Question about Raising Pressure

[Starlette]

Good morning all. Happy Wednesday and August 1st

I've just recently raised my pressure from 9.5 - 12.5cm to 10 - 13cm. When the data is looking a little squirrely on a FFM, I go back to pillows to compare the data which the 10 - 13 is appearing to be the better choice at this time.

I'm going to present a chronology since the beginning of the year when I got my apap.

1/9/2012 - Starting pressure was 8 - 11cm.
Two weeks - Pressure was raised to 9 - 12.
Keep in mind this is the first time I've used an apap so I was checking for the right pressure.
3/13/2012 - Pressure changed to 9.5 - 12.5 till the beginning of July
7/6/2012 to present - Pressure raised 10-13cm. Even now for a night or two, I'd lower the pressure to 9.5 - 12.5cm. Still, the better pressure is at 10 - 13cm.

Here's my question/concern: Currently, I feel 10 - 13cm is the better pressure for me. As I think into the future (I've been wondering this for a long time), even 5 years from now. Could I actually see my pressure going to 15cm, and if so where does one go after that?

Starlette

[nanwilson]

Starlette
You can set your end pressure at 15 or even 20 for that matter and it will only go as high as it needs to. I had mine set at 10 to 15 but the 95% was at 11, maybe 12 for a few minutes every night and occasionally up to 13...but it has never gone any higher than the occasional 13...what I'm trying to say is it will only go higher "if" its needed and from your stats it doesn't look like it does. In 5 years time who know where your pressure will be, it may go down it may go up, thats why we prefer an auto machine, we can track things on a regular basis and change as needed. I started out at 11 over 2 years ago and I'm still at 11 if I "ever" need to go over 20 (which I highly doubt) then I may have to go to an asv or bipap, but will cross that bridge when the time comes. Stop worrying my friend and live for today..remember the old saying "what will be, will be"

[Buckhorn dan]

How do you change the pressure? My Doctor locked mine in so I can't play with it. I shouldn't complain however since it's only set at 6 but should be at 8.

[Pugsy]

How do you change the pressure? My Doctor locked mine in so I can't play with it. I shouldn't complain however since it's only set at 6 but should be at 8.

The provider manual explains how to get to the clinical setup menu where things can be changed.
http://www.apneuvereniging.nl/forum/pdf ... manual.pdf Might want to save it. This is a different manual from the user manual that you likely have.

Video explaining your machine here
http://www.cpaplibrary.com/machine-education

[pats]

Starlette
You can set your end pressure at 15 or even 20 for that matter and it will only go as high as it needs to. I had mine set at 10 to 15 but the 95% was at 11, maybe 12 for a few minutes every night and occasionally up to 13...but it has never gone any higher than the occasional 13...what I'm trying to say is it will only go higher "if" its needed and from your stats it doesn't look like it does. In 5 years time who know where your pressure will be, it may go down it may go up, thats why we prefer an auto machine, we can track things on a regular basis and change as needed. I started out at 11 over 2 years ago and I'm still at 11 if I "ever" need to go over 20 (which I highly doubt) then I may have to go to an asv or bipap, but will cross that bridge when the time comes. Stop worrying my friend and live for today..remember the old saying "what will be, will be"

I'm not so sure about the "only go as high as it needs to" theory. My prescribed a pressure range has the upper limit less than the maximum that had been reached during the home titration. It seems to be working fine - low AHI, no problems with swallowing air, no waking up feeling as though a hovercraft is trying to take off from my face. The APAP does reach the prescribed maximum most nights, so the upper limit is affecting it, but given the low AHI, and the elimination of sleep apnea symptoms, I'm not convinced it really needs to go any higher.

[Starlette]

Starlette
You can set your end pressure at 15 or even 20 for that matter and it will only go as high as it needs to. I had mine set at 10 to 15 but the 95% was at 11, maybe 12 for a few minutes every night and occasionally up to 13...but it has never gone any higher than the occasional 13...what I'm trying to say is it will only go higher "if" its needed and from your stats it doesn't look like it does. In 5 years time who know where your pressure will be, it may go down it may go up, thats why we prefer an auto machine, we can track things on a regular basis and change as needed. I started out at 11 over 2 years ago and I'm still at 11 if I "ever" need to go over 20 (which I highly doubt) then I may have to go to an asv or bipap, but will cross that bridge when the time comes. Stop worrying my friend and live for today..remember the old saying "what will be, will be"

viewtopic/t80488/Upping-My-Pressure-Des ... d-AHI.html

Nan, I understand your comment. I have 2 question:

I just read the post you gave to VVV. From what I understood from the post, you started with an auto setting then went to straight cpap setting due to several wake-ups during the night, correct? I have the same issue as well. I was thinking along those lines also, continue with the range of 10 - 13 for a while and see what the data shows, then as a matter of comparison switch the auto to cpap with a setting of 10. Then compare.

