Should I set a higher pressure? Apap + nosepillow.

Julie · Post by **Julie** » Sat May 28, 2022 9:32 am

I hope there hasn't been a very basic misunderstanding... your English is so good I may have not realized something - when I said to raise your 'max' pressure, I meant only the one called 'maxium', not the minimum one that is set at about 8 now. Having the max be so close to it (as Pugsy said earlier) just keeps the min. from going up higher to where it needs to be (to do its job) and should therefore 'get out of the way' of the min. If this doesn't help, or only confuses further, please ignore.

Pugsy · Post by **Pugsy** » Sat May 28, 2022 9:57 am

Your last night's report looks a lot better...everything is reduced including the FLs which are actually now at a level we could live with as long as you feel like you are feeling a bit better and sleeping a bit better.

Those CA flagged events...they are central apnea flagging and more pressure isn't going to reduce those.

Your barely kissed the 10 cm max last night a few times. If the machine going higher than 10 cm does end up causing you to wake up....it won't hurt anything to not let it go higher. More pressure won't fix those centrals anyway.

I would actually suggest that you keep these current settings for a week or two and watch the results for trends and patterns and not go changing things anymore just yet.
You made 2 changes...increased the minimum a bit and the maximum a bit....give yourself some time for your body to adjust to the new settings before you go changing things again.

The machine is increasing the pressures now in response to the FLs....look at when the pressure kissed 10 cm and the FL graph at the same time. I would be surprised if the machine even went to 12 if it could.
The machine will only go to where it thinks it needs to go in response to FLs, OAs, hyponeas and snores no matter how high the max might be set. Now sometimes when the machine thinks it needs to go is a pressure that can cause sleep disruptions or actually more likely what the pressure is trying to kill could very well be the cause of the sleep disruption and the pressure increases just happen to get the blame because that's the last thing we notice.

I tend to agree with your sleep tech in one regard....I have always felt like my primary goal is to sleep first and worry about numbers later. Without sleep none of the numbers matter. What I don't agree with was the AHI numbers in the obstructive category that she was willing to accept. That's why I said your report was just screaming "more pressure".
Obstructive stuff...OAs, hyponeas, snores and FLs...that is what more pressure can kill.

You are more comfortable taking baby steps with any changes....that's fine...right now if last night's report becomes the new norm it is quite acceptable as long as you are ALSO REPORTING that your sleep is decent quality and you are feeling decent. There is no urgent, just have to do it now, need for more pressure. The small adjustments you did last night made a huge difference in your report. Sometimes it happens like that...small adjustments make big changes.

The CAs/centrals could be arousal related or even a real asleep central (which is normal to have a few here or there during the night anyway) so I would put them on the back burner for now. More pressure won't fix/reduce them anyway.
The machine won't even try to increase the pressure for the centrals...any pressure increase you see in the neighborhood of the CA/Central flags is just a coincidence because the machine was trying to kill the FLs.

I wouldn't make any changes for a week or two then after looking at the reports and the machine still wanted to kiss 10 cm occasionally....maybe try 11 cm max but if you are sleeping great and feeling great with the max at 10....there is no urgent need to increase it just so the machine can kill more FLs. Sometimes the attempted killing of the FLs ends up creating more of a problem than the FLs were causing.

I don't see a need for more minimum at this time. You had it looks like maybe 1 OA and 2 hyponeas over the entire night.
Pretty darn good results. A lot better than the previous night at lower pressures.

Now a word about how the maximum pressure setting works...the machine won't go higher just because it can go higher without a good reason. Having a high maximum that is never reached doesn't change the auto adjusting algorithm or anything like that. My machine will go to 25 cm...and I have my max set to 25 cm but it rarely goes to 16 and most of the time it's going to be around 12 to 14 max. Now I don't have a problem with going higher so on the off chance it goes higher it's not a big deal to me but if I had a problem with it going higher I would most certainly limit the max.
A common problem that might be a good reason to limit the max would be if the higher pressures seemed to create more aerophagia issues...belly pain from air in the stomach.

