Raise APAP Pressure?

[sleepyguy1]

I was wondering if I should raise my pressure on my new AutoSense10 from a top of 20 to 22?

The pressure is set at 10-20 but in looking at the software, the pressure is at 20 every night for 2-3 hours, so it is maxed out for much of the night.

What is strange is that I have been using a Resmed S8 and Tuesday I got a new AutoSense 10. The software showed that for the Resmed S8 the pressure spiked at 20 a couple of times a night but only for a couple of minutes and did not stay there, but the pressure on the AutoSense10 shows it is there for 2--3 hours per night. Usually it is at 20 for a hour in the early night and for two hours solid in the early morning.

Also, can you please tell me how to change the pressure on the AutoSense 10.

[lilly747]

Your machine only goes to 20cm if it is an autoset. Raising the EPAP/Min might work if your pressure is staying way above the 10 mark you have it set on. Post a graph for better feedback/ideas.

If you need more than 20cm you need a bilevel.

[Pugsy]

With the change in models after the S8 series to the S9 and now the AirSense 10 machines there was a significant change in the algorithm after the S8 machines so the way the S8 worked and responded is expected to be rather significantly different from what you are seeing with your AirSense machine. So your time spent at max pressure being significantly different really isn't all that unexpected.

The 2 most common reasons for seeing rather dramatic changes/spikes in pressure needs are supine sleeping or REM stage sleep. If you are seeing the max being reach in those wee hours of the morning then it very well could be REM stage sleep because that's when we have more REM sleep. It's very common to need more pressure when sleeping on your back or when in REM sleep or maybe even a combination of both.
I have it for REM sleep but supine sleeping doesn't seem to affect my pressure needs. In REM sleep I would sometimes need 8 cm more than non REM time frames.

Are you seeing any events getting flagged when you are seeing the maximum being reached? If so, how many?
You may or may not need to go higher depending on the results you are seeing now. Just because you reach it doesn't always mean that you need to go all that much higher.
Can you post a typical report with lots of time showing maxed out at 20....?

If you really do need a higher maximum then that would mean a different model machine and in the ResMed the new models that go higher than 20 cm are called AirCurve (and there are various models within that model line).

As Lily says...sometimes we can maybe reduce the max needed when the minimum is set a little higher.
Holds the airway open a little better in the first place so the machine doesn't maybe have to work so hard later. Can't guarantee that would happen in your situation but I have seen it happen fairly often....when the minimum is more optimally set we find that the maximum either comes down on its own or stays up there less longer.

Here's a link for the provider/clinical manual for the AirSense. In it you will find instructions on how to change the pressure.
https://sleep.tnet.com/home/files/resme ... -guide.pdf

If we could see what you are seeing on your software reports it would help us a lot in giving you better advice about what you might consider trying to improve and/or even if it needs improvement.

[sleepyguy1]

Thanks for your advice and help.

If someone can tell me how to post a report I will do so. I am not overly computer literate and I do not know how to post it.

[Pugsy]

Check out these links.
The thread has examples of how we like to see the reports (we don't need all those many graphs)
and the second link has some good "how to get and post" the reports.

new screen shot thread that is better with Imgur stuff viewtopic/t103468/Need-help-with-screen-shots.html
IMGUR instructions from Krelvin https://sleep.tnet.com/reference/tips/imgur

[sleepyguy1]

Pugsy,

Thanks for your help. I can scan the drafts to PDF but is there any way to attach it to my Reply post? I can not see an "Attach" box.

[Pugsy]

There is no way to attach anything to our posts here at the forum like we can do at other forums.
We have to host the reports to some place on the web and then go get them with links. You could put your pdf at some place like Dropbox and then provide a link for a download but most of us prefer to just view the image from some place like imgur. It's better to see the image in the post than it is to have to go download something.
The links I posted above pretty much cover how to do it.

So you could take a screenshot of your pdf and then put that screen shot at some place like imgur.com and you get pictures of the reports embedded in your post here. The thread I mentioned above has examples.

[sleepyguy1]

Thanks. I will try to read the link you sent this afternoon and figure out how to do it. I am no overly computer literate.

[palerider]

I am no overly computer literate.

all repeating that does is hinder your progress.

it's like trying to learn to drive a car while constantly muttering "I can't drive a car".

"I can't play sports" "I'm no good at this".

self defeating attitude.