You had stated, "it may go down it may go up". When do you know it may be time to lower the pressure? I can only see the pressure going up, not down.

[Pugsy]

Unless you are consistently maxing out the maximum pressure it is a moot point what the maximum is. If you never ever hit 15 cm...there is no reason to think that in a few years you would need to increase the maximum.
Been on the machine 3plus years now. Discovered early on that 10 min and 20 max did the best job for me. Most nights rarely got about 12 but some nights I would go higher 14, 15, even to 18 but times spent at those higher pressures were minimal.
After 3 years...still the same thing happens. Even on Bilevel machine. If the machine doesn't go to the maximum then the maximum never impacts anything. Now of course if the machine goes to whatever maximum it might be set at then it will impact things and that is a whole different discussion but if it is never reached then it is a non issue. Just because it can go there doesn't mean it will go there. It has to go there for some reason (valid or not) for it to be a factor in things. If max limit is being reached then the discussion switches to the usual why, valid, disrupting sleep, is lower pressure setting sufficient, etc.

[Starlette]

Pugsy, I understand what you're saying. Time to confess....I feel it's time to raise the pressure when I see the events increase above 25+ to 53+ for a long period time, even though the AHI may be looking great. Am I wrong in my thinking? Should I just ignore the amount of events and look only at the AHI?

Starlette

[nanwilson]

Nan, I understand your comment. I have 2 question:

I just read the post you gave to VVV. From what I understood from the post, you started with an auto setting then went to straight cpap setting due to several wake-ups during the night, correct? I have the same issue as well. I was thinking along those lines also, continue with the range of 10 - 13 for a while and see what the data shows, then as a matter of comparison switch the auto to cpap with a setting of 10. Then compare.

You had stated, "it may go down it may go up". When do you know it may be time to lower the pressure? I can only see the pressure going up, not down.[/quote]

That is what I am doing Starlette.......trying to see if I get less wake-ups with the straight 11 and make sure nothing else changes. So far after 5 nights I am only getting up once during the night as opposed to 2-3 times on auto. Whatever your 95% is should be what you set it to on cpap mode, if your getting a few ahis sneak through then raise it half a point at a time.

Ya, I can only see it going up too, but it seems I have read here that some of the guys have gone down after being on the hose for awile.....maybe its like your brain is adjusting to the machine.

[Starlette]

Thanks Nan.

[Pugsy]

I feel it's time to raise the pressure when I see the events increase above 25+ to 53+ for a long period time, even though the AHI may be looking great. Am I wrong in my thinking? Should I just ignore the amount of events and look only at the AHI?

I am confused (again). If your events are increasing how is your AHI not increasing? Where are you getting the increased numbers from 25 to 53? Are these over the entire night? Has the number of hours of sleep increased? You have a history of short hours of sleep on the machine in fragments. If you are finally getting longer number of hours asleep on the machine it would stand to reason that total overall number of events would also increase. Is supine sleeping or maybe REM sleep possibly playing into the increase?

My comments were mainly about maximum pressure. Example...if your maximum was say 18 cm and you never ever saw anything above 14 cm then the maximum is not an issue. If your events are increasing and the maximum doesn't seem to be increasing nor is it being reached then most likely the minimum pressure is the issue (in the absence of leaks or whatever impacting things).
If you never ever reach whatever maximum pressure you are using now....increasing the maximum now is not going to make it go higher. This is where the "just because it can go higher doesn't mean that it will go higher" comes in.
Now of course if you are indeed reaching the maximum pressure limit you have set...we have a totally different discussion.
I was under the impression that you weren't reaching the maximum.

[Starlette]

I'll answer your post Pugsy later on this evening.

[Starlette]

Pugsy - Changed my mind. I think I will continue in PM. I just read what how you replied to VVV (makes sense what you told him and me), then I'll show you by my sleep journal what I'm talking about.

