Increments for adjusting

wankel · Post by **wankel** » Tue Jun 05, 2007 7:36 am

Hi everyone....

I am a newbie here but have been lurking for some time.

I had symptoms of OSA developing about a year ago, went to my doc, and sure enough, was diagnosed during a sleep study. Was issued a ResMed S8 Elite and Mirage nasal pillow.

No problems adjusting to the CPAP (10 cm. precribed) or the nasal pillow. However, the quality of my sleep never improved that much. A few weeks ago, I started keeping records:

@10 cm. H20, my AHI is averaging around 9 (HI av around 7, AI around 2). So I figured I'd start increasing the pressure a bit.

I am an ex-respiratory therapist. However, I never worked in the home care sector. In the hospital environment, we would usually change CPAP/PEEP levels on the big Vision CPAP machines or ventilators in 2 cm. H20 increments.

However, I notice that the ResMed can be changed in .2 cm H20 increments.

Just curious - what size increments do you folks usually use when adjusting levels?

Thanks. This is a great forum....

W

Slinky · Post by **Slinky** » Tue Jun 05, 2007 7:56 am

.5 cm increments are what I've usually seen recommended in this forum but then this forum is pretty much dominated by Respironics users with us Resmed users in the minority. I certainly wouldn't raise the pressure more than 1 full cm at a time and I'd wait a week between pressure changes before making any further changes. Your stats sound like you aren't too far off what is probably the ideal pressure for you.

track · Post by **track** » Tue Jun 05, 2007 8:00 am

At 10 cm I was averaging 10-11 AHI. At 11cm about 8-9 AHI. At 12 about 6-7 AHI. AT 13 about 4-6 AHI. I don't see much change at 14 or 15 so I went to apap at 12-14 and it was AHI-4.0-6. I then tried putting a wedge pillow against my back and sleeping near the edge of the bed so I couldn't get on my back.(a little tip I picked up from reading here at cpap) That cut the AHI in half to 2-3 and lowered the AI from 1.0 to .5. I have not found .2 increments to be significant enough to make much difference. Just my experience so far in my attempts to see what works and what doesn't...but I am still a relative rookie as I have only been on the machine about 6 months.

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CPAPopedia Keywords Contained In This Post (Click For Definition): AHI, APAP

Goofproof · Post by **Goofproof** » Tue Jun 05, 2007 10:10 am

You are using a Nasal interface, before playing the pressure game, you need to insure you are not mouthbreathing, no amount of pressure can overcome a hole the size of your mouth.

A FF Mask or taping, are need to insure you aren't losing your treatment pressure out of your mouth. After that is addressed, software if you have it can point you to te pressure you need. Jim

Linda3032 · Post by **Linda3032** » Tue Jun 05, 2007 3:56 pm

Does your machine show you "leak rate"? That would be a good indication if you are mouth breathing or have a major mask leak.

Slinky · Post by **Slinky** » Tue Jun 05, 2007 4:18 pm

Yes, the Resmed S8 Elite does report the Leak rate via the Advanced or Detailed Patient Menu on the LED screen.

Push the Left & Right buttons down and hold for 3-4 seconds. An Efficacy Menu will appear on the LED screen. Press the Left button to Enter. The first data on the LED screen will be the average pressure for the night. Press the Down button, the next data to appear on the LED screen will be the average Leak rate for the night.

If you do this after noon, you will have to press the Left button for the weekly averages to appear on the LED screen. These machines have an internal clock that works on a 24 hour, noon to noon, basis so if you check after noon that night's averages will have been rolled over into the weekly averages.

Guest · Post by **Guest** » Tue Jun 05, 2007 7:18 pm

Checking my numbers;

- pressure averages 8.8
- leak rate is .2 l/s

I wonder if I should titrate the pressure upwards to raise that value of 8.8 closer to 10, which is what the doc prescribed, and see how that does...

Slinky · Post by **Slinky** » Tue Jun 05, 2007 7:42 pm

Well, mouth breathing, lip flutters and/or mask leaks sure weren't a problem THAT night!!!

.2L/s is almost too hard to believe!!! You sure that isn't a typo, a misplaced decimal point? Man, there are those of us on here who would almost kill for that low a leak rate!!

Guest · Post by **Guest** » Tue Jun 05, 2007 8:06 pm

I use a full face mask and I hardly ever exceed .2L/s. It's not uncommon to be at .06L/s. Perhaps you are thinking of L/m...which would naturally be 60 times the above numbers. Of course resmed machines have already subtracted out the mask venting figures.

Guest · Post by **Guest** » Tue Jun 05, 2007 8:48 pm

Just double checked...average leak is .20 l/s

wankel · Post by **wankel** » Tue Jun 05, 2007 8:50 pm

Sorry guys... I forgot to log in and the above message went in as "Guest".

Average leak is .20 l/s...

Mask

Additional Comments: Strictly a side sleeper