Why won't cpap raise the pressure?

General Discussion on any topic relating to CPAP and/or Sleep Apnea.
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palerider
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Re: Why won't cpap raise the pressure?

Post by palerider » Thu Sep 14, 2017 1:54 am

ajack wrote:The only thing I can think to add is that to remove the bacterial filter, to see if that is obstructing the unit
AMK wrote:I do not have an inline bacteria filter.
Good to see you're paying attention.

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Re: Why won't cpap raise the pressure?

Post by palerider » Thu Sep 14, 2017 1:57 am

AMK wrote:I watched that link palerider and I guess my question was, why doesn't an OA always appear as a spike in the flow limitation graph? Like here, from the same night we've been discussing:
https://gyazo.com/d2c34ce39991e5e11f788d941a4eb2fa
No flow limitations there. As an aside, I can't figure out how those OA marks are placed. It looks like one long 1min 33 sec OA to me.

Thank you for all the help!
Because an apnea is not a flow limitation.
Pay close attention to the flow waveform in the video when they're talking about flow limitations, they have flattened or chair shaped tops, instead of nice round tops of normal breaths.

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AMK
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Re: Why won't cpap raise the pressure?

Post by AMK » Thu Nov 23, 2017 9:00 am

To update my experience, turning off the "for her" and letting the machine go to a pressure of 20 hasn't been much of an improvement in terms of avoiding strings of apneas. This was last night:
https://gyazo.com/bcf68a93410bb3a8f5e8cc91a9c946b8

As you can see, within about a half hour the machine goes from just under 9 (I have pressure set from 7.6-20) to almost 19, with me waking up at that point. When the pressure goes that high and I wake up, it seems like the machine is trying to force me to continue breathing at a steady rate in a way that alarms me, and of course when the pressure is that high I can barely exhale even with EPR, so I turn the machine off and "start over," and then have trouble getting back to sleep.

If I understand things correctly, the next step is to raise the minimum pressure to see if I can prevent these incidents from happening. I am wondering, though, if this issue has to do with me turning and sleeping on my back, if raising the minimum would make a difference.

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Re: Why won't cpap raise the pressure?

Post by Pugsy » Thu Nov 23, 2017 9:06 am

AMK wrote:If I understand things correctly, the next step is to raise the minimum pressure to see if I can prevent these incidents from happening. I am wondering, though, if this issue has to do with me turning and sleeping on my back, if raising the minimum would make a difference.
Yes, raising the minimum to better hold the airway open in the first place is the next step to stop the clustering.
I experience a similar clustering but related to REM sleep. It doesn't really matter why IMHO though. Yours might be supine sleeping....might be related to REM or maybe a combination of being on your back in REM...whatever the reason if they are causing problems we want to stop them.

Raising the minimum so that the machine can do a better job preventing instead of playing catch up might also keep the machine from having to go so high which seems to cause you problems....so 2 reasons to try more minimum.

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Re: Why won't cpap raise the pressure?

Post by AMK » Thu Nov 23, 2017 9:31 am

Thank you Pugsy. I guess I'll try raising the minimum a bit at a time, like raise it to 8 now.

Since my original dx was REM-related sleep apnea, then that could be REM...but still, more nights than not I don't have strings of events like that, so I am capable of experiencing REM sleep with few or no events. Did you solve your clustering, or do you continue to experience it?

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Re: Why won't cpap raise the pressure?

Post by TedVPAP » Thu Nov 23, 2017 9:36 am

AMK wrote:To update my experience, turning off the "for her" and letting the machine go to a pressure of 20 hasn't been much of an improvement in terms of avoiding strings of apneas. This was last night:
https://gyazo.com/bcf68a93410bb3a8f5e8cc91a9c946b8

As you can see, within about a half hour the machine goes from just under 9 (I have pressure set from 7.6-20) to almost 19, with me waking up at that point. When the pressure goes that high and I wake up, it seems like the machine is trying to force me to continue breathing at a steady rate in a way that alarms me, and of course when the pressure is that high I can barely exhale even with EPR, so I turn the machine off and "start over," and then have trouble getting back to sleep.

If I understand things correctly, the next step is to raise the minimum pressure to see if I can prevent these incidents from happening. I am wondering, though, if this issue has to do with me turning and sleeping on my back, if raising the minimum would make a difference.
If your cluster can be attributed to sleeping on your back, then you may want to take actions to prevent all back sleeping - then you can continue to use a pressure of 9.

If it is due to REM, then you have no choice but to use higher pressure.
The nice thing about APAP is that it allows you to use lower pressure through much of the night. This can also cause problems as your data shows. You need to set the floor high enough so that the machine is always "close enough" to where the need is.
A floor of 9 is too low for you. Work your way up to a higher floor and you will see what "close enough" is for you.

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Re: Why won't cpap raise the pressure?

Post by Pugsy » Thu Nov 23, 2017 9:49 am

I did an experiment way back in the beginning of my therapy to see if I could figure out for sure if my ugly clusters were REM, supine or both.
I built a wall that wouldn't move and slept totally on my side for a month. I still would have times with some ugly clusters and some times with no clustering. I never could figure out why I might see a pressure of 18 one night and not have it even try to go over 12 the next night.
I finally just accepted it and raised the minimum and it was an easy fix.
Initially I was using 8 minimum and 20 max...some nights no clusters and some nights maybe 2 or 3 clusters. I increased the minimum slowly and ended up with 10 cm minimum. It didn't totally prevent a little clustering on occasion but for the most part the clusters (if they happened) were so broken up they really didn't amount to much and I ignored them.

