Should you modify your normal pressure when using a travel machine?

[tmetme]

Question: Should you modify your normal pressure when using a travel machine?

AT home I use an airsense 11, CPAP mode at pressure 11, EPR 2. AHI averages 0.95 and I feel rested. I recently bought an airmini for travel and have tried it out with a humidx. I've found that the pressure is more intense, maybe due to it having a 15mm slimline tube instead of a 19mm tube like my full-size setup. I've increased EPR to 3 which makes it more tolerable while on auto ramp. My AHI has been higher thus far when using it, around 2.0, although I've only used it a couple of nights. Should I adjust the pressure, or try autoset to see where it goes?

Jason has previously advised me to go higher on my pressure (up to 15), but I haven't done it due to aerophagia. I'm keeping my eye out for a bi-pap on FB marketplace to pick up and try out higher pressures some time. My sleep doc wouldn't prescribe a bipap.

[ChicagoGranny]

AHI averages 0.95

AHI has been higher thus far when using it, around 2.0

Statistically insignificant.

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I've found that the pressure is more intense

Jason has previously advised me to go higher on my pressure (up to 15)

How do you rate Jason's advice?

[tmetme]

His advice to switch from APAP to CPAP was good and reduced my AHI and provided some noticeable benefit. In APAP my AHI had averaged 1.4. Jason observed RERAs, hypopneas, and general flattening

But as I mentioned on CPAP mode I haven’t been able to get the pressure up as high as he recommended. Hason sais I still have some back to back RERAs on occasion at 11 but that it’s not too bad. If I get my hands on a bipap I’ll try 15 again.

[ChicagoGranny]

His advice to switch from APAP to CPAP was good and reduced my AHI and provided some noticeable benefit. In APAP my AHI had averaged 1.4. Jason observed RERAs, hypopneas, and general flattening

You are using CPAP 11.0 pressure now. What were your pressure settings when you were using APAP?

[tmetme]

His advice to switch from APAP to CPAP was good and reduced my AHI and provided some noticeable benefit. In APAP my AHI had averaged 1.4. Jason observed RERAs, hypopneas, and general flattening

You are using CPAP 11.0 pressure now. What were your pressure settings when you were using APAP?

APAP 6 to 20, EPR2. 95% pressure was around 8. Nasal pillows with mouth taped. Low humidity setting of 2.

[ChicagoGranny]

APAP 6 to 20, EPR2

This is where Jason demonstrates his lack of knowledge of APAP machines and APAP settings.

The problem was not that you needed CPAP instead of APAP. The problem was that your APAP minimum pressure was set very low for your pressure needs. Jason is also wrong about other subjects. Now, you may have a lifelong bias against APAP because of Jason's misunderstanding. A bias that can make your CPAP therapy suboptimal.

Jason is a great guy but he is like everyone else on this planet....not perfect in their thinking.

He's right about one thing though....the machine doesn't do anything during an event and only increases the pressure after the event happens and usually either has some other criteria that has happened or more events and then the machine does some thinking and decides to increase the pressure in an effort to PREVENT whatever just happened from happening again.

These machine's can't respond in the blink of an eye (except ASV machines can) and it's always been that way.
Yes, what Jason talks about "can" happen but that's when the machine's baseline minimum pressure isn't set up optimally.

The whole idea with using the auto adjusting algorithm is to set the machine to a minimum pressure that prevents the bulk of the airway collapses and then can also increase IF NEEDED for whatever outliers might be going on.
Special circumstances that cause a need for higher pressures short term.

I am a prime example of a good reason for using apap mode and not a fixed mode. I asked Jason one time what he would suggest I do given my REM worse OSA and a need for 6 to 8 cm MORE pressure in REM.
I get by just fine for all the other parts of the night I am not in REM with about 9 cm pressure but in REM I have seen upwards of 16 to 18 cm. By his thinking I need 16 all night long just to deal with the 20% of the time I am in REM.
It's doable I suppose but I am not fond of the idea and I bet I would be having aerophagia issues with that much constant pressure all night. Stupid ass idea IMHO. He hemmed and hawed a bit but would never give me a straight answer.
I don't fit his perfect mold and the fact of life is that most people don't fit his mold.

The minimum pressure IS THE MOST CRITICAL pressure setting though. Giving someone an apap set to 4 to 20 which is really the factory defaults with no thought to a real setting is in most cases going to end up with what Jason describes happening. Duh....easy fix....increase the minimum to act like that fixed pressure he wants to use but set a range that the machine can go to IF IT NEEDS TO GO up to deal with the special circumstances....like my REM worse OSA.
Or maybe for someone whose OSA is worse on their backs but they don't sleep on their backs all that much.

So I don't know why Jason is so reluctant to accept that auto mode can work if you set it up optimally to start with but that's just the way he is. I call it old school...just like some docs are old school.
When I set my machine to a minimum of around 8 or 9 and give it a range for the special circumstances and I see the machine go to over 12 and I have seen 18 cm...it can do a great job and I sleep right through the changes.

Jason also doesn't like EPR because it can cause centrals in some people. Well it doesn't cause centrals in everyone and I see no reason to punish 95% of the people who like or need EPR just because EPR "might" cause centrals in the other 5 % of the people. Actually I don't think that it is 5%....probably more like 2 %. We just see it here a lot because the people who don't have a problem aren't coming here to fix a problem they don't have.
We just get the problem people here. The people who don't have a problem have no reason to come here. So we do see more problems.

Like I said...Jason is a great guy and I love him to death but he is definitely an old school stick in the mud who just doesn't want to admit that auto mode can work as long as the minimum pressure is optimally set in the first place.
I respect his views...but I certainly don't agree with them.

Set the minimum in auto mode up better to PREVENT most events and then for the outliers like my REM sleep we let the machine sort it out.

Or I could use 15 cm all night....geez...that's a f'ing stupid idea. Why in the hell would I want to do that?

[tmetme]

ChicagoGranny, thanks, I’ll try this. What would you suggest for a min pressure on APAP mode? 11? Or instead 9 which was my old 95% pressure when using APAP 6-20?

[ChicagoGranny]

The AirMini is not supported by SleepHQ nor OSCAR. I won't try to help you optimize the machine settings because there is no detailed data to monitor the results. Sorry. Maybe another member wants to take a stab at it.

[TCLynx]

ChicagoGranny, thanks, I’ll try this. What would you suggest for a min pressure on APAP mode? 11? Or instead 9 which was my old 95% pressure when using APAP 6-20?

Test it out on the different pressures and see how you do I guess since I haven't seen anyone with experience with them giving you any experienced advice. Sounds like you have some Ideas where to start.