pressure range questions

[palerider]

We're a great driver (or so we tell ourselves) and so we'll be able to avoid getting into a car crash.

Statistically speaking, 95% of drivers think their driving skills are above average...

I would think that statistically speaking 95% of drivers think their driving skills are way above average.

And most of those drivers are wrong.

Truer words were never spoken.

[ozij]

The newer Resmed machines, of which yours is one, have two "response" options when set to APAP.
You're running on the Standard resopne. They also have a Soft response.
While the quote only mentions Autoset AS10 machine, your AS11 has the response set to Standard. I'm pretty sure you have the "Soft" options as well
A slower pressure change may help with aerophagia. Worth checking.

https://www.resmed.com.au/healthcare-pr ... technology

AutoSet Response mode
ResMed’s AutoSet algorithm now allows for additional customisation of therapy with the new AutoSet Response mode, which offers all the benefits of the enhanced AutoSet algorithm with gentler pressure increases for additional comfort.

For patients who are sensitive to faster changes in pressure during therapy, AutoSet Response can be set to either Standard or Soft. If set to soft, patients will receive gentler pressure rises during therapy.

Available in the AirSense 10 AutoSet and AirSense 10 AutoSet for Her devices.

[Dog Slobber]

I like the idea of trying Soft Response, to see if it helps with your aerophagia before messing with capping your max pressure.

[lynninnj]

I like the idea of trying Soft Response, to see if it helps with your aerophagia before messing with capping your max pressure.

Oji and DS, thanks! I will give that a try. I want to do one more day at current settings first, since I am two days in already and three or four is just about enough to draw conclusions as to whether changes should be made.

Last night my jaw was giving me grief and it was restricting my range of motion in my neck. So when I was on my left at the beginning leg of the night, I had zero AHI. Then I flipped over and had a bunch of events, the total of 9 for the night. This happens after spending extra hours in front of the computer.

https://sleephq.com/public/1f19228f-10e ... 4c12ab1fea

The median pressure was below 7 and max was around 9.54 (?). Hopefully as the day goes on my neck loosens up a bit and I can lay down properly. I find if I wake up with my head still extended I have far fewer events but if I go chin down, I have more. So for now, I blame that for the slight increase in events since starting my experiment.

I am actually eager to switch over modes to soft response after another day or so.

thanks for that input though guys. Its on my radar for sure.

[robysue1]

Last night my jaw was giving me grief and it was restricting my range of motion in my neck. So when I was on my left at the beginning leg of the night, I had zero AHI. Then I flipped over and had a bunch of events, the total of 9 for the night. This happens after spending extra hours in front of the computer.

Several comments:

1) How often does your jaw give you grief? Have you been diagnosed with TMJ problems? And if so, what (if anything) do you do to treat the TMJ problems?

2) All your events seem to be scored in a 4 hour window. 9 events in 4 hours is not particularly troublesome. Moreover, to my eyes there is no serious clustering of events.

3) You may want to find a way to prevent yourself from spending extra hours on the computer when the TMJs are bothering you. Or more practically, make sure you take good breaks from the computer. Many people don't realize how still they are when they're on the computer for hours at a time.

The median pressure was below 7 and max was around 9.54 (?). Hopefully as the day goes on my neck loosens up a bit and I can lay down properly. I find if I wake up with my head still extended I have far fewer events but if I go chin down, I have more. So for now, I blame that for the slight increase in events since starting my experiment.

The stiff neck seems to be a more serious problem than the number of events you had last night.

In other words, you may be trying too hard to prevent the last few events from happening.

Here's what I mean: When you wake up having slept with your head in an extended fashion for a long period of time, does your neck hurt more the next day? Do you have more problems with your TMJs?

From the neck's point-of-view: What position does your neck want to sleep in? In other words, what head position leads to the least neck pain the next day? Same question for your jaw and TMJs: What sleeping position minimizes the jaw pain and the TMJ pain?

I ask because my own TMJs and neck really do not like me sleeping in a position where my neck is extended and my head extended. They both much prefer me to sleep in a fetal position on my side and with a pretty tight chin tuck towards my chest. Yes, this may trigger a few more events (according to some people), but the increase in TMJ/neck pain is not worth the small decrease in number of events for me to attempt to change my sleeping position.

