Someone please help this Newbie!

SleepingUgly wrote:People have already mentioned a couple of possibilities: the EPR, and that your titrated pressure is not right.

I don't know why, but I have found that a full face mask does yield a higher AHI for me, and seems to require greater pressure. It shouldn't be the case, just my own experience.

That's exactly what I asked my Dr. and Tech about...the pressure being too low for a full face mask. I told him that under the sleep study I was fitted with a nasal mask and was prescribed 11cm and that I thought that having more volume to cover with a FFM I would need more pressure. He said it shouldn't make that much of a difference...

So you're saying that the EPR would also make a difference? Should it be lower or higher?

AJimen05 wrote:So you're saying that the EPR would also make a difference? Should it be lower or higher?

EPR is a comfort feature. It drops the pressure so that you can exhale more easily. An EPR of 3 means the machine drops the pressure 3 cm to make it easier to exhale. Some people have found that this drop lets events sneak in.

EPR of 2 means a 2 cm drop, EPR of 1 is 1 cm drop. EPR off means no drop in pressure.

To be honest, I doubt that EPR alone is your problem but since it is a comfort feature only (even though some people do notice a change in AHI when they change the EPR) it would hurt nothing to decrease the EPR or even turn it off if you can handle exhaling without the relief. Many people don't need the exhale relief. Some do....

Some people find they need the exhale relief and actually bump up the straight pressure to accommodate for the drop while using EPR.

AJimen05 wrote:

SleepingUgly wrote:People have already mentioned a couple of possibilities: the EPR, and that your titrated pressure is not right.

I don't know why, but I have found that a full face mask does yield a higher AHI for me, and seems to require greater pressure. It shouldn't be the case, just my own experience.

That's exactly what I asked my Dr. and Tech about...the pressure being too low for a full face mask. I told him that under the sleep study I was fitted with a nasal mask and was prescribed 11cm and that I thought that having more volume to cover with a FFM I would need more pressure. He said it shouldn't make that much of a difference...

It technically shouldn't make a difference, and I certainly wouldn't think that would be underlying your excessively high AHI.

So you're saying that the EPR would also make a difference? Should it be lower or higher?

Pugsy just responded to this part. If you can exhale against the pressure, I'd turn it off. If you can't, I'd at least try turning it down. You can turn it down to 2 while you're just laying there, and if that feels OK, turn it down to 1, and if that's tolerable, turn it off.

How long is ramp on for? If you're falling asleep during ramp you may be having quite a few events before your pressure ramps up to 11. But I am not sure if Resmed takes events that occur during the ramp time into account in the AHI.

If it were me, I would:
1. Call the doctor back now and tell them I want a call back today from him/her. If I didn't get it, tomorrow I would call back, and say, "I'm documenting that I've called the doctor now three days in a row to alert him that my AHI is X." But I bet you'll get a call back today if you express the urgency of the situation.
2. If I didn't hear back from the doctor by tonight, I would turn EPR off (or as low as I can tolerate), and turn ramp off ideally (or make it as short as possible).
3. If I didn't have it, I'd get software so I can see what is happening beyond what the LCD is telling me
4. Once I had the software, I'd start adjusting the pressure range, eg, set it to APAP with a minimum of what the prescribed pressure is, but a higher maximum (not WIDE open range, but enough so that I can see if I'm hitting higher pressures). I can't remember if you're already doing that.

SleepingUgly wrote:4. Once I had the software, I'd start adjusting the pressure range, eg, set it to APAP with a minimum of what the prescribed pressure is, but a higher maximum (not WIDE open range, but enough so that I can see if I'm hitting higher pressures). I can't remember if you're already doing that.

I think from the reported numbers, OP is using straight CPAP.


I agree with SleepingUgly #4 (all the others too). While my AHI wasn't nearly as high as yours with treatment, it was still elevated and use of the Auto feature with a range showed me that the minimum wasn't quite high enough.

SleepingUgly wrote:

AJimen05 wrote:

SleepingUgly wrote:People have already mentioned a couple of possibilities: the EPR, and that your titrated pressure is not right.

I don't know why, but I have found that a full face mask does yield a higher AHI for me, and seems to require greater pressure. It shouldn't be the case, just my own experience.

That's exactly what I asked my Dr. and Tech about...the pressure being too low for a full face mask. I told him that under the sleep study I was fitted with a nasal mask and was prescribed 11cm and that I thought that having more volume to cover with a FFM I would need more pressure. He said it shouldn't make that much of a difference...

It technically shouldn't make a difference, and I certainly wouldn't think that would be underlying your excessively high AHI.

So you're saying that the EPR would also make a difference? Should it be lower or higher?

Pugsy just responded to this part. If you can exhale against the pressure, I'd turn it off. If you can't, I'd at least try turning it down. You can turn it down to 2 while you're just laying there, and if that feels OK, turn it down to 1, and if that's tolerable, turn it off.

How long is ramp on for? If you're falling asleep during ramp you may be having quite a few events before your pressure ramps up to 11. But I am not sure if Resmed takes events that occur during the ramp time into account in the AHI.

If it were me, I would:
1. Call the doctor back now and tell them I want a call back today from him/her. If I didn't get it, tomorrow I would call back, and say, "I'm documenting that I've called the doctor now three days in a row to alert him that my AHI is X." But I bet you'll get a call back today if you express the urgency of the situation.
2. If I didn't hear back from the doctor by tonight, I would turn EPR off (or as low as I can tolerate), and turn ramp off ideally (or make it as short as possible).
3. If I didn't have it, I'd get software so I can see what is happening beyond what the LCD is telling me
4. Once I had the software, I'd start adjusting the pressure range, eg, set it to APAP with a minimum of what the prescribed pressure is, but a higher maximum (not WIDE open range, but enough so that I can see if I'm hitting higher pressures). I can't remember if you're already doing that.

