Help with Pressure Settings for New APAP User

General Discussion on any topic relating to CPAP and/or Sleep Apnea.
ApexAZ
Posts: 8
Joined: Sun Sep 12, 2021 11:00 am

Re: Help with Pressure Settings for New APAP User

Post by ApexAZ » Sun Sep 12, 2021 11:31 am

If I remember right, my inbound pressure is like 19. Very high. I have to use a F&P Forma full face mask, because it has a chin cup that helps a bit with leaking. I also have to fit it fairly tight. It's a balancing act trying to cinch it down as much as possible without going too tight. I had to learn to sleep on my side with my face turned toward the pillow a bit to help keep some pressure on the mask to reduce leaking. Even still, my mask still leaks if I roll onto my back in the middle of the night, and then my wife moves to the spare bedroom lol.

I can't really use the ones that are designed to "float" over your nose and mouth. They just leak too much at my high pressure settings. I'll be in big trouble if F&P ever discontinues my beloved forma mask!

I don't think it's a good idea to just adjust settings without consulting a doctor, personally.

User avatar
zonker
Posts: 8080
Joined: Fri Jun 19, 2015 4:36 pm

Re: Help with Pressure Settings for New APAP User

Post by zonker » Sun Sep 12, 2021 11:39 am

ApexAZ wrote:
Sun Sep 12, 2021 11:31 am


I don't think it's a good idea to just adjust settings without consulting a doctor, personally.
then be prepared to tut-tut a lot, because forum members DO believe in adjusting pressure.
the two great unwritten rules of life are-
1.
2.
Airsense 10 Autoset for Her
P10 Nasal Pillow Mask

User avatar
el344
Posts: 26
Joined: Fri Dec 29, 2017 1:59 pm
Location: Tennessee

Re: Help with Pressure Settings for New APAP User

Post by el344 » Sun Sep 12, 2021 12:14 pm

ApexAZ wrote:
Sun Sep 12, 2021 11:31 am
I don't think it's a good idea to just adjust settings without consulting a doctor, personally.
Given my druthers, I’d love to be working with a doctor who was truly knowledgeable and committed to working with us to get to a satisfactory pressure. But instead I get a nurse who just blindly parrots that the pressure settings have to be 4 to 20 and he’ll just have to get used to it. So on a Friday night, after spending a lot of time reading posts on this forum, and given that the choice was between me fiddling with the settings or him completely refusing to use the CPAP unless the max pressure was lowered, I felt pretty comfortable adjusting away.

The level of hard-won experiential expertise of the people on this forum is invaluable to folks like me.
me:
ResMed AirSense10 Elite
AirFit N30 Mask

him:
ResMed AirSense 10 Autoset
AirFit F20 Mask

User avatar
Pugsy
Posts: 59253
Joined: Thu May 14, 2009 9:31 am
Location: Missouri, USA

Re: Help with Pressure Settings for New APAP User

Post by Pugsy » Sun Sep 12, 2021 1:23 pm

Sometimes a person just has to do what they gotta do. While in an ideal world we would all prefer having a doctor on board but most of us don't live in an ideal world and reducing the pressure and some events is sure a better choice than having someone refuse to use the machine and not have any reduction in events....and subsequent total untreated sleep apnea sleep. Some reduction in events is certainly better than no reduction. We would rather someone be taking baby steps than no steps.

Besides this isn't rocket science and if people can be educated to managed diabetes.....this cpap stuff is a cake walk.
After all....it's just air and enough air to help hold the airway open.
Mask: Bleep no headgear mask.. https://bleepsleep.com/
Machine: AirCurve 10 VAuto

I may have to RISE but I refuse to SHINE.

ApexAZ
Posts: 8
Joined: Sun Sep 12, 2021 11:00 am

Re: Help with Pressure Settings for New APAP User

Post by ApexAZ » Sun Sep 12, 2021 6:11 pm

el344 wrote:
Sun Sep 12, 2021 12:14 pm
ApexAZ wrote:
Sun Sep 12, 2021 11:31 am
I don't think it's a good idea to just adjust settings without consulting a doctor, personally.
Given my druthers, I’d love to be working with a doctor who was truly knowledgeable and committed to working with us to get to a satisfactory pressure. But instead I get a nurse who just blindly parrots that the pressure settings have to be 4 to 20 and he’ll just have to get used to it. So on a Friday night, after spending a lot of time reading posts on this forum, and given that the choice was between me fiddling with the settings or him completely refusing to use the CPAP unless the max pressure was lowered, I felt pretty comfortable adjusting away.

