Is this possible?

cpapjack · Post by **cpapjack** » Wed Jun 21, 2006 8:30 am

My Dr. ordered an increase of my pressure from 8 to 10 two weeks ago. It seems like the days that I actually do set my machine for 10, I feel more tired when waking up and during the day. Is this really possible? Why might this be?

GoofyUT · Post by **GoofyUT** » Wed Jun 21, 2006 9:21 am

Well, its possible that the increased pressure, though not substantial, is crearing some mask leaks, or more likely some mouth-breeathing/leaks. Have you checked stats to see what your leakage is (if available)?

Hope this helps.

Chuck

GoofyUT · Post by **GoofyUT** » Wed Jun 21, 2006 9:24 am

I don't believe that your M-series Plus willr eport leakage stats, and your Activa is a damn fine mask known for its lack of leaks especially when the straps are adjusted appropriately loosely. But, I'd still betcha that you're having some mouth leaks.

Chuck

cpapjack · Post by **cpapjack** » Wed Jun 21, 2006 9:31 am

No mouth leaks going on. I use Miropore tape and taht really works well. Besides, If I had the slightest leak, my wife would wake me to let me know, as she has done in the past and she hasn't been doing that.

You're right, My M Series Plus doesn't report leakage stats. That's a whole other story.

viewtopic.php?t=10209

Linda3032 · Post by **Linda3032** » Wed Jun 21, 2006 9:51 am

I definitely believe it's possible. I was going to write up my recent discovery, but hadn't gotten around to it yet.

I have an auto, and my 90% pressure runs around 8. My machine is set for 6 to 10. Several days last week, I felt really tired. My eyes were puffy and felt swollen all day. I was exhausted.

So, I checked my SmartCard and saw that I was consistently hitting 10 with my 90% at 9 for 4 days. Now, I would have given someone else the advice to bump up the machine higher. But given that I knew I usually feel fine at 8, I lowered my pressure down to 8 instead of 10.

I immediately felt better, and my eyes weren't puffy and swollen all day. I am keeping a careful watch on my AHIs, etc. Everything looks the same as when I was hitting 10.

So yes, I definitely believe higher pressure isn't always better even if the software is showing you sometimes "need" it.

Goofproof · Post by **Goofproof** » Wed Jun 21, 2006 10:25 am

It is possible higher pressure will interfere with your treatment, but without a machine and software to see what your treatment is doing, you can't tell. Welcome to the Wonderful World of Mini-"M". It's a shame that machines that can't give data are allowed on the market.

I guess the DME needs the profit, and of course it's smaller and new, so that automatically makes it the machine of choice. Not for Me! Jim

Why did the Dr. up your pressure, did his Magic 8-Ball, tell him that was the magic number, sometimes you have to add in how you feel on the treatment. (Results)

Snoozin' Bluezzz · Post by **Snoozin' Bluezzz** » Wed Jun 21, 2006 10:28 am

This has certainly been my experience, quickly and directly.

I have been running on my new Remstar Auto since Friday and started out at a range of 7-12 and my 90% was 10.3. I woke up feeling great (best in weeks). My longest time was at 9cm H20 and my AHI there was 1.1.Above and below 9 my AHI was higher, significantly so. It looked like my Auto was wanting to clear Hypopenas but as it went up my Apneas went up while Hypopneas went down but overall AHI went up. Out of curiosity I set my range to the MDs prescribed range of 6-16. My 90% kept going up, maxing out at 12.9 with a highest pressure of 13+ but my longest time at pressure and lowest AHI stayed at 9cm, signficantly lower (never higher than 1.4) whereas my AHI in that range setting went over 5. From feeling good on Saturday morning I went to taking yesterday off from work (Monday was not good!). I don't know why my apneas went up as pressure went up unless they were centrals but there were no non-responsive apneas reported.

Because of the way I immediately felt I have decided to go straight CPAP at 9.5 and see what happens. If my AHI stays <= 1.5 I'll call that good and stick with it unless I change interfaces. It appears I am one of those folks who do better at a constant pressure.

BTW - My prescribed pressure from the sleep study was 8 and I spent quite abit of time at 8 on this machine but my AHI was pushing 5 while there.

Interesting. I would have liked to experiment more but I seem to be quite sensitive to relatively small pressure changes and I need to "feel better now!" so I'm not going to play around.

