Do you ever have trouble pulling in air?

brightcrow wrote: ↑

Sun Apr 08, 2018 8:53 pm

Which of my 2 issues in the OP would increasing the pressure be helping? Or both? And should I increase the max pressure too? Does EPR fit into this?

Yes, the start pressure if too low can make you feel short of air before going to sleep. The minimum pressure if too low is what you can go to in the middle of the night and again you can feel short of air.

The max pressure is another kettle of fish. You usually keep increasing that until no events are caused by it being too low. I can't really comment on it without seeing your detailed SleepyHead charts. But you said your provider told you you were never going above 10 cm. If you believe them, it should be fine at 10. It is better to have it too high, than too low.

That is the reason for doing SleepyHead. You see what is actually happening and don't have to depend on your provider to tell you and interpret the data for you.

TedVPAP wrote: ↑

Sun Apr 08, 2018 9:32 pm

Do you know how to make this change? This is not simply changing the ramp.

TedVPAP wrote: ↑

Sun Apr 08, 2018 9:47 pm

To make treatment changes, access to the clinician menu is needed. I don't have your machine but I have the manual. It says to depress the knob and home button together for 3 seconds and that should unlock the machine so you can change the minimum pressure setting.

Yes, this is what I did. Thank you.

Julie wrote: ↑

Sun Apr 08, 2018 9:35 pm

Your A or Cpap responds to how you breathe but does not breathe for you or change how you do it. You really need to understand what Apaps are for and you could look at the info notes at the top of the main page... it's really so basic - Cpap vs Apap. You should have been told exactly what the different machines do for you.

My most recent sleep study didn't meet clinical requirements for apnea, so they could not prescribe the machine or settings for that purpose. But I did have trouble with oxygenation, only I despised the oxygen concentrator and after a few months refused to use it. The AutoPAP was a compromise between my doctor and I, with the assumption that better quality of breathing at night would translate to better oxygenation. A home test confirmed improvement.

I do have problems with apnea, for sure, and so am trying to accommodate both issues. I am getting better quality of sleep than without the machine, and am no longer suffering with migraines and sleep deprivation as I had for most of my life.

I hope this clarifies. I need to revisit those notes you mention. When I first started using it I looked through many pages of notes from many years in the past, but most referred to CPAPs' not APAPs. There was such richness of information, but I kind of drowned in it. I'm sure I've forgotten a fair amount of it since then. Will read.

Note: Sorry to sound like an idiot but I look at the top of the main page and still only see posts from many years ago, none with APAP in the title. I'm pretty sure Apaps are pretty recent. It's so dense with information but I can't find what I'm looking for: Cpap vs. Apap. I become overwhelmed and can't find where to start for the basics you refer to.

Well... sorry... plain cpap delivers air at a fixed pressure (one setting) to keep your airway open a little better than it would be without it. Apap does the same thing (based mostly on a min. pressure setting - leaving the max, or higher one, set quite high) and allows the delivered pressure of air to vary according to what the machine believes is needed - all night, every minute, which makes it more responsive, or effective at treating your narrowed or closed (momentarily x however many times it happens each hour) throat/airway. A few people are too sensitive to the constant changes all night and find it wakens them, so they go on Cpap, or change their auto machine modes to Cpap - tho' plain cpap machines cannot do auto, but the majority prefer auto as it's more sensitive to their OSA.

The ramp, with its own settings based on time to reach the min. pressure setting (if one uses auto vs cpap) or the fixed setting in Cpap mode, is for most after the first week(s) turned off altogether unless their min. pressure setting is so high that they're uncomfortable at the beginning of the night so want to 'get there' (to the min. #) more slowly, tho' of course are not fully treated until that happens.

brightcrow wrote: ↑

Sun Apr 08, 2018 10:52 pm

I need to revisit those notes you mention. When I first started using it I looked through many pages of notes from many years in the past, but most referred to CPAPs' not APAPs. There was such richness of information, but I kind of drowned in it. I'm sure I've forgotten a fair amount of it since then. Will read.

What are you trying to learn? It's not very complicated for simple obstructive sleep apnea which is what you seem to have and most of us have. Ask questions in this thread. Also, here is a good overview of what sleep apnea is - https://www.youtube.com/watch?v=-gie2dhqP2c&t=5s And, here is a short wiki about APAP - wiki/index.php/AutoPAP

When first getting oneself educated, it may seem very complicated. But, the basics are really simple. Don't try to overthink things.

brightcrow wrote: ↑

Sun Apr 08, 2018 10:52 pm

I'm pretty sure Apaps are pretty recent.

