Help for husband with autoset (S9)

[jmcsmomma]

Ok, I got the autoset yesterday for husband so we can see what the best pressure is for him. We only have it til Tuesday, and last night, due to bad storms, he could only mask up for 1.5 hours. His AHI for that time was 1.3, obstructive. His usual pressure is 14, uses same mask as I with usually very minimal leakage. His median pressure last night was 13.2, 95th percentile was 19.3, and maximum was 19.7.
His leaks were higher, 19.2 for 95th percentile, with a max of 21.6

My question is this- leaks can cause pressure to increase, correct? So how do we fit his mask for him so it won't leak at higher pressure? The highest pressure at his titration was 12, but he is prescribed 14. His AHI is in the 5-10 range, so I know we can tweak his therapy. How do we best take advantage of using the autoset to find the sweet spot? It was set for 4-20, but I have 9 as his lowest pressure, b/c I told the DME that 4 would be smothery. No storms in the forecast for tonight, so it'll be interesting to see what happens in the morning.
thanks!
Liz

[CPAPARTY]

Dear Liz:

I never liked the full face mask. How does he do with the Nasal Cup one?

[Pugsy]

Regular cpap pressure of 14 cm and he was still having AHI that was too high?
If yes, increase the minimum pressure from 9 to 13. At 9 it will take too long for the machine to get the pressure up where it can be effective.

Fit the mask at 13 cm.

And yes, pressure will runaway trying to fix leaks, so that likely accounts for the higher max.

[HoseCrusher]

Pugsy, I am under the impression that with leaks the flow increases, but the pressure remains the same...

[Uncle_Bob]

Have you tried EPR on a setting of 3?

[jmcsmomma]

The nasal mask was a no go for him, he tried it, and hated it. He had some chest pains at his titration and ended up being admitted to coronary care the evening after his titration, thankfully, they couldn't find anything wrong with his heart. So, we weren't sure that the titration was truly a decent representative of a typical night for him, hence the autoset trial. Well, that and the fact of the flow patterns I posted here, and was advised he might need a higher pressure.
I did go in when I changed the start up pressure to 9 and turned off the ramp, turned the EPR to 3, full time. The mask was set to FF already. Tonight I'll put the pressure to 13 for the starting pressure.
Thanks again, everyone.

[Pugsy]

Pugsy, I am under the impression that with leaks the flow increases, but the pressure remains the same...

APAP with minimum and maximum pressures. Leaks can and will cause pressure increases up to the maximum setting.
I was basing my comment on the mention of trial with Autoset. If the maximum is 20 the machine might go there trying to fix the leak if it sensed that it needed to. I have experienced it myself and working right now with someone who is using APAP and has leaks and corresponding pressure increases. The possibility of "runaway" pressures with APAPs and leaks is a potential disadvantage to using APAP if pressure variations disturb sleep. Now if the maximum was 12 and minimum of 9, it won't go above 12. OP mentions max pressure of 19.7.. From this it is assumed that the max was set to 20.

Straight CPAP, flow increases to try to compensate for leak and should maintain at the straight cpap setting. So if a person uses 14 cm cpap and leaks a lot, there will be some attempt to compensate but the machine won't go above 14.

[Otter]

Straight CPAP, flow increases to try to compensate for leak and should maintain at the straight cpap setting. So if a person uses 14 cm cpap and leaks a lot, there will be some attempt to compensate but the machine won't go above 14.

In other words, a machine set for 14 cm H2O straight CPAP will maintain 14cm if it possibly can. Because leaks allow more air to flow out of the mask at a given pressure, flow will increase when there is a leak.