Awoken at night with high pressure

onedayling · Post by **onedayling** » Thu Nov 14, 2019 6:09 pm

Hi all,
I bought a Resmed Autoset S10 with Airfit N20 mask recently for my dad since he was diagnosed with OSA years ago. He just started to use the machine 4 days ago and got awoken every night due to the high pressure blowing into his nose. So he barely used the mask for whole night but only for 4-5 hours. I looked into his graph this morning wondering if I can adjust his max pressure down to probably 12 to hope he can have a whole night sleep without getting awoken by overflowed air.

BTW my dad lives in China and would not have a care provider that he can go to. So I hope experts from CPAP talk could give me some insights.

Any suggestion will be greatly appreciated!
Thank you!

onedayling · Post by **onedayling** » Thu Nov 14, 2019 6:24 pm

onedayling wrote: ↑
Thu Nov 14, 2019 6:09 pm
Hi all,
I bought a Resmed Autoset S10 with Airfit N20 mask recently for my dad since he was diagnosed with OSA years ago. He just started to use the machine 4 days ago and got awoken every night due to the high pressure blowing into his nose. So he barely used the mask for whole night but only for 4-5 hours. I looked into his graph this morning wondering if I can adjust his max pressure down to probably 12 to hope he can have a whole night sleep without getting awoken by overflowed air.

BTW my dad lives in China and would not have a care provider that he can go to. So I hope experts from CPAP talk could give me some insights.

Any suggestion will be greatly appreciated!
Thank you!

LSAT · Post by **LSAT** » Thu Nov 14, 2019 8:10 pm

Your dad's maximum pressure setting is 20 but the machine never got higher than 12.8 during the night. Lowering the maximum pressure will do nothing for him. The problem he has is that the minimum pressure is too low. Raise it to 8...maybe even 9...Also, reduce the ramp to 15 minutes.

jimbud · Post by **jimbud** » Thu Nov 14, 2019 8:12 pm

I am no expert.
The experts will probably check my post to make sure I do not give you bad advice.

(kind of a bump for your thread)
I would think lowering max to 12 if you think that will help would not be a problem. You can raise it back up whenever you need.
He needs to be comfortable so he will get therapy.
Is he OK with the 4 min. Many people are not. MIght think about raising that some. 6,7 or 8 whatever is most comfortable.

Good luck and hope the best for you and your dad.

JPB

I will bow out and hopefully an expert will check in.

Pugsy · Post by **Pugsy** » Thu Nov 14, 2019 8:21 pm

Having the ramp on for 45 minutes just prolongs therapy and it's useless anyway with the minimum pressure being 4 cm.
Ramp takes whatever time to get up to the minimum setting and the machine can't go up to 4 cm...the lowest it will go is 4 cm.
Might as well turn the ramp off. The machine won't flag anything or respond to anything happening until the 45 minutes is over with.
The absence of anything being flagged during the first 45 minutes doesn't mean nothing happened.

If he needs to start low and work up....set the minimum to around 8 or 9 cm and then use the ramp if he needs that time to work up to what he needs.
Once ramp is over the machine essentially goes to up around 9 or 10 and never really goes back down. The minimum pressure is the most critical setting and does the bulk of the work.

Limit the max if you feel you just have to but the more urgent need is a more optimal minimum pressure setting.
Get it up to a more optimal point and the machine might not even need to go to the near 13 it is going to now.
So...increase the minimum to at least 8 or 9 and see what happens.

onedayling · Post by **onedayling** » Fri Nov 15, 2019 1:33 am

LSAT wrote: ↑
Thu Nov 14, 2019 8:10 pm
Your dad's maximum pressure setting is 20 but the machine never got higher than 12.8 during the night. Lowering the maximum pressure will do nothing for him. The problem he has is that the minimum pressure is too low. Raise it to 8...maybe even 9...Also, reduce the ramp to 15 minutes.

Thank you, LSAT! I just noticed his graph showing with many events and flow limitation in first 30 minutes when using CPAP. Probably is due to a long ramp time and low min pressure. I will adjust min pressure to 8 and see how the graph shows next morning. But it still not help explain why he got awoken at night, right? Do I still need to lower max pressure to 12 and see if that helps?

onedayling · Post by **onedayling** » Fri Nov 15, 2019 1:39 am

jimbud wrote: ↑
Thu Nov 14, 2019 8:12 pm
I am no expert.
The experts will probably check my post to make sure I do not give you bad advice. (kind of a bump for your thread)
I would think lowering max to 12 if you think that will help would not be a problem. You can raise it back up whenever you need.
He needs to be comfortable so he will get therapy.
Is he OK with the 4 min. Many people are not. Might think about raising that some. 6,7 or 8 whatever is most comfortable.

Good luck and hope the best for you and your dad.

JPB

I will bow out and hopefully an expert will check in.

