how high can the lowest pressure on auto CPAP be set

So I have been using my auto CPAP for about 4 weeks and have yet to get an AHI below 12 (some nights high as 20). The range of pressure I started with was 4-16, then the doc raised it 8-16, then yesterday 12-16. NO difference in AHI! AHI = 17 last night. The mask fit according to the machine is 100%, the humidity = 5 (because of extreme dry mouth), I use the mask all night. Have others had a higher starting pressure? The sleep test was an at home one. I haven't done a titration study (doc says a titration study just shows what is optimal for 1 night, blah, blah).
Is it possible I need a yet higher starting pressure???

Are the events still primarily obstructive apneas or hyponeas?

I have seen people need to use 18 or 19 or 20 as a pressure needed to keep the airway open...as yes, I have seen people need 18 minimum and 20 maximum and barely get effective results.

Did you ever get the software installed so we can see the detailed reports to see what the pressure did...like for last night...with the 12/16 range...did it go to 16 and stay there?

But to answer your question...your machine can go to 20 cm.

rosevader wrote:I haven't done a titration study (doc says a titration study just shows what is optimal for 1 night, blah, blah).

what an amazingly astute comment, coming from a doctor no less! wow.

rosevader wrote:Is it possible I need a yet higher starting pressure???

yes

I used the machine 6 hrs 47 minutes last night and had 10 clear apneas, 83 obstr. apneas, 15 hypopneas.
Just got off the phone with the tech, they're raising the pressure range to 15- 20. Has anyone else done pressures this high? Is there any chance this won't work at all?

rosevader wrote:they're raising the pressure range to 15- 20. Has anyone else done pressures this high?

yes, they have.

It's possible that with excessive mask leaks that you're not getting good therapy. I would advise you to install sleepyhead (whatever software is used with your model cpap), and post your sleep data so that we can see what's going on with leaks and pressure, etc. and perhaps offer some advice.

Just a thought...

My husband told me that Norton spotted a Trojan in the Sleepyhead download. I'll be installing Encore ASAP.
According to the data I get from Dreamweaver and the Dream Station itself, my mask fit is 100% and I have no large leaks

rosevader wrote:My husband told me that Norton spotted a Trojan in the Sleepyhead download. I'll be installing Encore ASAP.
According to the data I get from Dreamweaver and the Dream Station itself, my mask fit is 100% and I have no large leaks

Don't know for sure, but my experience with Norton was a lot of false positives. As long as you're installing software that works with the data formats that your cpap produces, that's just fine.

So I tried the higher pressure last night (15-20). What a complete disaster. I could make myself stay on for only 3 hours. (AHI for that brief period was 6.9 : 6 clear apneas, 9 obstr apneas, 5 hypopneas, which is surprising as I didn't think I fell asleep at all) I could tolerate the pressure, EXCEPT that it gave me aerophagia. Extreme discomfort/pain. My GI tract can't take the stress (I have Crohns and don't want to do anything to trigger a flare). So now what?? My sleep center is closed on Fridays, so I can't change the pressure back down, and even if I did, it doesn't matter since my AHI is still around 17 with the 12-16 pressure range. I remember someone saying that they could help me figure out how to get control of my machine, so if it is useful I suppose I could do that with help. But frankly, what would be the use? I'm not achieving any clinical usefulness from any of this. Any thoughts or ideas? I'm so very very tired and discouraged!

Go here to see the instructions for changing the pressure yourself. Do it...it's not hard and you have to get some sleep this weekend.
http://www.apneaboard.com/dreamstation- ... structions

What is the status of the Encore install?

I really need to see a detailed report to get an idea what pressure settings to suggest.
Do you know how to upload the contents of your SD card to some place like drop box or make a copy of the SD card email it to me? If you can get me a copy of your card I can use my SH to see what we need to see at least until you get the software up and running.

The Norton alert...it's a false positive...there are no trojans in SleepyHead but if hubby is concerned then you have to use Encore Pro and it's a real bitch to manage until you get used to it.

Until we see the report...let's back up on the pressures and maybe ease into higher pressures and go slowly.

You were using 12 min and 16 max. I assume no aerophagia at those pressures...try 13 min and 16 max.
See if you are more comfortable and at least sleep some.

Are you using the Flex relief available on your machine? If so at what setting and have you tried the other settings?

We really need to see the detailed report...send me a private message if you think you can email me a copy of that card (it has to be an exact copy though) and I will give you my private email address.
Best way is to zip/compress the entire card at one time....then email as attachment so I can then unzip it and put it on a SD card.

