questions about pressure settings

[memapenguin]

Since I got my RESMED machine I have been using it in autoset mode attempting to "dial in" my numbers. I noticed that all my OA's were in the first hour of usage, when I was trying to go to sleep so I bumped my min from 8 to 9.6 (my med was averaging 11.6 so I went 2 lower) and a couple days later I bumped my max down to 15 from 20 (my 95% was 12, my previous CPAP setting was 14 so I went 1 above the prescribed CPAP setting & 3 above my max 95%). This worked for about a week, 0 AHI, but now I am back to having the OA's during that 1st hour again so I am wondering if I should raise my min a little more or leave it alone? Also 4 out of the last 5 nights I have been having HA's (I have only had 1 before about 2 weeks prior) and my 95% the last 3 nights has been 14.90-14.92 just barely under my max. Should I be bumping up my max? If so how much? Thanks for any advice.

[LSAT]

Your OAs are insignifigant ...you will go nuts if you are trying to get to zero. You will fluctuate each night. Events that happen while you are awake or partially awake mean nothing. Leave your settings alone for a week. Don't change them every night.

[porete]

I am not an expert by any stretch of the imagination, but I do think you need to move your minimum pressure up some, maybe to 12, and raise your maximum to 16. It appears that your machine is not compensating fast enough to reach the pressure you need to prevent the Hypopneas. BTW, your AHI is VERY good, I would love to have those stats every night!!

[Pugsy]

What happened the second half of the night? While no apneas of any consequence your flow limitations are what is driving the pressure so high roughly the second half of the night.

Something change big time for the flow limitations to get so ugly.
Do you sleep on your back? Maybe you were on your back during that time frame.?

Don't go chasing the 0.0 AHI...the change you are seeing in terms of AHI number is insignificant and if you know you are awake for part of the time when events get flagged they don't count. You can't prevent awake apneas with more pressure.

Your Flow limitation line is super ugly though. How is the quality of your sleep? Breathing okay? Waking often.

[memapenguin]

What happened the second half of the night? While no apneas of any consequence your flow limitations are what is driving the pressure so high roughly the second half of the night.

Something change big time for the flow limitations to get so ugly.
Do you sleep on your back? Maybe you were on your back during that time frame.?

Don't go chasing the 0.0 AHI...the change you are seeing in terms of AHI number is insignificant and if you know you are awake for part of the time when events get flagged they don't count. You can't prevent awake apneas with more pressure.

Your Flow limitation line is super ugly though. How is the quality of your sleep? Breathing okay? Waking often.

I usually sleep on my side and since I have been using the apap machine I don't seem to be flopping around in my sleep like I did before the apap therapy. I used to wake up several times a night to recover my pillows and blankets from the floor where they had been tossed as I flopped around, but since I became a hosehead I often wake up in the same position I went to sleep in. However the last 3 nights I have had bad night mares (events in Boston mixed with some 9/11 memories) and I have been tossing and turning a lot I assume as most of my bedding is on the floor when I wake up, so there is a strong possibility that some of that time was on my back but I haven't been actually waking up so I am not sure. Also I have been having some issues with my allergies, too much rain triggers my restrictive airway disease and makes me short of breath. And I have been more tired during the daytime the last few days as well.

[Pugsy]

Okay, just watch the flow limitations to see if they stay looking ugly like that second half.
See what they look like after the stress has reduced and hopefully the allergies will reduce.

Do you see how nice and flat the Flow limitation is between 1 and 2 AM? That's what we like to see with maybe a few little blips. Even to 3 AM not all that horrible but around 4 AM things start to get real bad.
I wouldn't be surprised if you were on your back. Just keep an eye on it and watch the pressure line...see how it went up a lot when the Flow limitations also started looking ugly. That means the machine sensed that the airway was closing off.
It might be a response to the allergies.
Do what you normally do to try to relieve the allergies.

But your AHI is fine. Those minor little rare events...not worth worrying over.
The only thing I see on your report is the FL ugly stuff. Watch it.

[porete]

memapenguin, please disregard my earlier suggestions. Pugsy is the #1 expert, and I happily defer to her advice!

[memapenguin]

Okay, just watch the flow limitations to see if they stay looking ugly like that second half.
See what they look like after the stress has reduced and hopefully the allergies will reduce.

