Would you recommend lowering pressure? Air leaving vent keeps me up at higher levels.

[Pugsy]

For whatever reason the machine isn't wanting to be very aggressive with its auto adjusting algorithm in an attempt to prevent the OAs and hyponeas. It doesn't really do much of anything until around the 03:20 mark and even then it doesn't do much.
The short segment after the break in therapy...I doubt you were asleep but remember the machine doesn't know sleep status. So what it did (which wasn't much) try to do was probably in response to awake breathing irregularities.

You need more minimum most likely....if the flagged OAs and hyponeas are asleep events.
If the bulk of your AHI is awake breathing irregularities then you would of course need to work on what might be causing all the awake time.

Respironics machines in their auto adjusting algorithm are notoriously slow in response. It's been that way ever since I started cpap therapy back in 2009 with a Respironics machine.

You've come to the point in your experiments with lowering the pressure where the lower pressures are most likely allowing more apnea events to happen and those apnea events can and will also disturb sleep.

You need more minimum for sure. Now do you need more maximum...dunno because most likely the machine won't want to go very high so the minimum is going to be your critical settings and that's the case in most situations.

If you could get your hands on a ResMed auto adjusting machine...might be interesting to see how you sleep and do with it over the Respironics.

[Robb]

Got it. I will increase the minimum to 7, and will keep the max at 10, since I don't think the machine has gone beyond 9 ever anyway. Will take a look at the Respironics machine. Thanks a lot.

[palerider]

Got it. I will increase the minimum to 7, and will keep the max at 10, since I don't think the machine has gone beyond 9 ever anyway.

Then set it to 20.

[ElusiveSleep]

* Your leak rate is too high and you need to solve it. It's either due to poor mask fit or mouth breathing.
* I had high leaks and deduced it was mouth breathing by taping my mouth for one night (the leak rate was zero).
* Until you you reduce leaks to a negligible level, it will be difficult to know the minimum and maximum effective pressures.
* I overcame mouth breathing by using a soft cervical collar. Various chin straps were not helpful.
* With the collar, my leaks from mouth breathing have never exceeded the threshold of 24L/min (ResMed APAP), and on several nights, the leak rate has been ZERO.

[ElusiveSleep]

* Your leak rate is too high and you need to solve it. It's either due to poor mask fit or mouth breathing.
* I had high leaks and deduced it was mouth breathing by taping my mouth for one night (the leak rate was zero).
* Until you you reduce leaks to a negligible level, it will be difficult to know the minimum and maximum effective pressures.
* I overcame mouth breathing by using a soft cervical collar. Various chin straps were not helpful.
* With the collar, my leaks from mouth breathing have never exceeded the threshold of 24L/min (ResMed APAP), and on several nights, the leak rate has been ZERO.

Just realized you have a Philips machine and it shows the vent rate (the vent rate vs. pressure graph for this mask is here: https://www.resmed.com/us/dam/documents ... er_eng.pdf).

Mouth breathing can occur without overt leaking detected by the machine. This sometimes shows up as a particular pattern in the flow rate.

Artificial detection of apnea by the machine algorithm can occur when the flow rate goes awry due to even the briefest of awakening, which you may not be aware of, and also can happen if you are changing sleep positions.

[chunkyfrog]

And, it's a Respironics . . .

[palerider]

* Your leak rate is too high and you need to solve it. It's either due to poor mask fit or mouth breathing.

Please don't talk about things when you have no idea what you're talking about, the OPs leak rate is very well controlled.

irrelevance

It'd be good if you just deleted your whole post.

[Robb]

Last night I used my Bleep mask, as I just received the filter. The air coming out the holes was keeping me awake before, but not last night since I used the filter. Results look much better. Bumped up minimum to 7. Forgot to increase max, but will do so tonight. I am more tired than usual, whichis kind of odd, given my low AHI score, but I realize there must be other factors involved as well. Thanks a lot.

screenshot-20210108-065111.png (96.8 KiB) Viewed 921 times

[Pugsy]

If your machine never reaches the max of 10 then changing it to something higher is unlikely to change anything.
The max doesn't do anything if never reached. My machine will go to 25 and I set it to the max just to cover any "what ifs" that might happen but it's very rare that I see even 15 cm anymore. I suppose I could set the max to 15 but I know that it doesn't matter what the max is. If the machine doesn't want to go there...it won't and it becomes a moot point. Having a maximum that is a lot higher doesn't really change the way the machine responds if it never goes there.

Your minimum pressure is going to be your most critical setting in that regard and coupled with the Respironics auto adjusting algorithm you may end up needing a little more minimum. The machine doesn't want to go higher but it appears you may need it to go higher so in this situation you have to help it out with more minimum. I see this a lot with some Respironics users...and actually saw it in my own results when I was using the Respironics apap. It simply couldn't or wouldn't respond quickly enough to deal with my pressure needs in REM stage sleep where my OSA is much worse and I just need more pressure to hold the airway open.

If your machine never wants to go above 9 cm...then setting the max to 10 or 15 or 20 isn't going to change where it goes.

My suggestion is a few more nights at your new minimum and see how things go and if the trend you see from last night continues then a little more minimum should be tried.

[Robb]

If your machine never reaches the max of 10 then changing it to something higher is unlikely to change anything.
The max doesn't do anything if never reached. My machine will go to 25 and I set it to the max just to cover any "what ifs" that might happen but it's very rare that I see even 15 cm anymore. I suppose I could set the max to 15 but I know that it doesn't matter what the max is. If the machine doesn't want to go there...it won't and it becomes a moot point. Having a maximum that is a lot higher doesn't really change the way the machine responds if it never goes there.

Your minimum pressure is going to be your most critical setting in that regard and coupled with the Respironics auto adjusting algorithm you may end up needing a little more minimum. The machine doesn't want to go higher but it appears you may need it to go higher so in this situation you have to help it out with more minimum. I see this a lot with some Respironics users...and actually saw it in my own results when I was using the Respironics apap. It simply couldn't or wouldn't respond quickly enough to deal with my pressure needs in REM stage sleep where my OSA is much worse and I just need more pressure to hold the airway open.

If your machine never wants to go above 9 cm...then setting the max to 10 or 15 or 20 isn't going to change where it goes.

My suggestion is a few more nights at your new minimum and see how things go and if the trend you see from last night continues then a little more minimum should be tried.

Makes sense, thank you. I had looked back 6 wks ago and remembered I had levels over 10, so last night I figured it couldn't hurt to turn the max level up to 12. I also increased my minimum to 8, and my AHI was the lowest it has ever been. Of course, one night is just a snapshot, so I am going to try 8 again and see if the AHI stays low.

screenshot-20210109-183032.png (97.04 KiB) Viewed 887 times

[Pugsy]

That little spike to almost 11 cm is nothing more than a normal pressure probe spike and it means nothing. The machine wasn't responding to anything special. It was just testing the waters.

How did you sleep last night? Pretty solidly or very many wake ups?

[Robb]

That little spike to almost 11 cm is nothing more than a normal pressure probe spike and it means nothing. The machine wasn't responding to anything special. It was just testing the waters.

How did you sleep last night? Pretty solidly or very many wake ups?

Gotcha.

I slept very soundly compared to usual and just 3 wake ups that I am aware of, which is better than the 6+ usual. Felt sleepy today, but as you said in a pm, I need to give it time