Pressure settings by limb movements obsevations

[Leo Estevão]

Hello,I am very happy to get in this forum. My question is -my mother was sleeping and I could perceive betwen 30' to 40' then I increased pressure from 7 to 11 in a Resmed Tango model and the movements stoped at 11 although titrations done in a Resmed Elite (41 days used) said 7 pressure set. Can I keep pressure at 11 with no problems ? Many thaks.

[Julie]

Hi, I think you need to move the pressure up just by one number at a time, and then stay there for a few days (not hours) to get an accurate picture of how well it works. Then move up again by one and do the same thing. You might find that 11 is unnecessary. The less needed the better, though 7 is probably a bit low for a lot of people. The fact that the movements stopped at 11 at one point on one night is not necessarily the way to test anything really, and it's not just about the movements because her respiratory system needs to be taken care of. There are other factors involved with limb movements and they should be looked at separately to some extent. I don't know the model of your mother's machine, but is it just straight Cpap, or is it an Autopap - in which case a range of two pressures should be set, 8-12 for example.

[Leo Estevão]

Nice Julie, Is not auto cpap or relief. You gave a real point that I was looking for. I've increased pressure until limb movements stoped and you are right to move it up slowly night by night. I' ve readed that limb movement may occur due to over pressure too in a cpap without relief pressure. Many thanks.

[Velbor]

I know of no evidence that CPAP prevents or reduces periodic limb movements during sleep (PLMS).
Rather, quite the opposite: there have been reports that PLMS can be worsened by CPAP, primarily early in the night.
Your observation of decreasing PLMS may not be due to increasing the pressure, but simply due to the passage of time.
You may want to check the duration of PLMS several nights while staying at 7cm, and then several nights while staying at 11cm, ideally alternating the pressures each night.
Fortunately, it is not likely that 11cm will cause any risks, so long as there are no complicating medical conditions.
Still, if additional pressure does not really help, there is little reason to use it.
You have presented a very interesting approach to pressure adjustment!

[Breathe Jimbo]

Since excessive pressure may cause central apneas (another can of worms), you need to be very careful about increasing pressure. Do you have a copy of the sleep study and titration data? Did centrals start appearing at a certain pressure range? Is her CPAP machine fully data capable? If so, you should be watching the data for any centrals and not go that high. If centrals are appearing, your mom may need a different kind of machine, and you should probably work closely with her sleep doc.

[Leo Estevão]

I know of no evidence that CPAP prevents or reduces periodic limb movements during sleep (PLMS).
Rather, quite the opposite: there have been reports that PLMS can be worsened by CPAP, primarily early in the night.
Your observation of decreasing PLMS may not be due to increasing the pressure, but simply due to the passage of time.
You may want to check the duration of PLMS several nights while staying at 7cm, and then several nights while staying at 11cm, ideally alternating the pressures each night.
Fortunately, it is not likely that 11cm will cause any risks, so long as there are no complicating medical conditions.
Still, if additional pressure does not really help, there is little reason to use it.
You have presented a very interesting approach to pressure adjustment!

Dear Velbor, It happend exactly at early in the night and I have readed about relations PLMs and pressure. It demand nights to get better conclusions. I have set 7cm and started again. Thank Velbor.

[Leo Estevão]

Since (another can of worms), you need to be very careful about increasing pressure. Do you have a copy of the sleep study and data? Did centrals start appearing at a certain pressure range? Is her CPAP machine fully data capable? If so, you should be watching the data for any centrals and not go that high. If centrals are appearing, your mom may need a different kind of machine, and you should probably work closely with her sleep doc.

Ok Jimbo, the titration and polisonografia were not done with video and did not consider PLMs. I read that we can make a fine adjust by observing PLMs. I set 7cm and monitor her tonight.You are right, excessive pressure may cause central apneas an then I stopped. Thanks Jimbo, lets improve our knowledge.

[Leo Estevão]

Hello I am here again to say that as I could check, It was not a limb movement. It looks like a all body movements done before a snoring event using a cpap. I have increased press from 7 to 11 and I could not hear the snoring sound but the same body movement was done.