Resmed S9 Min-Max Pressure Tuning - Without titration study

Hello everyone,

I am relatively newly diagnosed sleep apneac ; I have been using APAP for 6 weeks with few good days and mostly bad days (see my detailed post: newly diagnosed - viewtopic.php?f=1&t=94354&st=0&sk=t&sd= ... +diagnosed ). I live in the middle east where sleep centers are not widely available and the hospital where I did my sleep study used a simple machine that doesn't measure brain signals (EEG). So, after being diagnosed with moderate sleep apnea, my doctor prescribed ResMed S9 AutoSet. and started me on min-max pressure of 6-14 and then asked me to increase it to 7-15. However, even after increasing the pressure, I still don't feel rested (like the first few days when I started the APAP therapy). I understand that recovery takes time (weeks or even months), but if therapy is working, shouldn't one feel rested when he/she wakes up in the morning????

Last week, I started increasing the pressure every day to see how I feel, I reached 10-14 and still don't feel that good. I wanted to seek some advice on the following:

1. If someone doesn't have access to tit-ration sleep study, what is the best way to find the correct pressure. Please note that my AHI and leak are all withing acceptable range, during both, good and bad days.

2. I noticed that my Pressure 95% used to be around 10 (when min-max pressure was 7-15), but it increased to 12 after I pumped the pressure to 10-14. Shouldn't the 95% pressure remain consistent?

3. Does it make sense to use the S9 AutoSet in CPAP mode and increase the pressure in 0.6 or 1.0 increments until I feel good again to find my correct pressure. How many days will be good indicator to judge if the pressure is OK or not?


Thanks...

Wow! How to reply.

Just to keep the legal department at bay, anything you hear here is not medical advice. We post anecdotal evidence on our personal treatment.

That said, almost no one feels good after one CPAP treatment. Often it take weeks (or months). Some respond within as little as a week but again this the exception rather than the norm. The goal of CPAP is to minimize the awakenings (hypopneas, Obstructive Events, and Central Apnea events).

The current thinking is that we should strive to keep the AHIs under 5. That is a tall over at the beginning. When we had our sleep studies, part of the study was to find the "sweet spot" for the minimal amount of pressure that will keep the airway open and not cause central apnea events. So we had a starting point. Mine was 10. When I got my machine, I dutifully pulled the statistics off my machine every day for quite a while to see how I was doing.

Initially, my AHIs were in the teens (or higher) due to leaks (mask and mouth). After I finally got the leaks under control (took a couple of weeks) I started looking at the data to see how to reduce the AHIs (my goal was to get under 5, and maybe under 3). Minor adjustments (.5 cmH2O) at a time for at least a week before changing the setting again looking at the data every day.

Haphazardly changing you setting is not recommended. Please be careful.

YYMV,
T-tino

newcpap wrote:Hello everyone,

I am relatively newly diagnosed sleep apneac ; I have been using APAP for 6 weeks with few good days and mostly bad days (see my detailed post: newly diagnosed - viewtopic.php?f=1&t=94354&st=0&sk=t&sd= ... +diagnosed ). I live in the middle east where sleep centers are not widely available and the hospital where I did my sleep study used a simple machine that doesn't measure brain signals (EEG). So, after being diagnosed with moderate sleep apnea, my doctor prescribed ResMed S9 AutoSet. and started me on min-max pressure of 6-14 and then asked me to increase it to 7-15. However, even after increasing the pressure, I still don't feel rested (like the first few days when I started the APAP therapy). I understand that recovery takes time (weeks or even months), but if therapy is working, shouldn't one feel rested when he/she wakes up in the morning????

Last week, I started increasing the pressure every day to see how I feel, I reached 10-14 and still don't feel that good. I wanted to seek some advice on the following:

1. If someone doesn't have access to tit-ration sleep study, what is the best way to find the correct pressure. Please note that my AHI and leak are all withing acceptable range, during both, good and bad days.

2. I noticed that my Pressure 95% used to be around 10 (when min-max pressure was 7-15), but it increased to 12 after I pumped the pressure to 10-14. Shouldn't the 95% pressure remain consistent?

3. Does it make sense to use the S9 AutoSet in CPAP mode and increase the pressure in 0.6 or 1.0 increments until I feel good again to find my correct pressure. How many days will be good indicator to judge if the pressure is OK or not?


Thanks...

Newcap,

You might want to visit Pugsy's Sleepyhead tutorial and look for the part where she discusses changing pressure in a responsible manner. Many people advise waiting between at least a week to to give your body time to adjust. And yes, please go very slowly.

viewtopic/t88983/Pugsys-PointersSleepyH ... Hints.html

49er

This is a really good post as it raises an issue faced by many. Especially now that home sleep testing is becoming more and more popular. Autosets and guess work are replacing titration studies.

One of the advantages of a lab titration with a brain monitor is the ability to detect what's called REM rebound. Commonly referred to in your doctor's interpretation. The titration would be considered successful in part, by evidence of increased length and frequency of rapid eye movement (dream) sleep at a specific pressure or pressures (Bipap).

The disadvantages of lab titrations could be inconvenience, increased expense, or as the poster mentions, distance.

#1. In my view, the best way to find the correct pressure with an autoset device is to take the 95% number, subtract 4 to obtain the lower number and add 2 to obtain the higher. Use the device for 3 to 7 days and do another download. 95% pressure, hopefully, will remain the same. The problem with autosets is that too much air pressure can cause irregular breathing. When that happens the autoset responds by adding more air pressure. The least amount of air necessary to do the job I have found to be best. In your case, starting at 10 wasn't good as it increased your 95% to 12.

#2. Change in 95% pressure could be due to a number of things, weight gain/loss, heavy meal, alcohol, sleeping position. In your case it looks like the extra air on the low end caused a change in your breathing enough for the machine to add additional air pressure.

#3. Adding pressure to "feel good again", I don't think is a good idea regardless of the increments. The sleep lab manual references changes by 1 cmH2O typically. Once your AHI is in an acceptable range, my suggestion is to look at other things that may be causing your sleep to feel non-recuperative. Is your mask clean? Are leaks a problem? Is your tubing staying out of your way? How about things completely unrelated to your machine? Diet, and everyone's favorite, exercise? Stress, chronic pain, a poor quality sleep environment are also things to consider.

Hope that helps, good luck!

Newcpap.. this therapy is not a magic pill, it won't make you feel better after one night or even a few nights... it takes time to get it right. Your brain needs to be re-trained to accept this thing blowing into our throats and is telling you ..no way, I am the boss, go away What you are doing by changing your pressures every night is what we call dial winging...do not do that! You need to go about a week with each change so that you can see how it has affected you, not one night. Some of us have adapted very well in a short time to therapy, others it takes time, several months sometimes. Have you read all the info in the wiki, new users and tips at the top of the page... you will find VERY good advise there, if after your have read and digested the advise and you still have questions, then please ask... but please, please stop dial winging the pressures you are not doing yourself any good by doing that.
Good luck

Thanks everyone for the feedback. And Thanks SleepWellCpap for the detailed response... I realized after reading the replies and thinking about what I did (increasing the pressure in fairly quick intervals), that it wasn't good idea. I will stick with my doctor advice, I changed pressure back to 7-15 and will give it a week and see how I feel. The doctor has offered to do another sleep study while using the machine if I still don't feel good. Which I think will be a better idea than taking things into my own hands without enough medical knowledge.

See folks, after feeling good for some days, feeling bad again seem worse than the original symptoms I have been having for 10 years. It is as if you take someone thirsty to a pool of water, let him stand by it and then drag him back to the desert without letting him drink!!!



newcpap