Worst night yet

[Pugsy]

has nothing to do with how fast the machine is as the minimum pressure is enough to keep the airway open when set properly

It has everything to do with it if the minimum is too low and it takes too long to get to where it needs to be to hold the airway open.
That's why wide open settings of 4 to 20 in apap mode doesn't always work so great.
Works fine if a person only needs maybe 8 or 9 cm to prevent the airway from collapsing but doesn't work so great if 14 cm is needed.
They can't go from 6 cm to 14 cm in the blink of an eye.

[Pugsy]

Yeah well....her doc has the minimum set too low and that's the problem and taking his own sweet time increasing it.

[MoodyMolly]

I don't know about Dreamstation, but with the ResMed Airsense 10 Autoset that I use, you need to tell the machine which kind of mask you-re using - FFM, Nasal, or Nasal Pillows. I wonder if that would make a difference for you?

It does have a setting for mask type, but I'm not sure what it means. It has a mask setting of 1-5, the manual says it adjusts the level of air pressure relief based on the specific Philips Respironics mask. The DME just skipped over the mask setting, leaving it turned off. She didn't say anything about it. Maybe it's because I'm not using a Philips mask, and the mask setting is brand specific?

I also use a P10 nasal pillow with a Dreamstation CPAP. Nasal pillows are X2 resistance (or you can turn it off), which you access from the My Setup menu.

As for changing the pressure: Press the round white button on the front to turn on the display, then press and hold the round white button and the ramp button at the same time until the display changes to the clinician's menu. From there, you can change things like pressure. Turn the round button to select what to change, then press the button, which allows you to make adjustments up or down. Turn the round button to the desired setting, then press the round button to set the change. I hope this helps.

Awesome! Thank you!! Do you think my doctor will get mad at me for changing the settings on my own? I'm sure he'll see the change when I bring in my sd card to my one month follow up appt.

[MoodyMolly]

Yeah well....her doc has the minimum set too low and that's the problem and taking his own sweet time increasing it.

Yeah, exaclty... He hasn't gotten back to me after I sent him a message asking to increase the minimum 5 days ago. I'm thinking about just increasing it myself, but I wonder what he would say at my follow up appt when he sees the data from the machine saying it's higher than he prescribed it?!

[Julie]

Relax, we all change our settings and if your MD is so antiquated and egotistical, change doctors! You want to be in control of your therapy, just as young children calibrate their blood sugars in diabetes, and the worst thing you could do is stay ignorant and incapable of taking care of your OSA.

[Bertha deBlues]

I don't know about Dreamstation, but with the ResMed Airsense 10 Autoset that I use, you need to tell the machine which kind of mask you-re using - FFM, Nasal, or Nasal Pillows. I wonder if that would make a difference for you?

It does have a setting for mask type, but I'm not sure what it means. It has a mask setting of 1-5, the manual says it adjusts the level of air pressure relief based on the specific Philips Respironics mask. The DME just skipped over the mask setting, leaving it turned off. She didn't say anything about it. Maybe it's because I'm not using a Philips mask, and the mask setting is brand specific?

I also use a P10 nasal pillow with a Dreamstation CPAP. Nasal pillows are X2 resistance (or you can turn it off), which you access from the My Setup menu.

As for changing the pressure: Press the round white button on the front to turn on the display, then press and hold the round white button and the ramp button at the same time until the display changes to the clinician's menu. From there, you can change things like pressure. Turn the round button to select what to change, then press the button, which allows you to make adjustments up or down. Turn the round button to the desired setting, then press the round button to set the change. I hope this helps.

Awesome! Thank you!! Do you think my doctor will get mad at me for changing the settings on my own? I'm sure he'll see the change when I bring in my sd card to my one month follow up appt.

Don't know the answer to that one, but my doctor was okay with it after I showed him a few Sleepyhead printouts. He seemed impressed that I took the initiative and wanted to be actively involved.

I didn't even realize I could change the settings myself until I found help online, and by that time the rental period for my machine was over and I owned it free and clear. I then decided that if it was mine, I was allowed to make changes.

[Julie]

.

[Okie bipap]

Changing your pressure setting is much like a diabetic taking charge of their treatment and adjusting their insulin as needed. Most of us have taken charge of our own therapy and have made adjustments we feel are necessary. My sleep specialist knows I change mine and she has never said anything since my results are better after I mad the adjustment.

[MoodyMolly]

I am at a loss. I decided to try a second night with the FFM and give it a chance. But today I woke up to an AHI of 17.5. That surpasses my worst AHI number. I don't think there were any significant leaks. And to top it off, I am getting horrible aerophagia in the middle of the night, stomach pain and gas. I think my problem is that my mouth opens but I'm not breathing through it, so I end up swallowing the air. I'm switching back to nasal pillows tonight, hopefully I'll get better numbers. But seriously? Why is my AHI so high with a FFM over nasal pillows? It doesn't seem like it's a huge well known problem, masks are supposed to be interchangeable without changing your pressure. I did increase my minimum pressure to 7, but apparently with the FFM it doesn't make any difference.
Here's my results from last night: https://imgur.com/a/fniTA

[Pugsy]

Do me a favor tonight.
Change the minimum to 10 (use the ramp if you aren't comfortable with 10) and go back to the nasal pillow mask.
See what happens.

