Maximums are creeping up

I think I should just set the Maximum to 20.0 to see where it goes.....comments. Here are graphs of the last several nights.
A big plus is my hours of theory have increased by more than an hour over the past 2 days.

In theory, you could set the maximum to the max (20) and the machine will go as high as it needs and it shouldn't be a problem. In practice, increased pressure could result in more leaks and more disturbance from greater pressure swings from min to max. These things are going to vary in individual cases, so the only way to find out is to do it. If you find the machine is going substantially higher and the greater pressure swings are disturbing, the minimum could be increased as well to reduce the differential.

That being said, since your pressure graphs are not hitting the max setting and staying there (flat topped), it doesn't look like your max pressure needs are much greater than your current setting so you may not notice much difference.

Jay Aitchsee wrote:In theory, you could set the maximum to the max (20) and the machine will go as high as it needs and it shouldn't be a problem. In practice, increased pressure could result in more leaks and more disturbance from greater pressure swings from min to max. These things are going to vary in individual cases, so the only way to find out is to do it. If you find the machine is going substantially higher and the greater pressure swings are disturbing, the minimum could be increased as well to reduce the differential.

That being said, since your pressure graphs are not hitting the max setting and staying there (flat topped), it doesn't look like your max pressure needs are much greater than your current setting so you may not notice much difference.

So what your saying is even thought the machine hits 17.99 during the night that doesn't mean you should set your machine to a maximum of 18.0?

Really struggling with understanding this. If someone hits 17.99 as a maximum I would think that the machine should be set to at the least 18.0.....please enlighten me.

Setting the Minimums and Maximums closer together is fully understandable. In my case it appears that 11.0 ish is a good Minimum but the Maximums has hit 16.0 now up from 14.0, 15.0 and now 16.0. Really getting confused.

If you set the max at 16..that's as high as the machine will go...even if there is an event that may need 18 to stop it. If you set the machine at 20 it won't matter. The machine will only go as high as needed to stop an event from happening. With the machine set at max 20 you may never see a pressure higher than 16 or 17 because there is no need to go any higher.

There's no urgent need to limit the maximum unless a person is having problems when/if the machine goes up there.
Problems being mainly aerophagia or leak issues or if the pressure that high wakes them up.
The machine won't go to where it doesn't think it needs to go...so there's a reason it goes up there. Now sometimes the reason it goes up there isn't a really horrible thing to have happen but the going up there creates more problems than the reason it wants to go there. Like maybe a snore or flow limitation....sometimes it's better to limit the maximum should hitting the limit cause problems.

Having a higher maximum and the machine never goes there....it becomes a moot point in terms of response time or therapy.
If the machines could go to 100 cm...and they never went above 15 cm...it doesn't really matter what the maximum "it could go to number is".

Maximum numbers hit will/can vary a lot depending on sleep position or whatever.
I have apap reports where I barely saw any increase above my 10 cm minimum...stayed around 12 all night long...but I also have reports where I hit 18 or 19 cm maximum briefly. It just happens and doesn't mean much.
Since I have no issues with higher pressures causing aerophagia or leaks or wake ups then I just left the settings at 10 min and 20 max and let the machine sort it out. If I had some sort of issue then I would then make adjustments to the maximum based on the issues I was having. Like if I had aerophagia issues at 17 cm then I would limit the maximum so I wouldn't be having those aerophagia issues.

But if you have no issues with the pressure changes...just open up the range and let the machine decide where it wants to go because it won't go up there unless it has a reason that it thinks it needs to address.

LSAT wrote:If you set the max at 16..that's as high as the machine will go...even if there is an event that may need 18 to stop it. If you set the machine at 20 it won't matter. The machine will only go as high as needed to stop an event from happening. With the machine set at max 20 you may never see a pressure higher than 16 or 17 because there is no need to go any higher.

I fully understand what your saying.

What I don't understand is JC's reply

That being said, since your pressure graphs are not hitting the max setting and staying there (flat topped), it doesn't look like your max pressure needs are much greater than your current setting so you may not notice much difference.

Wow.....Pugsy clearly explained, thank you. So for being so inquisitive.

What LSAT said.

The only reason to set the maximum lower than where the machine would go if not limited is to make the therapy more comfortable. Under certain circumstances, one might give up a little in AHI for undisturbed sleep. A few hypopneas, for example, may not be as disturbing as squeals from a mask if the pressure gets too high. Or, for some people, the greater the pressure differential the more disturbing the it is. Again, sacrificing some AHI by limiting the pressure swing, could provide a more restful sleep.

So, the goal is not necessarily to get to the lowest AHI number. It is to find the combination that provides the most restorative and restful sleep.

Make sense?

I see Pugsy has posted similarly while I was composing, but I'll leave this anyway.

fdw wrote:What I don't understand is JC's replyThat being said, since your pressure graphs are not hitting the max setting and staying there (flat topped), it doesn't look like your max pressure needs are much greater than your current setting so you may not notice much difference.

All I meant was that at your maximum setting (what ever that is now) you pressure graphs are only reaching the maximum briefly, if at all, before starting back down. If your pressure requirement was much greater than your max setting, your pressure would hit the max setting and stay there until the flow limitations or apneas causing the rise in pressure had stopped. In other words, the machine is taking care of most of your events now at your current max setting. Hence your relatively low AHI.

Jay Aitchsee wrote:What LSAT said.

The only reason to set the maximum lower than where the machine would go if not limited is to make the therapy more comfortable. Under certain circumstances, one might give up a little in AHI for undisturbed sleep. A few hypopneas, for example, may not be as disturbing as squeals from a mask if the pressure gets too high. Or, for some people, the greater the pressure differential the more disturbing the it is. Again, sacrificing some AHI by limiting the pressure swing, could provide a more restful sleep.

So, the goal is not necessarily to get to the lowest AHI number. It is to find the combination that provides the most restorative and restful sleep.

Make sense?

I see Pugsy has posted similarly while I was composing, but I'll leave this anyway.

Absolutely, you people are so smart. Thanks for having the patients to explain.

BTW, I think my pressure increases also has something to do with the Full Face Mask, I never seen the numbers that high with just the nasal mask.