If your machine never ever goes above 11 or 12 or 13 (if it could go higher)...then it really doesn't matter what you have the max pressure set at. But if you feel better and sleep better knowing it can't go higher...that's fine too.
I always tell people that if the machine doesn't ever go above a whatever pressure (let's use 12 as an example) when it could then it really doesn't matter what the max limit is set at...be it 13 or 15 or 20 or even 100 if the machine could go there.

Good job on last night....I really wouldn't change anything for at least a week so you can see if last night is the new norm or a fluke night. Give your body a chance to adjust. Ignore the CAs/centrals for now...we can't really do anything about them anyway and you aren't really having enough of them to be a problem anyway. It's normal to have a few centrals anyhow.

Miss Emerita · Post by **Miss Emerita** » Sat May 28, 2022 11:25 am

Very good to see the improvement! While you continue with these settings for the coming week, try to notice how you feel during the day *before* you look at Oscar. Try jotting a note each day about how you feel, in areas like how tired or sleep you are, what your mood is like, and how well you're able to think. Doing this can help you spot trends, even fairly subtle ones.

I'm so angry on your behalf at the way you've been treated. It can happen to anyone, but I am certain it happens more to women than to men. I also know that it can be a huge problem for diagnosis and treatment of conditions (like CFS) that have primarily "subjective" symptoms.

Just curious: have you had blood tests to investigate the possibility of autoimmune disease?

Pugsy · Post by **Pugsy** » Sat May 28, 2022 5:38 pm

Miss Emerita wrote: ↑
Sat May 28, 2022 11:25 am
I'm so angry on your behalf at the way you've been treated. It can happen to anyone, but I am certain it happens more to women than to men.

Yep....like realizing that my OSA symptoms I had were misdiagnosed as pre menopause and anxiety/depression symptoms because I didn't meet the usual criteria for OSA since I was a skinny assed female with a skinny neck.
At least 3 or 4 years with O2 going to low 70s percent and killer morning headaches blamed on "female stuff" and menopause.

Yeah...it was related to menopause all right but the menopause caused the loss of patency of the airway tissues causing the OSA to crop up. Menopause caused the floppy airway tissues. Low O2 caused the killer headaches...and my bitchiness did improve once I got on cpap.

No one even bothered to ask me if I snored or not....guess women who are skinny aren't expected to snore.

zonker · Post by **zonker** » Sat May 28, 2022 7:55 pm

Miss Emerita wrote: ↑
Sat May 28, 2022 11:25 am

I'm so angry on your behalf at the way you've been treated. It can happen to anyone, but I am certain it happens more to women than to men.

just listened to a podcast last week from the cbc. canadian researchers have discovered that women have a much higher likelihood of pelvic injuries in car crashes compared to men. one of the most blatant reasons for this is down to crash test dummies. they are ALL based on the male physique! even those that are supposed to represent women are based on 12 year old boys. and these dummies are expensive to manufacture, so it looks like it will be a long time before we see a anatomically correct dummy for women.

<sigh>

babydinosnoreless · Post by **babydinosnoreless** » Sat May 28, 2022 9:22 pm

I too struggled, it took a trip to the er where my husband said I snore and stop breathing to get me the sleep test. If he hadn't said anything they would never have looked at SA. The er doctor actually asked him what my symptoms were. I was so MAD! My heart was racing and my blood pressure was over 200 and he is asking my husband.

babydinosnoreless · Post by **babydinosnoreless** » Sat May 28, 2022 9:38 pm

zonker wrote: ↑
Sat May 28, 2022 7:55 pm

Miss Emerita wrote: ↑
Sat May 28, 2022 11:25 am

I'm so angry on your behalf at the way you've been treated. It can happen to anyone, but I am certain it happens more to women than to men.
just listened to a podcast last week from the cbc. canadian researchers have discovered that women have a much higher likelihood of pelvic injuries in car crashes compared to men. one of the most blatant reasons for this is down to crash test dummies. they are ALL based on the male physique! even those that are supposed to represent women are based on 12 year old boys. and these dummies are expensive to manufacture, so it looks like it will be a long time before we see a anatomically correct dummy for women.

<sigh>

That is not correct Zonker. My husband, before he retired, was working with both male and female ATD's for military crash testing. It was originally a 50% male but in the last several years before he retired they had a 50% anatomically correct female as well as infant and children ATD's. The testing world had come a long way recently and military testing to support the Iraq and Afghanistan wars. They may not be available to the general public yet but they are out there.