Do I still have clustering issues....not really but then I keep the minimum up so it can do a better job.
Every now and then I might see a very small cluster and the pressure obviously go up trying to work hard to get things better opened up.
Even now I will see a fairly wide variation in where the machine wants to go. I just scrolled through about 2 weeks of data...my max went to 16 for a high...and was 9 one night. Go figure that one.

I am using 7 minimum...20 max with EPR of 3. I could maybe use a little more minimum but what clustering I might see is so rare and small that I just don't want to change anything. Like I might have 5 or 6 events clustered in 10 minutes..but that's all that happens during the night and it doesn't happen every night.

Now your clusters....a lot uglier than mine now...more like what I was seeing before I found a better minimum pressure.

Oh...the difference between early in therapy with APAP 10 min and 20 max...and now with 7 min and 20 max....different brands of machines so different algorithms. ResMed responds more aggressively and it seems to end up meaning I can get by for a good bit of the night with less minimum than I needed with the Respironics machine that I started with back in 2009.

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Re: Why won't cpap raise the pressure?

Post by AMK » Thu Nov 23, 2017 11:27 am

Thanks for that detailed information, Pugsy. Ted's post had me thinking about ways I've seen recommended to keep us off our back and I have arthritis in my spine and things like the tennis ball are not going to work. My observations are exactly like yours, Pugsy. I'll have 3 nights that are wonderful, with the pressure going no higher than 12 and maybe three events, but about twice a week now I have these ugly nights and it's too much, I can actually feel the effect on my brain as I go back into the short term memory problems I had before treatment. I'll raise the minimum. Happy Thanksgiving to you, too.

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Re: Why won't cpap raise the pressure?

Post by lindsayschach » Sat Mar 18, 2023 10:59 am

How do I do the “factory reset thing?”
I have a Resmed Airsense 10. Instead of staying at a pressure of 10, it starts at 0 and only goes up to 4, then stops.

Any other ideas?

Thanks,

Lindsay

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Re: Why won't cpap raise the pressure?

Post by Pugsy » Sat Mar 18, 2023 11:03 am

lindsayschach wrote:
Sat Mar 18, 2023 10:59 am
How do I do the “factory reset thing?”
I have a Resmed Airsense 10. Instead of staying at a pressure of 10, it starts at 0 and only goes up to 4, then stops.

Any other ideas?

Thanks,

Lindsay
How do you know that it starts at 0 and only goes to 4 cm??? How long does it take?
What are your settings? Mode? Pressure? Using ramp? If so, how long?

Look on your ResMed machine front where the model name is. What does it say? AirStart 10 or AirSense 10? AutoSet or Elite?

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Re: Why won't cpap raise the pressure?

Post by lindsayschach » Sat Mar 18, 2023 11:11 am

It’s an airsense 10 autoset.

I watch the screen and it shows the pressure as it ramps up.

Min pressure 10, max is 18. 20 minute ramp.

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Re: Why won't cpap raise the pressure?

Post by Pugsy » Sat Mar 18, 2023 11:17 am

lindsayschach wrote:
Sat Mar 18, 2023 11:11 am
It’s an airsense 10 autoset.

I watch the screen and it shows the pressure as it ramps up.

Min pressure 10, max is 18. 20 minute ramp.
The reason it goes to 4 cm and seems to stay there is because you have the ramp feature turned on and ramp starts at 4 cm and will take 20 minutes to get to 10 cm. Do you need the ramp?

If you reset to factory defaults you will end up with a worse problem.

You might want to edit your equipment profile. It is showing the AirStart model instead of AirSense 10 model.
If you can't find the ResMed AirSense 10 AutoSet up in the "A's" in the equipment list just scroll down to the R's...that's where it is at.

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Re: Why won't cpap raise the pressure?

Post by lindsayschach » Sat Mar 18, 2023 12:19 pm

I ser the ramp for 10 and it goes up to 10 and hangs out there. Is there a way to tell what the pressure is while it’s in treatment mode?

Thanks so much! I guess I did panic.

Lindsay

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Re: Why won't cpap raise the pressure?

Post by Pugsy » Sat Mar 18, 2023 12:30 pm

lindsayschach wrote:
Sat Mar 18, 2023 12:19 pm
I ser the ramp for 10 and it goes up to 10 and hangs out there. Is there a way to tell what the pressure is while it’s in treatment mode?

Thanks so much! I guess I did panic.

Lindsay
You can see the pressure during the night by using available software.
Use OSCAR. You need a SD card in your machine while in use to get the detailed graphs.

OSCAR https://www.sleepfiles.com/OSCAR/
http://www.apneaboard.com/wiki/index.ph ... stallation
http://www.apneaboard.com/wiki/index.ph ... rpretation
http://www.apneaboard.com/wiki/index.ph ... ganization organize and how to do screen shots.
wiki/index.php/Oscar:organize Wiki

Here's a sort of example of just part of what you can see.

Image

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