Pressure Issue?

Pugsy · Post by **Pugsy** » Sat Apr 04, 2020 7:54 pm

Ahhh....I understand. Give me a couple of minutes to go find something I wrote just a week or so ago that should explain things better for you. It's long and I don't want to retype it.

You were expecting the machine to do something it can't do...let me go find that post for you.

Pugsy · Post by **Pugsy** » Sat Apr 04, 2020 7:56 pm

viewtopic.php?p=1345745#p1345745

Look for my post in this thread....about in the middle...I think it's number 8 or 9... around 3:16 PM....I made several but the one that explains how apap works was posted at 3:16 March 17.

Miss Emerita · Post by **Miss Emerita** » Sat Apr 04, 2020 9:58 pm

It seems from your chart that your flow limitations are a big driver for your pressure. I recommend setting your EPR to 2 to see what happens. It might reduce hypopneas and FLs a little; then again, it might increase CAs. But try it and let’s take a look at the results to figure out what step to take next.

ChicagoGranny · Post by **ChicagoGranny** » Mon Apr 06, 2020 8:11 am

SyCoREAPER wrote: ↑
Sat Apr 04, 2020 1:46 pm

Full-Size Image

For future reference, we can right-click on the image and select Open Image in New Tab to see the full-size image. This will save you a step.

SyCoREAPER · Post by **SyCoREAPER** » Tue Apr 07, 2020 11:41 am

Miss Emerita wrote: ↑
Sat Apr 04, 2020 9:58 pm
It seems from your chart that your flow limitations are a big driver for your pressure. I recommend setting your EPR to 2 to see what happens. It might reduce hypopneas and FLs a little; then again, it might increase CAs. But try it and let’s take a look at the results to figure out what step to take next.

My sleep center is being of no help, trying to get my machine linked to them, so here we go with crowd-sourced advice (nothing wrong with that but am annoyed by how little help the sleep center is offering after the hundreds of dollars I've paid them). I will try setting the EPR and posting a new graph tomorrow. Thank you for your advice.

ChicagoGranny wrote: ↑
Mon Apr 06, 2020 8:11 am

SyCoREAPER wrote: ↑
Sat Apr 04, 2020 1:46 pm

Full-Size Image
For future reference, we can right-click on the image and select Open Image in New Tab to see the full-size image. This will save you a step.

I only did it as a courtesy, not implying anyone is not tech savvy but wanted to be as helpful as possible.

Edit:
After re-reading the above
Please do not mistake my frustration with a lack of gratitude or appreciation for this community or it's advice. Quite the contrary, without you I would be Dead in the water right now. Thank you everyone. I will post an update tomorrow.

SyCoREAPER · Post by **SyCoREAPER** » Wed Apr 08, 2020 6:56 am

Miss Emerita wrote: ↑
Sat Apr 04, 2020 9:58 pm
It seems from your chart that your flow limitations are a big driver for your pressure. I recommend setting your EPR to 2 to see what happens. It might reduce hypopneas and FLs a little; then again, it might increase CAs. But try it and let’s take a look at the results to figure out what step to take next.

Good Morning Miss Emerita and everyone else.

Please see attached for my latest result.

Dog Slobber · Post by **Dog Slobber** » Wed Apr 08, 2020 7:19 am

Your minimum pressure is *WAY* too low.

As soon as you fall asleep it jumps to 12 and never drops below it.

As a starting point, I'd set it to 12 and see where it wants to go from there.

Al though you've turned ramp off, it wasn't necessary while you were on minimum 5. If you're going to increase your pressure, you may want to set ramp again. Put ramp on Auto and set a pressure you're comfortable with. Somewhere between 5 and your minimum.

SyCoREAPER · Post by **SyCoREAPER** » Wed Apr 08, 2020 7:25 am

Dog Slobber wrote: ↑
Wed Apr 08, 2020 7:19 am
Your minimum pressure is *WAY* too low.

As soon as you fall asleep it jumps to 12 and never drops below it.

As a starting point, I'd set it to 12 and see where it wants to go from there.

Al though you've turned ramp off, it wasn't necessary while you were on minimum 5. If you're going to increase your pressure, you may want to set ramp again. Put ramp on Auto and set a pressure you're comfortable with. Somewhere between 5 and your minimum.

I am not questioning you, just trying to better understand.

Is ramp really needed? I find the slow pressure build up to be distracting while falling asleep. It never quite detects correctly on Auto and the timer doesn't go high enough for how long it sometimes takes me to fall asleep. But if it must be on, I will certainly turn it on.

Also, should it be 12 or should I set it to something a little higher. Again, I am not an expert, but read with EPR on the effective pressure is reduced.