I currently do not use a ramp. I'll check into changing the EPR down according to how I can take it.
Once I find the software today...and I don't hear back from my Dr. which i just left a stern message at his desk about today's levels...I'll follow your recommendations. However, I don't think that my s9 Elite has the ability to put a range on the pressure. I think its a constant pressure set?

Ooooh, you have the Elite. I don't know whether that is an Auto-Pap or just a CPAP. How long have you had it? I would think your doctor should be able to make a pretty good case that you need an APAP now, as your titration obviously didn't yield the correct pressure and now you have to self-titrate at home.

Elite, straight CPAP only, for now forget what I said about Auto. So sorry.

For the software?? So sorry, thought I had already addressed that issue.
Check a recent post on the forum first page for a thread called "I love Titrations" by member Uncle Bob.
Look at his profile and on the left where his signature is, I think you should find some very useful information.

I would really try to get an S9 Autoset. If you just got your machine, your doctor may be able to help you get an Autoset. Titrating yourself will go much better with an APAP. Unless the doctor is going to bring you back in for another titration in the sleep lab...which will cost more than a new S9...

SleepingUgly wrote:I would really try to get an S9 Autoset. If you just got your machine, your doctor may be able to help you get an Autoset. Titrating yourself will go much better with an APAP. Unless the doctor is going to bring you back in for another titration in the sleep lab...which will cost more than a new S9...

I got the machine arounds the ends of January this year. I'm not hoping for the latter, even though i really do feel that 11cm is not right...a new machine where I can have a range to show where my true pressure would be at..would be great!

AJimen05 wrote:I got the machine arounds the ends of January this year. I'm not hoping for the latter, even though i really do feel that 11cm is not right...a new machine where I can have a range to show where my true pressure would be at..would be great!

You've had it less than a month. Push your doctor hard for it. Good luck!

If patient care was the only concern, I doubt that many people would even get a straight CPAP anymore. Unfortunately, we don't live in such a world, so we have to advocate for ourselves. Reasonable sleep professionals realize this and will work with their clients. Settle for less, and you'll get less.

BernieRay wrote:If patient care was the only concern, I doubt that many people would even get a straight CPAP anymore. Unfortunately, we don't live in such a world, so we have to advocate for ourselves. Reasonable sleep professionals realize this and will work with their clients. Settle for less, and you'll get less.

Well, with a RESIDUAL AHI of 79, after having undergone a titration in the lab, I think he has pretty damn good bargaining power. If you are assertive, and your doctor is reasonable, you may get somewhere. A titration is one night, and there is night to night variability. So it's common for the pressure to not be exactly, but it's rare to see someone with a RESIDUAL AHI of 79 and no leaks. I'd demand an APAP and tell your doctor it's less expensive than another titration, which might get it wrong again. The Doc should be able to pressure the DME, if they are a problem. Honestly, I truly believe that DMEs would buckle to many of our demands if doctors got involved more often. Afterall, the doctor is the referring party, and if the doc isn't happy, he/she won't refer to that DME.

SleepingUgly wrote:

BernieRay wrote:If patient care was the only concern, I doubt that many people would even get a straight CPAP anymore. Unfortunately, we don't live in such a world, so we have to advocate for ourselves. Reasonable sleep professionals realize this and will work with their clients. Settle for less, and you'll get less.

Well, with a RESIDUAL AHI of 79, after having undergone a titration in the lab, I think he has pretty damn good bargaining power. If you are assertive, and your doctor is reasonable, you may get somewhere. A titration is one night, and there is night to night variability. So it's common for the pressure to not be exactly, but it's rare to see someone with a RESIDUAL AHI of 79 and no leaks. I'd demand an APAP and tell your doctor it's less expensive than another titration, which might get it wrong again. The Doc should be able to pressure the DME, if they are a problem. Honestly, I truly believe that DMEs would buckle to many of our demands if doctors got involved more often. Afterall, the doctor is the referring party, and if the doc isn't happy, he/she won't refer to that DME.

His tech called me back and I gave him all the figures. Sounded confused. I told him that I wanted another machine, an APAP...S9 Autoset. He said he would get back to me because he thinks I MIGHT NEED AN ADJUSTMENT TO MY PRESSURE! He's going to talk to the Doctor and get back to me. I'm tired of me...anyone care to take over control? J/k.

Do you know how to change the pressure yourself? If not, someone here can walk you thru it. The first thing I would do is turn off the EPR. My understanding is....if you have a prescribed pressure of 11....but the EPR is set at 3....you're really only getting a pressure of 8. See if you can manage without the EPR turned on....and watch what happens with your AHI. If that doesn't do the trick....keep the EPR turned off...and over a period of time...bump up your pressure 1 step up at a time until you get the results you want.

Of course, you can wait on the doctor to call you back....but I think you will find that many of us here on this forum manage our own therapy as much as possible. Good luck to you!

SleepyT wrote:Do you know how to change the pressure yourself? If not, someone here can walk you thru it. The first thing I would do is turn off the EPR. My understanding is....if you have a prescribed pressure of 11....but the EPR is set at 3....you're really only getting a pressure of 8. See if you can manage without the EPR turned on....and watch what happens with your AHI. If that doesn't do the trick....keep the EPR turned off...and over a period of time...bump up your pressure 1 step up at a time until you get the results you want.

Of course, you can wait on the doctor to call you back....but I think you will find that many of us here on this forum manage our own therapy as much as possible. Good luck to you!

Thanks SleepyT...looks like your advice and others from here, I might just do that. I'll try to see how I can deal with the EPR off first.