Adjusting Pressures

I've read many posts about people adjusting the pressures on their CPAP Machines and I'm wondering ????

Right now my on my Wifes Resmed Auto 25 the low pressure is set to 10 and the high pressure is set to 16. (I have been told that 16 is a fairly high setting)

Her Data Summary over the past 2 months seems to be pretty good ..... Apnea index: 0.0 .... % Time in Apnea: 0.0 .... Hypopnea index: 1.3 .... AHI: 1.3 .... Are they good?

Here's the question .... does "getting a CPAP Machine setup" include lowering pressures to be more comfortable when using the machine, while watching the resultant data, and finding the lowest pressure that still achives the desired result?

Fred

Hi, her numbers are terrific, so if she feels good, I wouldn't be too concerned. The '16', high setting, is not a problem unless it's the actual prescribed pressure itself, in which case the lower one, 10, is pointless as we usually have the low number at or just below the scripted one, and the other a few above that. The point is to make it easier for the machine to reach a higher pressure more quickly in the event of 'need' when an apnea occurs incidentally longer than the usual, e.g. if 90-95% of apnea events happen at a pressure of 11, that would be the 'norm'. Only if her prescribed pressure were much higher would it make sense to 'fix what ain't broken'. Having the higher number set at a 'high' place is not a problem - the much more usual one would be having the low set too low. IF her prescribed pressure, however, is actually lower than 10 by more than 1-2 numbers, and IF she was doing well when it was set lower (with the upper one appropriately lower too), would it be questioned as to why it's set much higher, but as it is, she's around the same place most of us are (including what may be the majority who were prescribed an initial low pressure of e.g. 7 by conservative MD's and had to discover for ourselves that it was too low to be effective or comfortable). Is she happy? Feeling relatively well? Then don't worrry about a thing.

fredn wrote:I've read many posts about people adjusting the pressures on their CPAP Machines and I'm wondering ????

Right now my on my Wifes Resmed Auto 25 the low pressure is set to 10 and the high pressure is set to 16. (I have been told that 16 is a fairly high setting)

Can you clarify whether your wife is using the ResMed VPAP Auto 25 (which is a bi-level machine that auto-adjusts both the EPAP and IPAP) or whether your wife is using a ResMed S8 AutoSet or a ResMed S9 AutoSet with a pressure range of 10cm to 16cm.

Her Data Summary over the past 2 months seems to be pretty good ..... Apnea index: 0.0 .... % Time in Apnea: 0.0 .... Hypopnea index: 1.3 .... AHI: 1.3 .... Are they good?

These are excellent numbers. But the real question remains: How is your wife feeling now relative to how she felt before starting xPAP? If her daytime symptoms have started to improve and if she's not fighting problems with using the machine, then leave well enough alone. But if she's not feeling any better or if she's feeling worse, then a call to the doctor's office may be in order since in that case while her current therapy is effectively treating the apnea, it is not yet effectively allieviating her symptoms. And in that case exploring whether a lower pressure would be as effective may be worth it.

Here's the question .... does "getting a CPAP Machine setup" include lowering pressures to be more comfortable when using the machine, while watching the resultant data, and finding the lowest pressure that still achives the desired result?

Fred

"Getting a CPAP machine setup" usually does not involve any official help in trying to find the lowest pressure that achieves the desired result. After all, all the CPAP is blowing into you is slightly pressurized room air, so it's not like there's a host of serious drug-related side effects. And the titration study was supposed to have identified an appropriate pressure level that was a good approximation for "lowest pressure that will achieve the desired result" of effectively treating the apnea. But titration studies are highly artificial settings and over or under titration is not unheard of. If a patient is under titrated, the data from the home CPAP machine should pretty quickly point to this since the AHI numbers will still be high. If a patient is over titrated but has not developed any problems or new symptoms, then there won't likely be any compelling evidence to prescribe a new pressure range. But if the patient develops a tendancy towards central apneas or is having real problems with aerophagia (air in the stomach) or real problems with mask leaks due to high pressure or real problems with anything else that might be associated with the pressure setting, then the sleep doctor (or his nurse or PA) may well suggest exploring what reducing the pressure does to alleiviate the new symptoms while still effectively managing the apneas.

fredn wrote:I've read many posts about people adjusting the pressures on their CPAP Machines and I'm wondering ????

Right now my on my Wifes Resmed Auto 25 the low pressure is set to 10 and the high pressure is set to 16. (I have been told that 16 is a fairly high setting)

Her Data Summary over the past 2 months seems to be pretty good ..... Apnea index: 0.0 .... % Time in Apnea: 0.0 .... Hypopnea index: 1.3 .... AHI: 1.3 .... Are they good?

Here's the question .... does "getting a CPAP Machine setup" include lowering pressures to be more comfortable when using the machine, while watching the resultant data, and finding the lowest pressure that still achives the desired result?

Fred

Fred, is there a reason you are trying to change things?

