Took advice and raised my minimum pressure

[Minky]

I had a much better night last night. I raised my minimum pressure to 7 and slept much better. I don't get why a doctor would set it at 4. When you get into bed ready to go to sleep and then fight the feeling of suffocation for several minutes until the pressure adjusts itself, you then wake up. I also turned on the EPR to 2 so that I would stop waking up when the pressure raises in the middle of the night.

Thanks again to everyone for your advice.

Merry Christmas!

[Julie]

Hi - be prepared to see your AHI go just a bit higher than normal because of the EPR setting... it's just a thing that goes with that and you can play with it a bit (maybe raise your pressure again by 1 cm).

[englandsf]

Are you using a pressure range? Any idea what your average pressure is for the night? 4 is usually just a DME laziness setting but 7 may be too low too depending on your results. Are you using Sleepyhead?

[Minky]

My pressure range was set at 4-12. Based on what I see on Sleepyhead I think that 12 is fine as a maximum, as I'm having few to no RERAs, which is the reason I went on CPAP (I have UARS, not apnea). My pressure averages around 10 for the night. Sometimes it goes to and stays at 12, so if that keeps happening I may bump it up to 13 and then see how the data looks. I may also try changing the minimum to 8 and then will see how my data is affected.

I'm not using a DME. The hospital tried to send me to a DME, but the DME was going to take several weeks, so I made myself such a nuisance to the hospital that they gave me the prescription in hand. I scanned it, placed an order with CPAP.com and the machine, masks, hose, etc. were on my front step around 20 hours later .

I'm really glad to be without a DME. The people on this forum know WAY more and a DME would just irritate me.

Thanks!

[palerider]

I don't get why a doctor would set it at 4.

I'd guess because of two things, some people might not need much above 4, (thought that's probably rare) and it's the default setting, and they're too lazy to think?

probably better to start at 6 and only lower it if the pressure never auto adjusts up.

also, bear in mind that the epr of 2 at 7 effectively means your pressure is 5 except when you inhale.

merry christmas to you too!

[cathyf]

Have you looked at your data in Sleepyhead? I started with settings of 7-20 and my data showed that the instant I fell asleep the pressure would climb to the mid-high teens, and as long as I stayed asleep it would never drop below about 11-1/2. So I set my minimum pressure to 11 (raised gradually) and since the machine isn't playing catch-up at the beginning now it doesn't seem to climb quite as high.

I tried a week with a constant pressure of 12cm, and I had the same level of AHIs, but I had a lot more FLs -- the machine clearly wants to send me to higher pressures. I am back at 11-20. I am relatively "pressure deaf" in that the high pressures don't bother me, and while the machine doesn't go much past 15 or 16 very often, it does occasionally, and if the machine can raise the pressure and keep me asleep I'm all about that life!

[Dirty Martini]

My PCP instructed my DME to leave my APAP range with factory settings: 4 to 20. Based on what I read here, I feared it was laziness. (And truthfully based on my recent experiences with my PCP over the last 12-24 months, the assumption of laziness may actually have merit...but I digress.)

Once I settled in after 6-7 weeks, got access to SleepyHead and started looking at my data......turns out that I am one of those rare people who don't require that much pressure most of the time. But apparently when I do -- I really do. (16, 18)

After 3 months of usage, my average pressure is 4.7, my 90% pressure is 6.5. But apparently I have had a few moments, and seen one or two significantly higher spikes. My AHI has averaged 1.29, but I have had a couple of bad nights that are still just under 5.

I struggled at first with the 4.0 when I first went to bed, feeling like I was suffocating. It was suggested on here I pump it up a notch or two in the early weeks. I probably would have done so if I had the time and patience to figure out how--but I was swamped at work, really stressed, and working 15-18 hours most days then. Now I don't feel suffocated by 4, I guess my body and mind just knows I"m not suffocating and has adapted.

I have come to the conclusion that I am one of those rarity's with actually pretty low pressure needs. But that's me.

Curious though for my continued learning: What would happen if you have your pressure needs set too high? What kind of side effects, what's the harm, etc.?

[cathyf]

Curious though for my continued learning: What would happen if you have your pressure needs set too high? What kind of side effects, what's the harm, etc.?

Some people are awoken by high pressures -- which kind of defeats the whole purpose of the therapy! Some people swallow lots of air at high pressures, and then get woken up by the resulting pain/belching/farting. Some people have mask fit challenges, and that spike to 20cm will blow their mask out of place.

Some of these people need the higher pressures, so there is a balancing act between letting a few more events through vs the bad effects of the high pressures.

It's all about the sleep!

[archangle]

There are lots of reasons this happens.

Far too often, DME's and doctors practice assembly line medicine. Get a patient in, do what's required to ring the cash register, next!

They don't pay enough attention to patient comfort and figuring out what works best. Many don't even look at the therapy results like AHI that the machines provide or may even allow a non-data capable machine to be used.

There's a big bias in the medical mafia for running $leep te$t$. They tend not to put much faith in home data or APAP machines. They tend to just sort of ignore the patient's individual needs and set it on the full range thinking the machine will figure it out.

Many patients complain of too much pressure. The simple solution is ramp or starting at a low pressure. They tend to not realize that a low pressure can be uncomfortable, even if you're not having apneas.

I think the discomfort at low pressure for many people is because of increased CO2 from rebreathed air. The CO2/O2 level is still at a very safe level, but your brain and respiratory system may be unhappy because of the higher CO2 and give you feelings of not getting enough air.

[palerider]

Curious though for my continued learning: What would happen if you have your pressure needs set too high? What kind of side effects, what's the harm, etc.?

in addition to what cathy said, some people (maybe 1 in 7, ish) have central apnea caused by higher pressures, which is why the better modern machines try and tell the difference between central and obstructive and don't raise the pressure with centrals. (plus, more pressure doesn't help centrals)

[Tatooed Lady]

I don't get why a doctor would set it at 4.

I'd guess because of two things, some people might not need much above 4, (thought that's probably rare) and it's the default setting, and they're too lazy to think?


merry christmas to you too!

Careful, Hoss. ..last time I said that, it caused a ruckus.

[palerider]

merry christmas to you too!

Careful, Hoss. ..last time I said that, it caused a ruckus.

what kind of ruckus did you cause wishing someone a merry christmas???

not that I doubt you could do that, just puzzled

[Tatooed Lady]

Lol!! Not the Christmas thing...The DME being lazy. Sillyass.

[palerider]

Lol!! Not the Christmas thing...The DME being lazy. Sillyass.

made ya giggle

[zoocrewphoto]

I tried a week with a constant pressure of 12cm, and I had the same level of AHIs, but I had a lot more FLs -- the machine clearly wants to send me to higher pressures. I am back at 11-20. I am relatively "pressure deaf" in that the high pressures don't bother me, and while the machine doesn't go much past 15 or 16 very often, it does occasionally, and if the machine can raise the pressure and keep me asleep I'm all about that life!

That sounds like me I can't sleep through hissing, but the pressure can get into the upper 16s, and I don't wake up unless I drop my chin enough to get my cheeks flapping (only happens if I stay on my back too long). But the actual pressure doesn't bother me, and the changes don't either. So, I have it set for 11-17, and it does its thing, mostly between 11 and 13, with some spikes to 15. And some nights, some really short spikes to 16 and 16.9. I'm really happy that my machine can handle the extra needs of back sleeping, congestion, asthma, taking a muscle relaxer, etc. I don't have to do or change anything. It simply adjusts to my needs, and I can sleep