[lynninnj]

Last night my jaw was giving me grief and it was restricting my range of motion in my neck. So when I was on my left at the beginning leg of the night, I had zero AHI. Then I flipped over and had a bunch of events, the total of 9 for the night. This happens after spending extra hours in front of the computer.

Several comments:

1) How often does your jaw give you grief? Have you been diagnosed with TMJ problems? And if so, what (if anything) do you do to treat the TMJ problems?

2) All your events seem to be scored in a 4 hour window. 9 events in 4 hours is not particularly troublesome. Moreover, to my eyes there is no serious clustering of events.

3) You may want to find a way to prevent yourself from spending extra hours on the computer when the TMJs are bothering you. Or more practically, make sure you take good breaks from the computer. Many people don't realize how still they are when they're on the computer for hours at a time.

The median pressure was below 7 and max was around 9.54 (?). Hopefully as the day goes on my neck loosens up a bit and I can lay down properly. I find if I wake up with my head still extended I have far fewer events but if I go chin down, I have more. So for now, I blame that for the slight increase in events since starting my experiment.

The stiff neck seems to be a more serious problem than the number of events you had last night.

In other words, you may be trying too hard to prevent the last few events from happening.

Here's what I mean: When you wake up having slept with your head in an extended fashion for a long period of time, does your neck hurt more the next day? Do you have more problems with your TMJs?

From the neck's point-of-view: What position does your neck want to sleep in? In other words, what head position leads to the least neck pain the next day? Same question for your jaw and TMJs: What sleeping position minimizes the jaw pain and the TMJ pain?

I ask because my own TMJs and neck really do not like me sleeping in a position where my neck is extended and my head extended. They both much prefer me to sleep in a fetal position on my side and with a pretty tight chin tuck towards my chest. Yes, this may trigger a few more events (according to some people), but the increase in TMJ/neck pain is not worth the small decrease in number of events for me to attempt to change my sleeping position.

I appreciate the well considered reply.

Some days there’s not much I can do ergonomically at work. Will have to take more breaks or switch up what I am working on when I find I am stiffening up.

I had a mouth guard but the headaches were worse afterwards.

It just occurred to me that I *think that part of what may be an issue is the earplugs I’ve been wearing since there’s construction going on next door starting early in the morning. I can’t tell them to start later so I wear earplugs. I haven’t worn them in ages. My earlobe hurts even. Mental note: no earplugs. I don’t wake up feeling bad after head extension and kind of the opposite.

I knocked the pressure back up to 7 but turned it to soft changes.

Gotta work on the sleep hygiene now. Will let you know how it turns out. I have about a week or so of high level stress and hope things settle after that.

Thanks.

[lynninnj]

So, after several days of headaches I decided to go the opposite direction. I bumped my minimum back up to where I was stable and doing well. Had it there for a day or two and bumped it up .2 last night.

On paper I had fantastic sleep. In reality, my sleep was broken up and the middle of the night involved very little sleep. I realize now that there are some major stressors going on that add to the TMJ problems because I clench when stressed. I have a snorer next to me at night and could not fall back to sleep.

I really need to work on the sleep hygiene but I know that until I get through some issues that carry over until at least Tuesday, my expectations are low. Doctors. Lawyers. Documents to sign.

That said, this was last night. https://sleephq.com/public/ea151bb4-206 ... d42507994a

I also changed the settings to Soft. I will give that a try since I raised the pressure. Honestly, I would rather pass wind all day long than have that all day headache that doesn't respond to tylenol. Can this be seen in the chart as less spikes in pressure? Or maybe it is a combo of both raising my minimum and the soft setting. Not sure.

So it is clearly a work in progress. I anticipate improvement after I get some work done on realigning the jaw and getting rid of the neck tension on Friday.
I think I need to take up meditation. maybe add that to the to-do list on my day off.

Thanks for all the ideas and help so far.

[robysue1]

I also changed the settings to Soft. I will give that a try since I raised the pressure. Honestly, I would rather pass wind all day long than have that all day headache that doesn't respond to tylenol. Can this be seen in the chart as less spikes in pressure? Or maybe it is a combo of both raising my minimum and the soft setting. Not sure.

That's the problem with changing two variables at the same time: There's no way to know which is more responsible for any changes. If I had to hazard a guess, it's a combination:

The higher minimum pressure setting makes it harder for your airway to collapse in the first place, so there's fewer flow limitations and less need to increase the pressure.