Andréa · Post by **Andréa** » Mon May 30, 2022 1:07 pm

I got it the right way

Raised just the max, the min is still where it should be.

Thanks for checking up!

Julie wrote: ↑
Sat May 28, 2022 9:32 am
I hope there hasn't been a very basic misunderstanding... your English is so good I may have not realized something - when I said to raise your 'max' pressure, I meant only the one called 'maxium', not the minimum one that is set at about 8 now. Having the max be so close to it (as Pugsy said earlier) just keeps the min. from going up higher to where it needs to be (to do its job) and should therefore 'get out of the way' of the min. If this doesn't help, or only confuses further, please ignore.

Andréa · Post by **Andréa** » Mon May 30, 2022 1:14 pm

Thanks for caring! <3 <3 Yes, it has been, is, a surreal ride my last soon to be seven yrs.

Blood test wise I'm quite thoroughly checked up. I believe they looked for autoimmune illness, 99% sure. They have done some rigorous blod testing. Will double check in my med.journals.

Miss Emerita wrote: ↑
Sat May 28, 2022 11:25 am
Very good to see the improvement! While you continue with these settings for the coming week, try to notice how you feel during the day *before* you look at Oscar. Try jotting a note each day about how you feel, in areas like how tired or sleep you are, what your mood is like, and how well you're able to think. Doing this can help you spot trends, even fairly subtle ones.

I'm so angry on your behalf at the way you've been treated. It can happen to anyone, but I am certain it happens more to women than to men. I also know that it can be a huge problem for diagnosis and treatment of conditions (like CFS) that have primarily "subjective" symptoms.

Just curious: have you had blood tests to investigate the possibility of autoimmune disease?

Andréa · Post by **Andréa** » Mon May 30, 2022 1:34 pm

Pugsy!

Thanks for the time and guidance you're throwing my way. Makes me feel happy, validated and actually a bit safe. I'm to brainfogged to respond everything I'd like to, but in short, I get it - I get all what you're saying! I do also get aerophagia so there are many reasons for me to titrate slowly.

I'll get back to you in a week or two. Will stay on these settings as you recommend. Cross your fingers.

<3 <3

Pugsy wrote: ↑
Sat May 28, 2022 9:57 am
Your last night's report looks a lot better...everything is reduced including the FLs which are actually now at a level we could live with as long as you feel like you are feeling a bit better and sleeping a bit better.

Those CA flagged events...they are central apnea flagging and more pressure isn't going to reduce those.

Your barely kissed the 10 cm max last night a few times. If the machine going higher than 10 cm does end up causing you to wake up....it won't hurt anything to not let it go higher. More pressure won't fix those centrals anyway.

I would actually suggest that you keep these current settings for a week or two and watch the results for trends and patterns and not go changing things anymore just yet.
You made 2 changes...increased the minimum a bit and the maximum a bit....give yourself some time for your body to adjust to the new settings before you go changing things again.

The machine is increasing the pressures now in response to the FLs....look at when the pressure kissed 10 cm and the FL graph at the same time. I would be surprised if the machine even went to 12 if it could.
The machine will only go to where it thinks it needs to go in response to FLs, OAs, hyponeas and snores no matter how high the max might be set. Now sometimes when the machine thinks it needs to go is a pressure that can cause sleep disruptions or actually more likely what the pressure is trying to kill could very well be the cause of the sleep disruption and the pressure increases just happen to get the blame because that's the last thing we notice.

I tend to agree with your sleep tech in one regard....I have always felt like my primary goal is to sleep first and worry about numbers later. Without sleep none of the numbers matter. What I don't agree with was the AHI numbers in the obstructive category that she was willing to accept. That's why I said your report was just screaming "more pressure".
Obstructive stuff...OAs, hyponeas, snores and FLs...that is what more pressure can kill.

You are more comfortable taking baby steps with any changes....that's fine...right now if last night's report becomes the new norm it is quite acceptable as long as you are ALSO REPORTING that your sleep is decent quality and you are feeling decent. There is no urgent, just have to do it now, need for more pressure. The small adjustments you did last night made a huge difference in your report. Sometimes it happens like that...small adjustments make big changes.