Do you see how nice and flat the Flow limitation is between 1 and 2 AM? That's what we like to see with maybe a few little blips. Even to 3 AM not all that horrible but around 4 AM things start to get real bad.
I wouldn't be surprised if you were on your back. Just keep an eye on it and watch the pressure line...see how it went up a lot when the Flow limitations also started looking ugly. That means the machine sensed that the airway was closing off.
It might be a response to the allergies.
Do what you normally do to try to relieve the allergies.

But your AHI is fine. Those minor little rare events...not worth worrying over.
The only thing I see on your report is the FL ugly stuff. Watch it.

Thanks for all the info I went back and looked all 4 nights that I had the HA's the flow limitations were ugly each of those nights so I will definitely keep and eye on it.

[Pugsy]

memapenguin, please disregard my earlier suggestions. Pugsy is the #1 expert, and I happily defer to her advice!

Actually it is good advice. It got me to look harder at the graphs because I thought "huh" that AHI is fine...and I hadn't looked any further. So what you said was sound advice based on the pressure graph itself. It's obvious the pressure wants to go higher. It's really odd to have such a marked increase with essentially no events...one would think that a person should have some little something get flagged with that pressure increase the last half of the night.
The machine is responding to the Flow limitations obviously...I just don't know if the flow limitations are in the nose from nasal swelling from the allergies or in the airway itself.

I was thinking a minimum pressure increase also until she told me about the allergies and the added stress.

Or if there were a truckload of OAs and hyponeas during that ugly FL line timeline...yeah for sure more pressure.

In this situation a little more minimum pressure wouldn't hurt but it may not help if the FLs are from nasal mucosa swelling.
The machine only knows that there is a reduction...it doesn't know what caused it.

Edit:...you say you are seeing the ugly FL lines on other nights? And having headaches?
You are using EPR of 3? How about either EPR of 2 and leave the pressures as they are? Or increase the minimum 1 cm?
Worry about the maximum...let's see if the FLs reduce with just a little pressure.

[memapenguin]

memapenguin, please disregard my earlier suggestions. Pugsy is the #1 expert, and I happily defer to her advice!

Actually it is good advice. It got me to look harder at the graphs because I thought "huh" that AHI is fine...and I hadn't looked any further. So what you said was sound advice based on the pressure graph itself. It's obvious the pressure wants to go higher. It's really odd to have such a marked increase with essentially no events...one would think that a person should have some little something get flagged with that pressure increase the last half of the night.
The machine is responding to the Flow limitations obviously...I just don't know if the flow limitations are in the nose from nasal swelling from the allergies or in the airway itself.

I was thinking a minimum pressure increase also until she told me about the allergies and the added stress.

Or if there were a truckload of OAs and hyponeas during that ugly FL line timeline...yeah for sure more pressure.

In this situation a little more minimum pressure wouldn't hurt but it may not help if the FLs are from nasal mucosa swelling.
The machine only knows that there is a reduction...it doesn't know what caused it.

Edit:...you say you are seeing the ugly FL lines on other nights? And having headaches?
You are using EPR of 3? How about either EPR of 2 and leave the pressures as they are? Or increase the minimum 1 cm?
Worry about the maximum...let's see if the FLs reduce with just a little pressure.

My allergies hit me in my chest (like asthma, something to do with my restrictive airway disease) so it is not from nasal swelling, and yes I have been having headaches. I have never tried a EPR of lower than 3 because when I first started the therapy I had a real hard time exhaling against the 14 CPAP the DME had set even with the EPR set at 3, but I will try dropping it to 2 tonight as I haven't felt that fight to be able to exhale in a while. Should I go ahead and bump up my min by 1cm and my max by 1 or 2 as well or wait and see what dropping my EPR to 2 does first?

[porete]

memapenguin, please disregard my earlier suggestions. Pugsy is the #1 expert, and I happily defer to her advice!

Actually it is good advice. It got me to look harder at the graphs because I thought "huh" that AHI is fine...and I hadn't looked any further. So what you said was sound advice based on the pressure graph itself. It's obvious the pressure wants to go higher. It's really odd to have such a marked increase with essentially no events...one would think that a person should have some little something get flagged with that pressure increase the last half of the night.
The machine is responding to the Flow limitations obviously...I just don't know if the flow limitations are in the nose from nasal swelling from the allergies or in the airway itself.