While those are in fact very good numbers without knowing a few more numbers/things they don't mean a lot.

1st which mask she is using is also important.

The Avg. (or 90% point) pressure is most helpful. They are not the same and I don't want to confuse things by adding that right now but knowing her pressure is important.

Cuz then with the leak rate it will tell if her other numbers are realistic. Seeing a graph of the leak line is no doubt the best way to tell cuz numbers can hide things in the avg.

So along with the AHI you should be checking to see if the leak is out of range for her mask at her pressure.
Knowing the Leak/Mask/Pressure will reveal the real AHI....

I like to also add in Flow Limitations with my AHI but that can come along later.

Learn a little more each day

But don't go changing things without a reason, Ok?

Hello again .....

1st things first ..... the machine that she is using is the "ResMed VPAP Auto 25 (which is a bi-level machine that auto-adjusts both the EPAP and IPAP)"

Now to the crux of it ... why am I even thinking about changing pressures?

My wife has only had the machine since October 25th. She works nights (11:45PM to 7:45AM) and often (2 to 3 times a week) gets mandated to work an 8 hour overtime shift. On thos days she gets a 4 1/2 sleep window and needs every bit of it sleeping .... so it's been a slow hard battle for her to get used to using it at all. She's only gotten to the point of making it past her 4 hour minimum per night to qualify for Medicare (so far she's got 15 days out of her 28 in the first 90 days of having it) The longest she has made so far is 7 1/2 hours .... most nights 4 1/2 to 5 1/2 are more like the norm.

The main reason she doesn't go longer is that it's just so damn uncomfortable .... more often than not after around 4 1/2 - 5 hours her nose hurts like hell. She says some times it's a burning feeling, other times the base of her nose around the Nasal Pillow is painful to even touch. Every morning she blows her nose and there is "slight" blood spotting. The mask that she is using is a "Resmed Swift FX for her". We've played with the Humidifier/Heater a little ... it doesn't seem to make a difference. Playing with the pressure is only something that I had thought of that "MAYBE" could help.

As far as feeling better ... yes, she says (and I can see the difference) that she is starting to have more energy ... problem is she isn't wearing it full time so we don't know what's going on when she doesn't NOR how much better she could feel.

She is retiring at the end of this month ... and life will become normal at last. Then we'll have 7 days for a full nights sleep and if we can get to the point that she can tolerate it all night there may be GREAT improvements on the horizon.

The sleep apnea is compounded by the fact the back in July she got socked with afib ... she's on meds and the plan is to get the apnea under control before she goes through cardio version (shock her heart) to try and get the heart rhythm back to normal so she can get off her meds.

I did a screen capture of a 2 month summary page from ResScan and posted it on my Web Site ..... here's the url to get to it ... if anyone needs any other data I'd be happy to upload it as well .... http://www.cyberfanatics.com/cpap_numbers.jpg

Thanks to everyone .... Fred

Tell her to use Lansinoh for the soreness on her nares. Search this forum for more reading but just a dab between thumb and forefinger on the nares and another around the pillows.

The summary is nice but the real info is on the daily details pages. I'm not familiar with the Resmed software but do know she has a real good machine (plus you).

Tell her to plan her work schedule are her sleep or soon she will have more troubles with Medicare and not be working

Lansinoh ordered ....

I'll grab daily details for 3 of her longest days ..... that sound OK?

fredn wrote:Lansinoh ordered ....

I'll grab daily details for 3 of her longest days ..... that sound OK?

for sure yea

It sounds like she has mask problems, take care of that first. Nasal pillows should be adjusted somewhat loosely, sounds like she has the wrong size, it's to tight, or she is trying to put them to far into her nose. The large part of the cone should rest lightly on the outside of the nose. Try loosening the straps, hold pillows to nose, turn on the machine, pull straps over head, adjust the back one just until it seals, then the top one to hold in place. Lanisoh ointment( found in the baby aisle at drug stores, )will ease soreness and be safe for the mask, it is also a little tacky and may help seal. If the straps are slipping around attach a small piece of the hook side to the underside of the silicon strap.it will grip her hair and hold things in place, won't hurt or tug hair. Good luck, hope this helps her get more comfortable.

Here is the Report from December 9th .....

http://www.cyberfanatics.com/page2.jpg

http://www.cyberfanatics.com/page3.jpg

http://www.cyberfanatics.com/page4.jpg

http://www.cyberfanatics.com/page5.jpg

http://www.cyberfanatics.com/page6.jpg

Took me awhile .... Fred

I wouldn't change the pressure settings -- she's getting great results with the settings the way they are.

From what you've described about her sore nostrils, it's the mask that's the sole culprit. Changing pressure wouldn't help her with that.

Lansinoh, as GumbyCT and mayondair mentioned, should help.

Also, good suggestions from mayondair if the headgear is slipping.

If your wife can get the DME to give her (or just buy it herself -- online may be cheaper) a second mask of a different type, she can switch masks depending on which mask she wants to use on any given night. Or even switch during the night if she wakes up with nostrils hurting.

