Intro and newbie Q

Hi all,

I've been lurking here since I was diagnosed roughly a month ago. You've unknowingly helped answer a variety of questions that I've had since I was diagnosed and started therapy. Forgive me if I ask something that has been discussed prior, but I can't seem to find something.

During the titration study, my optimal pressure was determined to be 8-10 and therefore the max pressure was set to 10. My AHI seems to hover around 3 most nights with leaks in the acceptable range. However, in viewing the data, I see that during the night the max pressure is hit for extended periods of time. Would the experts here advise bumping up the max pressure? Are there any other red flags that jump out at you?

With the snores you are also having...yes, I would increase the maximum (to maybe 12 or 13) and see what happens with not only the AHI but the snores as well.
If that doesn't help reduce the snores then I would also increase the minimum to maybe 9 or 10.

For whatever reason, I can't see the image you posted.
But, going off of Pugsy's comments, if you're having lots of snores, try doing some nasal cleansing before bedtime. Lots of the "snoring" events can indicate nasal congestion. Also, along that line, if you're using a high humidifier setting, that can also cause more congestion. You may try tweaking your humidifier settings or even turning it off for cool, "passover" humidity.


Den

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Den.... the snores are extremely dense and they all coincide with the pressure being pegged out at 10 max. Other times the pressure comes down and no snores or OAs but with the snores there is also clustering of OAs...followed by times with no OAs but the OA clusters are a bit ugly/dense.
The machine wants to go higher for sure.
From the looks of the clustering pattern...maybe REM sleep or maybe supine sleeping.
Looks like a simple not quite optimal pressure settings issue from the clusters I saw. Might need a little more minimum but since the max is pegged out for probably half the night...also might be fixed with just a little more maximum.

Pugsy wrote:Den.... the snores are extremely dense and they all coincide with the pressure being pegged out at 10 max. Other times the pressure comes down and no snores or OAs but with the snores there is also clustering of OAs...followed by times with no OAs but the OA clusters are a bit ugly/dense.
The machine wants to go higher for sure.
From the looks of the clustering pattern...maybe REM sleep or maybe supine sleeping.
Looks like a simple not quite optimal pressure settings issue from the clusters I saw. Might need a little more minimum but since the max is pegged out for probably half the night...also might be fixed with just a little more maximum.

OK. Kind of sounds like possible positional sleeping and/or positions which also promote snoring and apneas. From my point of view on snoring, nasal cleansing may help. So, I agree.......a little pressure increase on both ends may also help.
It usually takes a little introspection by the user to analyze what specifics may be affecting the events.


Den

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And, as I've said before, when I started therapy, my snore index was in the "hundreds"......some nights almost a solid red line (in Encore) through the night. I have never been a back-sleeper. Even without changing any settings, my numbers dropped on their own, but I finally came up with my own method of "nasal cleansing" and with a little extra pressure, the snore numbers eventually dropped to sub- 1.0 and currently about 0.4.

My point is......it can be done.


Den

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Sorry about the figure or lack thereof. I'll figure out a better way of including it next time.

Thank you all for your shared insight. Looks like fine tuning the pressure is in my immediate future. I'll try it out for a few days and report back. Since starting the therapy, I've noticed and have been told that I am sleeping almost exclusively on my back. This seems quite the departure from someone that used to sleep on my stomach. During the consultation, the doctor predicted this due to the disappearance of night-time gerd. I'm happy to report that he was correct, at least concerning the gerd.

One small question if I may? While I don't fully comprehend the algorithm each manufacturer/machine uses to mitigate or control events, the role of the maximum pressure seems fairly clear. The minimum pressure, however, is still a bit fuzzy for me. My naïve assumption was that it served the dual role of the minimum pressure needed to keep your airway open and improve comfort. I gather it is much more important than that. Anyone care to share an analogy or educate me?

Thank you for all of your help and thoughts. They are appreciated.

Your assumption is correct, though there may be more technical ways of explaining it.

I also strongly suggest you try side sleeping as it can make quite a difference in the number of events you have.

fissik wrote:My naïve assumption was that it served the dual role of the minimum pressure needed to keep your airway open and improve comfort.

it's not for comfort, it's to keep your airway open most of the time. there's someone on the forum that needs about 8cm under normal circumstances, but when she enters rem sleep, her pressure needs shoot up to around 17 (if I remember right) so she sets her minimum pressure at 8, and let's auto handle the exceptions.

does that make sense?