Quick Pressure Question

General Discussion on any topic relating to CPAP and/or Sleep Apnea.
decker12
Posts: 58
Joined: Thu Oct 27, 2022 9:59 am

Re: Quick Pressure Question

Post by decker12 » Tue Jan 17, 2023 12:09 pm

Yeah, things have been decent in the 7 to 12 range for me for the past couple of weeks. I have not been waking up feeling as full or "gassy". I'll post a new couple of days from SleepHQ when I get home later and plug in my SD card.

Now that being said, I had an absolute MISERABLE night last night with my CPAP. I was thinking about making a new topic because this is the first time in months I've had such an awful night.

User avatar
palerider
Posts: 31606
Joined: Wed Dec 16, 2009 5:43 pm
Location: Dallas(ish).

Re: Quick Pressure Question

Post by palerider » Tue Jan 17, 2023 8:02 pm

decker12 wrote:
Tue Jan 17, 2023 11:39 am
Thanks for the insight here. However everything I'm reading, I thought an AHI of under 5 is considered normal?
No, 5 is not "normal", it's actually crappy, an AHI of 5 means that on average you're getting waked up every 12 minutes.

Do you really think you're going to get any meaningful rest that way? It may be "good enough" for insurance and doctors who don't care about you, but it should NEVER be "good enough" for YOU!
decker12 wrote:
Tue Jan 17, 2023 11:39 am
What I don't want to do is make myself miserable with an increased pressure range all night long to get an AHI of under 2, waking up several times
What wakes you up is the BREATHING EVENTS, apneas, hypopneas, flow limitations and snoring, not the pressure.
decker12 wrote:
Tue Jan 17, 2023 11:39 am
Especially when 5 is still considered within the normal range.
:shrug: it's your health, if you want to have crappy sleep, that's entirely up to you.

_________________
Mask: Bleep DreamPort CPAP Mask Solution
Additional Comments: S9 VPAP Auto
Get OSCAR

Accounts to put on the foe list: dataq1, clownbell, gearchange, lynninnj, mper!?, DreamDiver, Geer1, almostadoctor, sleepgeek, ajack, stom, mogy, D.H., They often post misleading, timewasting stuff.

decker12
Posts: 58
Joined: Thu Oct 27, 2022 9:59 am

Re: Quick Pressure Question

Post by decker12 » Tue Jan 17, 2023 10:22 pm

What is the trick to getting it consistently under 5? I know it's a question with a lot of possible answers, but I'm 7 months in, and kind of running out of ideas. If you had a week of 5's, what would be your first step in figuring it out why and how to fix it?

I'm flipping through my SleepHQ data and most of the time I'm under 3, with an occasional night at 4 or 5. I do get under 1's several times in a month but it's not consistent. My leak rate is consistently close to 0% (and always has been) since starting my therapy, and my "Large Leak" is always at 0%. I'm just running out of things to try and change in order to get it always below a 1.

I'm thinking I set the pressure max too low if my SleepHQ data has multiple minutes of me being pegged at my Max. I'll try to increase it back up to 15, but I have a feeling that's going to give me that sore back / gassy feeling in the morning (which is what I was trying to fix when I lowered it to begin with). Thanks for any tips.

User avatar
ozij
Posts: 9367
Joined: Fri Mar 18, 2005 11:52 pm

Re: Quick Pressure Question

Post by ozij » Tue Jan 17, 2023 10:47 pm

decker12 wrote:
Tue Jan 17, 2023 10:22 pm
I'm just running out of things to try and change in order to get it always below a 1.
Some of us don't get the AHI consistently below 1.
Don't aim for a number.
Aim for good sleep, good feeling when awake, and a number that is lower than 5.
Also, study your graphs carefully: if the machine marks apneas when your breathing is irregular, it may be marking them in what we call SWJ (Sleep Wake Junk) - those apneas are not to be counted.

Breathing problems aren't the sole reason sleep gets disrupted. Pressure changes will have not help if - for example - sleep is disrupted by pain.

If i had a week of 5, I'd be studying my flow charts, and keeping a diary of what's going on.
I've actually had almost a week of 5 (or more) just now. In this case the reason was simple:
A cold that had me switch to full face mask.
I won't do anything until my cold is over, and I'm back on a pillows mask.

