Anyone do better with lower pressure?

[Rainmom17]

I've had repeated problems with trying to raise my minimum pressure from 7.5 to 8. I've wanted to raise it to hopefully improve my therapy. But every time I try I get a worse AHI. Please don't suggest it's an "attitude" thing. Every time I've tried I've been excited to improve my therapy and optimistic about upping it. But, I've now tried about 5 different times (for multiple days each time), and the results are worse. I calculated my average ahi at different starting pressures and it was 3.4 at minimum of 7, 2.7 at minimum if 7.5, and 3.9 at minimum of 8. It's mystifying to me because everyone seems to do better with higher minimum pressure. So, I'm wondering if anyone out there is doing better with a minimum of 7.5 or lower?
As far as my most recent attempt with 8.0 minimum, I felt like I slept well and felt somewhat rested when I awoke. I was very surprised to see I had a 5.2 ahi. BTW, I am no longer bothered with mask leaks and have few awakenings during the night.
Thanks for any help. It's been a frustrating 5 months and I'd love to feel more confident that my therapy is working well for me. Maybe at this point a 2.7 ahi is good enough and I should just stick with 7.5 minimum for now.

One final note: I'm still using my original mask. Was going to try Amara View but couldn't get a good fit at all.

[Goofproof]

Everyone that's pressure is set higher than needed to keep their airway open will find a lower pressure does better. That's why the data is used to find the settings that work best. The object is to get the lowest pressure needed to keep the airway open, while providing the pressure needed to cover the worst cases of need. A APAP, does this if set up correctly, and leaks are managed. Jim

[Mark55]

My initial settings were for a fixed 8cm, and EPR of 3. I dropped it to 7cm and EPR of 2 and post better numbers than before. I am usually <1 AHI wise, so that is where I leave it.

[Rainmom17]

Good to know, Mark55. What prompted you to change the EPR? That's something I haven't touched and it's still at 3.

[Mark55]

Good to know, Mark55. What prompted you to change the EPR? That's something I haven't touched and it's still at 3.

Mainly to keep my exhalation pressure at 5cm,....just feels better to me for some reason.

[TedVPAP]

I've had repeated problems with trying to raise my minimum pressure from 7.5 to 8. I've wanted to raise it to hopefully improve my therapy. But every time I try I get a worse AHI. Please don't suggest it's an "attitude" thing. Every time I've tried I've been excited to improve my therapy and optimistic about upping it. But, I've now tried about 5 different times (for multiple days each time), and the results are worse. I calculated my average ahi at different starting pressures and it was 3.4 at minimum of 7, 2.7 at minimum if 7.5, and 3.9 at minimum of 8. It's mystifying to me because everyone seems to do better with higher minimum pressure. So, I'm wondering if anyone out there is doing better with a minimum of 7.5 or lower?
As far as my most recent attempt with 8.0 minimum, I felt like I slept well and felt somewhat rested when I awoke. I was very surprised to see I had a 5.2 ahi. BTW, I am no longer bothered with mask leaks and have few awakenings during the night.
Thanks for any help. It's been a frustrating 5 months and I'd love to feel more confident that my therapy is working well for me. Maybe at this point a 2.7 ahi is good enough and I should just stick with 7.5 minimum for now.

One final note: I'm still using my original mask. Was going to try Amara View but couldn't get a good fit at all.

The problem that many people have is as they are getting adjusted to the alien, they are also changing treatment settings so it is nearly impossible to separate the causation. As you said, you feel better even though your numbers are not better. You credit the improvement to less mask leaks and less awakenings - makes sense to me.
I would want to see to see your sleepyhead data before advising on any pressure changes.

[Julie]

Can't remember if it's come up for you, but do you know that most of the time when EPR is set higher, AHI also goes up a cm or 2? It may not be a big deal unless your AHIs are very high to begin with, but if you care about those and the EPR can be turned down a little if not off, then find a balance. EPR's a convenience, not mandated therapy.

[Rainmom17]

Julie, I didn't know that. Sounds worth a try to lower it. Thank you!

[TedVPAP]

Can't remember if it's come up for you, but do you know that most of the time when EPR is set higher, AHI also goes up a cm or 2? It may not be a big deal unless your AHIs are very high to begin with, but if you care about those and the EPR can be turned down a little if not off, then find a balance. EPR's a convenience, not mandated therapy.

I have heard this a few time, I just want to clarify what you mean.
Do you mean that increasing EPR will increase AHI so 1-2 cm-H2O of pressure will be needed?

[Pugsy]

Sometimes for some people when they use any exhale relief that drop during exhale of the pressure will bring the pressure down to a point where the pressure can't optimally hold the airway open and apnea events could happen and thus the AHI could go up.
It's not a given that it happens to everyone though. A lot depends on if that drop during exhale just happens to go low enough to allow the airway to collapse a bit.