I was thinking a minimum pressure increase also until she told me about the allergies and the added stress.

Or if there were a truckload of OAs and hyponeas during that ugly FL line timeline...yeah for sure more pressure.

In this situation a little more minimum pressure wouldn't hurt but it may not help if the FLs are from nasal mucosa swelling.
The machine only knows that there is a reduction...it doesn't know what caused it.

Edit:...you say you are seeing the ugly FL lines on other nights? And having headaches?
You are using EPR of 3? How about either EPR of 2 and leave the pressures as they are? Or increase the minimum 1 cm?
Worry about the maximum...let's see if the FLs reduce with just a little pressure.

Thanks, Pugsy. I just didn't want to give any advice that would make the OP more uncomfortable or have even more problems.

[Pugsy]

Should I go ahead and bump up my min by 1cm and my max by 1 or 2 as well or wait and see what dropping my EPR to 2 does first?

Reducing EPR to 2 from 3 is going to increase the exhale pressure by 1 cm..so a slight increase in the overall average pressure being delivered.
If reducing to 2 is harder to exhale...by all means leave it at 3 EPR and just increase the minimum by 1.
Don't know anything with maximum just yet. In theory if the FLs are better controlled to start with by the minimum then they shouldn't need to go near the maximum.

The FLs may also just be the reactive airway thing and not soft tissues collapsing a little so it may not help and probably should be addressed as a reactive airway/asthma type of thing. The cpap machine isn't designed to fix that type of problem.

So I don't know if a little more pressure will help the FLs or not. Won't hurt to try 1 cm more but if it doesn't seem to help then I would tackle it from the reactive airway side of things like you would normally do if you were not on a cpap machine.
You know the routine..treat the allergy symptoms/causes/asthma thing separately.

[n0hardmask]

I'm not experienced in reviewing other folks' graphs, but I can't help notice the Resp Rate averages well over 20 all night; and until 0300, it's in the mid-20's. Do you have any idea if this is your normal?
I know I wake up feeling breathless if I am above 20 and am most comfortable 16 to 18. But then again, that may be just me. If I breathed like you in these graphs, I'm sure I'd feel like I'd been worked over with a bat. Hope you figure out what's messing with you. earl

[NotLazyJustTired]

Should I go ahead and bump up my min by 1cm and my max by 1 or 2 as well or wait and see what dropping my EPR to 2 does first?

Reducing EPR to 2 from 3 is going to increase the exhale pressure by 1 cm..so a slight increase in the overall average pressure being delivered.
If reducing to 2 is harder to exhale...by all means leave it at 3 EPR and just increase the minimum by 1.
Don't know anything with maximum just yet. In theory if the FLs are better controlled to start with by the minimum then they shouldn't need to go near the maximum.

The FLs may also just be the reactive airway thing and not soft tissues collapsing a little so it may not help and probably should be addressed as a reactive airway/asthma type of thing. The cpap machine isn't designed to fix that type of problem.

So I don't know if a little more pressure will help the FLs or not. Won't hurt to try 1 cm more but if it doesn't seem to help then I would tackle it from the reactive airway side of things like you would normally do if you were not on a cpap machine.
You know the routine..treat the allergy symptoms/causes/asthma thing separately.

Pugsy has a very good suggestion. The flow limitation you are experiencing may be resulting in RERAs, little arousals that result from respiratory effort. Unfortunately the ResMed machine does not score these like the Respironics machines do, so it is nearly impossible to tell from your data whether you are having them. If you can reduce the flow limitations by increasing your minimum pressure as Pugsy has suggested, and you notice you are feeling better rested then that would support the idea that you may be having these RERAs.

I hope Pugsy doesn't mind but here is a link where she recently quoted the definition of RERA from the Resperonics documentation:
viewtopic.php?f=1&t=88470&view=unread#p811277

Of course, if you can treat the root cause of the respiratory effort, then you may not need the increase pressure either. I have gone to a two prong approach: increasing my pressure and doing a daily nasal saline rinse. It has been helping me until recently when my back started acting up...but that is another story. Sleep Well!