Is it possible to adjust pressure?

General Discussion on any topic relating to CPAP and/or Sleep Apnea.
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Leatherneck
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Is it possible to adjust pressure?

Post by Leatherneck » Thu Aug 07, 2008 8:26 am

I've been keeping track of my basic numbers for a bit now and am wondering if I might need a bit more pressure. It came to me set on 5, but when I read the data it says 4.8 pressure - 0 leaks/7.3 AHI/6.1 HI/1.2 AI.

S8 Elite

I switch between a Swift LT and a comfort classic but have only taken readings after the Swift so I'll see if there is any difference with the nasal mask.

Just wondering if I have to go to the doc if I feel I might like a little extra pressure. Can't see how bumping it 1 could hurt?


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Wulfman
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Post by Wulfman » Thu Aug 07, 2008 8:32 am

Yeah, you might be a little low. Also, if you switch masks, be sure to change the mask definition settings in the machine (if they're applicable).

You should be able to find the instructions in this thread:

viewtopic/t33730/still-struggling-after ... tment.html


Den
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birdshell
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Post by birdshell » Thu Aug 07, 2008 9:07 am

Probably 1 cm won't be too dangerous, but what I would do first is to phone the doctor's office and report your symptoms. But, that is just me.

I did set my own pressure up one point, BUT: When I had the third PSG, the tech told me that I could use a 12 cm or a 13 cm. My machine was set at 12 cm, but when I took it in to the DME provider for a humidifier problem, they set it back to my initial titration pressure of 9 cm. Unfortunately, they did not tell me that.

After a couple of weeks of starting to feel crappy, I finally had a friend (who is a tech) look at my pressure. NINE CM??? Image So she talked me through the process, and decided to try 13 cm. It has been a good move for me, and I WAS told that 13 cm could be a good choice of pressure for me based on results.

Some machines are off a bit in their calibration. The AWAKE group here has a pressure check available for any machine at every meeting. That might be something you would like to have checked. If you have a good relationship with your DME provider, they should also be able to confirm that the machine is accurate. One other thing about ResMed machines is that they set pressures in 0.2 cm increments. Your 4.8 pressure makes one wonder if you are calibrated properly?

That said, there is at least one newer machine out that has a +/- 1 cm adjustment. This is an openly available patient choice on that machine. Sorry, I cannot recall which machine. Image

The Elite is a CPAP machine, I believe, NOT an adaptable CPAP. You may want to consider buying an APAP because it will absolutely determine, from within a range of pressures, what you TRULY need as a pressure at each moment. Thus, you should have a range of set pressures. The machine adapts to your needed pressure instantaneously. The machine will also have data reporting and management capabilities.

Now, if you are looking for information on how to change your pressure, search the forum OR the Internet. There is one online DME company that has manuals on their website for ResMed machines, but I can't recall that name either. It was referenced from one posting on the forum, but WHERE? HAH! I don't know... Image

Of all the things I've lost, my detailed memory is one that I have missed the very, very most. However, there is Google, which can be a friend or seem to be an enemy.

Best wishes,

Karen
Who is trying to get an APAP


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Slinky
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Post by Slinky » Thu Aug 07, 2008 12:05 pm

Leatherneck, are you using the EPR feature? That would reduce your reported 95th percentile pressure. You exhale half the night and inhale half the night which will bring your reported pressure down.

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Leatherneck
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Post by Leatherneck » Thu Aug 07, 2008 12:43 pm

Slinky wrote:Leatherneck, are you using the EPR feature?
I know a lot of acronyms after 20+ in the Corps, but the CPAP acronyms are all new! I'll go through what settings I can find when I get home tonight.


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Slinky
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Post by Slinky » Thu Aug 07, 2008 1:09 pm

EPR = expiration pressure relief. Resmed's equivalent of Respironics' C-Flex. Settings are: 1 (1 cm), 2 (2 cms) and 3 (3 cms).


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Snoredog
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Post by Snoredog » Thu Aug 07, 2008 1:14 pm

I would increase your pressure to 6.5, that should bring the AI down. Don't be alarmed if HI rises after you do that, if it does just increase pressure a bit more to lower it.

EPR is Expratory Pressure Relief or Exhale Pressure Relief same thing. It lowers pressure on exhale by what ever you have it set to, but I don't think it works if you are at the minimum pressure settings. Even if you set it to 3 with your current pressure of 5 it would only lower exhale to 4 cm pressure.

Use of EPR effectively lowers your OSA splint pressure ability or lowers the effectiveness of pressure for the sake of exhale comfort.