Thank you, JPB! You all pointed out the facts that I was not aware of before. And I really appreciate your suggestion here:)
My dad thought 4 min is good which won't wake him up. But his graph shows with many events and flow limitation in first 30 minutes when using CPAP. Probably is due to a long ramp time and low min pressure. I will adjust min pressure to 8 and see how the graph shows next morning.
Thank you again!

onedayling · Post by **onedayling** » Fri Nov 15, 2019 1:47 am

Pugsy wrote: ↑
Thu Nov 14, 2019 8:21 pm
Having the ramp on for 45 minutes just prolongs therapy and it's useless anyway with the minimum pressure being 4 cm.
Ramp takes whatever time to get up to the minimum setting and the machine can't go up to 4 cm...the lowest it will go is 4 cm.
Might as well turn the ramp off. The machine won't flag anything or respond to anything happening until the 45 minutes is over with.
The absence of anything being flagged during the first 45 minutes doesn't mean nothing happened.

If he needs to start low and work up....set the minimum to around 8 or 9 cm and then use the ramp if he needs that time to work up to what he needs.
Once ramp is over the machine essentially goes to up around 9 or 10 and never really goes back down. The minimum pressure is the most critical setting and does the bulk of the work.

Limit the max if you feel you just have to but the more urgent need is a more optimal minimum pressure setting.
Get it up to a more optimal point and the machine might not even need to go to the near 13 it is going to now.
So...increase the minimum to at least 8 or 9 and see what happens.

Good to know, Pugsy! I am a newbie here and didn't know "machine won't flag anything or respond to anything happening until the 45 minutes is over with"... I thought 23:00-23:10 is when he started to go to bed..... Your comment is very informative and I really appreciate it! Will increase the minimum to 8 tonight and reduce ramp time to 15 minutes since he is still in the stage of getting himself used to his new "toy".
I still am not sure why he was awoken every night by the overflow air. It is not because max pressure is too high for him? I was wondering if I need to reduce max to 12 so he won't get awoken at night?

Thanks again, Pugsy!

Pugsy · Post by **Pugsy** » Fri Nov 15, 2019 6:26 am

Most likely it was the apnea event itself that caused the awakening and when he was awake then he noticed the higher pressure because the machine was trying to prevent the airway collapses. People often blame the pressure increase when it could very well be the apnea event itself that the pressure was trying to prevent.
It could also have just been a spontaneous arousal/awakening from anything in general and then he notices the pressure.
These arousals happen a lot to people when they first start therapy. The body/brain is just a bit hyper sensitive to all the new stuff going on with wearing the mask and having the machine blow air up our nose.
Arousals can happen from just about anything...last night I had a truckload of them because of hip pain.

onedayling · Post by **onedayling** » Thu Nov 21, 2019 3:03 am

Pugsy wrote: ↑
Fri Nov 15, 2019 6:26 am
Most likely it was the apnea event itself that caused the awakening and when he was awake then he noticed the higher pressure because the machine was trying to prevent the airway collapses. People often blame the pressure increase when it could very well be the apnea event itself that the pressure was trying to prevent.
It could also have just been a spontaneous arousal/awakening from anything in general and then he notices the pressure.
These arousals happen a lot to people when they first start therapy. The body/brain is just a bit hyper sensitive to all the new stuff going on with wearing the mask and having the machine blow air up our nose.
Arousals can happen from just about anything...last night I had a truckload of them because of hip pain.

Thank you, Pugsy! I had updated ramp time to 15 minutes and min pressure to 8 for last 3 days and his number goes better while he was claiming he didn't feel a big difference though. He said the mask was too tight for him and we will potentially buy a bigger mask if needed. Do you see any needs for minor change on CPAP machine itself based on the updated stats attached?

Thanks!

Pugsy · Post by **Pugsy** » Thu Nov 21, 2019 5:19 am

Does he ever get more than 6 hours of sleep?
Are those 6 hours he does get fragmented with very many wake ups?
6 hours really isn't enough sleep to expect much from and especially if there are very many wake ups during those 6 hours.
Is he ever sleeping without the cpap?

As for the report you shared....first part of the night things actually look really good but the last part has some increased activity in terms of snores and OAs. Was he by chance on his side the first part of the night and on his back the last part?
The other reports with the minimum at 8...do they look similar to this one with periods of nothing much happening and then some clustering late again?
Two things can cause clustering like that....going onto our backs from our side and REM sleep.
So if not on his back then most likely REM which would go along with the time frame because those wee hours of the morning is when we have more REM. Both supine sleeping and REM can cause OSA to worsen and need more pressure.

If he is always on his side...maybe a little more minimum to better break up the clustering as it likely is REM related. Probably not urgent and I doubt the cluster is the cause of not feeling so great but it's worth trying. Maybe 9 cm minimum.
I think he likely simply needs more sleep and needs good solid sleep without very many awakenings.

Does he take any medications? If so, what? Forgive me if I asked this already but I don't remember and I can't see the older posts right now.

Awoken at night with high pressure

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