Why does pressure jump so much? [SleepyHead pressure stats]

[appo]

It looks like my pressure jumps to the max and then drops a few times in the night.

Here is the SleepHead report screenshot: https://www.dropbox.com/s/0hmm4m1yphsjn ... 8.png?dl=0

Does this mean I need to increase the pressure?

Thank you so much!
-appo

[Pugsy]

Can you show us the flow limitation graph for the night you just posted?

I suspect that the FLs probably were a significant factor in the pressure variations.
Yes, you do max out occasionally but you never stay up there for very long...so from that aspect I don't think that more maximum is urgently needed. If allowing the machine to go a little higher doesn't cause a problem (aerophagia mainly) then it wouldn't hurt to allow it to go higher.

Are you sleeping decently and feeling decently?

If it is the FLs driving the pressure...more minimum is a better approach.

[appo]

Thank you Pugsy!

Here is the flow limitation graph: https://www.dropbox.com/s/yc1dlnqkq2ztd ... 5.png?dl=0

I was getting a lot of aerophagia at using 11-13cm pressure, so I changed it to 7-10cm.

I sleep decently if I don't have a high leak rate - sleeping on 4 pillows (kind of an incline) helps a lot with that.

It looks like the flow limitations do spike just before the pressure jumps - is that normal or a bad thing?

(It looks like it's pretty bad and could lead to arousals: https://www.youtube.com/watch?v=3Ehb7U78P5w)

[Pugsy]

Flow limitations "can" be disruptive to sleep but then as you have found out with the higher pressures, the pressure increases needed to deal with them can also be disruptive (the aerophagia) so you have to weigh the benefits vs the problem.
Your flow limitation graph is far from being horrible...believe me when I say I have seen much worse.
If you are sleeping decently (except for the leak issues which is an unrelated issue unless you are seeing the leaks only with the higher pressure) and aerophagia is not a problem with these settings then I would leave things alone.

Flow limitations are generally considered early warning signs that the airway is trying to collapse and part of the algorithm that dictates how the machine goes about doing its job. Your AHI is nice and low so whatever flow limitations you are having aren't growing up to become full fledged apnea events.

You are using a relatively small range...7 to 10 and the scale involved with reporting that small of a range sort of makes things look like there's a lot of rapid changes but if you were to zoom in closely the changes aren't so big and aren't so fast as it first looks like.

Since you know that with more pressure you have aerophagia issues...I wouldn't go increasing anything...there's no urgent need to do anything. Sit back and just roll with the flow and try to deal with the leaks as best you can.
Leaks are a war we never really win...they are just battles that sometimes we win and sometimes leaks win.
Your flow limitation graph isn't ugly enough to increase the minimum...but at some time if you want to give more minimum a try...as long as it doesn't worsen the aerophagia issue...it's something to consider but it's not something that is urgent by any means.

[robysue]

As pugsy has already said this is a case where the machine is responding as it is designed to respond to the flow limitations. Since the flow limitation graph settles back down after the pressure increase, that does indicate that these flow limitations are likely "real" in the sense of indicating an airway that is unstable and in danger of collapsing. The additional pressure stabilizes the airway--the flow limitation graph settles back down AND no events are scored---and so the pressure increase did what it was supposed to do.

If the relatively sharp increase in pressure is bothering your sleep, you could try bumping up the min pressure by 1 cm. That may be enough to help smooth things out where there are fewer times when the machine feels like it must bump the pressure all the way up to your max pressure.

[Pugsy]

Also...there is a chance ( I can't guarantee it ) that if the minimum was increased just a little that the airway would be better held open in the first place and you might not see the machine go up and kiss 10 cm so much.
I have seen it both ways...increase the minimum and the machine doesn't go up as much...and I have seen it where increasing the minimum didn't affect the movement upwards at all.

It's something you might want to consider trying at some time in the future if you just want to try something...tweaking as we call it.

[chunkyfrog]

Note to anyone curious about the supplier cited in appo's sig line:
Please feel free to compare prices with the hosts of this forum, cpap.com.
Freedom of speech: Johnny has lower prices.

[Pugsy]

To be fair..
EasyBreathe will file insurance in lieu of payment...cpap.com doesn't file insurance in lieu of payment.
Filing insurance costs money...both for just the cost of someone handling the billing and the waiting for the money from the insurance companies...plus some insurance do the rent to own thing and can take up to 13 months before all monies are paid.

Cpap.com keeps its prices low by electing to not file insurance in lieu of payment.
They will provide a universal insurance form so the patient can file the claim themselves...now whether the insurance company will reimburse or not...that's up to the insurance plan involved.
Medicare will not reimburse at all...so if someone is on Medicare and wanting Medicare to pay...you have to use a Medicare acknowledged provider.

If insurance isn't going to be involved...for sure check out cpap.com prices.

[chunkyfrog]

So, Easybreathe is, or is NOT a Medicare provider?

[Pugsy]

So, Easybreathe is, or is NOT a Medicare provider?

Last time I looked EasyBreathe took Medicare in lieu of upfront payment. I haven't looked lately but I suspect that they are still an option like Verus, Crapria, Liberty Medical, American Home Patient, etc for people wanting to use their Medicare coverage for payment.
Medicare is still shown in their list of insurance companies that they work with.
For 100% correct information I would suggest a person go to the website and follow the instructions for "what does my insurance cover".
If Medicare pays them directly...they are a Medicare provider.