APAP adjustments

[milboltnut]

Would anyone care to give some adjustment advice?

I try and seep on my side as much as possible, and wear a chin strap.

[jimbud]

If you can tolerate a little more pressure you might try min of seven.

Maybe prevent some of those OAs and Hypopneas.

JPB

Any reason why you are only getting aprox. 5 hrs on CPAP?

[milboltnut]

If you can tolerate a little more pressure you might try min of seven.

Maybe prevent some of those Hypopneas.

JPB

I tried 7...too much. It felt like the machine forced me to inhale, and I think it was.

[jimbud]

Have you tried going up in small increments?

Go up one notch for a few days to acclimate, then make another small increase.

'Bout all I got.

JPB

[milboltnut]

Have you tried going up in small increments?

Go up one notch for a few days to acclimate, then make another small increase.

'Bout all I got.

JPB

you know what bro... I thought about that... I can bump up to 6.5....

[DreamDiver]

Have you tried going up in small increments?

Go up one notch for a few days to acclimate, then make another small increase.

'Bout all I got.

JPB

you know what bro... I thought about that... I can bump up to 6.5....

I assume you've already got your EPR set to 3cm of exhale relief, correct?

I have to agree with JimBud. You can assimilate to the pressure slowly in increments by raising the min 0.2cm increments every few days or every week or so.
If you're aren't experiencing any aerophagia, after a while you may find yourself welcoming the higher pressure during sleep.

Chris

[milboltnut]

Have you tried going up in small increments?

Go up one notch for a few days to acclimate, then make another small increase.

'Bout all I got.

JPB

you know what bro... I thought about that... I can bump up to 6.5....

I assume you've already got your EPR set to 3cm of exhale relief, correct?

I have to agree with JimBud. You can assimilate to the pressure slowly in increments by raising the min 0.2cm increments every few days or every week or so.
If you're aren't experiencing any aerophagia, after a while you may find yourself welcoming the higher pressure during sleep.

Chris

You gotta spell out the jargon bro.. no air in the stomach, EPR you mean flex? I have Flex at 3. I only have increments of .5 for pressure

[DreamDiver]

You gotta spell out the jargon bro.. no air in the stomach, EPR you mean flex? I have Flex at 3. I only have increments of .5 for pressure

Looks like you're figuring it out. Way to go! Yeah, EPR and Flex are [EDIT: similar]. On a ResMed machine it means the constant pressure is dropped automatically by 3cm exactly as you exhale. Respironics machines may or may not use the exact same pressure relief scale, I'm not sure. From my own experience with Respironics, they tend to start the exhale relief a couple milliseconds earlier than is comfortable, causing my breathing to race. For others, it's perfect, though, so it's all about what works for you.

The jargon... Yeah, it's a lot to learn! It will absolutely help you to learn it. There's a really great wiki in the lightbulb area of the forum that has an explanation for a lot of jargon. If you get a spare moment, why not check some of that out? It may help you feel more comfortable with the cpap geek speak.

Chris

[milboltnut]

I assume you've already got your EPR set to 3cm of exhale relief, correct?

I have to agree with JimBud. You can assimilate to the pressure slowly in increments by raising the min 0.2cm increments every few days or every week or so.
If you're aren't experiencing any aerophagia, after a while you may find yourself welcoming the higher pressure during sleep.

Chris

You gotta spell out the jargon bro.. no air in the stomach, EPR you mean flex? I have Flex at 3. I only have increments of .5 for pressure

Looks like you're figuring it out. Way to go! Yeah, EPR and Flex are equivalent. "Exhale Pressure Relief". On a ResMed machine it means the constant pressure is dropped automatically by 3cm exactly as you exhale. Respironics machines may or may not use the exact same pressure relief scale, I'm not sure. From my own experience with Respironics, they tend to start the exhale relief a couple milliseconds earlier than is comfortable, causing my breathing to race. For others, it's perfect, though, so it's all about what works for you.