The Soft setting may also cause the machine to be more cautious about how fast and how high it increases the pressure in response to a particular kind of event, including flow limitations and snoring.

[lynninnj]

I also changed the settings to Soft. I will give that a try since I raised the pressure. Honestly, I would rather pass wind all day long than have that all day headache that doesn't respond to tylenol. Can this be seen in the chart as less spikes in pressure? Or maybe it is a combo of both raising my minimum and the soft setting. Not sure.

That's the problem with changing two variables at the same time: There's no way to know which is more responsible for any changes. If I had to hazard a guess, it's a combination:

The higher minimum pressure setting makes it harder for your airway to collapse in the first place, so there's fewer flow limitations and less need to increase the pressure.

The Soft setting may also cause the machine to be more cautious about how fast and how high it increases the pressure in response to a particular kind of event, including flow limitations and snoring.

I hear ya.

Sleepless in Jersey doesn’t help figure it out very well either.

Still, the early part where I actually slept was uneventful so I’m good with the change. I originally had 8-16 settings after 1m visit so I know I can handle higher pressure.

Looking forward to the end of stress week.

Thanks.

[lynninnj]

So, last night was a hot mess. I had lifted my pressure up to 7.2 a few days ago but by end of night down to 7. The reason for this was concern that the increased pressure was causing my mouth to open and air to rush out. This doesn't feel good, especially when it happens over and over and over again.

https://sleephq.com/public/48e95d5b-1c7 ... c838534a74

When looking at this, does one figure the FL or the leak graph best depicts the open mouth times? Anyone know? This is the highest my pressure has ever gone up.

Then I figured it out. I had a half stuffed nose. One nostril was completely open. Ugh. Mental note to self, treat this before bedtime. Only being able to half breathe out of one nostril clearly is a problem. This morning I blasted it with a silver nasal spray mainly because I didn't have a simple saline one. (I hate netti pots). Never been so happy to sneeze and take a steamy shower. I may need to employ the "pluck your eyebrows to make yourself sneeze" gambit.

I can't/dont want to use a strap or cervical collar due to TMJ. I tried to keep my chin in place by positioning my hands and air just kept coming out of my mouth. I ordered some mouth tape today, due in on Tuesday. I guess though at the end of the day it seems like if I am not breathing clearly in the pap I am not going to sleep well no matter how badly I try to fix it so the air goes in and doesn't get stuck on the way down.

So as the weather changes I also note that I am using far more water in the humidifier. This learning process will be starting all over for me again with this change of season.

so what do you guys do for these situations please? I hate pharmaceuticals for routine stuff so I tend to steer that way but last night I prob should've dropped a decongestant.

[Dog Slobber]

Setting your pressure to 7.2 (or 7.) would not be responsible for pushing your mouth open.

Your machine is set to Ramp pressure 4, for 5 minutes. Then as soon as you exit ramp your machone responds to events (mostly FLs) goes above your minimum and never returns to it. Your pressure graphs would have been virtually identical had your minimum been 7.2, 7.0, 6.8, 6.6,...

One thing to consider, last night's hot mess was caused because you couldn't breath through your nose and your were compensating by opening your mouth.

Your AHI is well treated, but your Flow Limitations are a little active.Y ou do have some options, but try one thing at a time:

• Turn on Soft Response
• Turn on EPR, when my nose is clogged, EPR (actually PS for me) is my saviour. It allows me to breath against the pressure so much easier.

I see you're using 5 minute ramp. When I had an AutoSet, I *loved* AutoRamp. Have you tried it.

AutoRamp is not timed, it makes a determination of whether your asleep or not based on your breathing patterns, then when it believes your asleep switches to therapy mode. IMO, it offers a lot of features timed ramp doesn't:

• Continuous pressure at your comfort level instead of gradually increasing over the timed period.
• Pretty accurate determination of sleep, at least for me
• Still monitors events and will switch to therapy mode if it detects events within it's threshold.

[lynninnj]

Setting your pressure to 7.2 (or 7.) would not be responsible for pushing your mouth open.

Your machine is set to Ramp pressure 4, for 5 minutes. Then as soon as you exit ramp your machone responds to events (mostly FLs) goes above your minimum and never returns to it. Your pressure graphs would have been virtually identical had your minimum been 7.2, 7.0, 6.8, 6.6,...

