More Pressure - More Leaks - More Problems

[Thunnar]

My doctor says that increasing the pressure of the APAP will create the best results in reducing AHI. I think it might be true up to a point, but as I went from 10cm to 16cm gradually over a 10-week period, as the AHI went down I also started experiencing more mouth leaks (using nasal pillow), chin strap is already on max lockdown. Even the nasal pillows started blowing a gasket more frequently during the night with loud hissing that wakes up me an the wife both.

My question for you long-time users, isn't there a trade-off between higher pressure and other associated problems? I just don't remember having so many blowouts at 13 or even 15cm as I do now. The idea of starting low and letting the machine figure out the required support pressure level seemed to work OK without forcing the issue.

Cheers,
Rich

[Sheriff Buford]

That is one of the pitfalls of the autopap mode. The increasing pressure in the middle of the night can awaken some... some get used to it. In the autopap mode, you adjust your mask at a low pressure when going to bed. When the pressure increases in the middle of the night, the adjustment may not be sufficient to manage the leaks. Also, at night, most folks' faces' will relax and may cause more leaking. Again... this is natural with adjusting to the autopap mode. Though some leakage is acceptable, it is a deterrent to successful apnea therapy.

Sheriff

[Julie]

The higher the pressure the more likely you'll mouth breathe (without knowing it, in your sleep), and it can be a vicious circle. I'd try taping (though ideally a full face mask) for a while to see if it helps and then you might not need to increase pressure - just the opposite.

[SleepWellCPAP]

Though not a pressure therapy patient myself, I have worked with many people in your same situation.

The more pressure, as you say, the more problems. In my experience, anything about 12 with a nasal pillow mask and problems become par for the course.

Though reducing AHI is certainly a good objective, you also want to feel like your sleep episode was recuperative. I wonder if Julie's suggestion of using a full-face mask at least temporarily, would work for you? With that, at least you wouldn't have to worry about mouth breathing or blowing bubbles.

For most of my clients, the FFM is what usually ends up working best. If you do go that route, I would suggest the new Quattro Air by ResMed.

Good luck.

[JDS74]

My question for you long-time users, isn't there a trade-off between higher pressure and other associated problems? I just don't remember having so many blowouts at 13 or even 15cm as I do now. The idea of starting low and letting the machine figure out the required support pressure level seemed to work OK without forcing the issue.

Cheers,
Rich

Rich,

Your equipment choice shows an auto-adjustable CPAP machine with what is described as Smart Flex. It this a machine in which you can set an EPAP-IPAP range?

What do you have your pressure range set to?

It could be that the EPAP is set too low so that when you put your mask on at night, you are adjusting to a too low pressure. If the range is smaller, then the initial pressure will be closer to the max and less likely to create leaks later on.

Can you take off your mask without disturbing the adjustments? If so, when you wake up with a leak, make a new adjustment to control that leak. That may help the problem.

[robysue]

My question for you long-time users, isn't there a trade-off between higher pressure and other associated problems? I just don't remember having so many blowouts at 13 or even 15cm as I do now. The idea of starting low and letting the machine figure out the required support pressure level seemed to work OK without forcing the issue.

Cheers,
Rich

Rich,

Your equipment choice shows an auto-adjustable CPAP machine with what is described as Smart Flex. It this a machine in which you can set an EPAP-IPAP range?

Clarifying something for the newbies.

The OP's machine is a auto adjusting PAP also known around here as an APAP. As such, it does not have IPAP and EPAP settings. Those settings are only available and relevant on bilevel machines---BiPAPS (from the PR's model name) as they're often called around here. (The Resmed VPAP is a bilevel machine too.)

I believe that what JDS74 really means to ask about is what the OP's min and max pressure settings are. On an APAP, the minimum pressure set is the pressure you start out at (after any ramp time). The maximum pressure is the upper limit that the pressure is allowed to reach during the night.

JDS74's question: What do you have your pressure range set to? is highly relevant. But when JDS74 goes on to write:

It could be that the EPAP is set too low so that when you put your mask on at night, you are adjusting to a too low pressure. If the range is smaller, then the initial pressure will be closer to the max and less likely to create leaks later on.

the word "EPAP" needs to be replaced with "minimum pressure setting"

[JDS74]

Robysue

Thank you for the clarification of my post.
I was unfamliar with this particular model and so, made a mistake in my comments.

Starting out at a much lower pressure while adjusting the mask for leaks and then having the machine move up to a much higher pressure later can lead to leaks.