APAPs have been in use a long time -

Jeremy Malecha, ResMed’s director of healthcare informatics, says ResMed’s first APAPAutoSet device was built in 1995 and has been clinically validated in numerous third-party tests and peer-reviewed journals for more than a decade.

brightcrow wrote: ↑

Sun Apr 08, 2018 9:23 pm

Ron AKA wrote: ↑

Sun Apr 08, 2018 7:23 pm

I think a minimum of 4 cm is too low for almost anybody, and will give you the "trouble pulling in air". At 4 cm all the pressure developed by the machine is lost in flow friction. If you feel 10 is the most you need for a maximum, then I would set the minimum at 6 cm, leave the Ramp in Auto, and set a Ramp Start (Pressure) at 5 cm. A 6 cm pressure is not very high, so the other option to try is simply shutting the ramp off and letting it start out at the 6 cm minimum.

I will try this tonight. Thanks.

Increasing the minimum pressure to 6 cm is a good first step. It may solve most of your problems. Or, you may need to increase the pressure a bit more (7.0). As a side note, I feel like I am starving for air at any pressure below 7.0. But, everyone is different. 6.0 cm may work fine for you.

Of course, if you still find your nasal pillows slipping into the nostrils because they are one size too small, that will need to be addressed.

Ask questions. People here love to help. If you get any snark, just ignore it and move on the next reply.

brightcrow wrote: ↑

Sun Apr 08, 2018 10:52 pm

My most recent sleep study didn't meet clinical requirements for apnea, so they could not prescribe the machine or settings for that purpose. But I did have trouble with oxygenation, only I despised the oxygen concentrator and after a few months refused to use it. The AutoPAP was a compromise between my doctor and I, with the assumption that better quality of breathing at night would translate to better oxygenation. A home test confirmed improvement.

There are two ways an APAP can help you with oxygen. First is with pressure. The higher you run the average pressure of treatment during the night, the more oxygen you will get. Higher pressure means more dense air. It is like moving down to sea level when you normally live at higher elevations. And the higher you set the exhale pressure relief, the more oxygen you will get. It works by improving the mass transfer of air in and out of the lungs.

That said, more oxygen can get some people in trouble with central apneas. That may not be you, but is something to watch for.

The AirSense 10 for Her machine is very flexible and cost aside is probably one of the best on the market. Could you get away with a fixed pressure machine (CPAP)? Yes probably, but it will not be any better than what you have, other than cost less, and not much. You can set your AirSense 10 to CPAP fixed pressure mode if you want to try it.

brightcrow wrote: ↑

Sun Apr 08, 2018 8:53 pm

Thank you so much for your help. Is my APAP supposed to make shallow breathing deeper? This is my main problem, shallow breathing, low oxygen. I use Ambien which contributes to that, but is necessary because it calms my severe Periodic Limb Movement Disorder at night.

Edit: I do think the difficulty pulling in air has to do with my pillows going in too deep sometimes, and it occurs only occasionally, not nightly. I'm still experimenting with using less lanolin at the edges of my nostrils so it's not unintentionally lubing the pillows.

Which of my 2 issues in the OP would increasing the pressure be helping? Or both? And should I increase the max pressure too? Does EPR fit into this?

@TedVPAP: I'd assumed my machine would compensate for my needs automatically. That's how it was presented to me. I check My Air daily and clean my equipment precisely on schedule. I spend more time on my APAP than I do with my beloved cat. I call it my other pet. I chose not to dive into the rabbit-hole of data because I don't want my machine to dominate my mental space any more than it already does. Please don't judge me.

The pillows are not supposed to go in the nose

Ron AKA wrote: ↑

Mon Apr 09, 2018 8:31 am

There are two ways an APAP can help you with oxygen. First is with pressure. The higher you run the average pressure of treatment during the night, the more oxygen you will get. Higher pressure means more dense air. It is like moving down to sea level when you normally live at higher elevations. And the higher you set the exhale pressure relief, the more oxygen you will get. It works by improving the mass transfer of air in and out of the lungs.

That said, more oxygen can get some people in trouble with central apneas. That may not be you, but is something to watch for.

Please stop posting about stuff that you have no 'effin clue about.

You're wrong, on all of these issues, but I don't have time right now to explain your wrongness.

I really appreciate the time and care you've shared with me. Yes, I did understand that much of APAP basic concept. In fact, neither my sleep doctor (neurologist) nor my pulmonologist had even heard of APAPs at the time. I had to tell them about it and convince them to give me one!

The pillows sit on the nose. (from Resmed's site)

Ron AKA wrote: ↑

Mon Apr 09, 2018 8:31 am

There are two ways an APAP can help you with oxygen. First is with pressure. The higher you run the average pressure of treatment during the night, the more oxygen you will get. Higher pressure means more dense air.

One standard atmospheric pressure is approximately 1033 cm H2O. A basic APAP delives a maximum of 20 cm H2O. That's about a 2% increase in pressure. The additional amount of oxygen delivered to the lungs is negligible.

Ron AKA wrote: ↑

Mon Apr 09, 2018 8:31 am

And the higher you set the exhale pressure relief, the more oxygen you will get. It works by improving the mass transfer of air in and out of the lungs.