The jargon... Yeah, it's a lot to learn! It will absolutely help you to learn it. There's a really great wiki in the lightbulb area of the forum that has an explanation for a lot of jargon. If you get a spare moment, why not check some of that out? It may help you feel more comfortable with the cpap geek speak.

Chris
[/quote]


I can jack up the max too... 9 is what it usually is but the max on the machine is 20cm.??

[DreamDiver]

Respironics machines may or may not use the exact same pressure relief scale, I'm not sure.

They don't use the same scale for drop during exhale at all...and what you do get is based on how forcefully you breathe so there's no guarantee a person will get the maximum drop of 2 cm even at the setting of 3.

Thanks Pugsy, I thought I'd seen that somewhere.
Also, Ugh... Not a fan of that algorithm.

[DreamDiver]

I can jack up the max too... 9 is what it usually is but the max on the machine is 20cm.??

For those who don't have aerophagia as a problem, leaving the upper limit to 20cm isn't ordinarily the challenge. Most people find they'll regulate around a particular pressure regime. Our job is simply to find out for ourselves which limits are important.

The more helpful thing is finding just the right pressure to start at so that you're not seeing clusters of apneas due to pressure that's too low at the beginning. Some people with exceptionally high min pressures like to start with a ramp, but if your start pressure is 5 or 6, ramp is pretty useless.

Once you get used to a pressure regime that reduces your events to a reasonable level, you'll start sleeping better. Then it's a case of tweaking with tiny changes, testing those changes for a few days to compare with previous settings in order to maximize that time in sleep. That's the sum of it.

Chris

[Dog Slobber]

I tried 7...too much. It felt like the machine forced me to inhale, and I think it was.

Don't dwell on what was too much pressure earlier.

What was "a lot" of pressure in our first few days of therapy, becomes very manageable as we become accustomed to it. So long as we convince ourselves that it was too high, we'll never get past it.

• Take advantage of ramp
• Move up in small increments
• Stay at the interim levels for a few days
• When moving up, make the change in the morning. You might forget you've changed it and it's not on your mind laying their awake.

[DreamDiver]

I can jack up the max too... 9 is what it usually is but the max on the machine is 20cm.??

So the 95 percentile pressure is 9cm.
That means most of the time, your pressure was a little under 9cm.
Sometimes it goes higher, so it's not the max.

If my median were 6cm and my 95% were 9cm, I would think about trying maybe 7 cm or 8cm minimum pressure. I would leave the Max pressure at 20 for now, since it doesn't seem to be a limiting factor.

If that's too much to start, you could increment your min pressure up in 0.5 cm increments and watch every few nights to see if your AHI continues to fall.

Don't make changes every night. AHI may rise or fall a little anyway. You really need to average out a few days. AHI can hinge on diet, what happened that day, emotions, etc. Wait a few days between changes so you can see in general how your changes are affecting your AHI.

Go back to your last previous known setting regime if you experience a drastic increase in AHI.

That's about it.

Chris

[DreamDiver]

Don't dwell on what was too much pressure earlier.
...

• When moving up, make the change in the morning. You might forget you've changed it and it's not on your mind laying their awake.

What a great idea!

Chris

[milboltnut]

I can jack up the max too... 9 is what it usually is but the max on the machine is 20cm.??

So the 95 percentile pressure is 9cm.
That means most of the time, your pressure was a little under 9cm.
Sometimes it goes higher, so it's not the max.

If my median were 6cm and my 95% were 9cm, I would think about trying maybe 7 cm or 8cm minimum pressure. I would leave the Max pressure at 20 for now, since it doesn't seem to be a limiting factor.

If that's too much to start, you could increment your min pressure up in 0.5 cm increments and watch every few nights to see if your AHI continues to fall.

Don't make changes every night. AHI may rise or fall a little anyway. You really need to average out a few days. AHI can hinge on diet, what happened that day, emotions, etc. Wait a few days between changes so you can see in general how your changes are affecting your AHI.

Go back to your last previous known setting regime if you experience a drastic increase in AHI.

That's about it.

Chris

Ok so.... as I increase the start pressure gradually the max pressure will gradually increase?