The level of hard-won experiential expertise of the people on this forum is invaluable to folks like me.
You do what you feel is right, but there's a reason why they titrate the machine pressure and shoot for AHI < 5 (the lower the better). This is what is considered a satisfactory pressure in terms of treating the apnea. If it isn't correcting the sleep apnea, then it isn't doing him as much good.

Is it better than nothing? Probably, but I guess you'll have to see what the AHI numbers are after you adjust it. I think so long as you are working toward getting to the correct titrated pressure and an AHI less than 5, that should be your long term goal.

You mentioned a range. Does this mean the respiratory therapist wants to set it to auto with a range between 4 and 20? Are there no sleep doctors in your area? Is it a bipap? Perhaps a bipap with a lower exhalation pressure would be helpful. I'm assuming you also have the ramp mode turned on with the lowest possible starting pressure.

ApexAZ
Posts: 8
Joined: Sun Sep 12, 2021 11:00 am

Re: Help with Pressure Settings for New APAP User

Post by ApexAZ » Sun Sep 12, 2021 6:20 pm

zonker wrote:
Sun Sep 12, 2021 11:39 am
ApexAZ wrote:
Sun Sep 12, 2021 11:31 am


I don't think it's a good idea to just adjust settings without consulting a doctor, personally.
then be prepared to tut-tut a lot, because forum members DO believe in adjusting pressure.
I don't find it annoying if people want to change their pressure. I don't find it annoying that the OP wants to change their husband's pressure. But I do believe a good sleep study with a titrated pressure is required to treat the sleep apnea effectively. If someone lowers their titrated pressure, they may not get the full benefit of the therapy.

Best to discuss with a pulmonologist certified in sleep disorders and what needs to happen to get there. Another reason is insurance. Insurance companies probably won't cover the cost of the equipment if they find out you aren't being compliant with it.

User avatar
Pugsy
Posts: 59253
Joined: Thu May 14, 2009 9:31 am
Location: Missouri, USA

Re: Help with Pressure Settings for New APAP User

Post by Pugsy » Sun Sep 12, 2021 6:43 pm

ApexAZ wrote:
Sun Sep 12, 2021 6:20 pm
. But I do believe a good sleep study with a titrated pressure is required to treat the sleep apnea effectively.
So what do you suggest be done when someone doesn't get a titration sleep study at all....and they are given apap machines set at factory defaults 4 to 20 and told to let the machine sort it out??? Are you aware that this is becoming a very common way to go? Lots of insurance companies won't pay for titration in lab studies unless a problem comes up.
And to top it all off the person flat out tells you that if the pressure isn't reduced they refuse to use the damn machine at all???

BTW...I had an in lab titration sleep study...they didn't do such a great job figuring out best pressure for me.
They are far from perfect in what they come up with.
Mask: Bleep no headgear mask.. https://bleepsleep.com/
Machine: AirCurve 10 VAuto

I may have to RISE but I refuse to SHINE.

ApexAZ
Posts: 8
Joined: Sun Sep 12, 2021 11:00 am

Re: Help with Pressure Settings for New APAP User

Post by ApexAZ » Sun Sep 12, 2021 6:52 pm

Pugsy wrote:
Sun Sep 12, 2021 6:43 pm
ApexAZ wrote:
Sun Sep 12, 2021 6:20 pm
. But I do believe a good sleep study with a titrated pressure is required to treat the sleep apnea effectively.
So what do you suggest be done when someone doesn't get a titration sleep study at all....and they are given apap machines set at factory defaults 4 to 20 and told to let the machine sort it out??? Are you aware that this is becoming a very common way to go? Lots of insurance companies won't pay for titration in lab studies unless a problem comes up.
And to top it all off the person flat out tells you that if the pressure isn't reduced they refuse to use the damn machine at all???

BTW...I had an in lab titration sleep study...they didn't do such a great job figuring out best pressure for me.
They are far from perfect in what they come up with.
I'm not trying to offend you here. This is why I asked so many questions about how they came up with their numbers. I'm not convinced just setting it to auto with a range between 4-20 is ok, so in a way I am agreeing with the OP to some extent. Much better to get it titrated to find the exact pressure needed to keep it under 5. Under 1 would be even better. But trying to just experiment with it until it works doesn't seem like a good plan either. A qualified sleep doctor and/or respiratory tech should be able to help with this.

Work with a doctor to do an in home study. I realize the machines have a lot of accessible data, but they need to get it dialed in. I also brought up ramp settings and possible BiPAP with a lower exhalation value as a possible solution. I also have a pretty high pressure (19) and the bipap with a lower exhalation pressure of 14 helped tremendously. I also suggested trying a F&P forma mask, as it helped a lot being at a high pressure. I gave lots of useful suggestions, in addition to the suggestion to find a good doctor.

