Maximum pressure keeps increasing

[Miss Emerita]

Fair enough, DS, but I think Wulfman’s suggestion would make a harmless and good experiment. Depending on how it goes, the OP can then fiddle with EPR, pressure ranges, and different minimums. How does that sound?

[Wulfman...]

There's absolutely no good reason for you to be using a range of pressures.
From these reports, you're having no obstructive events.......Hypopneas or Apneas.

Which completely disregards the possibility that the reason he's not experiencing Hypopneas and Apneas is *BECAUSE* the pressure has been increased.

I'm going to "politely" disagree with you because your logic is incorrect.
Pressure ranges aren't always the be-all end-all solution to everyone's therapy.
Each person has to evaluate and tweak their own settings for optimal therapy.
If this was the case, the user would be having obstructive events at the lowest pressures.
The pressure increases aren't fast enough to head off ALL obstructive events before they can happen.
On another side of this argument is the fact that the minimum pressure of 12 cm is sufficient to prevent all but the Central events.

Den

.

[crshirley7]

How's the nose been??? Experiencing much nasal congestion at all?
My nose is congested off and on quite a bit...use a full face mask because I get congested easily.

That old A10 ResMed algorithm was discontinued with the release of the S9 models. The auto adjusting algorithm was reworked once it was discovered that centrals can happen at any pressure (even as little as 5 cm) and 10 cm wasn't the magic line it was thought to be.

[crshirley7]

How's the nose been??? Experiencing much nasal congestion at all?

Congested quite a bit...use a full mask so I can breathe when congested.

That old A10 ResMed algorithm was discontinued with the release of the S9 models. The auto adjusting algorithm was reworked once it was discovered that centrals can happen at any pressure (even as little as 5 cm) and 10 cm wasn't the magic line it was thought to be.

[palerider]

There's absolutely no good reason for you to be using a range of pressures.
From these reports, you're having no obstructive events.......Hypopneas or Apneas.

Which completely disregards the possibility that the reason he's not experiencing Hypopneas and Apneas is *BECAUSE* the pressure has been increased.

Yeah, well, we've got to have one person on the forum that waves around the "variable pressures are bad" flag, no matter how discredited and blind to facts that old tired mantra is.

Of course, nobody NEEDS variable pressure, as long as they set the machine high enough to prevent all events, figure out what the maximum pressure one might need is, add one just for good measure, and then spend the whole night at that, even if that person is like Pugsy, where 7-8 is fine when not in REM, but she needs 16-17 in REM... better to just have 17 all night long, right wulfman?

[palerider]

During the titration portion of the sleep study, I did not enter REM.
How high should the minimum pressure be set? I have it set at 12 and difficult to fall asleep at 12 so I use a 30 min ramp from 10 to 12 which works. Should I set the min pressure at the 95% pressure? Seems very high to me...
Thanks

"how high" is a question that has to be determined by experiment. however, what I'll point out is that when you've got a min of 12, with EPR3, that means your base (EPAP, or between breaths) pressure is only 9, which isn't high at all.

I'd suggest increasing the minimum to 13, then 14, and see how things go, leave the EPR on. Your pressure is pretty smooth, but it's clear (wulfman's avowed bias notwithstanding) that you DO need higher pressure during parts of the night.

PS, he's never accepted the plain fact that flow limitations are a breathing disturbance that reduces the rest and recuperation you can achieve through sleep, because you're working harder to breathe, and that can and will lead to arousals from what should be recuperative sleep.

[Wulfman...]

"crshirley7"

Do what you want to, but when all that other crap you've been told isn't helping, try some of the "reasonable" suggestions.

By the way, I'm not the only one who prefers straight pressure, but there are the obnoxious "ranges of pressures solve all the problems" jerks who try to drown out the logical posters.

Den

.

[Pugsy]

How's the nose been??? Experiencing much nasal congestion at all?

Congested quite a bit...use a full mask so I can breathe when congested.

Nasal congestion can show up on the reports as increased flow limitation activity.
The machine doesn't know if the flow limitation is from the nose being stopped up or the airway trying to collapse.
It simply doesn't have any way to know BUT it will try to reduce FLs that are happening in the nose just like it does when it's in the airway.
Only problem is more pressure won't help reduce FLs that are caused by nasal congestion. Instead we have to try to deal with nasal congestion in the usual ways....decongestants, nasal rinses, nasal sprays, whatever helps.

Since you know you have issues with nasal congestion....does make me wonder if your machine wanting to go higher is from the nasal congestion...certainly not impossible and if that is the case even if you set the machine to 20 cm it is very unlikely that the FLs will improve.

You have several options available to try if you wish to experiment.
1...you can try a higher minimum pressure and see what happens
2...you could try a special attempt to reduce the nasal congestion in the more traditional ways...me...I would give myself a good shot of Afrin for one night and/or maybe a decongestant....see what happens
3...you could try a fixed pressure of your choice
4...you could reduce your minimum pressure and limit the max and not worry about the FLs.

I seriously doubt your centrals are triggered by higher pressures. We see centrals flagged (assuming asleep and not awake/arousal centrals) even at the lower pressures and none at higher pressures.
You might also want to take a crash course in figuring out if those centrals are real asleep centrals or arousal related centrals.
Watch the videos here...especially the last one.
http://freecpapadvice.com/sleepyhead-free-software
I have a sneaking suspicion that a good chunk of your centrals are arousal related

I have always preferred to try to identify the problem and make sure that changes in pressure are actually needed before I go advising changing the pressures. To fix a problem we first have to try to know exactly what the problem is.
Sometimes when the machine wants to go killing FLs with more pressure it's chasing its tail when the FLs are in the nose and not in the airway. More pressure can't fix nasal congestion FLs....simply can't.

My personal opinion...I doubt that you need the minimum of 12 anyway. I think you could get by with lower but I don't suggest a drastic lowering....you are so used to 12/9 that if you lower it much you won't be comfortable. Been there and done that myself and a big drop was NOT comfortable.
So if going higher doesn't give you the results you expect or creates a problem....maybe backup up a little might be worth looking at.

On the Nov 2 report....lots of evidence of fragmented sleep....why?

[crshirley7]

Thanks everyone for your input. Sorry I have been silent for the last couple weeks. Just recovering from influenza B and an asthma exacerbation, haven't felt like staring at a computer screen much. So to answer a few questions:

Wulfman: Why do I use APAP: My initial prescription was for a fixed pressure of 8. After a few weeks, I complained to the RT that I felt like I was suffocating at certain times during the night. As a result, the sleep doctor changed the prescription to apap 8-11 with pressure relief of 2. I just kept with the apap with my pressure changes.
When my pressure is less than 12, I have groupings of csa's that resemble CSR and lots of OSA, RERAs and hypopneas. Raising the pressure to 12 gets rid of most of those events save csa's, at least they are not grouped together...

Several people suggested to use a constant pressure instead of APAP. I did try a constant pressure of 14, but it was difficult to get back to sleep when aroused. Ended up switching back to APAP during the night. This was before I came down with the flu, so might try again when by asthma returns to normal...

Pugsy asked "On the Nov 2 report....lots of evidence of fragmented sleep....why?" I turned the EPR off and ended up having more flow limitations than with EPR on so the pressure went higher which kept causing mask leaks. Once aroused to fix the mask, I could not get back to sleep at the high pressure so I kept shutting the machine off and back on to ramp the pressure...

Thanks for all your help...