Increase Pressure?

[jonesresidence]

Hello and thanks for helping with my inquiry.

1. I just ditched the Phillips DS1 (RX'd in 2019) for a ResMed Airsense 10 Card to Cloud machine. Tonight will be the 3rd night of use and I'm revisiting my attempt at understanding this stuff.

2. My knowledge is limited to "If it's under 5, your good!" However I know there is more to it than that... My average range is between 3-6. My goal is to get to 0 and feel great but I need help understanding how to go about getting there. I still feel tired during the day.

3. I find my provider is lacking in availability and willingness to go into "data deep dives" to further customize my treatment.

4. When looking at Oscar data, it looks pretty messy. Last night for example had many events.

154 (LL)
19 (H)
9 (CA)
4 (UA)
3 (RE)
2 (OA)

5. My pressure is set between 8min-10max. On 4 or 5 occasions throughout the session it hits the 10 mark. Does this mean that I need to increase the minimum pressure to 10?
6. Should I change my setting from APAP to CPAP to get a single continuous pressure as opposed to a range of pressures?

[Pugsy]

Should I change my setting from APAP to CPAP to get a single continuous pressure as opposed to a range of pressures?

Not necessarily. Why? What makes you think cpap fixed mode is the way to go?

My pressure is set between 8min-10max. On 4 or 5 occasions throughout the session it hits the 10 mark. Does this mean that I need to increase the minimum pressure to 10?

No...it just means you probably need to increase that max of 10 to something a bit higher depending on just how much time you spend at 10 cm.

[Pugsy]

We really need to see those reports ourselves but a couple of things stand out right now

154 (LL)

4 (UA)

This tells me right now that you are having leak issues because when we see UAs flagged that means the leaks were so bad the machine didn't know what to call whatever event it sensed was happening.

Again...we really need to see what you are seeing in those reports.

[jonesresidence]

Hi, thanks for quick response.

Here is 1-11-24 and 1-12-24

https://www.dropbox.com/scl/fi/78nxxrnd ... 33cj3&dl=0
https://www.dropbox.com/scl/fi/4vy8ntim ... pbbmd&dl=0

[jonesresidence]

Should I change my setting from APAP to CPAP to get a single continuous pressure as opposed to a range of pressures?

Not necessarily. Why? What makes you think cpap fixed mode is the way to go?

To be honest, I really don't know, I'm just grasping at straws.

My pressure is set between 8min-10max. On 4 or 5 occasions throughout the session it hits the 10 mark. Does this mean that I need to increase the minimum pressure to 10?

No...it just means you probably need to increase that max of 10 to something a bit higher depending on just how much time you spend at 10 cm.

[jonesresidence]

Should I change my setting from APAP to CPAP to get a single continuous pressure as opposed to a range of pressures?

Not necessarily. Why? What makes you think cpap fixed mode is the way to go?

To be honest, I really don't know, I'm just grasping at straws.

My pressure is set between 8min-10max. On 4 or 5 occasions throughout the session it hits the 10 mark. Does this mean that I need to increase the minimum pressure to 10?

No...it just means you probably need to increase that max of 10 to something a bit higher depending on just how much time you spend at 10 cm.

Where I got the idea to increase minimum was from the CPAP FAQ's it says:

Why is the minimum pressure important on an APAP?

"The minimum pressure is what the machine mindlessly tries to attain all night long. It operates on the assumption that the minimum was set thoughtfully, by someone that has looked at data that gives a good indication what pressure a person needs for most of the night.
Breathing events cause an exception, which temporarily raises pressure, but as soon as those clear up.... Back to minimum we go. If the minimum is too low... More events, more fractured sleep, more oxygen desats, more problems.
Minimum pressure is what it's all about. You want to have the minimum pressure set high enough to prevent the majority of events outright, and then let the machine handle exceptions, such as rolling onto your back, or REM cycles, (both of which typically require more pressure than side/front positions, or NREM.

[Pugsy]

1.....you gotta work on leak management for sure. Are you mouth breathing by any chance. Wake up with Sahara Desert in your mouth?
2....you do need to increase that maximum pressure for sure...We don't know how much but I would set it from 10 to 15 and see if you hit 15 or not. I doubt you will but we have to make sure.
3....Your AHI isn't horribly horrible but it can stand some reducing....I am hoping that if the machine can go higher it will do a better job of preventing the airway collapses you are seeing in hyponeas and OAs and UAs.

AND clean up the leaks because they are just too excessive and prolonged and happening almost all night and they are likely allowing some apnea events to materialize.

The CAs/centrals....not much we can do about them with this machine so put them on the back burner for now.
Lets see what happens if you can sleep better and get the leaks under better control to lessen chance of leaks disturbing sleep which could potentially lead to false positive centrals.

[Pugsy]

Where I got the idea to increase minimum was from the CPAP FAQ's it says:

Why is the minimum pressure important on an APAP? xxxxxxxx

I see now...and accurate points but when someone is using such an extremely tight range like your 8 min and 10 max when we see reports like yours we know straight away more max is needed.
That faq thing you quoted....really pertains to someone wanting to use a 4 cm minimum...your 8 minimum is quite respectable.
Now you may end up needing a little more minimum but before I would recommend that you need to
1...work on the leaks
2...allow the machine to go higher

and then see if a little more minimum is needed.
right now you have stuff muddying up the evaluation of current settings so I like to keep changes to a minimum and right now the maximum needing to be higher is much more critical than the minimum might be.

