Minimum Pressure setting

Thefrog wrote:

Wulfman... wrote:

Thefrog wrote:I've been playing around with my Resmed S9 Autoset. Does the Minimum pressure setting really matter if I run it on Autoset? My Dr set it at 5cmH20 I've slowly moved it up to 10.8cmH20 Should I go back down or up? See lots of different things on here. Here is last nights sleepy head graph.

I just switched to a Airfit F10 full face mask, not sure how much I like it? I was using Amara View, but having some leakage, so I switched to this, I woke up tired the last two mornings and my girlfriend said I am snoring with the Airfit F10. I didn't snore with the Amara View. Any thoughts?

After looking at your reports, I believe using ranges of pressure will NEVER get you to therapeutic settings. Your Flow Limitations are driving your pressures up and causing lots of pressure changes that needn't be.

You're having very few events (AHI) to begin with, so if you can find a fixed pressure that prevents most of them, you'll have better therapy and sounder sleep.

My initial "instinct" is to suggest a straight pressure of about 13 cm. for a few nights and see how that works. It's possible that an even lower pressure might work (I'm looking at where your pressure is on the reports in relation to where there are fewer events occurring), but if you can try a straight pressure for a bit, you may see how that's going to work.

As it is with these reports, it's hard to figure out what's causing what. But, the Flow Limitations do present a problem for the machine trying to give decent therapy.


Den

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Den,
So you think I should run a fixed pressure setting? I've been struggling with this machine since last April, I've gone through 4 mask and finally I put the pressure setting back to 6min and 20Max as prescribed by my Dr. I also have a Oral Appliance Therapy that wear for traveling. I've worn that a bit lately and I feel like I have more energy in the morning with that? Any other suggestions?

And can you explain why the fixed pressure would be good?

Thank you

I would suggest TRYING it for awhile. It's sure not going to hurt anything to try it for some nights to see how the reports look.

APAP machines primarily respond (with pressure increases) to Flow Limitations and Snores........with the programmed belief that they may precede Apneas. Not everyone has those preceding events and it doesn't appear that they precede your apnea events either. Also, having the pressure changing all night long CAN be very disruptive to a person's sleep. As a person enters a deep or REM sleep stage, their breathing may change (more FLs and/or Snores) and trigger the machine to increase pressure. That pressure change MAY bump the person out of their needed sleep stage and into a lighter one. That may leave them feeling unrested.
I've also seen reports posted on the forum (or sent to me) which have shown that pressure increases in response to Flow Limitations can (possibly) generate a reflex reaction by the user and lead to the machine interpreting that reflex reaction as another Flow Limitation and further increase pressures.......and that chain of reactions can become a sort of "feeding frenzy" where one condition leads to a reaction, leading to another condition leading to another reaction.


Den

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I have to agree that a different strategy is warranted and just using a constant pressure or small ceiling pressure might give you better results.
I use for example ceiling 8.2cm/h2o- 7.6 cm/h2o floor pressures with some good results(last night .1AHI) but they are usually <1ahi.
I used auto to look for my sweet spot and experimented with little changes and have not changed any settings for a while, getting 0 AHI would be hard and the only time I get 0 AHI are short naps.(30min naps)
Almost constant pressure in my way of thinking is more natural- it works so far for me.
Wulfman is right in my way of thinking.

I have one suggestion. If you leave your mode APAP and set MIN=MAX it would act like CPAP and continue to track flow limitations but if you put it into CPAP mode I don't believe it will track FL's. I believe either way, min=max or a tight range will be an improvement. After a week reevaluate and see if it needs to have small changes.

OkyDoky wrote:I have one suggestion. If you leave your mode APAP and set MIN=MAX it would act like CPAP and continue to track flow limitations but if you put it into CPAP mode I don't believe it will track FL's. I believe either way, min=max or a tight range will be an improvement. After a week reevaluate and see if it needs to have small changes.

I believe (I was told that) the S9 Autoset will show Flow Limitations in both APAP and CPAP modes.


Den

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You are probably right. I was thinking of Respironics. The graph (with nothing on it) does come up on my Aircurve with fixed pressures. But it doesn't on my Respironics 760. So it does look like only the Respironics have to be in Auto mode. Thanks Den.