Increasing Pressure

General Discussion on any topic relating to CPAP and/or Sleep Apnea.
Drpjfitz
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Increasing Pressure

Post by Drpjfitz » Sun Jul 05, 2015 10:32 am

Hi everyone,

I was diagnosed with moderate sleep apnea about a year ago and despite being very compliant with CPAP over the last few to several months, I have continued to struggle with fatigue, mental dullness and sleepiness. The prescribed pressure level was 8cmH20 so I had the thought a couple of days ago that maybe I need a higher pressure level? I increased it to 9cmH20 and did feel much more alert yesterday. Then I decided maybe 10cmH20 would be better--not a good idea as I kept waking up coughing last night and finally took the mask off at 3:00a.m. Today (no surprise), I'm exhausted.

Question--have any of you, on your own, increased the pressure and found it helped? If so, how much did you increase it?

Thanks for any help!

Pam

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chunkyfrog
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Re: Increasing Pressure

Post by chunkyfrog » Sun Jul 05, 2015 10:56 am

So, what kind of machine do you have?
Therapy data, if you can get it, would be infinitely more useful than
blindly "dial-winging" and relying on how you "feel"

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tedburnsIII
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Re: Increasing Pressure

Post by tedburnsIII » Sun Jul 05, 2015 11:03 am

For once I agree with CF.

My optimal pressure was 12cm according to lab titration, which followed the Clinical Guidelines. I SLEPT during the titration, that is imperative.

I have chosen to go straight CPAP after months using APAP. Currently at 11.5 and have no intention of exceeding the optimal pressure of 12cm- not needed, assuming my data remains excellent and I feel good, very good, or terrific at 11.5cm.

If your lab titration was a good one that conformed to Clinical Guidelines, the 8cm should be a maximum for you that works, even if in REM while supine.

But people differ, and the titration was a one-nighter. However, CF advice is sound. Very important to monitor your data and if that's good and your 02 is sufficient, there may not be cause for any significant increase in pressure. And your waking up coughing may be that you are increasing pressure too much when it should be done incrementally in smaller increases. Time will tell.

But you are flying 'blind' without your data. It may be that your data at 8cm is not good, you really need to check it out for a week or so. Among other things, you need to monitor your AHI and leaks, information that you apparently have not as yet accessed.
Last edited by tedburnsIII on Sun Jul 05, 2015 12:32 pm, edited 7 times in total.
Machine - https://www.cpap.com/productpage/resmart ... ducts.html
Setting: APAP, 10.5-14cm
Software: Proprietary
Mask- PR Wisp nasal (large); ResMed FX Nasal (wide);
Oximeter: CMS50D+

JDS74
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Location: South Carolina

Re: Increasing Pressure

Post by JDS74 » Sun Jul 05, 2015 11:20 am

Pam:

If you have selected, via the User Control Panel, your equipment so that it should display like the heated humidifier does, then it may be that your CPAP is a discontinued model. In that case, just add a text description to your signature line.

To be sure you are selecting the correct model, remove the humidifier tank and then look on the bottom of the blower unit part to see if a model number that looks like REF in a little box followed by a 4 digit code like 450P or 460P or something like that. The 50 or 60 part of the code relates to the series, 50 for 50 series, now discontinued, and 60 for 60 series, the current models in the Respironics line.

If it is a 50 series unit, then, because it is discontinued, it won't display properly and you should use the signature line.
If it is a 60 series unit, then you have selected the wrong one from the list. Make sure that the one you select contains the number 60 in the description.

As for the humidifier, if you have a 60 series unit, then the humidifier to select is the 60 series heated humidifier with heated hose even if you don't have the heated hose. Its just a nomenclature thing.

Because of the way your question is phrased, it is likely that you have either a model 260P or a model 460P. The difference is important because the 260P doesn't collect the efficacy data needed to help you in monitoring your therapy results as pressure changes.

If it is a 460P, then you can get your own reports on your progress. Two software packages are available.
Encore, a product of Philips-Respironics, and
SleepyHead, a product of one of the members of this forum who is also an apnea patient.

Both can be obtained at no cost and provide useful information.
If you want to get either, post a separate request with "Need Software for my Respironics CPAP" as a subject line and put in the body text indicating your model number.

Finally, lots of us do change pressures to try to get more effective CPAP therapy. Sometime raising helps, sometimes lowering helps. It is always a good idea to have data upon which to make the decision.

I always recommend that getting your doctor on board while you change things is always a good idea. It helps keep you out of trouble and keeps the communications lines open.

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Julie
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Re: Increasing Pressure

Post by Julie » Sun Jul 05, 2015 12:13 pm

If your machine is a PR S1 model, the link to display some of them doesn't work, so just type into a note here what machine and model you have.

Drpjfitz
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Location: Dallas, TX

Re: Increasing Pressure

Post by Drpjfitz » Mon Jul 06, 2015 6:02 pm

Hi everyone,

I just tried updating my profile & equipment to see if it now shows for posts. I have the REMstar Pro 460 series with heated humidifier. I've heard of the Sleepyhead software but the version that I've seen available to download is not compatible with my old MacBook Pro. I would need an earlier version to download it.

I did just check the minimal information that is available from my CPAP unit. There have been no large leaks, BUT my AHI over the last 30 days was 6.3, over the last 7 days was 4.0, and over the last day was 2.7.

I do need to follow up with my sleep medicine physician--I cancelled the last appointment due to have surgery and dealing with recovery.