For example if you were titrated in the sleep lab with an ideal pressure of 10 cm using their labratory equipment THEN are issued a machine with EPR and use a EPR setting of 3 you are effectively only getting 7 cm of treatment pressure. (CPAP Pressure -EPR setting = treatment pressure).

However, in the presence of certain SDB events EPR will become disabled (or supposed to) it may back off a 3 setting to 2 to 1 as events dictate. As EPR becomes disabled it has a similar effect of increasing pressure. The drawback to doing this is it may "allow" some events to persist where if a lower EPR was used or it was off would never be present.

The pressure that eliminates nearly all SDB events is the constant pressure maintained on exhale or EPAP pressure. Technically a machine that uses separate IPAP and EPAP pressure is a bilevel but they appear to skirt that issue by not changing IPAP and/or maintaining it. IPAP is set by CPAP pressure setting, EPAP gets adjusted by use of EPR, with the latter manipulated by events seen.

someday science will catch up to what I'm saying...

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Slinky
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Post by Slinky » Thu Aug 07, 2008 1:14 pm

Whew! You can even BREATHE at 5 cms of pressure?? You sure don't want EPR turned on if your set pressure is 5 cms!

Most of us need AT LEAST 5 cms to breathe w/a CPAP mask on, and usually that would be for expiration.


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Leatherneck
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Post by Leatherneck » Thu Aug 07, 2008 5:30 pm

I just went through the settings. My pressure was set at 5 with EPR at 3. Seems like it could be det more effectively to I turned the pressure up to 6 and left the EPR as is? Maybe I will go 6.5 like mentioned.

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Slinky
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Post by Slinky » Thu Aug 07, 2008 6:58 pm

Leatherneck, we usually recommend making only ONE change at a time and stayng w/that ONE change for ONE week before making another ONE change for ONE week so that you have at least one week of data to base your decisions on. One night does not the entire story tell. We don't sleep the same every night.

I would suggest that you leave your pressure setting as it is at 5 cms and turn the EPR off. (You can't go to 6.5 cms of pressure anyway, Resmed pressure settings go by .2 cms). You obviously have been breathing comfortably at 5 cms of pressure w/the EPR setting dropping you to 4 cms of pressure on exhale so I would make haste slowly in self-adjusting your therapy pressure.

When using the ComfortClassic you should be switching your Mask Selection to Standard. The allowed vent rate for the Standard mask setting is .4 L/M or 24 L/s. You then have to check your ComfortClassic literature for the vent/pressure chart and do your own math. Your accumulative data so far isn't any too accurate if you've been alternating masks. (And a mask change counts as ONE change).


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Leatherneck
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Post by Leatherneck » Thu Aug 07, 2008 7:15 pm

O.K. I will set the pressure back to 5 and turn off the EPR. Right now I am using the Swift so the mask setting is on swift. If I put the pressure back to 5 then the EPR setting will be the only change at this time.


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Slinky
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Post by Slinky » Thu Aug 07, 2008 10:14 pm

Well, I'm the conservative type and that is the way I would do it and I think you are wise to do the same. Next week you can change to 6 cms w/o EPR and see how you do. Keep in mind how you feel as well as the data in making decisions on any changes. We can have nights of great data and feel rotten the next day and vice versa so one week at one change gives us a better picture of how things are going.

It can be HARD to be this patient!

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Leatherneck
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Post by Leatherneck » Fri Aug 08, 2008 6:08 am

I appreciate all the help thus far. Things already look and feel better!

I kept my pressure setting at 5.0 and turned off EPR like recommended. My numbers before and after:

4.8 pressure
0.0 leaks
7.3 AHI
6.1 HI
1.2 AI

after no EPR

5.2 pressure
0.0 leaks
3.9 AHI
3.5 HI
0.4 AI

Completely easy to breathe with no EPR at that little pressure.


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Post by bearcatx16 » Fri Aug 08, 2008 7:01 am

Leatherneck:

Thanks!, for your service. If you want to know more about the Elite feel free to PM me.

Semper Fi
Sgt. 63-67
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roster
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Post by roster » Fri Aug 08, 2008 7:09 am

[quote="Leatherneck"]I appreciate all the help thus far. Things already look and feel better!

I kept my pressure setting at 5.0 and turned off EPR like recommended. My numbers before and after:

4.8 pressure
0.0 leaks
7.3 AHI
6.1 HI
1.2 AI

after no EPR

5.2 pressure
0.0 leaks
3.9 AHI
3.5 HI
0.4 AI

Completely easy to breathe with no EPR at that little pressure.