And now - to make things ever more complicated (sorry about that...) sometimes it's the humidity, or air temperature that make a difference in AHI...

_________________
Machine: ResMed AirSense™ 10 AutoSet™ CPAP Machine with HumidAir™ Heated Humidifier
Mask: Bleep DreamPort CPAP Mask Solution
Additional Comments: Machine: AirSense??? 10 AutoSet??? For Her CPAP Machine with HumidAir??? Heated HumidifierSoftware: Oscar; alternating masks
And now here is my secret, a very simple secret; it is only with the heart that one can see rightly, what is essential is invisible to the eye.

Antoine de Saint-Exupery

User avatar
Miss Emerita
Posts: 2730
Joined: Sun Nov 04, 2018 8:07 pm

Re: Quick Pressure Question

Post by Miss Emerita » Wed Jan 18, 2023 12:11 am

decker12 wrote:
Tue Jan 17, 2023 10:22 pm
What is the trick to getting it consistently under 5? I know it's a question with a lot of possible answers, but I'm 7 months in, and kind of running out of ideas. If you had a week of 5's, what would be your first step in figuring it out why and how to fix it?

I'm flipping through my SleepHQ data and most of the time I'm under 3, with an occasional night at 4 or 5. I do get under 1's several times in a month but it's not consistent. My leak rate is consistently close to 0% (and always has been) since starting my therapy, and my "Large Leak" is always at 0%. I'm just running out of things to try and change in order to get it always below a 1.

I'm thinking I set the pressure max too low if my SleepHQ data has multiple minutes of me being pegged at my Max. I'll try to increase it back up to 15, but I have a feeling that's going to give me that sore back / gassy feeling in the morning (which is what I was trying to fix when I lowered it to begin with). Thanks for any tips.
It’d be helpful if you would provide a chart with your new settings.
Oscar software is available at https://www.sleepfiles.com/OSCAR/

User avatar
ozij
Posts: 9367
Joined: Fri Mar 18, 2005 11:52 pm

Re: Quick Pressure Question

Post by ozij » Wed Jan 18, 2023 12:23 am

Miss Emerita wrote:
Wed Jan 18, 2023 12:11 am
It’d be helpful if you would provide a chart with your new settings.
Absolutely

_________________
Machine: ResMed AirSense™ 10 AutoSet™ CPAP Machine with HumidAir™ Heated Humidifier
Mask: Bleep DreamPort CPAP Mask Solution
Additional Comments: Machine: AirSense??? 10 AutoSet??? For Her CPAP Machine with HumidAir??? Heated HumidifierSoftware: Oscar; alternating masks
And now here is my secret, a very simple secret; it is only with the heart that one can see rightly, what is essential is invisible to the eye.

Antoine de Saint-Exupery

decker12
Posts: 58
Joined: Thu Oct 27, 2022 9:59 am

Re: Quick Pressure Question

Post by decker12 » Wed Jan 18, 2023 12:04 pm

ozij wrote:
Wed Jan 18, 2023 12:23 am
Miss Emerita wrote:
Wed Jan 18, 2023 12:11 am
It’d be helpful if you would provide a chart with your new settings.
Absolutely
SleepHQ doesn't seem to let me share a link of multiple days, so here's a few of the past week. The gaps are from naps I (tried) to take.

https://sleephq.com/public/8a5be939-141 ... 14e3b72570
https://sleephq.com/public/b8b76430-14b ... c0902fd5eb
https://sleephq.com/public/a6d930bb-8f9 ... 40787ea5e1
https://sleephq.com/public/15612999-67d ... a7130ba7ba
https://sleephq.com/public/90bfe7ee-e86 ... ef48bf55de
https://sleephq.com/public/afd13174-2e1 ... 471e92b810

Thanks again for any insight. I did set my max pressure to 15 last night and woke up feeling better, but I'll need to keep it like this for more than a few days to make sure.

Richie Ernst
Posts: 2
Joined: Tue Jun 23, 2015 4:37 pm

Re: Quick Pressure Question

Post by Richie Ernst » Wed Jan 18, 2023 12:41 pm

This discussion strikes a chord with me. I believe I'm waking too often during the night, and the machine is practically blowing the FFM off my face (or leaking around it). I no longer feel that I'm getting a good night's sleep.