So, like Linda says, in my experience higher is not necessarily better.

David

GoofyUT · Post by **GoofyUT** » Wed Jun 21, 2006 10:42 am

I want to echo what everyone else here has said. I was getting frustrated with the remaining hypops that my S8 was continuing to score at my range of 7-14 on my auto. So, I began raising the floor (on the advice of some folks here). I noticed that my 95% pressure was going up each day, my usage was going down, my AI was going up, and I was feeling BAD!!!! It kept up for a while and I said "Screw it!" and decided to return to my original 7-14. Almost immediately,I felt better, my 95% pressure dropped and stayed down( I was titrated at 10, and my 95% pressure is staying at 8.and my AIs dropped dramatically. My HIs continued up. However, I then discovered my error of leaving "Settling" off on my S8, and I corrected that and my HIs have now dropped as well (It was scoring tons of hypops during those times that I was awake while first getting into bed, or having gone to the bathroom).

So, I learned too that "more is NOT better" necessarily when it comes to pressure and I've been feeling LOTS better since!!!!

Chuck

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CPAPopedia Keywords Contained In This Post (Click For Definition): auto

Snoozin' Bluezzz · Post by **Snoozin' Bluezzz** » Wed Jun 21, 2006 10:53 am

I think that is where my Hypopneas are coming from as well. I'm going straight 9.5 because even a glance tells me I'm doing great at 9-10, not nearly as good <9 and same for >10. This is reflected by my subjective sense of well-being. I don't know how one could make this sort of adjustment, with any confidence, without having an Auto and software. I will continue to sample my titration with the auto and monitor my therapy regularly but for now - back to straight CPAP.

David

mikemoran · Post by **mikemoran** » Wed Jun 21, 2006 1:20 pm

Just a thought, but if you are moving your pressure around you may just not be giving it enough time to adjust to the difference. The increase in pressure may be disturbing your sleep more than your events do. The breathing agaisnt higher pressure, sound changes and, with the Activa, the feel of the mask against your face. Little nagging things that take time to adjust to, can interrupt your sleep.

I also found that when my therapy started kicking in better, lower AHI, that I was finding it harder to get up in the morning at first, because once my body was getting better rest I wanted more of it. I was tired during the day but not zoning out.

Snoozin' Bluezzz · Post by **Snoozin' Bluezzz** » Wed Jun 21, 2006 1:49 pm

Mike,

I don't know if you were addressing me or Chuck but from my point of view you may be correct but it is impacting me pretty seriously in the here and now (work performance etc.) and the 9cm AHI of 1.4 is acceptable (it is all hypopneas too) and I felt distinctly better at 8 and the brief time at 9 than when the APAP ranges hence the expression of my desire to experiement more but my need to find a workable setting right now.

It also does not explain why my apneas go up as the pressure goes up.

David

Darth Vader Look · Post by **Darth Vader Look** » Wed Jun 21, 2006 2:11 pm

Linda3032 posts - I have an auto, and my 90% pressure runs around 8. My machine is set for 6 to 10. Several days last week, I felt really tired. My eyes were puffy and felt swollen all day. I was exhausted.

So, I checked my SmartCard and saw that I was consistently hitting 10 with my 90% at 9 for 4 days. Now, I would have given someone else the advice to bump up the machine higher. But given that I knew I usually feel fine at 8, I lowered my pressure down to 8 instead of 10.

I immediately felt better, and my eyes weren't puffy and swollen all day. I am keeping a careful watch on my AHIs, etc. Everything looks the same as when I was hitting 10.

This is exactly how people with Auto's (or data recording CPAPs) need to approach a problem. Sounds like you did good Linda.

To me it sounds like mask leaks were causing at least some of the problems. Just more reason for limiting the upper pressure levels on an APAP rather than leaving them wide open. In Linda's case knowing your sleep data and where you feel best. Sleep data is your ally in treating OSA.

Snoozing Gonzo · Post by **Snoozing Gonzo** » Wed Jun 21, 2006 2:53 pm

This forum is amazing sometimes. As soon as I have a question or embark on something there seems to be a thread discussing similar things. That's happened twice today.

I finally got Encore working again (PC problems) and in reloading using Derrick's instructions (still can't load his secondary program) I came to his comments regarding tests he had run regarding reactions he had to changing pressures and cflex. I have started a similar program looking at two different masks under different conditions - now I'll add some addtional time between changes in order to cancel the "getting used to it" variable. Thanks for the tips. Great thread.

