Should I set a higher pressure? Apap + nosepillow.

[Andréa]

Hi!

Thanks for input!

Then I'm not unike having over 10 i max pressure

I'll try changing my setting according to your tips, see how that works.

I have most of my apneas in REM i believe, in the morning hours.

About my FL, I'm at my nose's peak the first hours of sleep, as I am then newly sprayed up my nose with decongestant, so that can't be the reason for higher FL in the beginning of the sleep cycle. Interesting is that tonights data showed 0.5 FL for a stretch of about 15 min. when I was wide awake reading a book. I'll play it cool for a a week or two, see where it goes.

Now I'll adjust my settings and go to bed. Cross your fingers. I'll be back!

Again, anda always, thanks! <3

I asked my sleep nurse about this and he said that almost nobody using nose pillow need max pressures above 10.

What a load of BS. That is one of the most idiotic statements I have ever heard of and I have heard a lot really stupid stuff coming from DME techs.

Am I some kind of extreme? Tell me that people need above 10 as max to wipe out apneas, even with nose pillow!

LOTS of people need a lot more than 10 cm while using nasal pillows. Myself included. I have seen 16 to 18 cm pressure needs and I have always used nasal pillow mask of some sort.

Though most likely it is your minimum pressure that would give you the most bang for your buck in reducing the AHI OA numbers. Look at what the pressure is doing when those OA clusters happened. I can't tell exactly what it was at but I don't think you were at the 10.2 max at that time. Now earlier in the the night you were at the 10.2 max.
I actually think you could use 9.0 or better yet 9.4 cm minimum with even higher max limitation and improve things just a little bit more.

It's the minimum pressure that does the majority of the obstructive apnea prevention anyway...not the maximum.

Odd that your FLs were worse at the beginning of the night and settled down later. Were you having some nasal congestion maybe early in the night that cleared up?? Or maybe on your back more earlier in the night and on your side later?
Or I wonder if you are like me and your OSA is worse in REM stage sleep and those wee hours of the morning are when we see more REM and that's the cause of the clustering of events later.

[Andréa]

Thanks for input and thoughts!

//A

I asked my sleep nurse about this and he said that almost nobody using nose pillow need max pressures above 10.That I should settle. Am I some kind of extreme? Tell me that people need above 10 as max to wipe out apneas, even with nose pillow!

oh for goodness sake! and people wonder why we on the forum have such a disregard for sleep medicine people. when i was still on apap, i was running a minimum of 18 and a max of 20. i needed it to indeed wipe out apneas.

What's particularly alarming is we have a few morons here who keep running around insisting that therapy advice here should never be taken over "medical" advice.

They:

• Do everything they can to undermine the credibility of experienced and knowledgeable contributors
• Have signatures indicating information here should never be a substitute for medical advice
• Create topics suggesting posters should be posting their qualifications
• But have nothing to say when topics like this (and hundreds more) come up where the medical professionals clearly don't know what they're talking about and give asinine advise.

Simple question to these morons.
Whose advise should be followed?

• The "medical professional" who stated "almost nobody using nose pillow need max pressures above 10."
  or
• Dozens of experienced nasal pillow users with pressures over 10cm

[Andréa]

What's particularly alarming is we have a few morons here who keep running around insisting that therapy advice here should never be taken over "medical" advice.

sorry for a slight deril, andrea.

not much can be done about them. it's the policy of john goodman that each gets their own say, no matter if it's helpful in the end. not much can be done except push back without causing even more ruckus.

No worries!

¯\_(ツ)_/¯

now back to topic. in case my angry answer wasn't clear, i use the p10 nasal pillow mask. and i bumped up my own pressure in an effort to squash my apneas. worked, for a bit. then i moved on to a bilevel machine.

Ok, thanks for input. I tried a bilevel (where you set ipap and epap - right?), but it felt like someone was sucking the air out of my lungs, in attacks. I wanted to take much longer breaths than the machine setting said, aka my apnea nurse said. It felt like being suffocated. So we went back to Apap, to keep trying. My guess is that we maybe should have experimented a bit more than with one setting. But also, I'm too out of energy, 'cus of my ME/Cfs, to have shitty nights, which I get if trying bilevel again, but I have it as a back up plan. To do it thoroughly next time, if there will be one.

All the best!
//A

[Pugsy]

Interesting is that tonights data showed 0.5 FL for a stretch of about 15 min. when I was wide awake reading a book.

We pretty much just have to ignore what the machine might report when we know we weren't asleep.
Our awake breathing is just more irregular than asleep breathing but the machine only measures air flow because it has no way to know if we are asleep or awake. So our awake breathing isn't "normal" to the machine because of the irregularities and it will often report stuff that is not really going on. We must be asleep for anything flagged or reported to matter.
This of it as sort of a false positive and shrug your shoulders and move on.
We don't notice any difference in our breathing but there is a difference that the machine can and will sense and sometimes the machine things something is going on that really isn't going on.

BTW....when using your apap with EPR enabled...you are making your machine work like a bilevel works.
You have an inhale (IPAP) pressure and then you have the reduction that EPR gives you so that your exhale pressure (EPAP) is lower.
The main difference between a regular in name real bilevel is that you can use greater than 3 cm drop during exhale.
There are a couple of other minor little comfort settings that can also be used when someone doesn't feel like what the machine is wanting to do matches your own respiration to your satisfaction. Without knowing what settings they used on you during your bilevel trial it's impossible to hazard a guess as to why you had a problem with it but you are using bilevel now. You probably won't have a physical need to use one of the "real" bilevels like I do and this current machine seems to be doing a good job for you so it's doubtful you will need to change but if something happens and you do end up needing to change there are things that can be done to make the machine match your own respiration a little better.

[Andréa]

<3

Interesting is that tonights data showed 0.5 FL for a stretch of about 15 min. when I was wide awake reading a book.

We pretty much just have to ignore what the machine might report when we know we weren't asleep.
Our awake breathing is just more irregular than asleep breathing but the machine only measures air flow because it has no way to know if we are asleep or awake. So our awake breathing isn't "normal" to the machine because of the irregularities and it will often report stuff that is not really going on. We must be asleep for anything flagged or reported to matter.
This of it as sort of a false positive and shrug your shoulders and move on.
We don't notice any difference in our breathing but there is a difference that the machine can and will sense and sometimes the machine things something is going on that really isn't going on.

BTW....when using your apap with EPR enabled...you are making your machine work like a bilevel works.
You have an inhale (IPAP) pressure and then you have the reduction that EPR gives you so that your exhale pressure (EPAP) is lower.
The main difference between a regular in name real bilevel is that you can use greater than 3 cm drop during exhale.
There are a couple of other minor little comfort settings that can also be used when someone doesn't feel like what the machine is wanting to do matches your own respiration to your satisfaction. Without knowing what settings they used on you during your bilevel trial it's impossible to hazard a guess as to why you had a problem with it but you are using bilevel now. You probably won't have a physical need to use one of the "real" bilevels like I do and this current machine seems to be doing a good job for you so it's doubtful you will need to change but if something happens and you do end up needing to change there are things that can be done to make the machine match your own respiration a little better.