AutoPAP pressure of 15 vs. CPAP pressure of 7???

[hjjsnell]

What a huge difference in pressures! Last night I tried for the first time my dr's loaner AutoPAP to determine what would be the best pressure for me since 7 just wasn't cutting it (read my previous post about New Sleep study Required? to find out why after only 2 months I need a new pressure...incompetent people!). Well the machine went up drastically to an average of 15 cmH2O. WOW was it hard to breathe against that but I did manage to get some good sleep in. I had a high leak rate but I will fix that tonight with some adjustments to my mask but my AHI was below 5 compared to above 10 with my CPAP pressure of 7. So has anyone else had such an increase in pressure by using an APAP and how did you manage it at first on such a high pressure setting? I constantly found my mouth was wide open and full of air throughout the night but I still, for the first time, managed to wake up feeling somewhat better than I have in many years, so that was a plus!!

Heather

ETA: I wanted to thank you Rooster for all your advice...as well as everyone else of course, but especially you Rooster, on my other thread about this. I thought a new post appropriately titled would be better for my questions. Thank you!!

[RipVW]

I used my CPAP for more than a year at a sleep study titrated pressure of 7, never feeling any better. Found this forum, learned about data, found that my AHI had averaged 12, got an auto, found that my minimum pressure should be around 12, now my AHI averages 0.4, and I've been feeling great ever since! Hooray for cpaptalk.com!!

[RMinOntario]

I have actually had a similar experience (to a point) as you. They started me with a Resmed Escape trial with 8cm of pressure. After a couple weeks I had really bad head-aches so they had me on an APAP for a week. The loaner mask that I used with it showed a necessary pressure of 15cm. My AHI was really good BUT the report shows an average leak of 50l/min and 90th percentile of 88l/min. The % time with excessive leak was 15%. This was on a F&P machine. I told them the mask was nearly blowing off my face. I hated the mask and it was always waking me up with the noise when it was flapping all over my face (Quattro FF mask). Their answer was that loaner masks are often use for a year or more.

After all that, I was put back on the Escape trial machine and had my pressure set to 15cm. A huge jump from the titration study suggesting 8cm. I found it hard to breathe as well. Since the APAP trial showed such a high leak rate, I don't really think the 15cm was correct. Then I get my one and only appt with the dr. He looked over the results and said to go back to trying out the CPAP between 11 to 15 cm pressure.

I am so glad in that trial time I found the forum and learned about the data capable machines, because they try to sell the Escape to everyone for the same price as they charge for the Elite II. The patient's cost and the OHIP gov't portion is charged the very same whether you get an Escape or ELite.

So I was at 12cm for 2 weeks on the Elite II with my software. My AHI was 11.9 (AI 2.5). I moved it up to 13cm for the last 2 nights and my numbers are even higher, plus I can't seem to breathe as deeply as I could at 12cm.

I am beginning to question whether I should be reducing my pressure as opposed to working up to 15cm again. It took 3 months after my sleep study to see the doctor, so I don't want to wait 3 more months.

hjjsnell, I found I couldn't use the Swift LT for Her at 15cm whereas I could at 8cm. That pressure also seemed to blow my mouth open.

[Wulfman]

What a huge difference in pressures! Last night I tried for the first time my dr's loaner AutoPAP to determine what would be the best pressure for me since 7 just wasn't cutting it (read my previous post about New Sleep study Required? to find out why after only 2 months I need a new pressure...incompetent people!). Well the machine went up drastically to an average of 15 cmH2O. WOW was it hard to breathe against that but I did manage to get some good sleep in. I had a high leak rate but I will fix that tonight with some adjustments to my mask but my AHI was below 5 compared to above 10 with my CPAP pressure of 7. So has anyone else had such an increase in pressure by using an APAP and how did you manage it at first on such a high pressure setting? I constantly found my mouth was wide open and full of air throughout the night but I still, for the first time, managed to wake up feeling somewhat better than I have in many years, so that was a plus!!

Heather

ETA: I wanted to thank you Rooster for all your advice...as well as everyone else of course, but especially you Rooster, on my other thread about this. I thought a new post appropriately titled would be better for my questions. Thank you!!

You obviously need more pressure than 7 cm. if you've had an AHI of 10. However, the amount of leakage you were apparently having will also affect the pressures that the machine was reaching. I would say that the information/data from the APAP is flawed. But, at least you were feeling better with some extra pressure.

With the M Series Pro, you could have just kept increasing the pressure on it till you got better numbers. It really doesn't take an APAP to find a better pressure setting. And, unless a person has the software to interpret the data from an APAP (or any data-capable machine), it's still just "guesswork"......because you don't know what's causing the pressure changes.


