Need some help to find my best pressure setting

I have been diagnosed with severe sleep apnea with a IAH=40,6 IA=38,9 Spo2=78%.
Doctor asked for another study with CPAP. My IAH lowered to 0,9 with 10cm of pressure.
I starterd my CPAP therapy this week with a Resmed S8 Autoset II, but my numbers are far from the number with CPAP at sleep lab, what is causing me some frustration.

I'm using the Auto Mode.
I'm wondering if I have to get rid of the comfort settings and go with the Cpap Mode with the prescribed 10cm of pressure.
Physician have setted my machine with 5-15cm and EPR=1.
Maybe someone could shed some light. Thanks.

I would definitely try it at straight CPAP with a pressure of 10. That seemed to work well at the sleep study.

A couple of explanations:

1. At the sleep study, with all the wires and the first night using the machine, you did not sleep deeply enough to have events, which produced an artificially low AHI. This is not terribly likely, as you did have a high AHI at the first study with all the wires.

2. The pressure changes and/or EPR could be disturbing your sleep, causing extra events as you change sleep stages.

So, go back to the straight pressure of 10 and see what happens. Also, in general, it's best to wait about 1-2 weeks between changes to allow yourself to adjust and get a good idea of how the numbers settle out.

Hi Derek70 and welcome to the forum. Speaking from personal experience, it's possible that your setting of 5cm is too low. Changing your bottom number to 8cm or 9cm could reduce your AHI. The reason: if your machine is coasting along at 5cm and you suddenly have a strong obstruction your S8 has to suddenly ramp up to a 10 or higher to stop it. Sometimes a too low cm number forces your machine to be "behind the 8 ball." Over the 18 months I've been a hosehead I've had to raise my bottom number to keep my AHI numbers low. Perhaps you don't have to sacrifice your comfort level... just raise your lower number and, like 'cowlypso' suggested, leave your new settings alone for several weeks to allow your body to get used to it and to see what your AHI numbers are. His #2 suggestion is also valid and very possible until you get used to it.
Please Keep us posted here as to what you discover.
Cindy

Edit: Hopefully your S8 will allow you to set the ramp number lower than your bottom cm. Suggest you set ramp for 5 or 6cm and the ramp time for the normal time it takes you to fall asleep, or slightly longer. That way you could fall asleep before it reaches 8cm and your body will get used to it. Everything with Xpap seems to take time. It's something new, kinda like getting used to sleeping in a different bed.
I'm suprised to see the Dr set your machine so 'wide open'. Is it possible that he/she is also doing a home study? It might be wise to call your Dr's. office before changing the conditions on your S8. I'd regret telling you to change something and mess up your Dr's. test.
Best Regards,
Cindy

cowlypso and Cindy, thank you for your help.

In my 5th night i've setted CPAP Mode with 10,6 and EPR=1.
My number have improved: IAH=12,6 (IA=2,5 IH 10,1).
Not the perfect numbers but better than before.

I wondering if my Full Face maks is causing more apneas, since I tend to breath with mouth open.
The mask used In my titration was a Nasal (Comfort Classic).

derek70 wrote:In my 5th night i've setted CPAP Mode with 10,6 and EPR=1.
My number have improved: IAH=12,6 (IA=2,5 IH 10,1).
Not the perfect numbers but better than before.

I wondering if my Full Face maks is causing more apneas, since I tend to breath with mouth open.
The mask used In my titration was a Nasal (Comfort Classic).

Historically the S8 series of machines seemed to record Hyponeas very aggressively. Meaning many people had a hard time getting the Hyponea Index down to where they would like to see it. That said..double digit Hyponea Index is more than we would like to try to explain away.

Your EPR of 1 will reduce your pressure 1 cm during exhale. Effectively giving you 9.6 cm pressure during exhale and while a minor reduction perhaps just enough reduction to allow some of those hyponeas to develop. Sometimes a small 0.5 cm difference in pressure will make a larger impact than one might think.

Full face mask and mouth dropping open shouldn't make for more hyponeas but some people feel that they get better therapy with an nasal interface only mask. Do you have problems breathing through your nose during the day? Like chronic congestion or such? If not, then you might be a better candidate for nasal interface mask than you think you are.

If it were me..I would increase the pressure to 11 (to compensate for EPR 1 cm reduction) and/or investigate using a nasal interface mask. While in theory pressure needs should not change with mask type there are some people who need less pressure with a nasal only interface mask to adequately deal with events than they need with a full face mask. Worth a try. Sure wouldn't hurt.

How is your leak number? Just make sure it is not impacting the data before changing things. Leaks have to be controlled first before making changes. On the S8 machine it reports in L/sec and not the L/min that the S9 reports. So for S8 Machines the red line where we don't want to go above is at 0.4 L/sec which would equal the 24 L/min that is commonly used. (multiple L/sec X60)

Hi Pugsy.
Thank you for this great piece of rich information.
My leaks are very well controlled. The highest I've till now was 0.16L/s.
The highest autoset pressure I have setted was 10-14 and the machine only used 12.6.
I'm wondering if this is the best pressure to set with CPAP mode and maybe get rid of the EPR.
I'l rise pressure step by step till 12.6 to see if my number get improved.

Don't you think that mouth breathing instead of nasal get apnea worse?
I'll try a Nasal mask. Anyway is a good idea have two masks.

Thank you very much.

derek70 wrote:The highest autoset pressure I have setted was 10-14 and the machine only used 12.6.
I'm wondering if this is the best pressure to set with CPAP mode and maybe get rid of the EPR.
I'l rise pressure step by step till 12.6 to see if my number get improved.

Sounds like a good plan. There is no need to give up EPR if you don't want to, just adjust the pressure a bit to compensate for it. Though some people actually have seen a remarkable change in AHI when they turned off EPR. Not everyone has but some have. Hurts nothing to try if you are comfortable without the exhale relief.

It's not all about the numbers...it's about how you feel...how you sleep...how comfortable you are.
Good sleep is number one. So while we do watch the numbers (AHI) we should also make note of how we feel and how we sleep. If EPR lets you sleep more comfortably then use it. Don't sacrifice good restorative sleep while trying to kill those hyponeas. Everyone is an individual and what works for one person may not work the same for another person.

My machine has a different form of exhale relief but it is exhale relief. For grins I tried turning it off a while back to see what would happen. Bad idea. Not something I am going to be doing again. I documented it here in case you are bored and want to read it. viewtopic.php?f=1&t=67883&p=631376&hili ... mb#p631376

Pugsy, I gave up on turning off EPR for a while..