When you set pressure, do you go by median or 95th percentil

How do you set your pressure based upon APAP readings? I am being given three pressures, a median pressure, a 95th percentile and a maximum pressure. My APAP reports the 95th percentile every morning if I check it on the machine. I did not realize my actual nightly pressures were higher than my 95th until I got this Resscan software recently.

What do you do? Take an average of a month and go by what? median pressure, 95th percentile pressure? I am thinking of taking matters into my own hands seriously because I am not getting very far with sleep medicine doctors lately.

Then verify it with the recording pulse oximeter I have? And also by how I feel?

Should the pulse oximetry line be basically a straight line across? Or approximate with a few ups and downs? Mine is up and down and looks real jagged with dips into the high to low eighties typically. My average oxygen in my sleep is around 90% according to my Nonin pulse oximetry software. Average O2 in my sleep typically is around 93%, awake its 95% to 97% on the same oximeter.

Eric

I already know how to get into the clinical menu and change pressures and stuff, have known how to do that for years, on both my Resmed and Phillips Respironics APAP. I just dont know what to go by, median pressure, 95th percentile ,maximum pressure.

Also, why are some sleep doctors so dismissive of data compatible machines? I have had one sleep doc who was super reliant on what my Resmed APAP was displaying and he was going to adjust my pressure just on that alone at one point. But we ended up doing a new sleep study instead. I had another who was was like that, he went by the Resscan software. The guy I am using now does not even want to see my machine in his office nor downloads of any type and only wants pressures changed based upon sleep studies in a lab. He gives me the impression (always has) that he does not know what he is doing really and relies on sleep techs and DMEs to give him info about patients.

Eric

EricinNC wrote:I already know how to get into the clinical menu and change pressures and stuff, have known how to do that for years, on both my Resmed and Phillips Respironics APAP. I just dont know what to go by, median pressure, 95th percentile ,maximum pressure.

In case you're wondering: Your median pressure is the pressure that is enough to hold your airway open for only 50% of the night. For the other 50% of the time, your machine uses pressure which is higher than the median.

ozij wrote:

EricinNC wrote:I already know how to get into the clinical menu and change pressures and stuff, have known how to do that for years, on both my Resmed and Phillips Respironics APAP. I just dont know what to go by, median pressure, 95th percentile ,maximum pressure.

In case you're wondering: Your median pressure is the pressure that is enough to hold your airway open for only 50% of the night. For the other 50% of the time, your machine uses pressure which is higher than the median.

Well my median pressure is always 11, never under 11. My 95th and max pressures are always way over that, typically in the 12s to 13s, sometimes going to the low 14s. I set my minimum pressure last night at 11 and woke up early, kind of like I was readjusting to things. I reset it back to 10 and went back to bed. Woke up feeling with a good mood for the first time in weeks.

Eric

I just looked at my Resscan downloads for my S9. My median has been AT LEAST 11, most nights more than 11 for all but two nights. The lowest my median has been was 10.7 and that was for two nights. For about the other thirty or so nights I scanned over, 11 something is median, sometimes 12 something and a few nights 13 something.

Then after that, my pressures skyrocket for 95th percentile and max pressures.

Eric

Eric,

If you cannot tolerate extended time at your 95% pressure setting and it's quite a bit higher than your median pressure setting, that's a pretty good reason to leave the machine in APAP mode in my opinion---as long as the AHI is low enough for you to feel well and function well in the daytime.

In Auto mode, the machine will increase the pressure when it's clearly needed to prevent lots more apneas, but will run at low enough pressure for enough of the night to minimize problems like aerophagia.

Best of luck

robysue wrote:Eric,

If you cannot tolerate extended time at your 95% pressure setting and it's quite a bit higher than your median pressure setting, that's a pretty good reason to leave the machine in APAP mode in my opinion---as long as the AHI is low enough for you to feel well and function well in the daytime.

In Auto mode, the machine will increase the pressure when it's clearly needed to prevent lots more apneas, but will run at low enough pressure for enough of the night to minimize problems like aerophagia.

Best of luck

Well, the only reason I cannot tolerate the 95th percentile pressures is my antidepressant. It just activates like crazy when I raise the minimum up at all. Off the SSRI, Im 100% positive I could tolerate the increased pressures.

The pressure settings Im at right now are not cutting it on APAP. I just do not know what to do. One sleep doctor recently told me "I may have to choose my poison." Meaning either CPAP/APAP or what Im on now plus SSRI. What Im on now plus SSRI is not getting it done.

Eric

EricinNC wrote: Well, the only reason I cannot tolerate the 95th percentile pressures is my antidepressant. It just activates like crazy when I raise the minimum up at all. Off the SSRI, Im 100% positive I could tolerate the increased pressures.

The pressure settings Im at right now are not cutting it on APAP. I just do not know what to do. One sleep doctor recently told me "I may have to choose my poison." Meaning either CPAP/APAP or what Im on now plus SSRI. What Im on now plus SSRI is not getting it done.

Life is full of compromises: But the need to balance one medically necessary treatment against another medically necessary treatment is NOT an easy thing to either accept or do.

Rather than thinking in terms of either/or, however, maybe the thing to do is to try to find a spot on the CPAP/APAP pressure where the OSA is being treated sufficiently well to deal with the worst of your OSA symptoms, but not worry about getting the OSA optimally treated until the issues with the SSRI start to stablize as well.

When you say the pressure you're at right now on the APAP is not cutting it while you are on the SSRI, what do you mean? Is the pressure at too high of a setting for too long and it triggers problems because of the SSRI? Or are too many events are happening and the OSA is acting up so much that you can no longer function sufficiently well during the daytime? Or both at the same time?

