Determine Max Pressure Setting

[photosmike]

I am at 11.60/15.0 pressure with mostly no snores, very few events, low AHI (1<) and I hit the max pressure every night. I have tried lower pressures and had similar results. It seems that the machine maxes out to the set pressure every night. Any advise is appreciated.

Mike

[Julie]

Have you not tried raising the high pressure to e.g. even 20? Because other than that your chart looks great. Many people leave the high setting 'open' at 20 or not far below it... it's the low setting that's more important and yours seems to be fine.

[chunkyfrog]

The AHI of .63 is excellent, why fix what's not broken?

[palerider]

The AHI of .63 is excellent, why fix what's not broken?

there are some fairly significant flow limitations on that chart.

[LSAT]

The AHI of .63 is excellent, why fix what's not broken?

+1 You have too much time on your hands

[Pugsy]

How are you sleeping and feeling?
Are you experiencing any nasal congestion?

Those flow limitations are likely what is driving the pressure...they may or may not be all that important in the grand scheme of things but the machine doesn't like them. Flow limitations will cause the machine to increase the pressure in an attempt to reduce/prevent the flow limitations. Flow limitations are reductions in air flow that don't meet the criteria for either hyponea or apnea...either the percent of reduction isn't enough or they aren't lasting at least 10 seconds. They may or may not be impacting how you feel or how you are sleeping...that's why it would be nice to know how you are sleeping and feeling.

Sometimes nasal congestion will show up as flow limitations and cause the machine to want to go higher with the pressure but more pressure probably won't fix nasal congestion flow limitations.

If you want to try to reduce the FLs...and stop seeing the max pressure being hit (which really isn't that big of a deal because you aren't maxing it out and staying there) just raise the maximum limit to something higher than the 15. How much higher we don't know. It might be something as little as 0.5 cm or it might want to go higher.
The machine won't go where it doesn't think it has a good reason to go to but sometimes the higher pressures cause more problems than they fix....like aerophagia or arousals.

If you are sleeping well and feeling good there probably isn't any urgent need to do anything in terms of that maximum pressure. It's not pegged out all night and the AHI is nice and low. Just because someone hits the maximum pressure briefly during the night doesn't necessarily mean that anything needs to be done.
Now if you aren't sleeping well at all and you feel like crap during the day...then maybe reducing the FLs might help (assuming they aren't from nasal congestion) and probably would be worth at least trying.

[photosmike]

How are you sleeping and feeling?
Are you experiencing any nasal congestion?

Those flow limitations are likely what is driving the pressure...they may or may not be all that important in the grand scheme of things but the machine doesn't like them. Flow limitations will cause the machine to increase the pressure in an attempt to reduce/prevent the flow limitations. Flow limitations are reductions in air flow that don't meet the criteria for either hyponea or apnea...either the percent of reduction isn't enough or they aren't lasting at least 10 seconds. They may or may not be impacting how you feel or how you are sleeping...that's why it would be nice to know how you are sleeping and feeling.

Sometimes nasal congestion will show up as flow limitations and cause the machine to want to go higher with the pressure but more pressure probably won't fix nasal congestion flow limitations.

If you want to try to reduce the FLs...and stop seeing the max pressure being hit (which really isn't that big of a deal because you aren't maxing it out and staying there) just raise the maximum limit to something higher than the 15. How much higher we don't know. It might be something as little as 0.5 cm or it might want to go higher.
The machine won't go where it doesn't think it has a good reason to go to but sometimes the higher pressures cause more problems than they fix....like aerophagia or arousals.

If you are sleeping well and feeling good there probably isn't any urgent need to do anything in terms of that maximum pressure. It's not pegged out all night and the AHI is nice and low. Just because someone hits the maximum pressure briefly during the night doesn't necessarily mean that anything needs to be done.
Now if you aren't sleeping well at all and you feel like crap during the day...then maybe reducing the FLs might help (assuming they aren't from nasal congestion) and probably would be worth at least trying.

Thanks Pugsy,

I have nasal congestion almost all of the time. Allergy and Asthma also (under Doctors care). I seem to be allergic to everything. The machine seems to help my breathing at night. I feel ok during the day but, become sleepy in the afternoon. As you can see, I wake up several times at night. What do you suggest as to how to proceed?

[Pugsy]

Hmmm. Wonder if the higher pressures are causing the wake ups??
Wonder if the nasal congestion is maybe causing the machine to go kill those flow limitations??
Wonder if the nasal congestion is the cause for the FLs shown...wonder if those FLs are really in the airway behind the tongue and the flow reduction itself is causing the wake ups.