I did a sleep study in a lab and my titration has been perfect and hasn't changed in over 13 years. I still consistently get less than 1 AHI most nights. I'm sorry you didn't have a good experience. But I mean if you wanna just shotgun it, then by all means. It's your health.

User avatar
zonker
Posts: 8080
Joined: Fri Jun 19, 2015 4:36 pm

Re: Help with Pressure Settings for New APAP User

Post by zonker » Sun Sep 12, 2021 7:05 pm

ApexAZ wrote:
Sun Sep 12, 2021 6:20 pm

If someone lowers their titrated pressure, they may not get the full benefit of the therapy.

the word "if" here carries a lot of weight. the majority of us here feel that sleep doctors are NOT doing the proper job of titrating. if the majority WERE, there would be very little reason for this forum to exist.

if you haven't noticed, the bulk of the work here is done by observing measurements taken by the free software program called oscar. with that, we can see at once whether a suggested change in pressure does good or harm. no one here blindly tells a new user to change pressure. just the opposite: that is referred to as 'dial winging" and is very much frowned upon.

instead, small changes are advised(well, for the most part. there are some here who will advise a huge jump!) and then observed, via oscar, to see what happens next or to advise something else altogether.

i'm not saying you should do similar. what you have going works for you and why change that? but your experience is NOT the experience of thousands of people who come here to get help.

it's those people we want to help and will continue to do so. if they aren't comfortable making any advised changes, that's up to them.
the two great unwritten rules of life are-
1.
2.
Airsense 10 Autoset for Her
P10 Nasal Pillow Mask

User avatar
zonker
Posts: 8080
Joined: Fri Jun 19, 2015 4:36 pm

Re: Help with Pressure Settings for New APAP User

Post by zonker » Sun Sep 12, 2021 7:09 pm

ApexAZ wrote:
Sun Sep 12, 2021 6:52 pm

I did a sleep study in a lab and my titration has been perfect and hasn't changed in over 13 years. I still consistently get less than 1 AHI most nights. I'm sorry you didn't have a good experience. But I mean if you wanna just shotgun it, then by all means. It's your health.
again, this is YOUR experience. it's not one that every person gets. too many tend to fall through the cracks.

we don't want that to happen. and that's why advice is given here with factual backing.

to el344: sorry to hijack your thread but when the very purpose of this forum is questioned, i gets my hackles up a bit.
:lol:
the two great unwritten rules of life are-
1.
2.
Airsense 10 Autoset for Her
P10 Nasal Pillow Mask

ApexAZ
Posts: 8
Joined: Sun Sep 12, 2021 11:00 am

Re: Help with Pressure Settings for New APAP User

Post by ApexAZ » Sun Sep 12, 2021 7:14 pm

zonker wrote:
Sun Sep 12, 2021 7:05 pm
ApexAZ wrote:
Sun Sep 12, 2021 6:20 pm

If someone lowers their titrated pressure, they may not get the full benefit of the therapy.

the word "if" here carries a lot of weight. the majority of us here feel that sleep doctors are NOT doing the proper job of titrating. if the majority WERE, there would be very little reason for this forum to exist.

if you haven't noticed, the bulk of the work here is done by observing measurements taken by the free software program called oscar. with that, we can see at once whether a suggested change in pressure does good or harm. no one here blindly tells a new user to change pressure. just the opposite: that is referred to as 'dial winging" and is very much frowned upon.

instead, small changes are advised(well, for the most part. there are some here who will advise a huge jump!) and then observed, via oscar, to see what happens next or to advise something else altogether.

i'm not saying you should do similar. what you have going works for you and why change that? but your experience is NOT the experience of thousands of people who come here to get help.

it's those people we want to help and will continue to do so. if they aren't comfortable making any advised changes, that's up to them.
That's fine, but all I'm seeing is he refuses to go to a higher pressure and he's having a lot of obstructive apneas still. All oscar is doing in this case is proving that 12 cmH20 is not sufficient.

I also mentioned in an earlier post that maybe they can do this for a while, but their long term goal should be to gradually increase the maximum pressure needed to correct the apneas. 18 AHI is still considered moderate sleep apnea and there could still be health implications by leaving it uncorrected. My way of trying to help is to try and point out that it's not enough and to work with a sleep doctor to figure out the exact pressure, which based on the data shared, is clearly higher than 12 cmH20. A doctor could also inform him of the danger of leaving it untreated. Perhaps OP and her husband live in the sticks and don't have access to a quality sleep center, of which you all are trying to help fill in that gap, and I understand that. But honestly it sounds like he just needs support more than anything and maybe needs someone to have a frank conversation about the danger he is in by insisting 12 is the max. Maybe he does know, I don't know.

