Pressure too high cause tons of hypopneas?

2girlsmom · Post by **2girlsmom** » Thu Oct 30, 2008 10:18 am

Can too high of a pressure cause tons of hypopneas? I am going nuts waiting to discuss my situation with my sleep doctor next Tues. I am having 9 and 10 hypopneas an hour. The last couple nights my AI is low but I am still waking with headaches so I know something is not right. I find it hard to believe I really need higher than a 14 as I have good nights at other pressures that are lower, I just can't seem to have good nights consistently. I just fell asleep, thankfully my kids were behaving.

2girlsmom · Post by **2girlsmom** » Thu Oct 30, 2008 2:17 pm

a bump just in case anyone has an answer...

dsm · Post by **dsm** » Thu Oct 30, 2008 2:55 pm

2girlsmom wrote:Can too high of a pressure cause tons of hypopneas? I am going nuts waiting to discuss my situation with my sleep doctor next Tues. I am having 9 and 10 hypopneas an hour. The last couple nights my AI is low but I am still waking with headaches so I know something is not right. I find it hard to believe I really need higher than a 14 as I have good nights at other pressures that are lower, I just can't seem to have good nights consistently. I just fell asleep, thankfully my kids were behaving.

2girlsmon,

With the S8, your HI score is going to be typically around 2.0 to 3.0 on a good night. It is more sensitive in scoring HI events compared to most other brands - partly this is to do with different manufacturers scoring events differently.

Raising the pressure too high can indeed cause hypopneas -and these will show in your HI score on the machine. But, typically a hypopnea that appears when pressure is increased and in the higher CMs range, is going to be a central induced hypopnea. These are not necessarily too big a problem.

If you have a restless night's sleep, you are also likely to be moving around a lot and that is always a time when you will score more HIs especially on an S8. These types of hypopneas are again very normal. If you are a back sleeper, that too can cause big variation in scored HI events.

DSM

KengEsq · Post by **KengEsq** » Thu Oct 30, 2008 3:20 pm

2girlsmom wrote:Can too high of a pressure cause tons of hypopneas? I am going nuts waiting to discuss my situation with my sleep doctor next Tues. I am having 9 and 10 hypopneas an hour. The last couple nights my AI is low but I am still waking with headaches so I know something is not right. I find it hard to believe I really need higher than a 14 as I have good nights at other pressures that are lower, I just can't seem to have good nights consistently. I just fell asleep, thankfully my kids were behaving.

Maybe when you see your sleep doctor he/she can change your script to an APAP like the ResMed S8 AutoSet II (pretty identical to the S8 Elite II) and then you don't have to worry as much about the numbers. The auto adjusting machine anticipates and adjusts to the needed pressure and are set to a range (typically 4 to 20 cm H20).

2girlsmom · Post by **2girlsmom** » Thu Oct 30, 2008 4:59 pm

I guess this is just another thing to add to my list of reasons to switch out my Elite for an Autoset. I am just frustrated. I am 100% compliant (save my dozing here and there, but if I plan a nap, I wear my mask) yet I still don't feel good. I can see why people give up, for me that is not an option but I can see why people do if they still feel bad.

dsm · Post by **dsm** » Thu Oct 30, 2008 9:42 pm

Re the headaches, 1st thought that comes to my mind is that you are having difficulty breathing out against the pressure and thus may be doing shallow breathing. If you breathe too softly your CO2 buildup can cause you to feel headaches in the morning.

Does this machine have the EPR feature ? (I think S* Elites did have it). If yes then my suggestion is to activate it and set EPR=3 & see if that helps.

DSM

2girlsmom · Post by **2girlsmom** » Thu Oct 30, 2008 9:58 pm

EPR is at 3 already. Anything less and I can't sleep well at all.

billbolton · Post by **billbolton** » Thu Oct 30, 2008 10:22 pm

KengEsq wrote:The auto adjusting machine anticipates and adjusts to the needed pressure and are set to a range (typically 4 to 20 cm H20).

No!

That's not at all how an APAP works in practice!

Snoredog · Post by **Snoredog** » Fri Oct 31, 2008 1:38 am

KengEsq wrote: Maybe when you see your sleep doctor he/she can change your script to an APAP like the ResMed S8 AutoSet II (pretty identical to the S8 Elite II) and then you don't have to worry as much about the numbers. The auto adjusting machine anticipates and adjusts to the needed pressure and are set to a range (typically 4 to 20 cm H20).

In her case that machine would NOT really help her. Reason is her pressure is already over 10 cm and the Resmed A10 algorithm in that machine won't respond to apnea at or above 10 cm pressure for fear of those apnea being central. So it prefers to ignore them altogether and respond to other events which depending on the persons SDB can resolve those apnea at the flow-limited state or if there is vibratory snore present. Machine looks at the event sine wave for specific flattening seen unique to FL's and the unique high frequency response seen with snore.

What that means then is if your SDB requires a pressure higher than 10 cm to resolve, you have to manually use the Minimum pressure on the machine and titrate up until AHI (sum of AI and HI per hour) drops to acceptable levels. With the Elite or AutoSet or a machine that is data capable that is easy,

You first observe the individual AI and HI, increase Minimum pressure until AI gets to 1 or below, then observe HI getting it to 5 or less. Leak must be kept under control when observing AHI data for accuracy. If leak is above acceptable levels for pressure and mask, the AHI info can be skewed.