You mentioned that the Encore software is free? Do you have a link that you could share?

Thanks so much to all of you!

Pam

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Krelvin
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Re: Increasing Pressure

Post by Krelvin » Mon Jul 06, 2015 9:06 pm

Drpjfitz wrote:I've heard of the Sleepyhead software but the version that I've seen available to download is not compatible with my old MacBook Pro. I would need an earlier version to download it.
How is it not compatible? What version iOS are you running?
Current Settings PS 4.0 over 10.6-18.0 (cmH2O) - Resmed S9 VPAP Auto w/h5i Humidifier - Quattro Air FFM
TNET Sleep Resource Pages - CPAP Machine Database
Put your equip in your Signature - SleepyHead v1.0.0-beta-1
Kevin... alias Krelvin

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Pugsy
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Re: Increasing Pressure

Post by Pugsy » Mon Jul 06, 2015 10:46 pm

All the various Encore software products are Windows based software. No Mac versions at all.
You would need some sort of Windows on your Mac to use Encore...people have done it with something like Bootcamp or Parallels.

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Drpjfitz
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Location: Dallas, TX

Re: Increasing Pressure

Post by Drpjfitz » Tue Jul 07, 2015 5:30 pm

My Mac software is OS X 10.5.8. I can't update it because my laptop is so old it doesn't have enough RAM. Until I get a new one, I'm limited. So, I need an older version of Sleepyhead if there is a link to that?

BTW, are the AHI's I listed above considered outside what is acceptable?

Thanks!

Pam

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Julie
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Re: Increasing Pressure

Post by Julie » Tue Jul 07, 2015 5:40 pm

You don't 'update', you just install like I did and I only have Snow Leopard.

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Pugsy
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Re: Increasing Pressure

Post by Pugsy » Tue Jul 07, 2015 6:06 pm

Generally AHI less than 5.0 is considered "acceptable".
For myself I also include "as long as I am sleeping well and feeling decent".

It looks like your AHI is trending downwards. How would you answer the "sleeping well and feeling decent" question?

_________________
Machine: AirCurve™ 10 VAuto BiLevel Machine with HumidAir™ Heated Humidifier
Additional Comments: Mask Bleep Eclipse https://bleepsleep.com/the-eclipse/
I may have to RISE but I refuse to SHINE.

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Drpjfitz
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Joined: Sun Sep 14, 2014 9:06 am
Location: Dallas, TX

Re: Increasing Pressure

Post by Drpjfitz » Tue Jul 07, 2015 6:57 pm

Juie--Upgrade, download, I don't have enough RAM to download the updated software. My MacBook Pro is probably 7 years old. I just hate the idea of putting out the cash for a new one at this point. Still paying off medical bills, unfortunately.

Pugsy--I upped the pressure setting from 8 to 9 on Saturday night which is the only explanation for the trending down of my AHI. I have continued to feel very tired even when I get 8 hours of sleep with the CPAP which is why I increased the pressure on Saturday night. My goal is to just feel more normal... Although I'm able to get up on time for work, I am exhausted by 7:00 or 8:00p.m. I generally go to bed at 8:00 or 8:15 to read for a while. Asleep by 9:15 or so to get up at 5:30a.m. Honestly, by Thursday I'm dragging myself into work and then am exhausted over the weekends...

Pam

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Pugsy
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Re: Increasing Pressure

Post by Pugsy » Tue Jul 07, 2015 7:32 pm

Can you get a compressed/zipped copy of your SD card uploaded to some place like dropbox online storage where we could snag it and use our software to get you some recent detailed reports?

If you are getting around 7 to 8 hours of sleep....how is the quality? Do you wake often?
Do you take any meds? If so, what? even OTC.

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I may have to RISE but I refuse to SHINE.

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Drpjfitz
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Re: Increasing Pressure

Post by Drpjfitz » Tue Jul 07, 2015 8:34 pm

Pugsy--just tried to access Dropbox and wouldn't you know, it no longer supports my Mac software and requires that I update to the version that I can't use on my computer. Gee, I'm getting a strong message that I need a new computer.

On a good night, I only wake up once and am able to fall asleep again within five minutes. That is the majority of my nights. No medication needed for me--I've always been a good sleeper. The only time I have trouble sleeping is when I have a lot on my mind and can't turn it off. This happens once every month or two. As I said, I'm a very good sleeper.

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Pugsy
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Re: Increasing Pressure

Post by Pugsy » Tue Jul 07, 2015 8:52 pm

I don't know if there would be anything on your software reports that might possibly be a culprit in your unwanted daytime issues.
Some people say they notice a marked change in how they feel with an AHI of 5.0 and with an AHI between 1 to 2. I never could see that big of a difference myself unless my AHI was way higher.
It's possible that you need to give the new pressures more time.
It's also possible that something else is the cause of your unwanted symptoms. I know we all like to put all our unwanted symptoms in the sleep apnea basket and expect the cpap machine to fix them all but sometimes it just can't or it takes its own sweet time fixing things.

If you can figure out a way to get me a copy of that SD card...I can get you some reports to at least look to see if something stands out that has room for improvement.

_________________
Machine: AirCurve™ 10 VAuto BiLevel Machine with HumidAir™ Heated Humidifier
Additional Comments: Mask Bleep Eclipse https://bleepsleep.com/the-eclipse/
I may have to RISE but I refuse to SHINE.

If you want to try the Eclipse mask and want a special promo code to get a little off the price...send me a private message.