The CAs/centrals could be arousal related or even a real asleep central (which is normal to have a few here or there during the night anyway) so I would put them on the back burner for now. More pressure won't fix/reduce them anyway.
The machine won't even try to increase the pressure for the centrals...any pressure increase you see in the neighborhood of the CA/Central flags is just a coincidence because the machine was trying to kill the FLs.

I wouldn't make any changes for a week or two then after looking at the reports and the machine still wanted to kiss 10 cm occasionally....maybe try 11 cm max but if you are sleeping great and feeling great with the max at 10....there is no urgent need to increase it just so the machine can kill more FLs. Sometimes the attempted killing of the FLs ends up creating more of a problem than the FLs were causing.

I don't see a need for more minimum at this time. You had it looks like maybe 1 OA and 2 hyponeas over the entire night.
Pretty darn good results. A lot better than the previous night at lower pressures.

Now a word about how the maximum pressure setting works...the machine won't go higher just because it can go higher without a good reason. Having a high maximum that is never reached doesn't change the auto adjusting algorithm or anything like that. My machine will go to 25 cm...and I have my max set to 25 cm but it rarely goes to 16 and most of the time it's going to be around 12 to 14 max. Now I don't have a problem with going higher so on the off chance it goes higher it's not a big deal to me but if I had a problem with it going higher I would most certainly limit the max.
A common problem that might be a good reason to limit the max would be if the higher pressures seemed to create more aerophagia issues...belly pain from air in the stomach.

If your machine never ever goes above 11 or 12 or 13 (if it could go higher)...then it really doesn't matter what you have the max pressure set at. But if you feel better and sleep better knowing it can't go higher...that's fine too.
I always tell people that if the machine doesn't ever go above a whatever pressure (let's use 12 as an example) when it could then it really doesn't matter what the max limit is set at...be it 13 or 15 or 20 or even 100 if the machine could go there.

Good job on last night....I really wouldn't change anything for at least a week so you can see if last night is the new norm or a fluke night. Give your body a chance to adjust. Ignore the CAs/centrals for now...we can't really do anything about them anyway and you aren't really having enough of them to be a problem anyway. It's normal to have a few centrals anyhow.

Andréa · Post by **Andréa** » Sat Jul 23, 2022 2:59 pm

So, I'm back!

Used my pap with my new settings, min 8.6, max 10, a couple of weeks and actually felt a little bit better, my AHI went down to around 3.5. Checked my memory card in Oscar and noticed that a lot of my curves still had the look of inspiratory FL, and that the FL 95% was around 0.35 and such. Raised max to 10.20 about a week ago, to see if that would change anything. My AHI's gotten down 2.5 average but today when i read the memory card I was surprised to se my FL's really high and my Flow rate curves not looking swell, foremost at the first hours of sleep (that would be my deep sleep).

I've attached two screes shots from the same night, so that you can see how it's worst the first hours (remember I have looong nights due to my ME/Cfs).

Should I try to raise max a bit more?

I asked my sleep nurse about this and he said that almost nobody using nose pillow need max pressures above 10.That I should settle. Am I some kind of extreme? Tell me that people need above 10 as max to wipe out apneas, even with nose pillow!

Hope you can see this, my first time using Imgur: https://imgur.com/a/0i3kH3v

Best regards
//Andréa

Pugsy wrote: ↑
Sat May 28, 2022 9:57 am
Your last night's report looks a lot better...everything is reduced including the FLs which are actually now at a level we could live with as long as you feel like you are feeling a bit better and sleeping a bit better.

Those CA flagged events...they are central apnea flagging and more pressure isn't going to reduce those.

Your barely kissed the 10 cm max last night a few times. If the machine going higher than 10 cm does end up causing you to wake up....it won't hurt anything to not let it go higher. More pressure won't fix those centrals anyway.

I would actually suggest that you keep these current settings for a week or two and watch the results for trends and patterns and not go changing things anymore just yet.
You made 2 changes...increased the minimum a bit and the maximum a bit....give yourself some time for your body to adjust to the new settings before you go changing things again.