A nasal mask (covers the nose instead of having nasal pillows) might be a welcome change from time to time. Kind of like switching to a different pair of shoes when one pair begins to rub the same spot, making it sore.

Ditto on all the above but also check humidity. The "burning" in the nose can be from dry air. As stated above, the other nose discomfort/pain may be from a poorly fitting mask or the mask is too tight.

Do not adjust the pressure at this time. She has a bilevel machine so the 10 and 16 you see are probably EPAP and IPAP and it would be inappropriate to change those without the doctor's input. This is a different issue from the autoset machines but, even with them, it is better to go to a sleep lab that titrates specifically for autoset machines rather than guessing a range of pressures from a single prescribed pressure.

rested gal wrote:If your wife can get the DME to give her (or just buy it herself -- online may be cheaper) a second mask of a different type, she can switch masks depending on which mask she wants to use on any given night. Or even switch during the night if she wakes up with nostrils hurting.

A nasal mask (covers the nose instead of having nasal pillows) might be a welcome change from time to time. Kind of like switching to a different pair of shoes when one pair begins to rub the same spot, making it sore.

The problem we have is that Terry (might as well get past calling her "my wife") is really clostrophobic and doesn't want anything that obstructs her field of vision or makes her feel closed in. We were looking at the ResMed Vista https://www.cpap.com/productpage/resmed ... dgear.html. It looking like a decent alternative to the nasal pillow models. Anybody have any experience with that one?

RDawkinsPhDMPH wrote: Ditto on all the above but also check humidity. The "burning" in the nose can be from dry air. As stated above, the other nose discomfort/pain may be from a poorly fitting mask or the mask is too tight.

After reading the post about "fitting" in this thread we think that maybe her mask is too tight also ... we're gonna play with that. We'll also fiddle with the heater/humidity setting too.

Thanks to everybody .... and I WILL keep my tampering hands out of the "Clinical Menu" ....

If I get good reports about that ResMed Vista I think I'll order it from CPAP.com ... she has other masks but all of them include nasal pillows of some sort .... BTW ... she is a nose breather ... but you guys probable figured that out by now,

Thanks .... Fred

fredn wrote: The main reason she doesn't go longer is that it's just so damn uncomfortable .... more often than not after around 4 1/2 - 5 hours her nose hurts like hell. She says some times it's a burning feeling, other times the base of her nose around the Nasal Pillow is painful to even touch. Every morning she blows her nose and there is "slight" blood spotting. The mask that she is using is a "Resmed Swift FX for her". We've played with the Humidifier/Heater a little ... it doesn't seem to make a difference. Playing with the pressure is only something that I had thought of that "MAYBE" could help.

As others have said, it sounds like mask problems. How are her leak rates? [I couldn't get the jpgs to show, but I think that's a problem on my end since others have seen your posted data.] In addition to all the other really good tips about fitting the FX for Her, I'll also offer this: Between possible mask leaks and the way this mask's exhale ports intentionally work, it's possible that your wife is getting a really bad case of simple chapped skin. I've been fighting chapped lips and a chapped nose all along since starting CPAP with a Swift FX. I find that if I am very careful to treat the chapped skin multiple times a day and particularly just before I go to bed, it starts to get better (and can even go away completely), but if I get lax and forget to moisturize and protect the skin involved at bedtime for even ONE night, I wake up with a pretty bad case of chapping the next morning.

So I have found that I'm going through Burt's Bees Lip Balm (no petroleum jelly) at a pretty good clip since it works. I've also finally found a skin cream that doesn't contain petroleum and also doesn't irritate my rather sensitive skin. It's called Thentix "A Touch of Honey". It ain't cheap and if I could use something more standard without making my face itch, I would.

So I'd suggest that your wife spend the time to properly moisturize her facial skin each night. Then slather on the Burt's Bees or a similar lip balm on all the chapped areas as well as the Lanolin on and inside her nostrils. And then put on the mask. And in the morning, again moisturize her facial skin again and slather on more Burt's Bees on all the chapped areas anytime they feel dry during the day.

And if the silicone parts of the mask are irritating her skin (like they did mine), then pads from Pad-a-Cheek are worth the money. Karen (the owner of Pad-a-Cheek who is also a poster here under the name padacheek I believe) will make barrel cozies for the Swift FX as well as side pads that are more substantial than those provided by ResMed or if you really want protection from the silicone, she can even make an "over the head" pad that covers the entire silicone part of the frame. You'll have to email Karen and ask her about prices and making the pads for the Swift FX since they're not yet on her website.

Fred
Tell her to try putting a q-tip (with Lansinoh on it ) inside her nose. I stick the q-tip into the lansinoh tube them up my nose...sounds gross.. swab as far up as she can. Now her nostrils will be coated and protect the delicate tissues, the sores should disapear in a day or so. If its really bad use polysporin instead of the lansinoh.
Good luck
Nan