User avatar
palerider
Posts: 31606
Joined: Wed Dec 16, 2009 5:43 pm
Location: Dallas(ish).

Re: Quick Pressure Question

Post by palerider » Wed Jan 18, 2023 5:14 pm

ozij wrote:
Tue Jan 17, 2023 10:47 pm
decker12 wrote:
Tue Jan 17, 2023 10:22 pm
I'm just running out of things to try and change in order to get it always below a 1.
Some of us don't get the AHI consistently below 1.
Don't aim for a number.
Aim for good sleep, good feeling when awake, and a number that is lower than 5.
No, aim for under 2. 5 is ridiculous and not at all well treated.

_________________
Mask: Bleep DreamPort CPAP Mask Solution
Additional Comments: S9 VPAP Auto
Get OSCAR

Accounts to put on the foe list: dataq1, clownbell, gearchange, lynninnj, mper!?, DreamDiver, Geer1, almostadoctor, sleepgeek, ajack, stom, mogy, D.H., They often post misleading, timewasting stuff.

User avatar
chunkyfrog
Posts: 33224
Joined: Mon Jul 12, 2010 5:10 pm
Location: in a nice, moist, Nebraska bog

Re: Quick Pressure Question

Post by chunkyfrog » Wed Jan 18, 2023 5:47 pm

Under 2 is consistent with my experience.
Over 2, and I already know it's been a lousy night--to be followed by a miserable day.

_________________
Mask: AirFit™ P10 For Her Nasal Pillow CPAP Mask with Headgear
Additional Comments: second Airsense 10 Autoset for Her --sticking with a good thing.

decker12
Posts: 58
Joined: Thu Oct 27, 2022 9:59 am

Re: Quick Pressure Question

Post by decker12 » Wed Jan 18, 2023 5:48 pm

palerider wrote:
Wed Jan 18, 2023 5:14 pm
ozij wrote:
Tue Jan 17, 2023 10:47 pm
decker12 wrote:
Tue Jan 17, 2023 10:22 pm
I'm just running out of things to try and change in order to get it always below a 1.
Some of us don't get the AHI consistently below 1.
Don't aim for a number.
Aim for good sleep, good feeling when awake, and a number that is lower than 5.
No, aim for under 2. 5 is ridiculous and not at all well treated.
It does bring me back to my previous question, what have you done to consistently gets yours below a 5, or even below a 2? There had to be at time you were over a 2, and you had to do something - analyze data, try this thing, try something else - to bring yourself under a 2.

I assume if you post your months worth of OSCAR data we'd see that at some point, your AHI was high, and then something changed, and that may help pinpoint what I can try on my end. You seem solid in your opinion that we all should be striving to definitely be under a 5 and hopefully under a 2, but after 7 months I am not consistently getting there. Unfortunately you have such a long post history that it's hard to determine at which point you "figured it out" so if you have some ideas I'd love to hear them!

User avatar
palerider
Posts: 31606
Joined: Wed Dec 16, 2009 5:43 pm
Location: Dallas(ish).

Re: Quick Pressure Question

Post by palerider » Wed Jan 18, 2023 6:54 pm

decker12 wrote:
Wed Jan 18, 2023 5:48 pm
It does bring me back to my previous question, what have you done to consistently gets yours below a 5, or even below a 2?
Like I said, 5 is hogwash, foisted upon us by a medical system that *does not care about you*. it's "good enough" for them, but it's *NOT GOOD*. Imagine someone sitting by your bedside and every night, ALL NIGHT LONG, they poke you with a sharp stick every 12 minutes... ALL NIGHT LONG.