[jonesresidence]

Where I got the idea to increase minimum was from the CPAP FAQ's it says:

Why is the minimum pressure important on an APAP? xxxxxxxx

I see now...and accurate points but when someone is using such an extremely tight range like your 8 min and 10 max when we see reports like yours we know straight away more max is needed.
That faq thing you quoted....really pertains to someone wanting to use a 4 cm minimum...your 8 minimum is quite respectable.
Now you may end up needing a little more minimum but before I would recommend that you need to
1...work on the leaks
2...allow the machine to go higher

and then see if a little more minimum is needed.
right now you have stuff muddying up the evaluation of current settings so I like to keep changes to a minimum and right now the maximum needing to be higher is much more critical than the minimum might be.

I will give that a shot, thanks so much for your input...I will report back my findings.

[jonesresidence]

1.....you gotta work on leak management for sure. Are you mouth breathing by any chance. Wake up with Sahara Desert in your mouth?
2....you do need to increase that maximum pressure for sure...We don't know how much but I would set it from 10 to 15 and see if you hit 15 or not. I doubt you will but we have to make sure.
3....Your AHI isn't horribly horrible but it can stand some reducing....I am hoping that if the machine can go higher it will do a better job of preventing the airway collapses you are seeing in hyponeas and OAs and UAs.

AND clean up the leaks because they are just too excessive and prolonged and happening almost all night and they are likely allowing some apnea events to materialize.

The CAs/centrals....not much we can do about them with this machine so put them on the back burner for now.
Lets see what happens if you can sleep better and get the leaks under better control to lessen chance of leaks disturbing sleep which could potentially lead to false positive centrals.

That makes sense to me, I will try 10-15 and try and keep leaks under control....any recommendations on how to approach that issue?

[Pugsy]

try and keep leaks under control....any recommendations on how to approach that issue?

How to try to fix the leaks better depends on what is causing them.

2 main culprits when using a nasal mask
1...mouth opening/breathing leaks letting the air out the mouth and that means it isn't going down the airway in full force.
2...simply mask moving around from either being too loose or wrong size cushion or whatever.

If it is mouth breathing leaks there are several options but first you have to try to determine if it for sure is mouth breathing.
The only way to know for sure is to tape your mouth shut and not have that tape come loose.

If the leak line is perfect with tape then you know you were opening your mouth too much and there are various options available besides just taping the mouth.

If the leak line is still ugly with tape eliminating potential mouth leaks....then you know that mask moving around is the cause of the leaks. When that happens you have to figure out what is causing the movement and fix it.

[jonesresidence]

1.....you gotta work on leak management for sure. Are you mouth breathing by any chance. Wake up with Sahara Desert in your mouth?

Yes on occasion, more recently than I care for.

2....you do need to increase that maximum pressure for sure...We don't know how much but I would set it from 10 to 15 and see if you hit 15 or not. I doubt you will but we have to make sure.

Ok I will give it a try tonight!

3....Your AHI isn't horribly horrible but it can stand some reducing....I am hoping that if the machine can go higher it will do a better job of preventing the airway collapses you are seeing in hyponeas and OAs and UAs.

AND clean up the leaks because they are just too excessive and prolonged and happening almost all night and they are likely allowing some apnea events to materialize.

The CAs/centrals....not much we can do about them with this machine so put them on the back burner for now.
Lets see what happens if you can sleep better and get the leaks under better control to lessen chance of leaks disturbing sleep which could potentially lead to false positive centrals.

Agreed!

[jonesresidence]

try and keep leaks under control....any recommendations on how to approach that issue?

How to try to fix the leaks better depends on what is causing them.

2 main culprits when using a nasal mask
1...mouth opening/breathing leaks letting the air out the mouth and that means it isn't going down the airway in full force.
2...simply mask moving around from either being too loose or wrong size cushion or whatever.

If it is mouth breathing leaks there are several options but first you have to try to determine if it for sure is mouth breathing.
The only way to know for sure is to tape your mouth shut and not have that tape come loose.

If the leak line is perfect with tape then you know you were opening your mouth too much and there are various options available besides just taping the mouth.

If the leak line is still ugly with tape eliminating potential mouth leaks....then you know that mask moving around is the cause of the leaks. When that happens you have to figure out what is causing the movement and fix it.

That makes perfect sense, I will try that, what is the preferred mouthtape choice? I’d have to get that on Amazon or something.

[zonker]

2. My knowledge is limited to "If it's under 5, your good!" However I know there is more to it than that... My average range is between 3-6. My goal is to get to 0 and feel great but I need help understanding how to go about getting there. I still feel tired during the day.

yes, that "under 5" nonsense has got to go! if i get an ahi of 2, i feel a bit groggy and not very good at all. BUT 0 is something that you shouldn't chase. why? because it can lead to a lot of frustration. you might not need to get to zero in order to feel great. i feel great when i'm under that ahi of 2 i mentioned.

the goal of cpap, when you get right down to it, is to help keep your airway open enough to breathe more easily. getting an ahi of 0 does NOT guarantee a good night of sleep.

at any rate, good luck on your journey!

[jonesresidence]

2. My knowledge is limited to "If it's under 5, your good!" However I know there is more to it than that... My average range is between 3-6. My goal is to get to 0 and feel great but I need help understanding how to go about getting there. I still feel tired during the day.

yes, that "under 5" nonsense has got to go! if i get an ahi of 2, i feel a bit groggy and not very good at all. BUT 0 is something that you shouldn't chase. why? because it can lead to a lot of frustration. you might not need to get to zero in order to feel great. i feel great when i'm under that ahi of 2 i mentioned.

the goal of cpap, when you get right down to it, is to help keep your airway open enough to breathe more easily. getting an ahi of 0 does NOT guarantee a good night of sleep.

at any rate, good luck on your journey!

Very good points and appreciate the comment. I’m trying mouth tape for the first time, apparently it’s risky?

https://www.osfhealthcare.org/blog/is-i ... -sleeping/