SO now that I've scurried off and found a definition about what FLEX is (steep learning curve for all this terminology!) my machine was set at 3. Is this good or bad for my situation??
When my hubby gets home today I'll have him do the SD card thing. We just got a SD card reader this week from Amazon. He's tech support at our house. I'm a really clueless type for anything tech. Thanks so much for all your help!
Do you think it's worth going back to the previous pressure even though it showed no benefit (AHI 17)? Also, I had a little bit of aerophagia with this setting, although nothing compared to last night at the higher pressure (still feeling really uncomfortable right now).

The Flex setting of 2 or 3 will probably offer the greatest amount of exhale relief but the very most it can give is 2 cm at 3. Respironics exhale relief is tied into how forcefully you breathe so if you tend to be a shallow breather you may not get the full 2 cm available even at the setting of 3. Also involved is more of a timing thing in terms of when the inhale/exhale drop happens. For this reason I usually tell people to try all the Flex settings and pick the one that is the most comfortable for them regardless of the number.
From my own personal experience I found that the setting of 3 seemed to want to rush my breathing rate and the setting of 1 didn't seem to keep up with my breathing rate but the setting of 2 seemed to totally match my breathing rate and was more comfortable so that's what I used.

In terms of aerophagia and the pressure...there's a good chance that it is the maximum pressure triggering the aerophagia and hopefully not the minimum. Sometimes with a little higher minimum pressure the machine won't need to go so high. We already know that you need more minimum so my thoughts were try minimum of 13 but still limit the max and maybe we will get lucky and with a little more minimum the machine won't need to go as high and maybe not trigger bad aerophagia.
It's actually the minimum pressure that is the most critical setting.

You are fast approaching pressures needs where a bilevel machine would be probably better suited for you especially since it appears that the pressure needs are going to create aerophagia issues. Bilevel so that you can have more exhale relief available than you have now would most likely be much more comfortable and has less chance of making the aerophagia worse.

Let's see what the software shows and go from there.
I will send you a PM in a bit with my private email address.
Tell hubby that I need an exact copy of the SD card and all in one zipped folder. Easiest way is to simply go to the SD card contents and zip/compress the main folder which in turns compresses all the files/folders inside the main folder. Sometimes people send me all the contents individually and it creates a real problem in reconstructing the needed file structure. If you weren't using the DreamStation we could get by with just the P0 folder and I could plug that folder into my PR S1 main folder and make it work but the DreamStation data files won't work in my PR S1 folder.

I have Rose's data loaded into SH. I don't have time to do all the screenshot things right now because I need to get to bed at a decent time tonight because I have to get up way early tomorrow morning and go help out a friend who has had hip surgery and he needs some help on his farm...so my hubby and I are heading up to his place early because we have to mow for him and want to get it done before the heat sets in. He's like me...lives out in the country and what we mow amounts to acres and not like a small lot in town. Lots of work but looks like a park when its done. It's over an hour to just get to his house...so I need to get up way earlier than I normally do.

Short version of what I have seen so far....looks like things are worse in the wee hours of the morning...don't know yet if it is supine sleeping or REM causing the increased pressure needs. The reports look typical for REM...some periods at lower pressures with not much going on and then some ugly clustering...and then nothing for a while at the lower pressures.

I stand by my most recent idea....try 13 minimum and keep 16 max for now and let's see if we can do a better job preventing the airway collapsing with a little more minimum and maybe get lucky and not need the 18 cm that happened last night ...it was brief but enough to cause aerophagia triggering.
I have seen it happen often enough to know that sometimes we get lucky and with a better/optimal minimum pressure the machine won't have to go so high trying to fix after the fact. It's worth trying for sure.

Tomorrow when I get back home I will take some time and post a couple of Rose's recent reports so that you can see what I see. She has already told me it was okay if I shared the images here if I thought it might help someone and I do think it would be educational to see if we can maybe get lucky here and get Rose's therapy down to more acceptable numbers and not cause the belly issues to get horribly bad. I can't promise for sure but I think that there is a chance we can get it done.

Thanks so much again for going to all this trouble helping a newbie!
I do end up on my back in the middle of the night. This has been since I had shoulder surgery last year and couldn't sleep on the side that had the surgery and also found that I couldn't sleep on the other side either as I would tend to brace myself in position with the arm that was injured. The shoulder that was operated on is now working okay for the most part but is still sensitive to too much weight and I get uncomfortable lying on it.
Thanks again!

Rosevader, my sibling is at a high pressure, but they worked up to it for exactly the reason you stated - aeorphagia. For many, apparently, the aerophagia will not develop if you go up in stages. For others, it will no matter what. Good luck!