Straying FAR from the norm with settings, but positive results

[AHI88]

Hi All, I was never ever happy with the high pressure settings, I've always found it FAR too much and ripping off my mask. I always see the normal recommendations are that "your max pressure is too low" ??
Out of despair, I've strayed from this to see my individual experience and pleased and quite shocked with a pleasant result ?

Upon my lab sleep test my median pressure was prescribed at 14, (ohhh my AHI was severe at 81)

Please can i have your input and views on my results below ? My range is set EXTREMELY NARROW, yes only 5 to 7, but although reaching the ceiling very often, I've really had a good night (8 hours is the best i've ever done in almost a year) with almost NO events ?

Your opinion will be highly appreciated

[Snoregone Conclusion]

It appears you've got it dialed in to where it works well for you (It appears to have a low AHI with the information visible).

It doesn't matter if it doesn't meet with other's approval for the range, it matters that you get good results for you. If that's the range that helps you get the best sleep that's the best treatment, go with it until things change. If going up higher causes you disturbed sleep when it happens (doesn't look like it should happen often, if those are your consistent nights) then seeking "perfect" 0 AHI may not be the best objective.

That being said, with the understanding that snoring long-term causes things to get worse, if you can manage to get the snoring down to nothing (ideally) in theory that should keep things from getting worse to where you need the much higher pressures later by having a little higher pressures now: it does depend on what the machine is sensing for the cause of the snoring. If it's in your nasal area from congestion, that may not be readily resolved.

It appears from your leak graphs that either your mask fit isn't the best (leaks may be disruptive to you, or perhaps not, that's an individual thing) or perhaps that's an indication you're sleeping well enough you don't even notice when you roll onto your face and dislodge things. The biggest leak time appears to be at startup when it gets the seal down, but otherwise it doesn't appear to be a big deal, and shouldn't affect results assuming you're not disturbed by what remains of leaks.

[ChicagoGranny]

Upon my lab sleep test my median pressure was prescribed at 14

Sleep labs only have one night to get the pressure right. They are often wrong. You have many nights to get it right.

BTW, what is a "median prescribed pressure"?

[Dog Slobber]

Your AHI might be low, but you have a lot of Snores and some Flow Limitations that could be reduced. There is more to sleep disordered breathing than events.

You have an aversion to higher pressure, increase you maximum pressure from 7 to 7.2, and your minimum from 5 to 5.2. The difference is so slight, you won't feel it.

Make the change in the morning so you're not dwelling on it while trying to fall asleep.

Wait a few days, increase by 0.2 again.

[djams]

You have an aversion to higher pressure, increase you maximum pressure from 7 to 7.2, and your minimum from 5 to 5.2. The difference is so slight, you won't feel it.

Make the change in the morning so you're not dwelling on it while trying to fall asleep.

Wait a few days, increase by 0.2 again.

This is great advice - based on personal experience. I did 0.4 min pressure increases weekly myself. Didn't even notice the difference when I did the weekly changes.

Doing it in the morning is something I didn't think about. That's a nice bit of icing on the cake.

[raisedfist]

You still have a decent amount of flow limitation and snoring. It would be normal for labs, or anyone really, to increase pressure in light of this.

As suggested, I would go slow and slightly boost the min and max pressure over time.

When I started bi-level any amount of pressure was frightening because, well, having a mask on which is connected to a machine providing positive airway pressure is weird and not normal.

If you now turned on bi-level at the starting recommendations of 8/4 I would be starved for air and checking the machine to make sure it's turned on.

[Pugsy]

Please can i have your input and views on my results below ? My range is set EXTREMELY NARROW, yes only 5 to 7, but although reaching the ceiling very often, I've really had a good night (8 hours is the best i've ever done in almost a year) with almost NO events ?

Well..... there is more to obstructive sleep apnea than just the flagged events...snores and flow limitations are indications that the airway is trying to close up. The fact that your AHI is low simply means they didn't grow up enough to earn an OA or hyponea flag.
Doesn't mean that they aren't potential troublemakers in terms of messing with your breathing or sleeping.
They are the reason you are seeing the pressure maxed out so much. The machine wants to kill them...it's part of the auto algorithm...it is designed to kill/prevent those snores and FLs because they are the first warning signs that the airway is trying to close off.