How I can also help is to just say I get it. My pressure is 19 (I am envious of those with < 10). It took me a full year to get used to it. But I didn't try to insist the pressure was too high. I just had to adapt. To be a bit cliche: At the end of the day, you can lead a horse to water, but you can't force it to drink.

I don't really have anything else to add at this point. Doctor or no, if a patient isn't willing to take what is prescribed, then what more can you really do?

User avatar
Pugsy
Posts: 59253
Joined: Thu May 14, 2009 9:31 am
Location: Missouri, USA

Re: Help with Pressure Settings for New APAP User

Post by Pugsy » Sun Sep 12, 2021 7:34 pm

ApexAZ wrote:
Sun Sep 12, 2021 6:52 pm
I'm not trying to offend you here.
Well....you are doing a damn good job of being annoying and offending. You might want to quit while you are ahead.

Get real...OP here has tried contacting a doctor and gets a clueless nurse instead. We have strongly urged increasing that maximum many, many times but if he won't use the machine at all with a higher max then it is better to use a lower sub optimal pressure than not use it at all....at least for now.

Sometimes people have to take baby steps....far from perfect or ideal but it's better than no steps at all.

I am very happy for you that your medical care team served you well but don't assume that all doctors/nurses walk on water because they don't. If they did there wouldn't be a need for this forum.
Mask: Bleep no headgear mask.. https://bleepsleep.com/
Machine: AirCurve 10 VAuto

I may have to RISE but I refuse to SHINE.

ApexAZ
Posts: 8
Joined: Sun Sep 12, 2021 11:00 am

Re: Help with Pressure Settings for New APAP User

Post by ApexAZ » Sun Sep 12, 2021 7:35 pm

Pugsy wrote:
Sun Sep 12, 2021 7:34 pm
ApexAZ wrote:
Sun Sep 12, 2021 6:52 pm
I'm not trying to offend you here.
Well....you are doing a damn good job of being annoying and offending. You might want to quit while you are ahead.

Get real...OP here has tried contacting a doctor and gets a clueless nurse instead. We have strongly urged increasing that maximum many, many times but if he won't use the machine at all with a higher max then it is better to use a lower sub optimal pressure than not use it at all....at least for now.

Sometimes people have to take baby steps....far from perfect or ideal but it's better than no steps at all.

I am very happy for you that your medical care team served you well but don't assume that all doctors/nurses walk on water because they don't. If they did there wouldn't be a need for this forum.
Calm down, chief.

User avatar
zonker
Posts: 8080
Joined: Fri Jun 19, 2015 4:36 pm

Re: Help with Pressure Settings for New APAP User

Post by zonker » Sun Sep 12, 2021 7:38 pm

ApexAZ wrote:
Sun Sep 12, 2021 7:35 pm


Calm down, chief.
congratulations!

you just pissed off the moderator.

clearly, you are here to argue, for however long you're here. i have no time for it.

but be of good cheer. if you last long enough, there are others who will be happy to engage you.

bye.
the two great unwritten rules of life are-
1.
2.
Airsense 10 Autoset for Her
P10 Nasal Pillow Mask

ApexAZ
Posts: 8
Joined: Sun Sep 12, 2021 11:00 am

Re: Help with Pressure Settings for New APAP User

Post by ApexAZ » Sun Sep 12, 2021 7:40 pm

zonker wrote:
Sun Sep 12, 2021 7:38 pm
ApexAZ wrote:
Sun Sep 12, 2021 7:35 pm


Calm down, chief.
congratulations!

you just pissed off the moderator.

clearly, you are here to argue, for however long you're here. i have no time for it.

but be of good cheer. if you last long enough, there are others who will be happy to engage you.

bye.
Moderator or not, I don't deserve to be bullied. He has been nothing but hostile toward me from my very first post. If I get banned, oh well. No great loss I guess.

I offered practical advice. Good advice, even. Just because it was a nurse doesn't mean they didn't get the titration right, or that it wasn't under the supervision of an actual doctor. We already know that 12 is not enough.

I understand high pressure sucks, but he needs more. You can't really help someone who refuses to acknowledge his unfortunate circumstances of needing *higher pressure*. A doctor would likely tell him the same thing.

At the end of the day, no one here has actually helped this man at this point. He still has moderate sleep apnea. Oscar doesn't do any good if people aren't willing to try to adjust to having to wear a mask blowing in their face at the right settings.