Is this pressure too high? Need help with Min/Max

[peppers]

I'm a total newbie, started APAP this week with F30i mask but I had too much trouble with major leaks during the night so I've now switched to F20 Airfit last night and it worked very well. I'm definitely more awake today, compared to years of feeling like a zombie.

BUT I'm worried after seeing that my machine is ramping up to max pressure (I just had it set at 4/20 with the hope of narrowing that range down after looking at my data). I'm worried that running at 20 will burn out the motor. I'm also worried that because it ramps to 20 that APAP might not be right for me, even though it is definitely working to make me feel more rested.

Here is last night's data: https://imgur.com/a/Y23ejEH

Would you adjust my min/max pressure range?
Is ramping up to 20 bad?
Anything else worrying about my data?

Thanks in advance for any replies!

[Dog Slobber]

Having your machine spend most of the night, at or close to its maximum (20cm), will not burn out the motor.

Some thoughts:

• "Ramping", up to 20cm isn't bad, but it shows a lot more pressure may be required to control your OSA, than most.
  • ps: don't use the term "Ramping". Although that's perfectly fine in the English language, Ramp has a very specific (and different) meaning in the context of CPAP machines. The ambiguity can cause confusion.
• Spending a lot of time at 20, could also mean your AutoSet may not deliver as much pressure as you need. You might need to upgrade to an AirCurve (BiLevel), capable of delivering up to 25cm. But we won't know until you're better optimized.
• A minimum of 4cm is *way* too low for your needs. I'd start off a lot higher, 10cm at minimum and likely more. This could also mean the device not needing to go as high.
• When changing your minimum, if you don't like starting at 10, consider using Auto-Ramp with a ramp pressure of 7.
• Consider turning on EPR (3), this will reduce pressure when exhaling and it might be more comfortable.

[Miss Emerita]

Welcome, and congratulations on starting PAP therapy and mastering leaks so quickly! Oh, and using Oscar right off the bat!

As a footnote to DS's post, if you introduce EPR, you may reduce your flow limitations, which are a primary driver of your pressure increases. As with a higher minimum pressure, this might help to reduce your pressure needs over all. So I strongly recommend that you give that a try. You might as well start with EPR of 3 and see how that goes. Be sure it's on full-time and not just during your ramp period.

Do you feel OK when you're using the ramp pressure of 4? Lots of people find it leaves them feeling a bit air-starved.

As far as events go, you're doing quite well, if this chart is typical. You had one cluster of OAs, and without that, your AHI would be stellar. Do you seem to have OA clusters every night?

[ChicagoGranny]

After you try a minimum pressure of 10.0, post another chart in this thread. We might be able to make some additional recommendations to help prevent your pressure needs from being high.

[peppers]

Thanks everyone, I appreciate the support so much!

Over the weekend I will try pressure range 10-20, start pressure of 7, and full-time EPR of 3 (I hope I got all of that correctly ), and then I'll post results.

ps: don't use the term "Ramping". Although that's perfectly fine in the English language, Ramp has a very specific (and different) meaning in the context of CPAP machines. The ambiguity can cause confusion.

Thank you, I see that now. Ramping up is just the mode at the beginning that gets you to your minimum pressure?

Do you feel OK when you're using the ramp pressure of 4?

Before the therapy I would purposefully breathe very shallowly to help fall asleep. Not sure if that was a good thing to do, but it probably contributes to me being fine starting at 4.

Do you seem to have OA clusters every night?

Yes, it was similar OAs the previous nights. I just woke up more from air blowing up into my eyes with mask leaks, but that's solved now with the new mask I think.

[palerider]

narrowing that range down

"narrowing the range" is a fallacy that is propagated by people that don't understand how the machines work.

I'm worried that running at 20 will burn out the motor.

Don't be. The same motors will happily run at up to 25 all night long with a bilevel machine.

I'm also worried that because it ramps to 20 that APAP might not be right for me,

the problem is your min pressure of 4, which is too low for almost everyone. leave the max pressure set at default, and raise the min pressure till things stabilize.

even though it is definitely working to make me feel more rested.

NOW you're talking about the important parts

[peppers]

So weirdly enough my AHI went up last night with the new settings, but it's only been one night. I'm too new to know if it's normal to fluctuate that much from one night to the next.