Now, you just contradicted the first part of your paragraph. A higher setting for the exhale pressure relief means a tiny bit less pressure in the lungs. How do you square that with what you claim in the first part of your paragraph?

Let's stick to the fact that CPAP splints the airway open and stay away from imaginative ideas about other benefits that don't exist.

ChicagoGranny wrote: ↑

Mon Apr 09, 2018 3:37 pm

Ron AKA wrote: ↑

Mon Apr 09, 2018 8:31 am

There are two ways an APAP can help you with oxygen. First is with pressure. The higher you run the average pressure of treatment during the night, the more oxygen you will get. Higher pressure means more dense air.

One standard atmospheric pressure is approximately 1033 cm H2O. A basic APAP delives a maximum of 20 cm H2O. That's about a 2% increase in pressure. The additional amount of oxygen delivered to the lungs is negligible.

Ron AKA wrote: ↑

Mon Apr 09, 2018 8:31 am

And the higher you set the exhale pressure relief, the more oxygen you will get. It works by improving the mass transfer of air in and out of the lungs.

Now, you just contradicted the first part of your paragraph. A higher setting for the exhale pressure relief means a tiny bit less pressure in the lungs. How do you square that with what you claim in the first part of your paragraph?
Let's stick to the fact that CPAP splints the airway open and stay away from imaginative ideas about other benefits that don't exist.

Yes the 20 cm of water is small, but not insignificant. The common view that higher CPAP pressures can cause centrals is correct, but I also agree that the impact is small. My second comment does not contradict the first. Consider that at maximum inhalation the lungs are inflated with the highest density air due to the higher pressure. During exhale the pressure is reduced so the mass of the air is less. That means the inhale exhale cycle is more efficient due to the EPR pressure differential. You simply transfer in more air and get more air out.

Ron AKA wrote: ↑

Mon Apr 09, 2018 3:54 pm

My second comment does not contradict the first. Consider that at maximum inhalation the lungs are inflated with the highest density air due to the higher pressure. During exhale the pressure is reduced so the mass of the air is less. That means the inhale exhale cycle is more efficient due to the EPR pressure differential. You simply transfer in more air and get more air out.

That's nonsense. The amount of air inhaled and exhaled is controlled by the diaphragm and the intercostal muscles. All the CPAP is doing is splinting the airway open. Go do some studying before posting incorrect and insignificant stuff that will confuse newbies.

Brightcrow has some problems. She doesn't need to be confused by someone who doesn't know what the hell he is talking about.

There are some threads on here where experts are debating issues. Stick to those with your nonsense instead of ones where people are in serious need of help.

ChicagoGranny wrote: ↑

Mon Apr 09, 2018 4:22 pm

Ron AKA wrote: ↑

Mon Apr 09, 2018 3:54 pm

My second comment does not contradict the first. Consider that at maximum inhalation the lungs are inflated with the highest density air due to the higher pressure. During exhale the pressure is reduced so the mass of the air is less. That means the inhale exhale cycle is more efficient due to the EPR pressure differential. You simply transfer in more air and get more air out.

That's nonsense. The amount of air inhaled and exhaled is controlled by the diaphragm and the intercostal muscles. All the CPAP is doing is splinting the airway open. Go do some studying before posting incorrect and insignificant stuff that will confuse newbies.

Brightcrow has some problems. She doesn't need to be confused by someone who doesn't know what the hell he is talking about.

There are some threads on here where experts are debating issues. Stick to those with your nonsense instead of ones where people are in serious need of help.

It'd be better if he'd stick to asking questions about his *OWN* failing therapy, and not try to act like he understands anything, in any thread.

Ron AKA wrote: ↑

Mon Apr 09, 2018 8:31 am

There are two ways an APAP can help you with oxygen. First is with pressure. The higher you run the average pressure of treatment during the night, the more oxygen you will get. Higher pressure means more dense air. It is like moving down to sea level when you normally live at higher elevations. And the higher you set the exhale pressure relief, the more oxygen you will get. It works by improving the mass transfer of air in and out of the lungs.

No, as typical with your posts, this is wrong. The extra pressure results in greater expansion of the alveoli, which results in better gas exchange, and thus better oxygenation. That's why in bilevel therapy, the EPAP (PEEP) pressure is raised to increase oxygenation.

Ron AKA wrote: ↑

Mon Apr 09, 2018 8:31 am

That said, more oxygen can get some people in trouble with central apneas. That may not be you, but is something to watch for.

No, oxygen has nothing whatsoever to do with causing centrals. The respiratory drive is not dependent on oxygen, it's driven by carbon dioxide in the blood, and that's why too much pressure support, which increases ventilation (and CO2 blowoff) can depress the respiratory drive, causing centrals.

Do please stop posting your garbage 'theories'.