Maximum pressure keeps increasing

crshirley7 · Post by **crshirley7** » Thu Nov 04, 2021 7:02 am

First post here...thanks for adding me. I have been on cpap for almost one year. Started with Dreamstation but switched to Resmed 10 in July. My prescribed pressure on apap is 8-11. Is it normal to have max pressure increase over time? For the first month or so the pressure stayed between 8 and 11. Then I notice a gradual increase in needed pressure as the pressure kept maxing out. I recently changed the max pressure to 20 to allow the machine to do its thing. Now my max pressure is around 15 with EPR set at 3 (to reduce flow limits) without EPR max pressure goes up to 18.9. How reliable are the sleep study results considering it was the worst night of sleep in my life? I am concerned with what happens if my max pressure goes past 20 (machine max).

Thanks for any help....

LSAT · Post by **LSAT** » Thu Nov 04, 2021 8:44 am

The machine will only go as high as necessary to stop an apnea event. The EPR reducers pressure on exhale. If the machine increases your pressure to 18, you will be exhaling at a pressure of 15. (Assuming EPR 3). You should download the Oscar software to see exactly what is happening with your pressure and why it is happening. How are you seeing the max pressure? Are you awake watching the machine's screen?

Miss Emerita · Post by **Miss Emerita** » Thu Nov 04, 2021 10:18 am

Welcome! Like LSAT, I'd really like to see an Oscar chart. Your comment about your pressure readings over the course of a night make me wonder whether you're already using Oscar. I hope so. If not, and if you have a laptop or desktop computer, just follow the link below.

It's possible your flow limitations are fruitlessly driving your pressures up. Or not. That's one of the things we might be able to tell by looking at an Oscar chart.

Are you sleeping OK with the higher pressures?

crshirley7 · Post by **crshirley7** » Thu Nov 04, 2021 11:24 am

I am using oscar to review my data, should have mentioned in original post. I will post charts later when I am able. For the most part, flow limitations with occasional apnea events, are driving pressure up with or without EPR at 3. It is worse without EPR. Yes I am sleeping when pressure increases but sometimes when pressure gets above 16, mask leaks wake me up. Just ordered a new mask ro hopefully solve that problem. Thanks for your help.

Wulfman... · Post by **Wulfman...** » Thu Nov 04, 2021 11:50 am

crshirley7 wrote: ↑
Thu Nov 04, 2021 7:02 am
First post here...thanks for adding me. I have been on cpap for almost one year. Started with Dreamstation but switched to Resmed 10 in July. My prescribed pressure on apap is 8-11. Is it normal to have max pressure increase over time? For the first month or so the pressure stayed between 8 and 11. Then I notice a gradual increase in needed pressure as the pressure kept maxing out. I recently changed the max pressure to 20 to allow the machine to do its thing. Now my max pressure is around 15 with EPR set at 3 (to reduce flow limits) without EPR max pressure goes up to 18.9. How reliable are the sleep study results considering it was the worst night of sleep in my life? I am concerned with what happens if my max pressure goes past 20 (machine max).

Thanks for any help....

You really need to scrutinize your reports to determine what breathing events are causing your pressures to rise.
Flow Limitations? Snores? Hypopneas? Apneas?
Those are what will drive up the pressures in pretty much that order.
Once you determine what is the cause then you can work on a solution.

Den

.

CyberSpiff · Post by **CyberSpiff** » Thu Nov 04, 2021 12:37 pm

Watching this thread closely as it is something I noticed recently as well. I accidentally turned off EPR which caused my pressure to max out and my AHI went from my usual ~0.5 to 4.5 with a lot of flow limitation. When I turned it back on the next night I was back to my usual numbers and flow limitations. I thought my machine went mental until I realised what I did.

Cheers to Wulfman for the simple explanation of why I was seeing it.

palerider · Post by **palerider** » Thu Nov 04, 2021 1:46 pm

crshirley7 wrote: ↑
Thu Nov 04, 2021 7:02 am
How reliable are the sleep study results considering it was the worst night of sleep in my life?

Not very reliable, you might not have gone into REM, and for many people, REM sleep needs more pressure.

crshirley7 wrote: ↑
Thu Nov 04, 2021 7:02 am
I am concerned with what happens if my max pressure goes past 20 (machine max).