The machine is increasing the pressures now in response to the FLs....look at when the pressure kissed 10 cm and the FL graph at the same time. I would be surprised if the machine even went to 12 if it could.
The machine will only go to where it thinks it needs to go in response to FLs, OAs, hyponeas and snores no matter how high the max might be set. Now sometimes when the machine thinks it needs to go is a pressure that can cause sleep disruptions or actually more likely what the pressure is trying to kill could very well be the cause of the sleep disruption and the pressure increases just happen to get the blame because that's the last thing we notice.

I tend to agree with your sleep tech in one regard....I have always felt like my primary goal is to sleep first and worry about numbers later. Without sleep none of the numbers matter. What I don't agree with was the AHI numbers in the obstructive category that she was willing to accept. That's why I said your report was just screaming "more pressure".
Obstructive stuff...OAs, hyponeas, snores and FLs...that is what more pressure can kill.

You are more comfortable taking baby steps with any changes....that's fine...right now if last night's report becomes the new norm it is quite acceptable as long as you are ALSO REPORTING that your sleep is decent quality and you are feeling decent. There is no urgent, just have to do it now, need for more pressure. The small adjustments you did last night made a huge difference in your report. Sometimes it happens like that...small adjustments make big changes.

The CAs/centrals could be arousal related or even a real asleep central (which is normal to have a few here or there during the night anyway) so I would put them on the back burner for now. More pressure won't fix/reduce them anyway.
The machine won't even try to increase the pressure for the centrals...any pressure increase you see in the neighborhood of the CA/Central flags is just a coincidence because the machine was trying to kill the FLs.

I wouldn't make any changes for a week or two then after looking at the reports and the machine still wanted to kiss 10 cm occasionally....maybe try 11 cm max but if you are sleeping great and feeling great with the max at 10....there is no urgent need to increase it just so the machine can kill more FLs. Sometimes the attempted killing of the FLs ends up creating more of a problem than the FLs were causing.

I don't see a need for more minimum at this time. You had it looks like maybe 1 OA and 2 hyponeas over the entire night.
Pretty darn good results. A lot better than the previous night at lower pressures.

Now a word about how the maximum pressure setting works...the machine won't go higher just because it can go higher without a good reason. Having a high maximum that is never reached doesn't change the auto adjusting algorithm or anything like that. My machine will go to 25 cm...and I have my max set to 25 cm but it rarely goes to 16 and most of the time it's going to be around 12 to 14 max. Now I don't have a problem with going higher so on the off chance it goes higher it's not a big deal to me but if I had a problem with it going higher I would most certainly limit the max.
A common problem that might be a good reason to limit the max would be if the higher pressures seemed to create more aerophagia issues...belly pain from air in the stomach.

If your machine never ever goes above 11 or 12 or 13 (if it could go higher)...then it really doesn't matter what you have the max pressure set at. But if you feel better and sleep better knowing it can't go higher...that's fine too.
I always tell people that if the machine doesn't ever go above a whatever pressure (let's use 12 as an example) when it could then it really doesn't matter what the max limit is set at...be it 13 or 15 or 20 or even 100 if the machine could go there.

Good job on last night....I really wouldn't change anything for at least a week so you can see if last night is the new norm or a fluke night. Give your body a chance to adjust. Ignore the CAs/centrals for now...we can't really do anything about them anyway and you aren't really having enough of them to be a problem anyway. It's normal to have a few centrals anyhow.

Pugsy · Post by **Pugsy** » Sat Jul 23, 2022 4:09 pm

Andréa wrote: ↑
Sat Jul 23, 2022 2:59 pm
I asked my sleep nurse about this and he said that almost nobody using nose pillow need max pressures above 10.

What a load of BS. That is one of the most idiotic statements I have ever heard of and I have heard a lot really stupid stuff coming from DME techs.

Andréa wrote: ↑
Sat Jul 23, 2022 2:59 pm
Am I some kind of extreme? Tell me that people need above 10 as max to wipe out apneas, even with nose pillow!

LOTS of people need a lot more than 10 cm while using nasal pillows. Myself included. I have seen 16 to 18 cm pressure needs and I have always used nasal pillow mask of some sort.

