my S9 VPAP auto is topping out at 24.8 cmH2O should I worry?

[space45]

not sure if I should play with lowering the top pressure number from the default of 25 seeing as it goes up the 24.8 and goes close to that some what regularly.

I was assessed as extremely extreme apnea with 80 plus AHI and o2 down to 47% before getting the machine

also wondered how much playing around I should do, I have been on it now for about 6 days, new machine I bought with 4 masks to try out.

anyone else running such high numbers?

[JDS74]

Six days is way too early to be even thinking about changing your numbers.
Do you have a copy of both your sleep-titration study and your prescription for your machine?

These would help to understand what is going on.

I have a different type of machine, ASV, and it regularly gets to 25 cm H2O when I stop breathing with what I think are central apnea events, so your number may not be out of line with what you need.

Do you have reporting software for your machine? The ability to post graphics of the data from your machine will be of great help in understanding what is going on.

[space45]

no prescription and no sleep-titration study, I live in Canada and can just buy one off the shelf.
yes to software both sleepyhead and resmed, also have a o2 meter and it records and charts as well, but has its own software

what would be the best way to post info, I did do a PDF file from resmed report and it has graphs, that was a one day one but could do a 6 day one, thing is when I am awake I throw all sorts of events and that messes with the data, and it can take awhile to get to sleep so there is plenty of messing around with data done. need a way to edit data to rid bad data or set sleep times

Six days is way too early to be even thinking about changing your numbers.
Do you have a copy of both your sleep-titration study and your prescription for your machine?

These would help to understand what is going on.

I have a different type of machine, ASV, and it regularly gets to 25 cm H2O when I stop breathing with what I think are central apnea events, so your number may not be out of line with what you need.

Do you have reporting software for your machine? The ability to post graphics of the data from your machine will be of great help in understanding what is going on.

[krassus]

I'm not sure if I understand the problem. If the pressure is going up when you are not breathing, isn't that good? It is not as if the pressure is instigating a central apnea, because it starts at the lower value when you exhale and then increases as necessary, or am I missing the point?

Oh and lucky Canadians, I should immigrate.

[space45]

here is a link to a report from day or 2 ago, the cmH2o was not as high that day, about 23.5

https://app.box.com/s/1wwek4g2kz1saql0simy

[Pugsy]

What are your pressure settings and more importantly how did you come by choosing those?
What is your pressure support setting and how did you come by choosing that large of a PS? Looks like 6.8??? Is that right?
Looks like EPAP minimum is 11 cm...with PS of 6.8 and allowing IPAP to go to max of 25.
That's a lot of PS....normally around 4 cm is a good starting point.

[space45]

I did start at PS 4 but my o2 levels were very low, I have a o2 meter as well, not a resmed one. before I was on PAP my o2 levels would drop as low as 47% and levels in 50s and 60 were more of the norm, they came up some as I raised the PS, that is how I got up to a PS of 6.8, now my o2 levels are low 90% hi 80% most of the time. I did lower the max to 20 but it was going up to that so I thought I would raise it back to the default 25 to see just how high it would go, it has gone as high as 24.8 so far. as for the low of 11, it would go up and stay up, the lows are around 12 or so, so I thought 11 would be a good number seeing as it never goes below that anyway. I was just tightening thing up some.

so 6.8 to get my o2 up to around 90, low of 11 seeing as it was not going below that and a high of 25 seeing as 20 was looking low. it is high, very high that is why I am asking

What are your pressure settings and more importantly how did you come by choosing those?
What is your pressure support setting and how did you come by choosing that large of a PS? Looks like 6.8??? Is that right?
Looks like EPAP minimum is 11 cm...with PS of 6.8 and allowing IPAP to go to max of 25.
That's a lot of PS....normally around 4 cm is a good starting point.

[Pugsy]

I think the EPAP of 11 is the thing I would modify first. It's too low IMHO and can't get to where it needs to be quickly enough.
Often if EPAP is more optimal the maximum doesn't go so wild.

I have used the same machine you are using and had max wide open but it never got close to maximum.
There was some occasional spiking but nothing like what you are seeing.
I would look at EPAP minimum first.
In general...EPAP for OAs and IPAP for hyponeas and I have found that if OAs reduce that hyponeas also will reduce as a byproduct and rarely does IPAP have to be pressure to alter.