That's an AHI of 5, actually, it's probably even less than 12 minutes because other breathing events that disturb sleep aren't even counted in the AHI.
decker12 wrote:
Wed Jan 18, 2023 5:48 pm
There had to be at time you were over a 2, and you had to do something - analyze data, try this thing, try something else - to bring yourself under a 2.
It's been years, but what I did was set my machine's max to 25, (which is as high as it goes, and forget about it. Then I increased the min pressure to where the pressure line was pretty flat during the night, and I ended up changing the Trigger setting (Something that you get on a Resmed VAuto) to High, so that when my throat started to close up, the machine would be more responsive to the tiny inhale that I'd start to make and it would help.
Here's last night's graph:
2023-01-18_18-42.png
2023-01-18_18-42.png (235.52 KiB) Viewed 149 times
decker12 wrote:
Wed Jan 18, 2023 5:48 pm
I assume if you post your months worth of OSCAR data we'd see that at some point, your AHI was high, and then something changed, and that may help pinpoint what I can try on my end. You seem solid in your opinion that we all should be striving to definitely be under a 5 and hopefully under a 2, but after 7 months I am not consistently getting there. Unfortunately you have such a long post history that it's hard to determine at which point you "figured it out" so if you have some ideas I'd love to hear them!
Yeah, not not so much, you'll notice that the TOP of this graph is 2.0, and none of my nights, going back to August, have hit 2.0:
2023-01-18_18-45.png
2023-01-18_18-45.png (34.28 KiB) Viewed 149 times
Now, if I go back *years*, then yes, I've had bad nights. but rarely over 5.
2023-01-18_18-48.png
2023-01-18_18-48.png (23.1 KiB) Viewed 149 times
See that blue mound on the left? that's back in 2014, and it's what made me decide to get an auto machine, because the fixed pressure CPAP wasn't adjusting to my changing needs.

_________________
Mask: Bleep DreamPort CPAP Mask Solution
Additional Comments: S9 VPAP Auto
Last edited by palerider on Wed Jan 18, 2023 8:30 pm, edited 1 time in total.
Get OSCAR

Accounts to put on the foe list: dataq1, clownbell, gearchange, lynninnj, mper!?, DreamDiver, Geer1, almostadoctor, sleepgeek, ajack, stom, mogy, D.H., They often post misleading, timewasting stuff.

decker12
Posts: 58
Joined: Thu Oct 27, 2022 9:59 am

Re: Quick Pressure Question

Post by decker12 » Wed Jan 18, 2023 7:33 pm

Thanks so much! I may have to try that "boost it 20" (my Resmed 11 only goes to 20), and see how it goes! Am I reading this right when your starting pressure is a 17? I see that your EPAP is at 11, which I guess (?) means your exhales are lowered by 6? I'm not sure how I can set that on my Resmed 11, I can only select "1 2 3". I am not sure if that means "2" as in a decrease of exactly 2 on exhale, or if it's a percentage of my starting pressure?

I wonder if my Resmed 11 has a Trigger setting I can increase. I'll go check it out, I thought I saw a setting in there that sounded familiar. Edit: I have a setting that I can change from "Standard" to "Soft" and that's it. I left it on Standard.

Thanks again! You've given me some good inspiration and your analogy about being poked with a stick makes a lot of sense to me.

User avatar
palerider
Posts: 31606
Joined: Wed Dec 16, 2009 5:43 pm
Location: Dallas(ish).

Re: Quick Pressure Question

Post by palerider » Wed Jan 18, 2023 8:29 pm

decker12 wrote:
Wed Jan 18, 2023 7:33 pm
Thanks so much! I may have to try that "boost it 20" (my Resmed 11 only goes to 20), and see how it goes! Am I reading this right when your starting pressure is a 17? I see that your EPAP is at 11, which I guess (?) means your exhales are lowered by 6? I'm not sure how I can set that on my Resmed 11, I can only select "1 2 3". I am not sure if that means "2" as in a decrease of exactly 2 on exhale, or if it's a percentage of my starting pressure?
Your question gets into details of the difference in a standard APAP (which you have) and an auto bilevel machine (which I have).

Suffice it to say, there are more possible settings on a bilevel, the equivalent pressure on your machine would be a pressure of 17 with an EPR of 6, (which is impossible). However, on a bilevel, you set the lower pressure and then a PS that raises the pressure during inhale, so sort of the opposite of a CPAP/APAP. My settings are MinEPAP 11, MaxIPAP 25 and PS of 6.
decker12 wrote:
Wed Jan 18, 2023 7:33 pm
I wonder if my Resmed 11 has a Trigger setting I can increase. I'll go check it out, I thought I saw a setting in there that sounded familiar. Edit: I have a setting that I can change from "Standard" to "Soft" and that's it. I left it on Standard.
No, Trigger, Cycle, MinPS, MaxPS are things that aren't available to tinker with on an EPAP. I don't believe that was a big part of what I did but it was part, and you asked. Also, just because it worked for ME doesn't mean it would work for you.

