ASV Epap max pressure thoughts

[tuzacat]

I have been wondering if my max Epap should be moved up. The reason? I'm always hitting the max. It's currently set at 11 for the low and 15 for the high Epap. I have been inching it up to see if I can get rid of the snores and every time I move it up it hits the max and pretty much stays there. For instance, last night it said 90% at 15. The higher the Epap the less I have been hitting the max on the Ipap which is 25. Here's the other thing I have had a bunch of 0 AHI's lately but snores between 17 and 30. This machine is registering snores even when I know I'm awake with the F10 but not with the nasal masks. I wouldn't care about the snores except I am really tired all the time in spite of having great numbers and I'm hitting the top of the Epap range. What do you think? Thanks for your thoughts!

Best,
Tuza

[Sleeprider]

What is IPAP or PS min and max set to?

So far we only see one side of the equation. EPAP is an important pressure for stabilizing the airway, but if you are +5 PS then IPAP is already at 16. If it is on a range from 0 to ? then I would increase PS rather than EPAP. No way to advise you without the other settings.

[tuzacat]

Ah, thank you, Sleeprider! Epap min is 11, Epap max is 15, PS Min is 6, PS Max is 13.5, Max pressure is 25. When I was at a lower Epap max I was hitting the 25 max pressure a lot. With this setting I am rarely hitting it; mostly I'm in the PS 6-7 range.

[BlueTalon]

When you say "hitting the max", what precisely do you mean? Or to put it another way, what's wrong with hitting the max?

[Sleeprider]

Tuza, if the PRS1 is registering VS2 snores, I wouldn't worry about it. I don't even know what those are and don't track them in SH. If they are the VS snores, and they don't lead to OA events or your bed partner slapping you for being noisy, I again would ignore them. Your treated AHI is great, and if you're not feeling sleep deprived, chasing flow limitations and snores recorded by the machine seems to be kind of a waste, and could make things worse.

A snore to a respironics machine is not a noise but a pattern on the wave-form, where the top of the inhale flattens out and gets this sawtooth pattern. Is it important? If it is a VS, then it often increases pressure in anticipation of OA events. If those don't actually occur, the pressure change can be more disruptive than just letting the machine hit its set maximum pressure. We don't need to prevent the "snore" if it doesn't go anywhere.

[tuzacat]

Sleeprider, I looked at my wave chart today but I am using Encore Basic so it just says VS. I can't tell much difference on the chart between where I snored and where I didn't. Last night I had another 0 and 14 snores. It is weird though that I have snores with the FF mask and not with the nasal masks.

BlueTalon, what I meant by hitting the max was that that the max Epap is set at 15 and it says that 90% of the night that's where I am. I was thinking if I made it higher I'd have less snores.

The only reason I am even thinking about this is because I am so exhausted in spite of having such good therapy. I also realize there are other reasons contributing to the exhaustion. I know RA is a cause for fatigue as is stress - both of which I have. Just trying to eliminate the apnea part.

I sure thank you for your responses! This forum has made such a huge difference in my life! If I had stayed at the doctor's settings I'd still be grunting and keeping myself awake most of the night! Now, for the most part I actually sleep much of the night!

Best,
Tuza

[Pugsy]

max Epap is set at 15 and it says that 90% of the night that's where I am

90% numbers are defined as...AT OR BELOW that number. It is NOT necessarily where someone spends the entire night.
You are doing what a lot of people tend to do....forgetting the "OR BELOW" part of the definition.
Do you have a report that offers an overall average or median average for the maximum EPAP number? I don't remember if Encore will do it but SleepyHead will give a median or weighted average depending on what you select.
Alternately you can sort of eyeball the max EPAP graph and see if max EPAP gets pegged out and pretty much stays there to give you an idea just how much time is spent at the maximum.