Pressure setting changes

[kaydacat]

I've officially been on xpap for 1 year now. My quality of life has greatly improved, but I'm still struggling to figure everything out. I recently got an APAP machine. When I did my sleep study, I was set on straight CPAP with a pressure of 7. I kept not feeling good, so my family doctor advised me to increase the pressures slowly. On my own, I had increased it to 13, and was feeling better, but still having a lot of daytime sleepiness. From reading on this forum, I decided to get an Auto Pap, and my family doctor agreed that would be a good idea. On the Auto Pap my average 90% pressure runs at 18.2, average CPAP pressure 17.2. Does that sound right??? I also got the EncoreViewer software and card reader, but I feel like I am reading a foreign language. My average leak is 51, my average AHI is 2.0. It seems like my AHI is good, but I think I am leaking too much. I recently just starting using tape, but then it seems like my mask won't seal well. Any suggestions???

Also, I tried A-flex, but it felt really weird. Right now I am using C-Flex at a setting of 1. Should I try to get used to A-flex, or does it matter?

Thanks for any help you can provide.

[jweeks]

Hi,

That leak number seems about double what it should be. Each mask has its own leak number, so you would have to look it up in the patient manual that came with your mask. When the leak number is high, the other numbers are going to be off, too. For example, the machine may have adjusted the pressure higher to compensate for the leaks. I think you need to figure this out, and once the leaks are under control, post back with some updated data.

-john-

[kaydacat]

Hi,

That leak number seems about double what it should be. Each mask has its own leak number, so you would have to look it up in the patient manual that came with your mask. When the leak number is high, the other numbers are going to be off, too. For example, the machine may have adjusted the pressure higher to compensate for the leaks. I think you need to figure this out, and once the leaks are under control, post back with some updated data.

-john-

I can't find the leak number for my mask. I misplaced the patient manual, and the one I found online, does not list the leak numbers. Any idea where I can find out this info online for the Mirage Active LT? Also, doesn't the leak number depend on the pressure? What if I don't know what pressure I'm at? My machine is set for 10-20.

[Wulfman]

You can download the mask user manual you need from the ResMed site.

http://www.resmed.com/us/products/masks ... c=patients


Den

[Muse-Inc]

Here's a graph of the vent rate for ResMed masks & the associated MASK SETTING to be entered into a ResMed flow generator: http://www.resmed.com/us/assets/documen ... sa_eng.pdf

According to the chart, at 18 cmH2O, the vent rate for the Activa LT is 43.

[kaydacat]

Here's a graph of the vent rate for ResMed masks & the associated MASK SETTING to be entered into a ResMed flow generator: http://www.resmed.com/us/assets/documen ... sa_eng.pdf

According to the chart, at 18 cmH2O, the vent rate for the Activa LT is 43.

Thank you very much!! Last night my leak rate was better. It was 47. So that means the actual leak rate was 4. Is that good? Or does it need to be at zero? Also, is it normal for a sleep lab to tell you you're pressure should be at 7, and then when you try an APAP, your median pressure is 18?

[DoriC]

I don't feel qualified talking about pressure settings but it does sound strange to me that the sleep study pressure is so "off" from what you're seeing. I'm hoping some of the others will possibly suggest making some adjustments.

[Muse-Inc]

Good leak rate, ideal is as close to 0 as possible and 47 is close. The pressure difference is confusing & I cannot understand why there is such a large difference. Gained lots wt since titration? Really stressed? New prescriptions? Lots of congestion-sinus problems?

[LinkC]

This is pure speculation, but it's possible the titration said 17 and the "1" got lost somewhere along the way...Stranger things have happened.

In any event, I'd go with what the Auto says. You might also tighten up that range a bit. The machine starts the night at the lower limit. If it detects apnea events, it bumps up a notch. Again. Again. Etc... By the time it gets to 18 (your most effective therapy) half the night is already gone (or maybe more!)

I'm uncomfortable recommending pressures with so little info, but let me tell you what *I* would do...and you can do whatever you think best. I would take the 90% pressure (18); and make the range from -1 to +2 (17-20) and try that for a week, while working on leaks. If the 90% pressure doesn't change, keep it there. If it changes, move the range accordingly. I bet if you...er..."someone" were to fix the leaks and use a tighter range, they would be seeing AHI about 1 in 2-3 weeks.

[kaydacat]

Good leak rate, ideal is as close to 0 as possible and 47 is close. The pressure difference is confusing & I cannot understand why there is such a large difference. Gained lots wt since titration? Really stressed? New prescriptions? Lots of congestion-sinus problems?

Actually I have lost 20 pounds since I started CPAP a year ago. I did start a new very stressful job about 3 months ago however. I have been extremely stressed, and sleeping a lot less. Could that really increase my pressure needs that dramatically? When I actually do lay down in bed, I fall asleep easily and stay asleep fine. I just don't actually go to bed as early as I used to because I work later, and have more to do. I used to sleep 9 hours a night, and now I only sleep 6 or 7 hours a night.

[kaydacat]

This is pure speculation, but it's possible the titration said 17 and the "1" got lost somewhere along the way...Stranger things have happened.

In any event, I'd go with what the Auto says. You might also tighten up that range a bit. The machine starts the night at the lower limit. If it detects apnea events, it bumps up a notch. Again. Again. Etc... By the time it gets to 18 (your most effective therapy) half the night is already gone (or maybe more!)

I'm uncomfortable recommending pressures with so little info, but let me tell you what *I* would do...and you can do whatever you think best. I would take the 90% pressure (18); and make the range from -1 to +2 (17-20) and try that for a week, while working on leaks. If the 90% pressure doesn't change, keep it there. If it changes, move the range accordingly. I bet if you...er..."someone" were to fix the leaks and use a tighter range, they would be seeing AHI about 1 in 2-3 weeks.

Thank you, LinkC!! That sounds completely logical to me!! I will try this and update later. Thanks for your help and wisdom!!!