That's one of the dangers of asking everybody "well, what did YOU do?" because what works for them doesn't necessarily work for you. Like if I asked Pugsy what worked for her as far as humidity, and I did it, I'd probably drown... and conversely, if she did what works for me, she'd be miserable, because our noses prefer completely opposite amounts of humidity.
decker12 wrote:
Wed Jan 18, 2023 7:33 pm
Thanks again! You've given me some good inspiration and your analogy about being poked with a stick makes a lot of sense to me.
I hope it helps to readjust your target, and get the "well, it's good enough for us" that the doctors and insurance companies say, they don't have to live with the effects every day. You do.

Generally, the only reason to limit the max pressure is if you get painful gas/bloating... otherwise, let the machine do what it wants to do to treat you, evaluate the data, and make informed decisions to make tweaks and see what that does.

If you are having bloating (more than a one off) then you might be between a rock and a hard place where the pressure is too low to adequately treat your apnea, but higher gives you painful gas. Then you might have to do like zonker did, and sneak the max pressure up a little at a time as you get more used to breathing slightly pressurized air, till you get into a range that adequately treats the apnea, and lets you breathe.

_________________
Mask: Bleep DreamPort CPAP Mask Solution
Additional Comments: S9 VPAP Auto
Get OSCAR

Accounts to put on the foe list: dataq1, clownbell, gearchange, lynninnj, mper!?, DreamDiver, Geer1, almostadoctor, sleepgeek, ajack, stom, mogy, D.H., They often post misleading, timewasting stuff.

User avatar
Miss Emerita
Posts: 2730
Joined: Sun Nov 04, 2018 8:07 pm

Re: Quick Pressure Question

Post by Miss Emerita » Thu Jan 19, 2023 12:43 pm

Decker12, thanks for posting those charts. What we see is that you have events pretty evenly divided between obstructive apneas and hypopneas, with frequent periods of heavy flow limitations and some periods of snoring. I also note that your sleep schedule seems to vary a fair amount from one night to the next, sometimes with not much uninterrupted time on the machine.

There are two questions that deserve separate answers. One is what the long-term effects on your health are of the level of breathing-related issues during sleep. Another is how you feel and function during the day. Often the answers go together, but they don't go together all the time.

I'm not a medical professional, but with your AHI still sometimes approaching 5, I'm going to guess your breathing issues are still posing some extra risk to your long-term health. Only you can answer the second question, about how you feel and function during the day. How would you answer it?

Hypopneas and flow limitations are generally addressed via EPR (aka pressure support), but you've maxed out on that. For the OAs and snores, I'd be curious what would happen if you raised your minimum pressure to, say, 10 and your maximum to around 15. Conceivably that could help with Hs and FLs too.

If you'd like to try that experiment, there's no need to jump straight to the new pressures, and there's something to be said for making only one change at a time. So you might start by inching up your minimum pressure by 1 and staying with that for at least three or four nights before going up some more. After increasing your minimum, you could try inching up your maximum.

This would call for some patience on your part, but in the long run, this slow-ish way of making changes will probably be more informative and effective.

In light of what seem to be your patterns of going to bed, I also want to encourage you to work on following the guidelines for better sleep:

• Keep a consistent sleep schedule. Get up at the same time every day, even on weekends or during vacations.
• Set a bedtime that is early enough for you to get at least 7 hours of sleep.
• Don’t go to bed unless you are sleepy.
• If you don’t fall asleep after 20 minutes, get out of bed.
• Establish a relaxing bedtime routine.
• Use your bed only for sleep and sex.
• Make your bedroom quiet and relaxing. Keep the room at a comfortable, cool temperature.
• Limit exposure to bright light in the evenings.
• Turn off electronic devices at least 30 minutes before bedtime.
• Don’t eat a large meal before bedtime. If you are hungry at night, eat a light, healthy snack.
• Exercise regularly and maintain a healthy diet.
• Avoid consuming caffeine in the late afternoon or evening.
• Avoid consuming alcohol before bedtime.
• Reduce your fluid intake before bedtime.
Oscar software is available at https://www.sleepfiles.com/OSCAR/