One thing to consider, last night's hot mess was caused because you couldn't breath through your nose and your were compensating by opening your mouth.

Your AHI is well treated, but your Flow Limitations are a little active.Y ou do have some options, but try one thing at a time:

• Turn on Soft Response
• Turn on EPR, when my nose is clogged, EPR (actually PS for me) is my saviour. It allows me to breath against the pressure so much easier.

I see you're using 5 minute ramp. When I had an AutoSet, I *loved* AutoRamp. Have you tried it.

AutoRamp is not timed, it makes a determination of whether your asleep or not based on your breathing patterns, then when it believes your asleep switches to therapy mode. IMO, it offers a lot of features timed ramp doesn't:

• Continuous pressure at your comfort level instead of gradually increasing over the timed period.
• Pretty accurate determination of sleep, at least for me
• Still monitors events and will switch to therapy mode if it detects events within it's threshold.

yeah, I kind of figured that it wouldn’t make much difference with the pressure settings were. I’m really hoping my nose will be completely clear tonight at bedtime. I see now that even just a little bit of a blockage can create a huge problem for me.

I have the EPR set at three already. If you’re looking at sleep HQ, (JFFR) you can look at settings and it says more settings at the bottom in that area and it’ll tell you everything that a person has it set on. I will try changing it to soft response ,

I used to have a much longer ramp and I didn’t really care for it. I actually felt more comfortable with the full blast of air a few minutes into it.

biggest problem with last night was that from 4 o’clock until about 7 o’clock I was wide-awake and just could not get back to sleep. Autoramp will be a variable I will change at a later time I think. I have a huge week ahead of me, and I desperately need my sleep.

Going to start with a soft response and go from there.

what do you guys do to get rid of congestion so you can fall asleep in the first place?

[robysue1]

biggest problem with last night was that from 4 o’clock until about 7 o’clock I was wide-awake and just could not get back to sleep. Autoramp will be a variable I will change at a later time I think. I have a huge week ahead of me, and I desperately need my sleep.

Lying in bed for three hours without being able to get back to sleep can be really nerve wracking.

You might actually be better off getting out of bed if you are still wide awake after 30 minutes of trying to get back to sleep. Just get up, go to another room and sit quietly for a while. Do something relaxing, but not too stimulating. When you find yourself yawning, you know that your body may be getting sleepy enough to get back to sleep reasonably quickly when you go back to bed.

what do you guys do to get rid of congestion so you can fall asleep in the first place?

Not much anymore: The cpap air is filtered (I use a pollen filter as well as the coarse reusable filter), so typically my nose gets less clogged once I put the machine on as long as I remember to change the filters on a weekly basis.

But back when I was new to xPAPing, I had to use a neti pot every evening about 30-60 minutes before going to bed. And saline nose drops as needed. And I had take a zyrtex on most nights. And at one point I was also using flonase nasal spray daily.

If your nose is clear during the daytime and only gets clogged up after you turn the machine on, you may be dealing with cpap-induced rhinitis. In other words, the air/pressure from cpap itself is triggering the congestion. Things to do to try to fix this problem involve experimenting with the humidifier and heated hose settings. You may find that you need more humidity than your current settings allow for. Or you may find that you need less humidity than your current settings allow for.

So if your humidifier is set near its max setting, try turning it down. If your humidifier is set near its minimum setting, try turning it up. If your humidifier is set near the middle, you'll need to try both turning it up and turning it down to see which feels better for your congestion.

[lynninnj]

i’ve done the whole get up and walk around or sit out in the other room and read for a little bit before going back to bed. Thank you for the reminder.

I have had a little congestion throughout the day. Not even enough to call it a stuffy nose, but just enough restriction in my airways but it’s annoying.

Like I had asked before I don’t know if it’s what you see on the flow limits graph but I did much better last night. I slept much more soundly. Right before bed I made a point to use the nasal spray. I think I will pick up some saline from the store tomorrow. The flow limit graph looked like a hot mess still but I felt better. I also didn’t have my mouth blowing open and to me that was the most annoying thing.

Thanks for the insights. Maybe I will look at those two medication that you mentioned as well just to have some on hand in case I need it.

[Dog Slobber]

I was wide-awake and just could not get back to sleep.

but last night I prob should've dropped a decongestant.

Has there been a correlation between decongestion use and insomnia.

A lot of decongestions, especially the pills can contribute to insomnia.