I have a lot of questions but only one for sure answer...the multiple wake ups during the night will sure mess with your sleep quality and cause a person to not have the optimal sleep cycles and that can sure make a person want to nap during the day.
Will fixing the wake ups mean no need for naps...I don't know but it's a place to start.

The hard part is figuring out for sure what is causing the wake ups and fixing it.

Two ways to proceed...let the machine go try to kill the FLs by allowing more pressure or reduce the max pressure a little and ignore the FLs along with the fact that the machine will max out the pressure fairly often.
Letting the machine go to war against the Fls will result in more pressure and I suspect that it probably won't help the FLs all that much since you complain of a lot of allergy type congestion but I can't be 100% sure of that.

If you look back on your other nights detailed reports...look to see if the wake ups seem to pretty much come right after or during a period where the max was reached. That might help in determining which way to go first.
Or is this night shown just a fluke and you have lots of wake ups when the pressure is not so high.

Flow limitations in the airway down behind the tongue are one of the things that drive these auto adjusting machines. They do it because FLs can be a warning sign that a bigger tougher airway collapse is trying to happen so that's why the machine increases the pressure. When the FLs are in the nose the machine can't really tell where the problem is...only that there is a problem and it still wants to go to war but it might be a battle that it can't win no matter how much pressure it blows up the nose.

Have you tried using EPR exhale relief? Sometimes the ebb and flow of EPR feels more natural and people can sleep a little better with "more natural". Not everyone of course but enough that makes it an option worth trying if you haven't already tried it. You certainly have room in the AHI to maybe try it.

So...either increase the max and see what happens with the FLs and your sleep quality...it may go totally in the toilet with the machine being able to go to full battle stations or it may help the FLs and help the sleep quality if the FLs get reduced. If you see a lot of wake ups on the other reports like this one though...I am betting more chance of it going worse into the toilet in terms of wake ups.
Or reduce the max and ignore the FLs and make the machine ignore them too...and you would have to ignore the fact that the machine is going to want to fight the FLs.....see if that helps the sleep quality.

Right now the sleep quality is what I would focus on because without good sleep quality (reduce those wake ups) it doesn't matter how good the AHI is.

Oh...do you take any medications that are known to mess with sleep quality or cause wake ups?
So...if you take any meds...what are they? A lot of the usual meds for nasal congestion will mess with sleep quality despite having a "may cause drowsiness" sticker on them. Same with some pain meds.
All this talk of FLs and pressures may be a moot point if you take a medication that could also be a factor in the wake ups.

What would I do in this situation? Tough one but I think I would back up and reduce the max to see if it's the higher pressures causing the wake ups. That is of course assuming that there are no meds we can lay partial blame on and it's not the nasal congestion itself waking me up. I know from my own self...if I can't breathe well through my nose I simply can't sleep well. Fortunately that is a rare happening for me.

So these are the experiments I might consider and bear in mind that improving sleep quality is the primary goal with out allowing a truck load of apnea events to occur
1...just reduce the max to say 13 and see what happens
2...add EPR into the current settings to see if "more natural" maybe helps with the existing pressure variations
3...open the machine up to 20 and see where it wants to go in terms of killing those FLs on the off chance that those FLs are in the airway behind the tongue and not in the nose and the airway partially closing is the cause of the arousal. If it goes to 20 and those FLs don't reduce...they are probably in the nose and nothing is going to reduce them in terms of pressure so might as well don't even try. This experiment would at least give you the greatest chance of an answer for "where are those FLs coming from".

So...remember the primary goal...good sleep quality with minimal wake ups so that we have a greater chance of not needing those naps during the day which I call excessive daytime sleepiness (with or without a nap as a result).
Your AHI is fine and there's even room for allowing a couple of apnea event flags slide through the defenses if it means that you are sleeping better. So if reducing that maximum allows a couple of hyponeas or OAs get a flag...but it let's you sleep better...it's a worth while compromise.

If it's the nasal congestion itself that is causing the wake ups then you have to address that issue in the usual manner that we address nasal congestion...more or less humidity, meds, saline spray, netipot rinses, etc...whatever works.

If it were me and I saw a lot of wake ups on the other reports associated with the maxing or near maxing out of the pressure...I think I would try option 1 first.
That is of course assuming that medication side effects have been ruled out.