Here is last night: https://imgur.com/a/BxwOfYH

My leak rate is higher, probably from me loosening the mask a bit because it was a little too tight on the bridge of my nose before. So that's probably the reason for more leaks, but hopefully still acceptable range?

[Pugsy]

Your leaks are well within the machine's ability to compensate for. Unless you start seeing leaks above 24 L/min they aren't a problem in terms of therapy effectiveness.

Now if those leaks woke you up....different story but because they caused the wake ups and not because they were bad enough to negatively impact therapy.

[Miss Emerita]

It looks as though you had several little clusters of OAs. Clustering suggests that you may be rolling onto your back, which can lead to more OAs than side-sleeping, or that you may be tucking your chin down toward your chest. (Chin-tucking can slightly narrow the airway, which makes both FLs and OAs a little more likely to occur.)

The least disruptive countermeasure to try is to make sure you're using a fairly low and firm pillow. If you're not using one already, could you give that a try? Also, do you think you ever sleep on your back?

Your FLS came down some with the EPR, though the FL graph is still fairly busy. You're already doing what you can on that front, so unless you dislike it, I'd suggest you continue with EPR of 3. (By the numbers, it looks as though EPR may also have helped with snores.)

You're right to say that it's hard to draw conclusions from one night, so if you can stick with these settings for another, say, four nights, that would be great. Down the road, you may want to raise your minimum, but let's see where the current settings leave you.

[peppers]

Unless you start seeing leaks above 24 L/min they aren't a problem in terms of therapy effectiveness.

That's good to know, thank you! I don't believe it's waking me up, so i'll continue with the current setup.

It looks as though you had several little clusters of OAs. Clustering suggests that you may be rolling onto your back, which can lead to more OAs than side-sleeping, or that you may be tucking your chin down toward your chest. (Chin-tucking can slightly narrow the airway, which makes both FLs and OAs a little more likely to occur.)

The least disruptive countermeasure to try is to make sure you're using a fairly low and firm pillow. If you're not using one already, could you give that a try? Also, do you think you ever sleep on your back?

I did not know this, but funnily enough I do already have a pillow filled with buckwheat hulls so it's probably as firm as you can get I started that years ago because I find it is very cooling which I love. I definitely sleep on my back though, so I'll try to at least fall asleep in a side position, and then see if I roll back in the night (probably will, I think I turn a lot).

I'd suggest you continue with EPR of 3. (By the numbers, it looks as though EPR may also have helped with snores.)

Will do, thank you so much! My wife did say that she immediately noticed I wasn't snoring like I used to.

[peppers]

So I think last night was one of my best nights, if I'm reading the data correctly.

data: https://imgur.com/a/6BhDcre

AHI of 1.36 was my lowest so far, and my max and median pressure were lower than usual.

I did toss and turn during the night a bit (I'm not sure if you can tell from the data when I'm awake?), but I made a conscious effort to reposition to sleeping on my side if I wasn't and I think that helped a lot with OAs.

A couple of concerns though.
I did get a CA event, which I usually don't; is that normal and harmless at that amount, or something to worry about?
Also, I woke up early with water in my mask, and was wondering if that was possibly because sleeping on my side covered a mask vent? Or if it was to do with the room temperature? It was colder last night and I just have the slimline hose, not a heated version.

Anyways, just wanted to say thanks, your advice helped a lot!

[Pugsy]

I did get a CA event, which I usually don't; is that normal and harmless at that amount, or something to worry about?

Nothing to worry about at all. An occasional central apnea flag is normal and no big deal and actually to be expected.
Centrals are a worry when present in large numbers or they cause desats.

Also, I woke up early with water in my mask, and was wondering if that was possibly because sleeping on my side covered a mask vent? Or if it was to do with the room temperature? It was colder last night and I just have the slimline hose, not a heated version.

Read this thread posts number 2 and 3
http://www.cpaptalk.com/viewtopic/t9403 ... -road.html

It has nothing to do with sleeping position and everything to do with the ambient bedroom temperate.
You gotta warm up that air in the hose/mask so that it doesn't cool down and release the moisture.

You do have several options which I outline in the above thread.
Easiest would be get the heated hose but if that isn't an immediate option there are others.

[peppers]

Thanks Pugsy, that helped. I raised the thermostat a little and kept my bedroom door open so that it stayed the same temperature as the rest of the house, and there was much less condensation inside the mask this morning.