If that happens, you'll need a bilevel to get more pressure. However, you've got some breathing room. As your apnea is better controlled, you may find less excursions in higher pressure.

It's likely that your min pressure is too low, I've seen cases where raising the min results in more stabilized breathing, and that reduces or prevents the episodes that end up driving pressure way up.

crshirley7 · Post by **crshirley7** » Thu Nov 04, 2021 4:50 pm

: Last night EPR 3; Screenshot (16).png (213.81 KiB) Viewed 1705 times

: Zoom of last night EPR 3; Screenshot (13).png (210.04 KiB) Viewed 1705 times

crshirley7 · Post by **crshirley7** » Thu Nov 04, 2021 4:51 pm

: Previous night no EPR; Screenshot (14).png (217.1 KiB) Viewed 1705 times

: Zoom previous night no EPR; Screenshot (15).png (204.37 KiB) Viewed 1705 times

crshirley7 · Post by **crshirley7** » Thu Nov 04, 2021 5:00 pm

palerider wrote: ↑
Thu Nov 04, 2021 1:46 pm

crshirley7 wrote: ↑
Thu Nov 04, 2021 7:02 am
How reliable are the sleep study results considering it was the worst night of sleep in my life?
Not very reliable, you might not have gone into REM, and for many people, REM sleep needs more pressure.
crshirley7 wrote: ↑
Thu Nov 04, 2021 7:02 am
I am concerned with what happens if my max pressure goes past 20 (machine max).
If that happens, you'll need a bilevel to get more pressure. However, you've got some breathing room. As your apnea is better controlled, you may find less excursions in higher pressure.

It's likely that your min pressure is too low, I've seen cases where raising the min results in more stabilized breathing, and that reduces or prevents the episodes that end up driving pressure way up.

During the titration portion of the sleep study, I did not enter REM.
How high should the minimum pressure be set? I have it set at 12 and difficult to fall asleep at 12 so I use a 30 min ramp from 10 to 12 which works. Should I set the min pressure at the 95% pressure? Seems very high to me...
Thanks

LSAT · Post by **LSAT** » Thu Nov 04, 2021 5:02 pm

If the changing pressures are bothering you, you could try a fixed pressure at 15 and see how that affects your sleep and your AHI. Go into the settings and change from Autoset to CPAP and put in a pressure of 15.

crshirley7 · Post by **crshirley7** » Thu Nov 04, 2021 5:27 pm

LSAT wrote: ↑
Thu Nov 04, 2021 5:02 pm
If the changing pressures are bothering you, you could try a fixed pressure at 15 and see how that affects your sleep and your AHI. Go into the settings and change from Autoset to CPAP and put in a pressure of 15.

The changing pressure does not bother me except when it causes a mask leak (minimal problem). I am fine with Apap to 20. Palerider suggested raising the minimum pressure which I may try. Just trying to figure out what minimum pressure to use...
Thanks

Wulfman... · Post by **Wulfman...** » Thu Nov 04, 2021 7:00 pm

There's absolutely no good reason for you to be using a range of pressures.
From these reports, you're having no obstructive events.......Hypopneas or Apneas.
The Flow Limitations are driving up the pressures.
You're only having Centrals And, if they're "pressure induced", the range of pressures may be contributing to them.
I'm in agreement with LSAT in setting the machine to fixed pressure.......only I'd try a setting of 12 to start with.
Try that and then you can adjust from there if need be.
Typically, the pressure of 10 cm. was the threshold for pressure induced Centrals. ResMed built that into their old A10 algorithm years ago for their APAPs.

Den

.

Pugsy · Post by **Pugsy** » Thu Nov 04, 2021 7:17 pm

How's the nose been??? Experiencing much nasal congestion at all?

That old A10 ResMed algorithm was discontinued with the release of the S9 models. The auto adjusting algorithm was reworked once it was discovered that centrals can happen at any pressure (even as little as 5 cm) and 10 cm wasn't the magic line it was thought to be.

Dog Slobber · Post by **Dog Slobber** » Thu Nov 04, 2021 7:18 pm

Wulfman... wrote: ↑
Thu Nov 04, 2021 7:00 pm
There's absolutely no good reason for you to be using a range of pressures.
From these reports, you're having no obstructive events.......Hypopneas or Apneas.

Which completely disregards the possibility that the reason he's not experiencing Hypopneas and Apneas is *BECAUSE* the pressure has been increased.

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