I use 7 inhale and EPR of 3 so that makes it 4 exhale...and I think you all have seen my reports....with a rare exception my AHI doesn't make it to 1.0 territory. I use 3 EPR because I like it...that's the only reason...it's comfortable and I like it. So why not use it is my thinking.

So while using any exhale relief "can" cause the AHI to sometimes increase....it doesn't necessarily do it for everyone.
If it did....then the person has a choice either turn off or reduce exhale relief or simply use a little more pressure so the drop during exhale doesn't allow the apnea events to slip past the defenses. Easy fix either way if it needs fixing.

[Okie bipap]

I have done much better with a lower pressure. When I first started my prescribed IPAP was 20 - 25 cm with pressure support of 5 cm. I am currently running IPAP 14 - 16 with pressure support of 4 cm. I sleep better with the lower pressure, and it is more comfortable. My AHI normally stays under 1 with a few nights between 1 and 2. Once a month or so, I will have a night whee I go over 2. These are the nights I do not sleep well and have a lot of arousals not caused by my SA.

[SnoringInOregon]

Note: the words "pressure" and "EPAP" I use below are SleepyHead terminology. One is for inhale, the other for exhale.

The original poster has a DreamStation. As do I.

Isn't it true that EPAP can't be changed on the DreamStation while in auto mode? It's simply whatever the machine decides it should be, which is approximately 2 less than the pressure. Which means the Dreamstation has a fixed EPR of about 2 (it seems to vary slightly according to SleepyHead). I realize the original poster didn't say anything about EPAP or EPR. I think that was just a bit of thread drift by following posters. But it's something important to me.

My understanding is that the lower of (pressure,EPAP) is what really keeps our airway open. So, if I don't need any difference between pressure and EPAP for comfort reasons, there's unfortunately nothing I can do about that.

Let's say that a pressure of 9 is good enough to keep my airway open under typical conditions. But I shouldn't set a min pressure of 9 on my DreamStation. If I did my EPAP would be about 7. I really need to set minimum pressure at 11 to keep EPAP above 9.

Isn't that right, and isn't that a big problem of the Respironics machines compared to the Resmed ones? The EPAP can be controlled on Resmed?

Also my understanding of any "flex" settings on the DreamStation is they don't really affect EPAP. They mostly just control the shape of the transition between pressure and EPAP as one transitions between inhaling and exhaling. Right?

[ChicagoGranny]

So, I'm wondering if anyone out there is doing better with a minimum of 7.5 or lower?

I wouldn't worry about what others are using as a minimum. You need a minimum that keeps YOUR airway open.

But, I've now tried about 5 different times (for multiple days each time), and the results are worse. I calculated my average ahi at different starting pressures and it was 3.4 at minimum of 7, 2.7 at minimum if 7.5, and 3.9 at minimum of 8.

I bet this data is statistically insignificant. There are too many variables in CPAP therapy/our own breathing to peg problems on a half cm minimum pressure difference.

As far as my most recent attempt with 8.0 minimum, I felt like I slept well and felt somewhat rested when I awoke. I was very surprised to see I had a 5.2 ahi.

I would like to see SH graphs of this night. These graphs can tell more about what pressure is needed than polling what others are doing.

I felt like I slept well and felt somewhat rested when I awoke .... I am no longer bothered with mask leaks and have few awakenings during the night.

No need to get frustrated - you have a lot of things going well.

BTW, your equipment profile needs updating.

[Pugsy]

Also my understanding of any "flex" settings on the DreamStation is they don't really affect EPAP. They mostly just control the shape of the transition between pressure and EPAP as one transitions between inhaling and exhaling. Right?

Wrong.

When exhale relief is used the EPAP drops to some degree. How much depends on the setting and how forcefully someone breathes since the amount of reduction depends on flow rate.

Isn't it true that EPAP can't be changed on the DreamStation while in auto mode?

No.

Let's say that a pressure of 9 is good enough to keep my airway open under typical conditions. But I shouldn't set a min pressure of 9 on my DreamStation. If I did my EPAP would be about 7. I really need to set minimum pressure at 11 to keep EPAP above 9.

Isn't that right, and isn't that a big problem of the Respironics machines compared to the Resmed ones? The EPAP can be controlled on Resmed?

No. There is no problem because EPAP can be controlled on either brand. Now it can vary when in auto mode but we can still control it.

The example I mentioned above and what you bring up would be the same example no matter what the brand when it comes to a minimum pressure that is needed to keep the airway open and IF (big IF) exhale relief is used and using that relief drops the pressure down and apnea events happen during the exhale.

Using exhale relief in any form creates a somewhat small bilevel situation where IPAP and EPAP differ. It is simply what happens when the pressure is reduced for any reason by the exhale relief option available on the machines...whatever they might be...either EPR or Flex or PS.

[ChicagoGranny]

Something seems to be getting lost here. Take a ResMed machine and set the minimum where it barely prevents events that start on exhale. Now turn on EPR. The pressure on exhale will be lower than what is needed to prevent events.

Maybe someone can explain how to look at wave flows on SH to determine whether a person is having events that start on exhale?