Offerocker · Post by **Offerocker** » Wed Jun 21, 2006 4:25 pm

Darth Vader Look wrote: Sleep data is your ally in treating OSA.

I'm getting dizzy, reading these posts

Would someone kindly list what the ideal numbers/ranges are for all readings? I have an AUTO w/ CFLEX...unfortunately, I have not yet educated myself on the acronyms, their meanings and 'best ranges'.

I apologize for asking for someone else to 'do this for me', but any guidance would be most appreciated, from those who are experienced in these studies.

Thanks in advance.
Kathleen

Sleepy-in-AL · Post by **Sleepy-in-AL** » Wed Jun 21, 2006 5:32 pm

Snoozing Gonzo wrote: I finally got Encore working again (PC problems) and in reloading using Derrick's instructions (still can't load his secondary program...

SG, Here is a link to another thread where I posted detailed instructions for getting EncorePro 1.6i to work with MyEncore 1.5b7. I believe that if you have EncorePro 1.3 to 1.5 you will need the older version of MyEncore. Either way, there are some tips regarding firewall software in the other thread that might help.
viewtopic.php?t=10149

Offerocker wrote: I'm getting dizzy, reading these posts

Would someone kindly list what the ideal numbers/ranges are for all readings? I have an AUTO w/ CFLEX...unfortunately, I have not yet educated myself on the acronyms, their meanings and 'best ranges'.

I apologize for asking for someone else to 'do this for me', but any guidance would be most appreciated, from those who are experienced in these studies.

Thanks in advance.
Kathleen

Kathleen,
I know what you mean. There is so much to learn. Although I'm still learning, here is a sample graph and hopefully someone will correct anything I might get wrong. This is from a BiPAP AUTO.

For the pressure graph, if you are using an auto then I believe as long as you are not "maxing out" for extended period of time and the times that you hit "max" pressure don't coincide with apnea events in "sleep therapy graph" then you are doing good. Your 90% pressures are the pressures you were at or less than 90% of the time. So in the BiPAP auto, as long as the 90% pressure remains below the Max IPAP pressure, I believe it is good. I'm not sure with regards to the 90% EPAP pressure.

The "sleep therapy" graph will show the timing of your events. A couple of things here, for each event, there is a "tick mark." If there are multiple events succesively, the tick mark will show up as a block or band on the chart. You want to reference these events against the pressure chart and the leak chart to see any coincidence. For instance, did you have any large leaks or were you at max pressure when you had an event.

Your event indexes are listed next to the sleep therapy graph. Ideally all of these would be 0 or as close to it as you can get. "Normal" AHI is anything below 5. Hopefully someone else will provide better detail regarding what "good" Obstructive Apnea and Hypopnea indexes are to reach that AHI. But an OA event is worse than an H event which is worse than an FL event. So, try to minimize them in that order??

The next graph is the "Leak" rate in Liters per minute. Lower is better here, but specific "good" numbers will depend on the leak rate of your particular mask and pressure level. The mask should have come with a leak rate vs pressure chart. This information will tell you how much air is supposed to vent out of the masks vent at a given pressure. Generally, I think I've read here that leak rates of less than 40 were "good" and more than 50 indicated some type of problem. You can see from my example that I had some potentially significant leaks. Also, if there is a "Large Leak" there will be a black band above the line on the graph during that time. To the right of this graph you will find large leak information and average leak information. Ideally, you spent 0 minutes at large leak and 0% of the night. If these numbers aren't 0, then you should be looking to find out why. The average level again will be dependent on the mask and pressure, but hopefully this will be close to the number published in the chart in the mask instructions.

Now what affects these numbers and how??? I believe that Hypopneas are more affected by EPAP pressure and Apneas are more affected by IPAP pressure. But how do other settings interact with these numbers? C-Flex?? Ramp?? Etc...

OK, so what have I missed?

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CPAPopedia Keywords Contained In This Post (Click For Definition): bipap, C-FLEX, cflex, AHI, Ramp, Hypopnea, auto

Is this possible?

Is this possible?

Mouth-breathing

Stats

Ditto

Mask

Additional Comments: Pressure MinE 11 MaxI 17.5