Are my pressure settings okay?

[MamaGord]

I was wondering if some the knowledgeable members could look at my sleepy time reports. My doctor started me on 6-12 for my pressure and that seems to be going in the right direction, I was diagnosed at a 20AHI and been under five since starting except for my first night which was an AHI of 6. I am still pretty tired during the day and so I just want to make sure I have my pressures optimized so then I can work on catching up on good sleep. I fall asleep pretty much right after I put on my mask and sleep mostly through the night, I only wake to use the bathroom. My mask fit feels great except I have had to tighten it twice when I have woke up and it has been in the high 13s, both times I was woken by one of my kids needing me.

Thanks in advance!

[Pugsy]

Any chance you were maybe on your back during the periods where the machine wanted to go higher?
Obviously some nights not much pressure changes and nice low AHI and some nights some rather significant pressure changes and higher AHI.
So it makes a person wonder why the differences in pressure...usual 2 suspects...REM stage sleep pressure needs and/or sleeping on one's back pressure needs. Both can commonly cause a person's OSA to worsen and need more pressure to hold the airway open.

Which detailed report to you see most often (and how long have you been on this theray?).
The April 5th or the March 31st?

[MamaGord]

I have been on the 7-14 since March 31st and I mostly see between 2-3 AHI. I totally could be sleeping on my back, I usually sleep on my stomach but every so often I will wake up on my back.

[Pugsy]

I think if it were me I might try a little more minimum pressure...like maybe 0.5 cm to 1.0 and see what happens.
That way if you do roll over on your back the machine maybe won't need to go so high and it will better prevent the airway trying to collapse.
If the pressure doesn't go so high...less likely for it to cause leaks to wake you up.
I have a similar situation where sometimes I need more pressure and sometimes I don't except mine is REM stage sleep. My OSA is worse in REM and sometimes the pressure needs are significant. We can't do much about limiting REM so I just use a little more minimum pressure.
Your current minimum is fairly low so there's some room upwards without likely causing a problem....then if you roll over on your back and need more the machine can handle things better and if it is REM related to can't do anything about that anyway.
Worth trying and if more pressure ends up causing more problems then maybe look at trying to stay off your back but for now I would let the machine try to sort it out and not force yourself to sleep in any one position. Trust me...it's easier said than done and often disrupts sleep even more.

[MamaGord]

Great, thank you so much. I will try to raise my lower pressure

[TedVPAP]

Congrats - you are doing great.
As pugsy said, increasing your min pressure will likely help you.
Keeping the minimum pressure higher usually eliminates the need for the machine to go as high, after having a number of events. In other words, a higher minimum pressure helps to avoid too much too late.
Raise the minimum pressure, track how you feel and your AHI for a week or two, then repeat. No hurry.

[MamaGord]

Thanks for the encouragement and reply, I will take it slow

[Ron AKA]

I would agree. Increase minimum pressure to 8 cm and see how that goes. You may even want to go higher to say 9 cm. The max pressure looks fine at 14. After you have settled on a minimum pressure you may even want to reduce it a bit to 13 or 13.5.

[palerider]

After you have settled on a minimum pressure you may even want to reduce it a bit to 13 or 13.5.

Why?

In other words, you don't know enough to even fix your OWN therapy, you shouldn't be giving "advice" to other people.

[Oltremare]

Hello,
just out of curiosity, I'd like to see the flow limitation chart, if available.
Thank you.

Oltremare

[Pugsy]

Hello,
just out of curiosity, I'd like to see the flow limitation chart, if available.
Thank you.

Oltremare

Not available on a Respironics machine report like there is with a ResMed report.
Instead Flow limitations are flagged individually up on the Events graph where the OAs, hyponeas, etc are all flagged and THEN only in auto mode.
See the Fl under RE??? That's how Respironics reports flow limitations. Just like a regular OA or CA or hyponea and you can zoom in on them the same way if you want.
She has a few FLs but not a horrible number by any means but still enough of them that I would recommend a little more minimum pressure....usually for a Respironics FL it takes very little more minimum to kill them off sufficiently.

Since FLs and RE (RERA)s aren't part of the AHI...when we see a number of FLs and REs along with maybe just a few more OAs and hyponeas than we would like to see...or we see clustering...we think a little more minimum pressure is needed because their presence points to the airway trying to collapse. Now it may not collapse to the point of earning an OA or hyponea flag but it's still not quite optimal therapy.

[Oltremare]

Pugsy you are a real well of knowledge!
I still have a curiosity:
With the Resmed chart, I see a continuous line rising and falling and its amplitude is directly proportional to the gravity of the flow limitation.
Respironics, how do you set a flow limit flag? Which benchmarks do you analyze to put a flag?

Thank you so much Pugsy

Oltremare

[Pugsy]

With the Resmed chart, I see a continuous line rising and falling and its amplitude is directly proportional to the gravity of the flow limitation.

Yep. As designed because Flow Limitations are part of what the auto adjusting algorithm is designed to aggressively try to kill.

As is the Respironics auto adjusting algorithm...as is all auto adjusting algorithms because Flow Limitations are normally warning signs of the airway trying to collapse.
I say "normally" because there are times that the machine mistakes maybe nasal mucosa swelling for airway tissue blockage and it's not the same thing.

Respironics, how do you set a flow limit flag? Which benchmarks do you analyze to put a flag?

You don't set anything. The machine flags whenever whatever criteria was used in the auto adjusting algorithm software.
You (cpap user) has no control over how or what the machine flags anything.
Now you can look at whatever the machine might flag just like you zoom in on any flagged event with Sleepyhead but as to changing it or what the algorithm's criteria is...that's deep within the patent and I have not needed or wanted to go there.
To be honest...the only evaluation I might do in terms of flagged FLs...how many and are they in clusters.
They aren't even available in fixed mode. So a person could have hundreds of them in fixed mode and the machine won't report a single one. It's one of the little things about Respironics that I don't particular care for.

[palerider]

Pugsy you are a real well of knowledge!
I still have a curiosity:
With the Resmed chart, I see a continuous line rising and falling and its amplitude is directly proportional to the gravity of the flow limitation.
Respironics, how do you set a flow limit flag? Which benchmarks do you analyze to put a flag?

Thank you so much Pugsy

Oltremare

Respironics doesn't tell us.

But, in general, this is what you look for: https://www.youtube.com/watch?v=3Ehb7U78P5w

[Oltremare]

ok,
I prefer the Resmed method, checking the graph, I can better understand my flow limitation.
The Respironics flag says nothing about the magnitude of the flow limitation, it can be big or small, I will not know it.

Thank you Pugsy and Palerider

Oltremare