If it's the former, a prudent trial might be to lower the max APAP pressure a bit (by a half cm to one cm) and see if the number of events remains somewhat stable. If it's the later, it would be prudent to raise the min APAP pressure a bit (by a half cm to one cm) and see if that reduces the number of events sufficiently to help with the overall way you're feeling.

robysue wrote:

EricinNC wrote:

When you say the pressure you're at right now on the APAP is not cutting it while you are on the SSRI, what do you mean? Is the pressure at too high of a setting for too long and it triggers problems because of the SSRI? Or are too many events are happening and the OSA is acting up so much that you can no longer function sufficiently well during the daytime? Or both at the same time?

If it's the former, a prudent trial might be to lower the max APAP pressure a bit (by a half cm to one cm) and see if the number of events remains somewhat stable. If it's the later, it would be prudent to raise the min APAP pressure a bit (by a half cm to one cm) and see if that reduces the number of events sufficiently to help with the overall way you're feeling.

If I decrease the pressure at all, I will likely end up in the ER to be honest. I would not be able to function.

What I mean by saying the current APAP is not cutting it is that it does not give me the end results, the clinical effect of what I was used to until a few months ago with another machine. Things were fine then. Now, the new machine at the "same settings" plus the same SSRI at the same dosage leave me feeling much more tired, fatigued, much more irritable, able to concentrate less and just generally, a total flareup of OSA symptoms and also, some depression symptoms.

My AHI is very low right now on this machine, much lower than on my old machine. But I felt much better on my old machine. It does not make any sense. If I increase the pressure, the SSRI becomes overly activating, making it hard to function, but in a different way. I become too jazzed, too jacked up, but still tired if that makes any sense at all. I dont know if youve ever been on an SSRI or other antidepressant but they can make you feel worse when you are on them at first, as your body goes thru the adjustment period.

Increasing pressure equals a "mini SSRI activation or adjustment" period. Too little pressure equals "Im dead" feeling.

I dont know if that makes any sense to you, its the best I can explain it.

Eric

All I want is what I had before, up until just a few months ago. Change equipment for me has led to a total deterioration in how I feel. Thats the best way I can describe it.

Eric

robysue wrote:Eric,

If you cannot tolerate extended time at your 95% pressure setting and it's quite a bit higher than your median pressure setting, that's a pretty good reason to leave the machine in APAP mode in my opinion---as long as the AHI is low enough for you to feel well and function well in the daytime.

In Auto mode, the machine will increase the pressure when it's clearly needed to prevent lots more apneas, but will run at low enough pressure for enough of the night to minimize problems like aerophagia.

Best of luck

This pretty much sums up what Ive experienced the last few months. The problem is the minimum pressure does not cut the mustard anymore on these new machines. On higher pressures, at least with the SSRI thrown in, I do experience all kinds of excessive activation side effects.

Eric

Its why I was thinking of the tracheotomy. If I cant get off SSRIs and cant tolerate higher pressures, tracheotomy looks to me like my only real option that actually works. Airway is open at night, no pressures, breathe normally.

Eric

Eric,

I've never been on any SSRI. And I will admit that I have no idea of just how badly the combo of too much pressure and the SSRI is leaving you feeling because I have no experience with SSRIs. But you have my sympathies. It cannot be an easy situation.

I take it the SSRI is prescribed by Doctor A and the APAP is prescribed by Doctor B. And of course, neither Doctor A nor Doctor B will talk to each other even though you've properly filled out the HIPPA forms giving them permission to release your records to the other doctor. That's frustrating to say the least.

Now, it could be that you are sensitive enough to the subtle changes in the pressure-adjustment algorithms that Resmed made between the S8 and the S9. You're currently using an S9 APAP running in what range?. And what exactly was your S8 setting? APAP? or CPAP? And what pressure levels? Are you using the same EPR settings that you were using on the S8? What is the EPR setting you are using? And what about the humidity settings? What were you using on the S8? What's the current humidity setting on the S9?

And finally a potentially silly sounding idea, but I'll pose it anyway: The default hose for the S9 is a slimline hose that is only 15 mm in diameter. But the S8 used a standard hose (22 mm in diameter, if I recall correctly). So on the S9 are you using a slimline hose? the fancier and more expensive climateline hose (also 15 mm if I recall correctly)? or a standard hose? The S9 can handle any of the hose types (with the appropriate setting). And if you are now using the slimline hose, maybe that's part of why the machine feels so different and is disturbing your sleep so much. Have you tried attaching a standard hose to the S9? Just make sure that you have the Hose setting set to Standard if you swap out the slimline that more than likely came with the S9 for your old, friendly standard hose from the S8.

EricinNC wrote:Its why I was thinking of the tracheotomy. If I cant get off SSRIs and cant tolerate higher pressures, tracheotomy looks to me like my only real option that actually works. Airway is open at night, no pressures, breathe normally.

Eric

Trachs are serious, not fun things to deal with on a day-to-day basis. And while it might fix the apnea at night, a trach would seriously and more than likely negatively affect the overall quality of your life during the day.

Keep plugging away at tweaking the APAP pressure range and the other settings on the S9 before you give up on it.

And consider working with the doctor who prescribed the SSRIs to see if you can reduce the dose of any of those meds slightly to see if that takes he edge of the situation you currently find yourself in.

Why not try to buy an S8 machine?
I'm sure you can still find some on sale, used or new -- and that will be much cheaper than a tracheotomy.

I would also suggest raising your pressure in the minimal increments possible: 0.2 at a time, and giving your body and brain time to adjust to those changes - a week at least for each increment.

Is your EPR setting on the S9 identical to what it was on the S8?

O.