the splint. This is why having the settings wide open is not a good thing in many cases.

Btw, I would like to see the Encore versions if possible. Thanks.

[avi123]

That data from the Respironics machine seem dubious to me.
It's questionable if 1 cm pressure change could have shown such a difference on a Resmed machine by using ResScan. I doubt it.
Even if your bodyworks was so different between the two days.
Continue with same set-up for a month or two and show it again on SleepyHead Statistics.

[Pugsy]

But there's one thing that I don't understand. What triggered all of those sawtooth
pressure increases? I don't see any sort of events that would have triggered them.

Those are the normal pressure probes that the Respironics APAP machines have always done. So entirely normal part of the way it works.
viewtopic/t80875/Respironics-APAP-press ... se-up.html

That change is results is dramatic for a 1 cm H2O pressure increase.

Yeah, I probably jinxed myself prematurely since last night was the first night but after 2 weeks of ugly reports I just had to do something. I was tired of looking at all the mess.

And why the double line in the first pressure graph and the single sawtooth line in the second?

I don't always get sawtooth pressure probe line on both lines..don't know why...it just works out that way. I think it has something to do with how the roaming Pressure support functions.

Btw, I would like to see the Encore versions if possible. Thanks.

Okay, give me a bit to get Encore fired up and get the images uploaded.

If we keep in mind, xpap is nothing more than an air splint, it only makes sense that the min pressure setting would be most critical because it effects the stabillity of the walls in the splint. This is why having the settings wide open is not a good thing in many cases.

Yes..this is true and what I have been harping on for years but I thought a picture showing results would maybe help people understand it a bit better.

That data from the Respironics machine seem dubious to me.
It's questionable if 1 cm pressure change could have shown such a difference on a Resmed machine by using ResScan. I doubt it.
Even if your bodyworks was so different between the two days.
Continue with same set-up for a month or two and show it again on SleepyHead Statistics.

I may have an example using my S9 VPAP from back when I first started using it and was fine tuning pressures. I don't remember but when I have time I will go look and check. I no longer have my S9 right now so I can't do a special test with it.
Like I said above...I may well have jinxed myself by posting the results prematurely but I don't think so...remember I used a Respironics APAP for 2 1/2 years before I ever got the S9. I am pretty comfortable with my assumptions here because of what I have seen in the past when I have played with my settings and I always gave the settings ample time for the "we don't sleep the same way" thing to be resolved.
You may not believe it can happen but I do...I have seen it happen too often and not just with me. Sometimes with as little as 0.5 cm change in pressure.
Now sometimes some people take a bigger change to see a marked difference but that doesn't mean that everyone has to have a big change. We are all individuals.

[jdm2857]

Aha. I only have experience with a ResMed auto, and it only increases pressure
in response to events or precursors to events (flow limitations and snores).

[Pugsy]

As requested...Encore reports for the 2 nights above.

May 25


June 3

[patrick_a]

Cool.... thank you very much.

[Pugsy]

Just have time for a quick update from last night. Checked my report from last night.
Had a little more activity...probably during REM where my OSA is documented worse....saw IPAP go to 17 around 4:50 or so in the AM.
Very common for me to see it happen in the wee hours of the morning when REM is more frequent and more prolonged.

Still a much "cleaner" report than the pre EPAP increase reports and I slept well. Got to bed later than usual...had a little bit of soda too late in the evening...I know better but I wanted it so badly and I had been working really hard outside so I deserved it. Made up for it by sleeping a little later.
Not idea I know but nothing in life is ideal anyway and we gotta have a life. It was a good time to sleep in...small thunderstorms and still dark outside and just good sleeping weather.

I will keep these settings for quite a while. They are very comfortable and I sleep well considering the other issues unrelated to OSA.
I see no reason to change anything at the moment. I know I will have some great night...some good nights...and likely a few not so good nights bordering on ugly but overall I suspect things will look more to the good/great side of things for the majority of the nights.

[Pugsy]

Here is my last night's report and from now on I won't bother with the boring stuff. Might update if something exciting shows up.
I did want to post this last one...there's a good example of a leak shown and pressures didn't increase with it...in fact the pressure went down.
So another example of why I say that these machines don't go chasing leaks with more pressure like the older technology machines used to do. I think it is pretty obvious...
Some people tend to think that in APAP mode that any leaks where there is an increase in pressure is the machine feeding the leak monster and it just is not the case with the new technology machines. They just don't do the same thing that the M series or older machines did and for ResMed users...the S9 doesn't do it like the S8 machines did.

[DoriC]

So right after the pressure decreased the leaks started. Did the high pressure disturb you and started the leaking? There seems to be some connection but I'd really like to know how the increase in pressure caused the leaks?

[Pugsy]

So right after the pressure decreased the leaks started. Did the high pressure disturb you and started the leaking? There seems to be some connection but I'd really like to know how the increase in pressure caused the leaks?

Dori the leaks are mouth breathing and totally unrelated to pressures.
I am using the Tap Pap. The nasal pillows NEVER leak or move...any leaks I see have to be coming from the mouth.
No, I didn't wake up.
Very rarely I might wake up with a bit of dry mouth from mouth breathing...when I look at the reports sometimes I can spot a little leak that corresponds to likely mouth breathing but sometimes I can't spot anything.
It doesn't take much mouth breathing to dry out the mouth...

The leaks are NOT caused by pressure increases..the only possible reason for leaks in my situation is the mouth...it's obvious that the pressures went down during the time with the larger leak.
I posted this report so that people could see evidence that these new technology machines don't increase the pressure trying to fix the leaks nearly as much as people think they do. The people that think this is going on seem to be using the older technology machines and yes..those machines would go chasing leaks with more pressure but these new machines don't do it nearly so much.
I read somewhere that these new machines actually reduce the pressure in an attempt to get the mask to reseat itself instead of increasing pressures...they simply don't feed the leak monster like the older machines did/do.

I almost always have some sort of leak happen about 90 to 120 minutes into sleep time which is of course likely REM related.
I think I am likely on my back and the mouth drops open just a little. From what I have read this is fairly common occurrence in REM sleep. I call it my witching hour. I see it fairly often. Sometimes just a little leak and sometimes more than a little so I am 99.9 % sure that it's just a little mouth breathing. I never wake up with leaks...never...except for a couple of mask experiments when I knew the nasal pillows were leaking.....like when I first used the Bella Loops and the first night with the Tap Pap and I used the Small size nasal pillows and I knew from the start that they weren't sealing good and I needed the next size up.
Pressure increases also never disturb my sleep. I never wake up during periods of higher pressure. I never have any idea as to where my pressure went during the night until I see a report. The changing pressures have never been an issue for me and that's why I do so well in auto adjusting mode. I need more pressure (sometimes pushing 20 cm) occasionally for some extra stubborn events during REM but I never know the machine has responded until I see a report.

Any pressure increase I see....I am certain are due to the machine responding to a potential collapse of the airway and NOT to my mouth breathing leaks. Over 2 years now using the PR S1 machine...not once have I seen a pressure increase during leaks unless there was also some sort of event precursor (snore, FL, or whatever).
95% of the time my leaks don't ever reach large leak territory....if they reach large leak territory they normally don't go very far into large leak territory but I have had a few excursions well into large leak territory...
Pressures did NOT increase...either with below large leak territory or above or even way above.
Both with the PR S1 and the S9 VPAP....Leaks simply don't feed the leak monster like people are thinking they are.

Below is my report from last night. Looks like one tiny bit of leak in the wee hours of the morning and zero pressure change.
Interestingly one little cluster of OAs early in the night...this is unusual for me. They are going to be blamed on aliens I think.