Pugsy · Post by **Pugsy** » Wed Apr 08, 2020 7:32 am

The machine is setting its own new and higher minimum and it is doing it fairly quickly.
Increasing the minimum to the machine's new minimum that it uses....isn't all that big of a deal IMHO and won't change things since the machine doesn't seem to ever go back down. That's why I haven't suggested increasing the minimum...it's already being done.
Now if you had a lot of drops back down below 10...then I would suggest increasing the minimum.

If you find ramp annoying....don't use it. It's something that some people like and some people don't.

You didn't mention as to how you felt or slept after making the change to EPR at 2?????

And yes....when EPR is added in there is a drop in the baseline EPAP pressure. Sometimes we need to adjust the baseline to compensate for that drop and sometimes we don't. When using EPR if the AHI increases in terms of the obstructive components (OA and hyponeas) we increase the pressure.

Dog Slobber · Post by **Dog Slobber** » Wed Apr 08, 2020 7:35 am

No the ramp doesn't have to be on. Purely a comfort issue.

My thoughts were, while you were lying awake the pressure was set to 5. Now you will be starting at 12, you might not be as comfortable.

About starting at 12. I actually think you will probably need to go higher. But, like to make a change, watch for a few days, then adjust. By being lower and inching up you know when to stop when the AHI and flow limitations stop improving.

SyCoREAPER · Post by **SyCoREAPER** » Wed Apr 08, 2020 7:43 am

Pugsy wrote: ↑
Wed Apr 08, 2020 7:32 am
The machine is setting its own new and higher minimum and it is doing it fairly quickly.
Increasing the minimum to the machine's new minimum that it uses....isn't all that big of a deal IMHO and won't change things since the machine doesn't seem to ever go back down. That's why I haven't suggested increasing the minimum...it's already being done.
Now if you had a lot of drops back down below 10...then I would suggest increasing the minimum.

If you find ramp annoying....don't use it. It's something that some people like and some people don't.

You didn't mention as to how you felt or slept after making the change to EPR at 2?????

And yes....when EPR is added in there is a drop in the baseline EPAP pressure. Sometimes we need to adjust the baseline to compensate for that drop and sometimes we don't. When using EPR if the AHI increases in terms of the obstructive components (OA and hyponeas) we increase the pressure.

I think I feel a little less "stressed?". My face feels better and my chest feels a little better. I do wake up sleepier (since starting PAP) but I think that is the better nights sleep offsetting the strength of my sleep meds.

While the machine is doing it automatically, I do find the pressure at 5 to be a bit low when laying in bed. I don't know if it is that I am now accustomed to feeling pressure. I may try raising the pressure as suggested by Dog Slobber?

TLDR: EPR definitely helped

Dog Slobber wrote: ↑
Wed Apr 08, 2020 7:35 am
No the ramp doesn't have to be on. Purely a comfort issue.

My thoughts were, while you were lying awake the pressure was set to 5. Now you will be starting at 12, you might not be as comfortable.

About starting at 12. I actually think you will probably need to go higher. But, like to make a change, watch for a few days, then adjust. By being lower and inching up you know when to stop when the AHI and flow limitations stop improving.

I may try raising to 12 just to see how it goes tonight

Pugsy · Post by **Pugsy** » Wed Apr 08, 2020 8:18 am

Going from 5 to 12 is a big jump even with EPR added in to help.
If you are comfortable with it then go for it but if you want to maybe go up in smaller increments that would be fine too.
I am a tough cookie but even I would have a problem with that big of a jump comfort wise while awake.

SyCoREAPER · Post by **SyCoREAPER** » Wed Apr 08, 2020 9:38 am

Maybe I'll try somewhere in the middle. Should I limit the max pressure at all?

Dog Slobber · Post by **Dog Slobber** » Wed Apr 08, 2020 9:44 am

SyCoREAPER wrote: ↑
Wed Apr 08, 2020 9:38 am
Maybe I'll try somewhere in the middle. Should I limit the max pressure at all?

No.

Pugsy · Post by **Pugsy** » Wed Apr 08, 2020 9:54 am

SyCoREAPER wrote: ↑
Wed Apr 08, 2020 9:38 am
Should I limit the max pressure at all?

Not unless you start having some sort of problem like aerophagia or a truckload of centrals.
The machine will go to where it needs to go and having the ability to go higher doesn't change that fact unless you limit it.

I have a machine that will go to 25 inhale pressure....the most is might go to is 15 for a brief amount of time.
If I reduce the max to 20 or 18 or even 16...it still will go to 15 no matter what the max might be and in the same amount of time.

It's like a car....just because it can go to 100 mph or 120 mph doesn't mean it will go there unless there is a need to go there and with a car the need is the foot on the accelerator.

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