Den

[sleepless in florida]

I don't know all the numbers but my RS says you can't use pillows with pressure that high. My pressure is 14 and I had to go to the quattro full mask which I am getting used to. GL

[hjjsnell]

I don't know all the numbers but my RS says you can't use pillows with pressure that high. My pressure is 14 and I had to go to the quattro full mask which I am getting used to. GL

Luckily the only leaking I noticed last night was from the mouthpiece and not from the nasal pillows. I have a hard time wearing a mask that goes over the bridge of my nose. I don't know if it has to do with the anatomy of my nose or what but all the ones I tried really hurt and left major indents and cuts and bruises on my nose. So, with that being said, I'd really like to try to stick with my Liberty if at all possible. Is it possible to stick to this mask with such a high pressure??

[sepool]

I've had a DME say you can't use nasal pillows at my pressure (18), and another that says you can. I'm using nasal pillows now, for almost a year.

The mask has published vent rates for pressures up to 20, so I figure they expect them to be used.

Some DMEs are too anecdotal.

Sam

[hjjsnell]

Night 2 - I adjusted my headgear and had a much better night leakrate-wise. It was well below the accepted leakrate on the flow chart for a pressure of 14-15, so that's a really good thing (even though I did have some leakage from my nasal pillows at the beginning of the night but once the leaking air woke me I adjusted again and all was fine). My pressure average is now at 14.1 but my AHI was above 5 at 6.0 (for 7 day average). I still feel better than I have and am not as exhausted so I think we're on the right track with increasing my pressure but now I'm not so sure since my AHI is still too high. What do you all think?

[hjjsnell]

Well after 3 nights on the APAP and 1 night back on the CPAP I can certainly notice a difference. I woke up (well it was hard to wake up this morning) feeling exhausted. I definitely need be on the higher pressure! So now I'm just waiting on a call from the nurse at my dr's office to tell me whether I get an APAP (which I did push for) or an adjustment in my pressure on my CPAP. We shall see!

[RipVW]

Hoping you get the APAP! At least from my experience, APAP has been the key to successful therapy for me, though others are just as happy with CPAP machines. Good luck!

[jnk]

I like autos. But as Wulfman points out, the main thing is having data and using it to tweak therapy for increased effectiveness.

Just so Wulfman's wise words aren't missed:

With the M Series Pro, you could have just kept increasing the pressure on it till you got better numbers. It really doesn't take an APAP to find a better pressure setting.

[LinkC]

Is it possible to stick to this mask with such a high pressure??

Absolutely! My pressure is 16 and I've used both the Hybrid and Liberty (as well as an Optilife nasal pillow).

With higher pressures you MAY have to "help" the nasal pillows stay seated. I use a piece of 1/16" elastic "beading cord" running around my head and under my nose to support the front of the pillows. Or you can try the "Rooster wears pantyhose" method .

[mindy]

Something I notice nobody has mentioned so far. For some of us high pressures result in central apneas which cannot be resolved by CPAP or APAP. In addition, I understand that there can be a tendency to start having centrals at a pressure over 10-ish for some people (apparently not the majority). When I had my M-Series, I experimented and when I had it set on APAP, could only get a reasonable AHI with pressure over 10, but when pressure hit 14 (for me), it looked like my AHI went *up* so I switched to CPAP mode and tried out one pressure at a time. Again I found that at 14 my AHI went way up again.

Then I switched to Sandman Auto which can be set to not "chase" apneas and I find a pressure of 10 keeps me at or below and AHI of 1 so I'm happy And I have my pressure range set to 10-20 and rarely go above 11.

Although I like the M-Series, in my case I couldn't use it in APAP mode because of the "chasing apneas" issue. There are some members of the forum who understand this issue much better than I do. There is an explanation for it.

You might want to try a fixed pressure and raise it one point at a time to see of your AHI goes up at some point.

Mindy

[hjjsnell]

Something I notice nobody has mentioned so far. For some of us high pressures result in central apneas which cannot be resolved by CPAP or APAP. In addition, I understand that there can be a tendency to start having centrals at a pressure over 10-ish for some people (apparently not the majority). When I had my M-Series, I experimented and when I had it set on APAP, could only get a reasonable AHI with pressure over 10, but when pressure hit 14 (for me), it looked like my AHI went *up* so I switched to CPAP mode and tried out one pressure at a time. Again I found that at 14 my AHI went way up again.

Then I switched to Sandman Auto which can be set to not "chase" apneas and I find a pressure of 10 keeps me at or below and AHI of 1 so I'm happy And I have my pressure range set to 10-20 and rarely go above 11.

Although I like the M-Series, in my case I couldn't use it in APAP mode because of the "chasing apneas" issue. There are some members of the forum who understand this issue much better than I do. There is an explanation for it.

You might want to try a fixed pressure and raise it one point at a time to see of your AHI goes up at some point.

Mindy

Thank you for that information Mindy. I know nothing about central apneas to be honest. So hopefully someone else will chime in here as well. But thank you for letting me know. I think it will take a little playing around with it if I get an APAP to find what works best for me. Thanks!