[sleepyguy1]

I am very reluctant to post images of medical report or chart by link because of an experience I had on this website about five years ago.

It was a similar situation where I was asking a question about a software report chart, and someone said I should post it. I said I do not know how, and someone explained how, to open an account at a website where people store their photos, and link to that, which I did, and then put the link in my CPAPtalk.com post. All went well with the post.

The only problem was that Facebook somehow saw on my computer that I had posted this image, and Facebook without my knowledge posted it on my Facebook page, and also sent an email with the medical chart to all of my Facebook friends saying "Hey, what do you think about Jim's photo. Write a comment to Jim on his timeline about his photo." I tried every way to take the medical chart off Facebook and finally the only way I could get it down was to close both my Facebook account, and also the account I had opened on the website where you store photos.

I assume that the Facebook Agreement says they can do that, but who would have remotely thought it?

Therefore if I can upload a PDF scan on a Forum I will o that, but I do not link to medical records after that, for not knowing what Facebook will do.

[Pugsy]

I have seen a couple reports...1 from the S8 and 1 from the AirSense 10. I will post them if OP tells me to.

Here's what I think the big difference is....the old S8 A10 algorithm where the machine wouldn't go over 10 cm unless it really, really thought it had a good reason. Old threads and discussion about it are in the archives but I don't have time right now to go hunting them.
The AirSense 10 apap mode is like the S9 apap mode where ResMed totally redid that algorithm for the S9 and no longer tied the machines hands at the 10 cm mark....essentially made the machine a lot more aggressive with the release of the S9. Criteria definitions for driving the pressure were changed greatly with the new S9 algorithm.

OP does spend some time maxed out at 20 cm but the times are for the most part very brief...more of the typical increases we might see in REM stage sleep cycles. Doesn't really stay there long and no clustering of apnea events at 20 cm which would mean that the machine really needed to go over 20 cm.

If it were me I would probably try the old "increase the minimum pressure a little" trick to see if it might stabilize that pressure line a little if it bugged me too much. I don't see any urgent need to do that unless the AHI gets a bit higher than we want or those pressuring changing around are disrupting sleep.
I don't see any need to have a bilevel device that will go above 20 cm at this time. There's plenty of room to play with that minimum pressure (which is the most critical setting anyway) if OP wants to tone down the roaming a little.

[Pugsy]

Here's one of the many old threads with discussion and explanation about that pesky A10 algorithm....and it has nothing to do with the Airsense 10 machines which are sometimes short cut named A10 machines.
See the 8th post from the top from forum member Ozij
viewtopic.php?f=1&t=36570&p=316992&hilit=A10#p316992
I didn't try the ResMed link but I bet it's broken because ResMed redid the whole website last year.

[sleepyguy1]

Thanks for your comments!

You can post the reports if you wish.

One more factor. For the night I sent you the report I had the Autosense10 set for the slimline tubing but was using the larger tubing.

Last night I put the slimline tubing on, and had it set for slimline, and the pressure chart was much different. It did not spend a length of time at 20. It spiked briefly at 20 3 times during the night.

In other words the pressure chart with the setting for tubing correct was much different than the Autosense 10 chart I sent you with it wrong, and was very similar to the chart from the S 8.

[Pugsy]

There's a reason there are different hose diameter settings...to complicate our lives I guess.
Actually the machine has certain things it goes on determined by various settings and if the machine thinks we are using one size hose and we are using another size then it gets things all confused and thinks it senses stuff that really isn't there and responds inappropriately.
So there may be a little of the A10 algorithm at play along with the wrong hose setting to further complicate things.

I can't upload to imgur at the moment (I have exceeded download allowance for the month...long story) so photo upload takes forever and a day. I will get a renewed allowance on the 11th at more workable speeds. Right now I am running on essentially dial up internet speed which works okay for the forum but makes image viewing and work really difficult.
Since a new potential culprit in the hose setting has come to light I don't think that we really need those report images at the moment since you report things essentially returning to normal.
If someone wants to see them...ask me on the 11th and I will get it done.

It never occurred to me verify hose settings...in the past when the wrong hose was selected people reported much different symptoms happening. So we both learned something out of this.

[sleepyguy1]

The whole report is a lot different. The AHI are much less. I will send you the report.

When I received the machine I just plugged it in and started using it and now am reading the instructions.