If you feel markedly better after this result from last night....and if using more pressure to try to kill those snores and FLs causes more problems in terms of your sleep quality and how you feel....then don't use more pressure. There are worse things than letting a few snores or FLs slide.
You have to decide what give YOU the best results for YOU...and you have to decide which is more important to YOU.
Sometimes people have to make compromises and this might be one of those times.

Your machine wants to kill those snores and FLs....if going higher to kill them ends up messing with you more than the FLs and snores mess with your sleep...then an extremely limited max is probably what YOU need to do.

Now you can try increasing the max in teeny tiny steps....and it might work and it might not.

IMHO Number one goal...manage the OSA itself as best you can and still get good quality sleep and feel good. Without decent sleep and feeling good the pretty graphs and low numbers don't mean much.

[zonker]

Your AHI might be low, but you have a lot of Snores and some Flow Limitations that could be reduced. There is more to sleep disordered breathing than events.

You have an aversion to higher pressure, increase you maximum pressure from 7 to 7.2, and your minimum from 5 to 5.2. The difference is so slight, you won't feel it.

Make the change in the morning so you're not dwelling on it while trying to fall asleep.

Wait a few days, increase by 0.2 again.

+1

to the OP, the ability of the resmed machines to allow for adjustment of pressure by .2 played a very major part of me dialing in my settings and therefor optimizing my therapy.

give it a go, i believe this will work for you.

as to the narrow band of pressure, well, whatever works for you. and it obviously does!

continued good luck!!

[AHI88]

Thanks so much you all, I've enjoyed reading your tips and advice, I'll definitely see if small increments reduces the snores and FL. Tonight I'll do 7.2

Thx again

[zonker]

Thanks so much you all, I've enjoyed reading your tips and advice, I'll definitely see if small increments reduces the snores and FL. Tonight I'll do 7.2

Thx again

hat-tip.gif

be sure to give your new pressure increase a few nights to "settle in", as dog slobber indicates.

and please come back in to this thread to let us know how it goes!

[AHI88]

So I've taken all your advice and went from 5-7 to 5-7.4.

Still feel I had a good sleep, 6.5hrs and i feel well rested. From the snoring and FL charts it looks better, once again your time and advice to assist will be much appreciated.

I also see that with the 0.4 increase much less hitting the ceiling in the pressure graph

[zonker]

So I've taken all your advice and went from 5-7 to 5-7.4.

Still feel I had a good sleep, 6.5hrs and i feel well rested. From the snoring and FL charts it looks better, once again your time and advice to assist will be much appreciated.

I also see that with the 0.4 increase much less hitting the ceiling in the pressure graph

thanks for letting us know. this all looks good to me. yup, you've got it now to where it isn't hitting it's head on the ceiling.

are you going to try any higher?

not that i'm suggesting it. i'm just wondering.

good luck!

[AHI88]

So I've taken all your advice and went from 5-7 to 5-7.4.

Still feel I had a good sleep, 6.5hrs and i feel well rested. From the snoring and FL charts it looks better, once again your time and advice to assist will be much appreciated.

I also see that with the 0.4 increase much less hitting the ceiling in the pressure graph

thanks for letting us know. this all looks good to me. yup, you've got it now to where it isn't hitting it's head on the ceiling.

are you going to try any higher?

not that i'm suggesting it. i'm just wondering.

good luck!

I'll leave it for a few days and see, then I'll hit 7.6 and monitor and compare charts etc.

[djams]

So I've taken all your advice and went from 5-7 to 5-7.4.

, increase you maximum pressure from 7 to 7.2, and your minimum from 5 to 5.2.

Just want to point out that the advice was to raise both min and max.

[AHI88]

WOW WOW WOW !!! This is really working great, im really liking this very low settings and the data shows it