Though most likely it is your minimum pressure that would give you the most bang for your buck in reducing the AHI OA numbers. Look at what the pressure is doing when those OA clusters happened. I can't tell exactly what it was at but I don't think you were at the 10.2 max at that time. Now earlier in the the night you were at the 10.2 max.
I actually think you could use 9.0 or better yet 9.4 cm minimum with even higher max limitation and improve things just a little bit more.

It's the minimum pressure that does the majority of the obstructive apnea prevention anyway...not the maximum.

Odd that your FLs were worse at the beginning of the night and settled down later. Were you having some nasal congestion maybe early in the night that cleared up?? Or maybe on your back more earlier in the night and on your side later?
Or I wonder if you are like me and your OSA is worse in REM stage sleep and those wee hours of the morning are when we see more REM and that's the cause of the clustering of events later.

zonker · Post by **zonker** » Sat Jul 23, 2022 5:14 pm

Andréa wrote: ↑
Sat Jul 23, 2022 2:59 pm

I asked my sleep nurse about this and he said that almost nobody using nose pillow need max pressures above 10.That I should settle. Am I some kind of extreme? Tell me that people need above 10 as max to wipe out apneas, even with nose pillow!

oh for goodness sake! and people wonder why we on the forum have such a disregard for sleep medicine people. when i was still on apap, i was running a minimum of 18 and a max of 20. i needed it to indeed wipe out apneas.

Dog Slobber · Post by **Dog Slobber** » Sun Jul 24, 2022 8:21 am

zonker wrote: ↑
Sat Jul 23, 2022 5:14 pm

Andréa wrote: ↑
Sat Jul 23, 2022 2:59 pm

I asked my sleep nurse about this and he said that almost nobody using nose pillow need max pressures above 10.That I should settle. Am I some kind of extreme? Tell me that people need above 10 as max to wipe out apneas, even with nose pillow!

oh for goodness sake! and people wonder why we on the forum have such a disregard for sleep medicine people. when i was still on apap, i was running a minimum of 18 and a max of 20. i needed it to indeed wipe out apneas.

What's particularly alarming is we have a few morons here who keep running around insisting that therapy advice here should never be taken over "medical" advice.

They:

Do everything they can to undermine the credibility of experienced and knowledgeable contributors
Have signatures indicating information here should never be a substitute for medical advice
Create topics suggesting posters should be posting their qualifications
But have nothing to say when topics like this (and hundreds more) come up where the medical professionals clearly don't know what they're talking about and give asinine advise.

Simple question to these morons.
Whose advise should be followed?

The "medical professional" who stated "almost nobody using nose pillow need max pressures above 10."
or
Dozens of experienced nasal pillow users with pressures over 10cm

zonker · Post by **zonker** » Sun Jul 24, 2022 11:41 am

Dog Slobber wrote: ↑
Sun Jul 24, 2022 8:21 am

What's particularly alarming is we have a few morons here who keep running around insisting that therapy advice here should never be taken over "medical" advice.

sorry for a slight deril, andrea.

not much can be done about them. it's the policy of john goodman that each gets their own say, no matter if it's helpful in the end. not much can be done except push back without causing even more ruckus.

¯\_(ツ)_/¯

now back to topic. in case my angry answer wasn't clear, i use the p10 nasal pillow mask. and i bumped up my own pressure in an effort to squash my apneas. worked, for a bit. then i moved on to a bilevel machine.

Should I set a higher pressure? Apap + nosepillow.

Re: Should I set a higher pressure? Apap + nosepillow.

Re: Should I set a higher pressure? Apap + nosepillow.

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Re: Should I set a higher pressure? Apap + nosepillow.

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Re: Should I set a higher pressure? Apap + nosepillow.

Re: Should I set a higher pressure? Apap + nosepillow.

Re: Should I set a higher pressure? Apap + nosepillow.

Re: Should I set a higher pressure? Apap + nosepillow.

Re: Should I set a higher pressure? Apap + nosepillow.

Re: Should I set a higher pressure? Apap + nosepillow.

Re: Should I set a higher pressure? Apap + nosepillow.

Re: Should I set a higher pressure? Apap + nosepillow.

Re: Should I set a higher pressure? Apap + nosepillow.