Snoredog · Post by **Snoredog** » Fri Oct 31, 2008 1:46 am

2girlsmom wrote:Can too high of a pressure cause tons of hypopneas? I am going nuts waiting to discuss my situation with my sleep doctor next Tues. I am having 9 and 10 hypopneas an hour. The last couple nights my AI is low but I am still waking with headaches so I know something is not right. I find it hard to believe I really need higher than a 14 as I have good nights at other pressures that are lower, I just can't seem to have good nights consistently. I just fell asleep, thankfully my kids were behaving.

Headaches can be normal if you are just starting out. Yes too high a pressure can increase the number seen. HI is not really what you want to adjust for. You should observe the events individually starting with AI (Apnea Indice). Adjust CPAP pressure up in 1 cm increments until AI gets to 1 or .8 or even .6. THEN you observe the HI count. If HI is above 5, you then increase pressure again but by .5 cm until HI drops to under 5 and you are good to go. Combined your AHI should be <5.

So once you observe AI=1 and continue with half cm pressure increases by the time HI gets down to the desired level, AI can drop even further to AI=.8 or lower.

Note: Once you get over 10 cm pressure, you should consult your PSG results for any CA (Central Apnea findings), if you are at risk of those, they are more likely to show up >10cm pressure. IF the AI climbs when you increase pressure and they are shown on your PSG, you have to suspect the AHI you are looking at including some central events.

The lowest AHI is nearly always the best, because if a machine is going to incorrectly count and include centrals, the AHI seen would include both types.

2girlsmom · Post by **2girlsmom** » Fri Oct 31, 2008 1:33 pm

The reason I want the hypopneas lowered is they are affecting my sleep. I had 30 in an hour one hour, but 9 was my HI. This was at pressure 14, last night I went to 11.6 and ended up with an AHI of less than 5. Boggles the mind.

So, if I had an APAP and it was set to a tighter range--say 8-15, would it work well for me with an original titrated pressure of 10 and now the new pressure of 14? I have had good AHI and bad AHI at all pressures inbetween there, I guess my needs change nightly. It boggles my mind.

Snoredog · Post by **Snoredog** » Fri Oct 31, 2008 1:43 pm

2girlsmom wrote:The reason I want the hypopneas lowered is they are affecting my sleep. I had 30 in an hour one hour, but 9 was my HI. This was at pressure 14, last night I went to 11.6 and ended up with an AHI of less than 5. Boggles the mind.

So, if I had an APAP and it was set to a tighter range--say 8-15, would it work well for me with an original titrated pressure of 10 and now the new pressure of 14? I have had good AHI and bad AHI at all pressures inbetween there, I guess my needs change nightly. It boggles my mind.

You live in Valparaiso or what? I already answered your question in the 2 immediate posts above this one, I know of no other way to explain it.

dsm · Post by **dsm** » Fri Oct 31, 2008 1:57 pm

2girlsmom wrote:The reason I want the hypopneas lowered is they are affecting my sleep. I had 30 in an hour one hour, but 9 was my HI. This was at pressure 14, last night I went to 11.6 and ended up with an AHI of less than 5. Boggles the mind.

So, if I had an APAP and it was set to a tighter range--say 8-15, would it work well for me with an original titrated pressure of 10 and now the new pressure of 14? I have had good AHI and bad AHI at all pressures inbetween there, I guess my needs change nightly. It boggles my mind.

An APAP could help. I know Snoredog said the S8 doesn't respond to an apnea over 10 CMs but what he really meant to say is that the S8 won't respond to a no-flow apnea over 10 CMs BUT it will respond to the signals that lead to an obstructive no-flow apnea. It looks out for flow-limitations, hypopneas (what you are experiencing) and snores - if it detects these it will raise pressure when over 10 CMs as they warn of a looming no-flow apnea & that is what Autos try to prevent as well as adjusting for hypopneas.

DSM

2girlsmom · Post by **2girlsmom** » Fri Oct 31, 2008 2:43 pm

Snoredog, I'm sorry, I am not a stupid woman, just ignorant when it comes to how the Resmed APAP (or any) work for the most part. I get that it will use what pressure it needs to to help correct events and the reason I'd like one is because I sometimes am ok at 14, sometimes it's a disaster, sometimes 11 works, sometimes it's a diaaster. It's obvious to me that straight CPAP is not cutting it and had I been given a full data capable CPAP from the getgo last year I would have all this figured out by now. Your response above quoted a poster who said 4-20 cm range was what should be done and since you commented on that I assumed your comment only applied to a situation where the range that was wide open, and a tighter range would be a different story. I know you are a very knowledgeable person from the many threads I've read and I do appreciate your inpot. Just know that some of us, while we may have been on PAP therapy a year now are still clueless about some things.

DSM, Thanks for the explanation. With me possibly paying for the APAP out of pocket I just have a lot of questions, and need the info. I do plan to suggest the APAP being given to me in place of my CPAP (CPAP is fairly new) but if she won't go for it I am willing to buy one, even though it means slapping it on a credit card. Ugh. I am just so tired.

If anyone is still following this, would *another* brand of APAP have a different algorithm and therefore treat apneas over 10cm better than a Resmed? I only am partial to the Resmeds due to me having the Humidaire already, and liking it tons better than my old M Series HH.

txnative · Post by **txnative** » Fri Oct 31, 2008 3:22 pm

I believe the PB 420E and Sandman can be set to respond to Apneas over 10cm/h20.
I have the PB 420E and the ResMed S8 AutoSet II. I do find that the ResMed is quieter than the 420E.

Pressure too high cause tons of hypopneas?

Pressure too high cause tons of hypopneas?

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