Starlette

[Todzo]

Good morning all. Happy Wednesday and August 1st

I've just recently raised my pressure from 9.5 - 12.5cm to 10 - 13cm. When the data is looking a little squirrely on a FFM, I go back to pillows to compare the data which the 10 - 13 is appearing to be the better choice at this time.

I'm going to present a chronology since the beginning of the year when I got my apap.

1/9/2012 - Starting pressure was 8 - 11cm.
Two weeks - Pressure was raised to 9 - 12.
Keep in mind this is the first time I've used an apap so I was checking for the right pressure.
3/13/2012 - Pressure changed to 9.5 - 12.5 till the beginning of July
7/6/2012 to present - Pressure raised 10-13cm. Even now for a night or two, I'd lower the pressure to 9.5 - 12.5cm. Still, the better pressure is at 10 - 13cm.

Here's my question/concern: Currently, I feel 10 - 13cm is the better pressure for me. As I think into the future (I've been wondering this for a long time), even 5 years from now. Could I actually see my pressure going to 15cm, and if so where does one go after that?

Starlette

Hi Starlette!

APAP always has apneas. I like straight CPAP. I use the data to help me make lifestyle changes to keep the AHI under 2 on the one end and the Minute volume (weight 200#) average under 6 lpm with the 95% under 8 lpm. If my lifestyle changes have resulted in a change, such as weight loss or if I move to a differant altitude (both of which happened in the last few months) I then consider changing pressure as I recently have. I tried auto-PAP for a night and did not like the results. Apparently my body is not in sync with their algorithm.

I think it is better to let the machine be if you can and see what other things you can change (less stress ...) to help keep the AHI and minute volumes down.

Have a lot of fun!

Todzo

[Starlette]

@Todzo and NanWilson – I hear what both of you are saying.
@ Pugsy – Rather than PM, I’ll lay it out here.

NOTE: I’m going to request that when responding that you list your responses as 1, 2, and 3 because I’m going to address three different issues.

Ok, I’m going to start from the beginning and hopefully I’ll be able to better communicate using SH data.
____________________

Mask – I’m going to present the mask I’m using at the time so you can correctly correlate the leaks to the mask. I’ll say from the getgo before I get comments, I do use the same mask for a period time. It just may appear the mask usage is different because I’m just trying to communicate a point.
Events – I’ll list those as well.
Data - I only used data where I’ve slept above 4 hours.
Pressure Setting - I’ve noticed all three issues occur whether my pressure has been set to 9.5 – 12.5cm or 10 – 13cm.
Maximum Pressure setting - @ Pugsy. I had to 3 times what you were posting to VVV and me. I understand what you’re saying.
Clusters - Since I’ve raised my pressure to 9.5 – 12.5, I no longer see clusters which is great.
Fragmentation - @Pugsy - That has been reduced to once a night pretty much for potty breaks.
Photos – I’ve provided two photos for issues 1 and 2.


#1 – Hills
08/01/2012: Mask – Aloha, Events 25
07/31/2012: Mask – Aloha, Events 29
I’ve seen using SH whether pressure had been set to 9.5 – 12.5cm or 10 – 13cm that I’m getting these “hills” for a lack of a better term. I don’t understand why. If I could get rid of the “hills”, I feel the events would be lowered. Maybe it’s because of what was stated to VVV that at the time I’ve either got my head snuggled up against my pillow or have the cover up near the vent holes *shrugs*




#2 – Maximum pressure reading
I’ve seen maximum pressure reached several times a night (not all the time) and I don’t know why.

8/1/2012 – Information and photo has been provided
6/19/2012: Mask – Hybrid, Events 13. May have been better if I only used 8/1/2012 and 6/17/2012
6/17/2012 – Mask – Hybrid, Events 39. This is obviously extreme, but I wanted to get my point across.




#3 – Increase in pressure
How do you know when to increase pressure? I don’t know which of those stated below I should be looking at more. Also, I know these change from night to night no matter which mask you use.
- Total Events average?
- AHI increase average?
- Pressure Average?
- 90% Pressure “average”?

Writing took me approximate 5 hours to type, so I hope I’ve been organized in what I’ve wanted to communicate.

Thank very much for reading my post and for your feedback.

Starlette