How high is too high? Minimum pressure

Okay the end of last week I increased the minimum pressure to 7. Seems to be helping. I am going to leave it there until the end of the week to see if things continue this way.

Although things are better, it still isn't as good as I think it can be. I'm still waking up maybe twice a night. Albeit for short periods of time.

I was thinking of trying 7.5 and then wondered if there was an issue about the minimum pressure being too high. What are some of the signs?

Issue is hypopnea events. 9 or over seems to be the issue. Based on the change, I'm now down to 10-13.

The typical problems with the pressure being too high are: aerophagia (swallowing air), waking up due to discomfort, and centrals (not that common). Your pressure is fairly low as pressures go, so unless your ahi goes up, or you have comfort issues, you are fine with higher pressures. Mine is 11-17, and I have the occasional belch upon waking, but nothing painful or uncomfortable. Those few who do have centrals due to higher pressure can try a few things before trying a different machine better suited for that problem. But you are unlikely to have an issues going up to 8 or 9. Just take it slow and see how it works for you.

Dogjudge wrote:I was thinking of trying 7.5 and then wondered if there was an issue about the minimum pressure being too high. What are some of the signs?

When I was using APAP my minimum was 10 (and lots of people start their minimums even higher).
I often saw my pressures climb to 18 on APAP for short periods of time. I had no issues with those changes...no aerophagia...no centrals...just effective therapy and I slept right through it all happening.

Now some people will experience aerophagia and a small % of people might develop centrals but if you are already seeing your pressure go higher anyway during the night then it is unlikely that changing the minimum is going to cause problems because you were already using higher anyway.

Only other real potential problem might be simply the small adjustment needed for getting used to breathing against a higher pressure. Might be a significant problem if a person was to jump from 7 to 10 or more but probably not a huge problem when someone is only making small increases at a time. That's why I usually suggest people go up slowly even if it is known that they probably will end up needing a big jump in pressure...might as well adjust slowly and might get lucky and not need as much pressure as we first thought.

Dogjudge wrote:Okay the end of last week I increased the minimum pressure to 7. Seems to be helping. I am going to leave it there until the end of the week to see if things continue this way.

Although things are better, it still isn't as good as I think it can be. I'm still waking up maybe twice a night. Albeit for short periods of time.

I was thinking of trying 7.5 and then wondered if there was an issue about the minimum pressure being too high. What are some of the signs?

Issue is hypopnea events. 9 or over seems to be the issue. Based on the change, I'm now down to 10-13.

Are you looking at your reports to SEE why you're waking up? (pressure changes.....leaks?)
Lots of people wake up during the night for various reasons.

Unless you've got some other "issues" (like central apneas or GERD or aerophagia to name a few), you're no where near being "too high" of a pressure setting. Many people use pressures in the 15 - 20 cm. range......and Bi-Level machines can go higher than that.


Den

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Sleeprider wrote:The graph shows some pretty remarkable similarity in timing of increased pressure and events, although results have gotten worse. If it was my therapy (and it's not), I'd increase minimum pressure in hopes of heading off the H and OA that seems to onset with REM or sleep position changes. Hypopneas are getting through under low pressure without preceding snores (VS) and flow limitation (FL) to head them off. The leaks look good and you may need just a little more pressure to head off those mid to late night events.

I have also had pretty good success with reducing flex level. It seems higher flex levels contribute to a higher RERA for me. That may not hold true for you, but it may be worth a try. Whatever you decide to change, try doing only one thing at a time, and give it some time to show a trend.

This is why I increased the low pressure.

viewtopic.php?f=1&t=103859&st=0&sk=t&sd ... best+worst

Since you're looking at things.

He mentions changing the flex level.

I thought there were only two options. A-flex or C-flex.

Can one actually adjust these? My machine is on A-flex.

You've been doing great, and there is no reason not to try changing something by 0.5 cm. I have been guilty of doing that from time to time. The worst case is you return to the previous setting that worked. The best case is, you find something better. Your sleep = your decision. Go for it.

Thanks.

Your previous suggestion worked. Obviously you're a genius.

Yes, you can adjust your AFlex setting if you wish. 3 setting choices...try all and see which feels the best to you or turn it off even.
It's all about what feels the best.
The amount of reduction is flow based meaning if you are a shallow breathing person you will have less reduction at the maximum setting (which is 3) than a person who breathes more forcefully.
At the highest setting the amount of reduction even with the most forceful breathing is limited to 2 cm.

I used to run with a minimum of 16. I'm at 14 now.

I got some gas, but could live with it. EPR seems to help with some of the symptoms. Flex may help you. Realize that Flex or EPR may have negative or positive effects on your therapy.

Bilevel has the same advantages and drawbacks.

On bilevel my epap id's set at 17 ps 7 ipap 25

Greg Riddle wrote:On bilevel my epap id's set at 17 ps 7 ipap 25

Good grief. Okay, I don't know real pressure!

I started with an IPAP of 21 and an EPAP of 15. These days, I 'm at 19 IPAP and 14.4 EPAP

higher pressures bring a brand new world of leaks, issues and solutions into play