Actually needing more pressure with a full face mask is quite common. Not sure why unless it's the mask straps on that full face mask maybe causing the jaw to come back a little and narrow the airway.

Until your pressure minimum is more optimal you don't stand a snowballs chance in hell of ever getting decent sleep or therapy.
Plus....sometimes when the minimum pressure is more optimal the maximum doesn't go so wildly up there (and that's likely the culprit on the aerophagia issues).

You may need more than 10 cm minimum but going from 7 to 10 is a sizeable jump....try 10 cm and see what happens.

[MoodyMolly]

Do me a favor tonight.
Change the minimum to 10 (use the ramp if you aren't comfortable with 10) and go back to the nasal pillow mask.
See what happens.

Actually needing more pressure with a full face mask is quite common. Not sure why unless it's the mask straps on that full face mask maybe causing the jaw to come back a little and narrow the airway.

Until your pressure minimum is more optimal you don't stand a snowballs chance in hell of ever getting decent sleep or therapy.
Plus....sometimes when the minimum pressure is more optimal the maximum doesn't go so wildly up there (and that's likely the culprit on the aerophagia issues).

You may need more than 10 cm minimum but going from 7 to 10 is a sizeable jump....try 10 cm and see what happens.

Changing the min to 10 and going back to the pillow? Do you think the 7cm min would be ok with the nasal pillow? With the FFM, I could hardly tell there was a difference in pressure from the 7cm min and when it started blowing at 15cm. With the nasal pillows, it feels like I'm not getting anything at 5cm, but feels like it's going at mach 10 when it gets to 14. But I'll try 10cm and the n pillow if you think it'll help.
Also, I saw the post on magnesium, and I do take a magnesium supplement. I'm thinking I'll go without for a few days and see if it makes any difference in my AHI.

[Pugsy]

Use the mask that is the most comfortable for you but change the minimum to 10 cm.

The minimum pressure is your main issue right now in terms of therapy effectiveness. You will stand a better chance of improved effectiveness with the change to 10 cm minimum with a nasal pillow mask but not at the expense of not being able to sleep at the higher pressure because of overall comfort.
So if you feel more comfortable with the FFM at 10 cm then use the FFM ..

The main thing I want you to do is get that minimum pressure starting point up closer to what your airway needs to better hold the airway open and thus prevent the collapse of the airway (which is what you are seeing with the high AHI and the high pressures where the machine is trying to fix a problem after it has happened).

These machines work best by preventing the airway from collapsing in the first place....hence the more optimal starting point or minimum.
You may well need even more than 10 cm but going from 7 to 10 is a big enough jump in terms of comfort as it is.
Start with 10 cm and see what happens and then we worry about maybe needing more.

[MoodyMolly]

Use the mask that is the most comfortable for you but change the minimum to 10 cm.

The minimum pressure is your main issue right now in terms of therapy effectiveness. You will stand a better chance of improved effectiveness with the change to 10 cm minimum with a nasal pillow mask but not at the expense of not being able to sleep at the higher pressure because of overall comfort.
So if you feel more comfortable with the FFM at 10 cm then use the FFM ..

The main thing I want you to do is get that minimum pressure starting point up closer to what your airway needs to better hold the airway open and thus prevent the collapse of the airway (which is what you are seeing with the high AHI and the high pressures where the machine is trying to fix a problem after it has happened).

These machines work best by preventing the airway from collapsing in the first place....hence the more optimal starting point or minimum.
You may well need even more than 10 cm but going from 7 to 10 is a big enough jump in terms of comfort as it is.
Start with 10 cm and see what happens and then we worry about maybe needing more.

Got it! I'll change it to 10 and try both masks tonight to see which feels more comfortable. Thank you for your tips!!! I hope it helps

[MoodyMolly]

I changed my minimum pressure to 10, and went back to the nasal pillow last night. My AHI went back to 7 Which is what I was getting half the nights with the n pillow. I was sleeping for a few hours without a chin strap, but woke up with a dry mouth, so I added my chin strap. As you can see on the data below, the first part of the night when I wasn't wearing a chin strap, I had horrible apneas, and it skewed my average. The nights I wore a chin strap before didn't give me any better results so I don't always use it. Tonight I'm going to wear the chinstrap all night and see if the combination of that and the higher pressure will give me a better result.

https://imgur.com/a/HBtr0

[Pugsy]

What position were you laying during that first part of the night without the chin strap?
On your back or on your side?

Your leak data doesn't support mouth breathing happening significantly so I am scratching my head as to why the big pressures being needed without chin strap.

Have you thought about wearing a cervical collar?