Adjusting an S9 to go above 20cm

[Goofproof]

It looks to me like when your pressure is lower you do better. The high pressure just drives your leak rate higher and then your numbers get worse. If it were me I'd pull the top pressure back to 18Cm and set the bottom to 16 cm for a couple of nights, the added pressure isn't lowering your events, looks to me like the added leaks from the higher pressure makes things worse. Jim

I'm not fimillar with the leak rates of your mask or the way Resmed measures your leak rate, I prefer Remstars system, but clearly when your leak rate goes up your treatment goes down.

[brain_cloud]

It looks to me like when your pressure is lower you do better. The high pressure just drives your leak rate higher and then your numbers get worse. If it were me I'd pull the top pressure back to 18Cm and set the bottom to 16 cm for a couple of nights, the added pressure isn't lowering your events, looks to me like the added leaks from the higher pressure makes things worse. Jim

I'm not fimillar with the leak rates of your mask or the way Resmed measures your leak rate, I prefer Remstars system, but clearly when your leak rate goes up your treatment goes down.

Leak rate? I didn't include any leak data because it is just a flat line of no leak. Flow and Minute Ventilation are not Leak.

[billbolton]

OR Just check with BB he thinks you can get 26cm out of what you have?

The point which many are missing here is that the S8, S9 (and similar APAPs from all vendors) machines are designed up to work as an APAP up to a delivered pressure of 20cms H20.

• Auto Altitude adjustment makes sure that blower can deliver up to 20 cms H20 at any altitude up the maximum specification, so the APAP algorithm can do its thing, but the APAP alogrithm just doesn't know anything about delivered pressures higher than 20 cms.
  
  Even is the machine could be spoofed in some way to deliver a higher pressure by the blower motor at less than its maximum alititude setting, the APAP algorithm is not set up to "do" anything above 20cms, so its not going to be able to actually "use" that pressure to address events (by whatever means each particular alogrithm does that).
  
  The earlier explanation about how the blower works was given solely to explain what used to be possible on CPAP (that is, NOT with APAP) machines several years ago, and which the DME tech seems not to have understood simply can't work any more.
  
  I was never suggesting that a delivered pressure over over 20cms H20 would ever be provided by any current or recent APAP machine.

I hope that is now explicitly clear to everyone here.

Cheers,

Bill

[billbolton]

See how she strains with all of her might 'gainst that red ceiling?

Have you tried running your S9 in non-auto (CPAP) mode at a fixed 20cms H[img]2[/img]0 to see what happens then?

You may find that gives you a better outcome (even if it doesn't entirely solve the problem) than running it in auto mode,

Cheers,

Bill

[Really]

I was never suggesting that a delivered pressure over over 20cms H20 would ever be provided by any current or recent APAP machine.

I guess you were Really misunderstood by this

Most xPAP systems will actually generate genuine flow rates at up to about 26cms H20 at sea level,

Or you Really misunderstood the Original question

Just got back from another titration study. I hear the last pressure they used was 21. The tech also said there is a way to allow the machine to go above the normal limit of 20. I don't see it in the clinician's menu. I guess it's a more invasive adjustment. Anyone know how to do it?

Really.

[GumbyCT]

I was never suggesting that a delivered pressure over over 20cms H20 would ever be provided by any current or recent APAP machine.

I guess you were Really misunderstood by this

Most xPAP systems will actually generate genuine flow rates at up to about 26cms H20 at sea level,

Guess I missed this but who'da thunk it?

viewtopic/t52251/BILL-BOLTON-WAS-RIGHT.html

[blakepro]

Here is a off the wall question..

What if you switched to a mask that has a lower vent rate? would that effectively give you a slightly higher pressure? Would be enough to get you the extra boost you need?

Probably a bit far fetched, but I thought I would throw it out there.

[timbalionguy]

I am going to disagree with everyone here. Those graphs scream LEAK! Notice the spikes in minute ventilation. Many of these do not correspond with any pressure change, or happening while the pressure is flat-topped. They also get much worse towards morning. IMHO, there is either mouth breathing or mask leak going on that need to be dealt with. It could be that the mask type is set to a mask with a much higher leak rate, and so this would explain the flat leak line.

The fact that this gentleman is not getting any REM sleep, even with these pressures, tells me that he needs a new workup from a fresh perspective. There is organic disease that prevents REM sleep.

I will agree though, that it would appear that these high pressures are not giving this gentleman good therapy. There is definitely more going on here than what meets the eye.

EDIT: See this thread. There could be a machine problem here.

viewtopic/t56923/My-S9-always-reports-t ... -leak.html

[elena88]

I cant imagine pressures like that with a flat line leak rate... when I adjust my mask there is a spike, even a tiny leak will give you
a bump or two, but not a flat line... that is very, very odd.

have you tried adjusting your mask and pulling it away from your face a few times while the machine is on? you should see the spikes

right there on the graph the next day, if you dont there might be something wrong with your machine..

geez, you need to get this figured out, that is quite a mess of red spikes you have going on there kiddo!

no unknowns or centrals very often?

[brain_cloud]

Actually, it is pretty much solved. Leak was not an issue. minute ventilation instability is here measuring actual breathing instabilities. Mouth taping while keeping the same mask (quattro) has allowed this pressure range to be effective. I no longer have huge clusters of apneas. Average AHI is now 1.8

[john5757]

I am a bit confused here. You saying by tappping the lips you no longer have a problem? Why would this not to be a leak issue?

[brain_cloud]

I am a bit confused here. You saying by tappping the lips you no longer have a problem? Whay would this not to be a leak issue?

Because I wear a full face mask.

[john5757]

I would think that by tapping your lips you are trying to prevent mouth leaks. In order for that to happen the air pressure in your full mask would have to be lower that the pressure in your mouth,ideally the mouth or nose air pressure should be close to the mask pressure . The auto CPAP does not care if your are breathing thru your nose or your mouth as long the full mask is making a good seal. You found something that works for you and I guess that counts.

[ozij]

The auto CPAP does not care if your are breathing thru your nose or your mouth as long the full mask is making a good seal. You found something that works for you and I guess that counts.

The auto CPAP may not care, but human physiology does care: studies have shown mouth breathing causes more airway collapse -- I've quoted the studies in previous threads on the subject of mouth leaks and taping -- forgive me for not searching for them again.

O.

[reznil]

Brain Cloud - I'm not a doctor, but I really think you might be a candidate for surgery. 20 cmH20 and still having events....
If surgery works (I'm guessing it would improve the apneas dramatically) your current cpap would probably be fine. Even a small but definite chance that you might not need cpap at all.