If your O2 as low...maybe it was low from the OAs that were happening because EPAP wasn't able to do an optimal job.
EPAP would be my first choice to change...not PS. When you get PS to high it can trigger unstable breathing.

How much to change? 1 or 2 cm or somewhere in between would be a good place to start but remember as long as PS is 6.8...IPAP is forced up there by default.

[space45]

thanks for the info and help
made the changes you suggested and my o2 stayed up so that was good, the inrush of pressure was gone, kind of miss that as it helped full the lungs more but all in all it was ok.
will try it for awhile and see how it goes. the pressure did come down tad, around 22 tops when asleep, but was just there one time and a short time at that, Ok just checked and that 22 was when I woke up at night so when sleeping it was not near as high as before, between 18 and 20 is where is settled down. so thanks again for the settings tip.

funny thing is I enjoy and look forward to going to sleep now days, very strange feeling indeed.

I think the EPAP of 11 is the thing I would modify first. It's too low IMHO and can't get to where it needs to be quickly enough.
Often if EPAP is more optimal the maximum doesn't go so wild.

I have used the same machine you are using and had max wide open but it never got close to maximum.
There was some occasional spiking but nothing like what you are seeing.
I would look at EPAP minimum first.
In general...EPAP for OAs and IPAP for hyponeas and I have found that if OAs reduce that hyponeas also will reduce as a byproduct and rarely does IPAP have to be pressure to alter.

If your O2 as low...maybe it was low from the OAs that were happening because EPAP wasn't able to do an optimal job.
EPAP would be my first choice to change...not PS. When you get PS to high it can trigger unstable breathing.

How much to change? 1 or 2 cm or somewhere in between would be a good place to start but remember as long as PS is 6.8...IPAP is forced up there by default.

[nanwilson]

[quote="space45"]no prescription and no sleep-titration study, I live in Canada and can just buy one off the shelf.
yes to software both sleepyhead and resmed, also have a o2 meter and it records and charts as well, but has its own software

You cannot buy a machine in Canada unless you have a prescription to have one. No "buying off the shelf". There are a bunch of us Canadians here on the forum and we all needed an rx to get a machine. A cpap machine is a medical item, prescription required in every province and territory in Canada.

[space45]

it your going through insurance then for sure yes

all I can say is I could have bought a new PAP machine locally from a medical supply store no questions ask, other then do you want a mask with that. their base line unit at the mom and pop place was resmed S9 APAP auto, $2300.00 plus tax no mask and I could have walked out with it.

I got a VPAP auto with 4 masks for $1560 out the door from the net thanks to some help on a forum, paid 200 and something in taxes at the door and I was PAP happy. it came through the border with FULL disclosure no hanky panky as I AM a law abiding guy. so if I needed a script why did it come though with out any questions? no border guys contacted me at all, little on asking about a script

even the sleep shop that was pushing a cheap $1500 Philips brick CPAP did not send me to a sleep study. one night with a o2 finger probe and they paid $50 to a doc and I was good for a sale. no prescription and no sleep-titration study, if there was a script from the $50 doc I never seen it. plus how could he of written a script when he had no idea about what settings, all he could say is I needed one, and the IRS shop that wanted to sell me a unit, all they did was some lame a$$ trial and error by ask me a few question as they tweaked the settings over a few days, some sleep-titration study.

so I am also talking from first hand experience, mine was very different from yours.

if it was not for the forums and the help I got from the good folks on the net I would still be PAP less and in a fog driving around from doc to doc and not getting any of the help I needed. the say they are clueless would be a promotion from what they really are when it come to sleep apnea.

no prescription and no sleep-titration study, I live in Canada and can just buy one off the shelf.
yes to software both sleepyhead and resmed, also have a o2 meter and it records and charts as well, but has its own software

You cannot buy a machine in Canada unless you have a prescription to have one. No "buying off the shelf". There are a bunch of us Canadians here on the forum and we all needed an rx to get a machine. A cpap machine is a medical item, prescription required in every province and territory in Canada.