Will increasing pressure fix hypopneas?

General Discussion on any topic relating to CPAP and/or Sleep Apnea.
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pspearsjr
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Will increasing pressure fix hypopneas?

Post by pspearsjr » Wed Aug 27, 2014 2:26 pm

Hi Everyone,

I am new to the forum and looking for information on hypopnea related to pressure. How much increase should I try to clear up my Hypopneas? I have recently switched mask and just about gotten my OA under control (I think). My original issue was OA of 48 during sleep study but that is now down <3 with a pressure setting of 8 with nasal pillows.

I'm now beginning to focus on my Hypopneas to try to get my AHI under 5. Should I try to fix the Hypopneas? Any input is appreciated.
https://www.dropbox.com/s/cz23y7k3hos26 ... e.JPG?dl=0
https://www.dropbox.com/s/8pajqq7y725q1 ... I.JPG?dl=0

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Pugsy
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Re: Will increasing pressure fix hypopneas?

Post by Pugsy » Wed Aug 27, 2014 2:38 pm

I didn't see a detailed events graph for the night where you posted the AHI that is a little higher than we would like to see.

It looks like you are using your machine in fixed cpap mode. That mode turns off Flow limitation flags so that's likely why there are no Flow Limitations showing up.
With your elevated hyponea count and your snores (which usually means the airway is trying to collapse) I would expect to see Flow limitations also.
All this means that your cpap 8 cm fixed pressure is probably a little too low.
If you want to see the flow limitations and keep a single pressure you can switch over to apap mode but set the minimum pressure to equal the maximum pressure and it will function like it is in cpap fixed mode but the Flow limitation flags will be turned on.
If you were using apap mode with a range of pressures the machine would likely respond to those snores/flow limitations and hyponeas with a little bit more pressure.

So yes...to answer your question...a little more pressure is needed to reduce the hyponeas and the snores (they sort of are tied together).

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pspearsjr
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Re: Will increasing pressure fix hypopneas?

Post by pspearsjr » Wed Aug 27, 2014 2:44 pm

That is exactly the type of feedback I was looking for. My original prescription was for 10 but they said I could back it down to as low as 7. I think based on your feedback I might should change to APAP mode and try a 8-10 to overcome my snoring problem and Hypopneas..

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Last edited by pspearsjr on Wed Aug 27, 2014 5:07 pm, edited 1 time in total.

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palerider
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Re: Will increasing pressure fix hypopneas?

Post by palerider » Wed Aug 27, 2014 2:50 pm

pspearsjr wrote:Hi Everyone,

I am new to the forum and looking for information on hypopnea related to pressure. How much increase should I try to clear up my Hypopneas? I have recently switched mask and just about gotten my OA under control (I think). My original issue was OA of 48 during sleep study but that is now down <3 with a pressure setting of 8 with nasal pillows.

I'm now beginning to focus on my Hypopneas to try to get my AHI under 5. Should I try to fix the Hypopneas? Any input is appreciated.
https://www.dropbox.com/s/cz23y7k3hos26 ... e.JPG?dl=0
https://www.dropbox.com/s/8pajqq7y725q1 ... I.JPG?dl=0
please don't play scrapbook cut and paste, just paste a full screenshot like this:
Image

preferably with a full res clickthrough, like that one has.

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pspearsjr
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Re: Will increasing pressure fix hypopneas?

Post by pspearsjr » Wed Aug 27, 2014 4:55 pm

I wasn't exactly sure what events should be in the graph. The IMG will not work like yours.
https://www.dropbox.com/s/u7l7c9jp3rmwt ... 6.JPG?dl=0

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Re: Will increasing pressure fix hypopneas?

Post by Pugsy » Wed Aug 27, 2014 5:18 pm

For some reason you need more pressure during the times where you see in increase in snores.
The usual culprits for that happening when the rest of the night is okay are sleeping on your back or REM stage sleep or maybe a little of both. Both are fairly common...OSA worse when sleeping on our back or in REM sleep and need more pressure during those times to prevent the airway collapse.

Yours seems to be second half of the night where we might expect to see more REM stage sleep but it seems to last a little longer than we would expect a REM stage to last so maybe a little of both is going on.

Doesn't really matter though..the fix is just a little more pressure or use APAP mode and let the machine go up a little on its own if that sort of thing doesn't bother you..
Your pressure is relatively low right now so using cpap mode with a little increase probably wouldn't be a problem. Now if your pressure needs were in the upper teens already you might not want higher all night when you only need it for part of the night so apap mode might be of benefit.

I have a similar situation myself but mine is strictly REM sleep related. Supine sleeping doesn't seem to change the pressure needs but REM sleep sure does and sometimes twice what is used at other parts of the night. My sleep study also documented that my OSA was much more severe in REM stage sleep.
If it's strictly supine sleep related some people go to extra measures to stay off their backs. I don't bother with that because REM is my big culprit no matter what position I am in.

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palerider
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Re: Will increasing pressure fix hypopneas?

Post by palerider » Wed Aug 27, 2014 6:03 pm

pspearsjr wrote:I wasn't exactly sure what events should be in the graph. The IMG will not work like yours.
https://www.dropbox.com/s/u7l7c9jp3rmwt ... 6.JPG?dl=0
that's because dropbox is not a good site for what we're trying to do here, photobucket or imgur work much better, I prefer imgur, because I can put a l on the end of the file name and imgur will give me a thumbnail for display here, and the full image behind it, you can see the code that's used if you hit 'reply' on the message above.

