My ACPAP took a huge jump in pressure

I'm only into this about a month or so. When I first used the unit I was using the small pillow and the max pressure would be 5.1. Almost 2 weeks ago I switched to the medium pillow and last week I noticed the pressure jumped up to 17. Last night it hit over 21! I took the pillow off and slept about 30 minutes or so w/o the unit. My nose was sore (I have it adjusted fairly loose) but my wife woke me up because I was snoring so I put the unit back on. This time I was still at 5.1.

So I guess my questions are: How does the 'auto' part of ACPAP work? and Why the jump, within one night, to 4 times the pressure of other times of the night? I did not use my ramp feature last night. I'm going to try the large pillows tonight. One theory I have is the larger the pillows the more pressure the unit can send, but that's just a theory. And I'm not sure about 4 times the pressure.

Apap 'sees' an event about to happen and goes up from the low pressure setting to catch it at whatever higher pressure it's about to happen at, but if the low setting's too low, it may not catch it in time, so.. what are your two pressure settings?
Plus, you have a 'nasal' mask that only covers your nose, but if you're mouth breathing when asleep, losing therapy air that should be going down and not out, you might want to try a full face mask (it only also covers your mouth, not your whole face). The larger pillows may not be any more 'right' for you than the smaller ones were (obviously worse, it seems).

I'm pretty good at keeping my mouth closed, in fact when sleeping w/o the pillow last night I noticed I was keeping my mouth closed and it felt natural. So that's progress for sure. I'm not sure what the pressure settings are. I've never seen the unit go below 3.

It can't go below 3 as that's the default machine low setting (for IPaps like we have), though 90% of the other machines only go to 4 and top out at 20. You must get your prescription (copy) from your MD - yours by law - so you know what what's and what settings were prescribed though half the doctors don't understand how the equipment works (only the science of OSA) so tell the dealers to just leave it wide open (3 to 20), which doesn't help you much at all for reasons explained in my other note. When you know what your sets are, get back here and we'll try again (use the same thread).

Julie wrote:Apap 'sees' an event about to happen

Note that the Resmed Apap has a 9 - 10 second delay when it "senses" an event. This is built-in to allow for snores, coughs, sneezes, holding your breath (like I do when I turn over), etc.. before responding. This also prevents the machine from chasing non-events all night.

Sheriff

Julie wrote:Apap 'sees' an event about to happen

the resmed s9 series will raise pressure aggressively when it senses flow limitations and snoring, becase those are often precursors to apneas, but it can't actually see one about to happen, and doesn't actually respond until *after* one or two apneas or hypopneas have happend (if there weren't snores or flow limits )

Well, I don't really have a prescription. My Dr. gave me a prescription to get the machine but I did not opt to do a further study to get settings because my insurance wouldn't cover it. That's why he suggested an auto machine. In so many words he said the auto machine would make the pressure study kind of moot. I just know about about 20 it's just about blowing the pillow out of my nose.

Sorry, I thought I was logged in for the above response.

I am not familiar with how your machine works in response to leaks but is it possible that the higher pressure is in response to a leak?

Are you using software so you can see exactly how much time you spend at the higher pressure? and what was the leak status prior to the increase in pressure? The older technology apap machines did this quite often....chased leaks with more pressure. The newer S9 and PR S1 machines don't do it anymore but I am unsure how your machine responds to leaks.

I do not have any software. I was totally unaware that information software was available and now that I've been on this site for a while it seems it's pretty valuable. I wonder if I can add it after the fact? I can't be certain that there were leaks when the pressure was up so high, I mean, I'm just waking up and that's not my mentally clear part of the day.

I believe the module necessary to use the software can be added after the fact.
What information is available to you now using the smart codes?
You can always reduce that maximum so that the machine doesn't go there and if your smart code AHI still looks good no need to worry.

For the last few nights what has been your time on the mask, AHI, 90 or 95% (average) pressure and average leaks? I'm worried you're quoting fleeting maxima that we all get.

I don't know about any smart codes or AHI or any of that. I'll dust off the owner's manual.

Julie wrote:Apap 'sees' an event about to happen and goes up from the low pressure setting to catch it at whatever higher pressure it's about to happen at, but if the low setting's too low, it may not catch it in time, so.. what are your two pressure settings?

Not really. APAPs are not psychic and they cannot predict the future. And they certainly cannot predict in advance of a cluster of events how much pressure you are likely to need to splint the airway open.

APAPs can and often do respond aggressively to snoring and/or flow limitations. The Intellipap responds (aggressively) to snoring, but don't score flow limitations if I recall correctly. The rationale is simple: Snoring indicates the airway is already compromised and in danger of collapsing at the CURRENT pressure level. Hence more pressure is likely needed in order to reduce the probability of an airway collapse.

APAPs can and often do respond aggressively to clusters of two or more apneas and hypopneas. They respond AFTER the apnea is over. The rationale is simple: A cluster of two or more events clearly indicates the the CURRENT pressure level is NOT doing an adequate job of splinting the airway open. Hence more pressure is likely needed in order to reduce the probability of additional airway collapes.

Under some circumstances, it is possible for an APAP to start "chasing" clusters of events when the minimum pressure is far too low. Usually what happens is that a cluster of events occurs; the machine drastically increases the pressure, but because the pressure increase is both rapid and large, the breathing does NOT have a chance to stabilize before more events occur and the machine continues to increase the pressure. Usually when a person has this kind of problem, it manifests itself on most nights rather than just a random one here or there.

Plus, you have a 'nasal' mask that only covers your nose, but if you're mouth breathing when asleep, losing therapy air that should be going down and not out, you might want to try a full face mask (it only also covers your mouth, not your whole face).

While mouth breathing causes a lot of problems, mouth breathing by itself is NOT responsible for drastic pressure increases. Most modern APAPs can gracefully handle a fair amount of unintentional leakage. They do this by increasing the amount of air being blown into the system in order to maintain the current pressure level. They do NOT increase the pressure level itself because that will cause the leak to grow WORSE, not better. Some APAPs will actually decrease the pressure level when faced with official Large Leaks in an effort to try to get the leak to resolve itself.

I may be mistaken, but I don't think his machine is an APAP.(?)