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pspearsjr
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Re: Will increasing pressure fix hypopneas?

Post by pspearsjr » Thu Aug 28, 2014 6:12 am

Pugsy I made the changes you suggested and here are my result. Should I increase my max pressure a bit more? The snore seems to have gone down a bit.

Image

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Re: Will increasing pressure fix hypopneas?

Post by 15+yearSleepPro » Thu Aug 28, 2014 6:58 am

I would try the suggestion that was stated and change it to APAP mode instead of simply increasing your pressure. I say that is because your pressure seems to be ok for a majority of the night and only at times does it look as though you need more pressure and that is where APAP comes in. As you may know the APAP mode (I suggest an 8cm-12cm APAP pressure) will in this example always start at the 8cm of pressure and only titrate higher when it detects flow limitation ie hypopneas, Apneas etc. After changing to these pressures see after even a couple of days if it looks better, and I would be almost certain that your Hypopnea events will be abated or should be virtually abated.

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Re: Will increasing pressure fix hypopneas?

Post by Pugsy » Thu Aug 28, 2014 7:28 am

You tried APAP 8 to 10 it looks like. And the 10 is being maxed out it looks like because I see a flat line in several places. The machine wanted to go a bit higher but couldn't. See where the snores and events are and compare to the flat line on the pressure graph? The machine wanted to do more but couldn't.
If the pressure changes don't bother your sleep I agree with SleepPro....set the max to 12 with current 8 minimum and see what happens.
The minimum still might need to come up a little but just having 10 cm available was a big help. Having 12 available might be all that is needed. If it doesn't do the trick then 9 cm minimum would be the next trial.

Or you might be like me and sometimes need twice that 8 cm.. That's why I used APAP...because for most of the night I could get by with around 9 cm but sometimes for short periods I would see the machine go to 18 or so...I sure didn't want to use 18 all the time. We can cross that bridge later should it come up.

Now some people find that those changing pressures through the night can sort of mess with their sleep quality and they don't feel so good. When that happens it's an easy fix though...either do a small tight apap range or use minimum equaling maximum so it works like cpap mode.

Oh...next time you post a report can you omit the snore graph and resp rate graph and just have the
Events
Flow rate
Pressure
Leak
graphs showing. It would make it easier to see the graphs. As they are now they are scrunched in a little too tight and small. Makes it hard to evaluate. Make the 4 graphs equal size and it's easier to see...especially pressure and events.
Then snore graphs isn't needed because the snores show up on the events graph and the way they show up on the events graph is better than the snore graph.

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Re: Will increasing pressure fix hypopneas?

Post by palerider » Thu Aug 28, 2014 9:22 am

pspearsjr wrote:Pugsy I made the changes you suggested and here are my result. Should I increase my max pressure a bit more? The snore seems to have gone down a bit.
next time, please turn off the calendar, (hit the ^ by the date) so we can see the detail numbers on the left.

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Re: Will increasing pressure fix hypopneas?

Post by palerider » Thu Aug 28, 2014 9:24 am

15+yearSleepPro wrote:I would try the suggestion that was stated and change it to APAP mode instead of simply increasing your pressure. I say that is because your pressure seems to be ok for a majority of the night and only at times does it look as though you need more pressure and that is where APAP comes in.
I think he's already in apap mode, but your suggestion of a wider range is likely a good one!

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Last edited by palerider on Thu Aug 28, 2014 5:25 pm, edited 1 time in total.
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Re: Will increasing pressure fix hypopneas?

Post by Pugsy » Thu Aug 28, 2014 9:33 am

I missed APAP mode at first glance (and that's all I did without enlarging the image) there was such little movement on the pressure line that it didn't register to me either. Also if I don't click on the image itself I can't see the numbers or letters on the left side at all. Maybe Sleep Pro didn't zoom in on the image.
I am just thankful SleepPro didn't say "you are going to kill yourself changing your pressures yourself" like a lot of the techs have done in the past that come here to "help".

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Last edited by Pugsy on Thu Aug 28, 2014 4:31 pm, edited 1 time in total.
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palerider
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Re: Will increasing pressure fix hypopneas?

Post by palerider » Thu Aug 28, 2014 9:43 am

Pugsy wrote: Not a big deal to me. At first glance (and that's all I did without enlarging the image) there was such little movement on the pressure line that it didn't register to me either. Also if I don't click on the image itself I can't see the numbers or letters on the left side at all. Maybe Sleep Pro didn't zoom in on the image.
I am just thankful SleepPro didn't say "you are going to kill yourself changing your pressures yourself" like a lot of the techs have done in the past that come here to "help". I just don't feel it is worth nit picking missing that detail. Lord knows I have missed more important stuff than that.
good point. I revised my post I'm glad the OP went with imgur over dropbox, works much better for the pics, I think, and I like the automatic large thumbnail you can have.

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pspearsjr
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Re: Will increasing pressure fix hypopneas?

Post by pspearsjr » Thu Aug 28, 2014 1:04 pm

Thanks Everyone for the feedback. I will update you after a night of sleep using APAP 8-12 as suggested. I will hopefully get the next graph like you suggested.

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