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APAP- High Pressure Waking Me in the middle of the night
Hi everyone, I'm new to PAP therapy and was originally prescribed the classic 4-20 CmH2O wide range of pressure. I had a hard time falling asleep with such a low pressure so I bumped the minimum up to 6 CmH2O, which has been great for falling asleep.
The problem is that most nights I am woken up by the high pressure ⚠ I'm swallowing air from the high pressure which is waking me up. I'm curious what is causing the machine to suddenly pump the pressure. This is happening every night, the OSCAR session chart attached below is a classic night of being aroused from peaceful sleep. I end up removing the mask around ~4AM-5AM because it keeps increasing pressure.
Any help would be appreciated with this, especially since the sleep clinic I go to is very aloof with figuring out PAP therapy.
Machine: Lowenstein Luisa Mask Type: Full face mask Mask Make & Model: Resmed Quattro FX Humidifier: separate F&P humidifier CPAP Pressure: Epap 4-20 PS 4-20; "auto" rate CPAP Software: Not using software
Other Comments: Using 45 degree angle upper body wedge (36"x36") and 4.5"soft cervical collar; 500 assured tidal vol
RE: APAP- High Pressure Waking Me in the middle of the night
If you would be so kind as to collapse your calendar in OSCAR, it would help see your pressures at night and even flow limitations better. Here is how to do it below:
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RE: APAP- High Pressure Waking Me in the middle of the night
(09-30-2024, 01:01 PM)Jay51 Wrote: If you would be so kind as to collapse your calendar in OSCAR, it would help see your pressures at night and even flow limitations better. Here is how to do it below:
(09-30-2024, 02:12 PM)Deborah K. Wrote: Also, get rid of the pie chart. We need to see valuable information that is now out of sight due to the calendar and pie chart. Thanks.
Sounds good, I updated my graph view to reflect the standardized version
I attached the images below, the first one being the overall session view and the second one a zoomed-in view of the routine 4AM pump.
I may have no choice but to purchase a BiLevel machine, the high pressure is intolerable since I am painfully having to burp air when awake. I am surprised the Resmed algorithm is only detecting flow limitations at the end of my sleep cycle instead of a steady pattern.
RE: APAP- High Pressure Waking Me in the middle of the night
hey Hanovertime,
the auto-adjusting algorithms are very imperfect tools, and as someone who works with patients one-on-one, they cause more harm than good, in my opinion. The machine is cranking up the pressure in response to the level of obstruction you're experiencing, but these things are complex, as that obstruction could be positional, the increased pressure itself could be causing more obstruction (yes, this can happen), etc. Seeing as it increases only a few times during the night, I advise narrowing the range, and perhaps thereafter increasing the minimum pressure. In other words, the majority of your pressure needs seem to be satisfied by relatively low pressures for the lion's share of the night, and only momentarily does the machine apply much higher pressures. Your median pressure is ~7-8cm.
In other words, the majority of your pressure needs seem to be satisfied by relatively low pressures for the lion's share of the night, and only momentarily does the machine apply much higher pressures. Your median pressure is ~7-8cm.
Sounds good, thank you for the insight. I will give this method a try, I'll set the machine at the static 8 cmH20 pressure. My clinic seems very hands-off, and doesn't care if I fine tune the settings. They don't even use a doctor for follow-ups, just a rushed nurse practitioner that looks at AHI. As long as the MyAir AHI event is low, that's all that matters to them.
I do agree with your theory about the algorithm having low precision. I've seen the machine slowly crank up the pressure while I'm awake just scrolling on my phone or reading a book.
I did some research on the official Resmed website and it states that most people have a pressure between 6-14 cmH2O "with an average of 10 cmH2O".
RE: APAP- High Pressure Waking Me in the middle of the night
What was your titrated pressure in your sleep study? If that is available, I would just set the machine's EPAP of that.
And use EPR if I need to feel comfortable. Otherwise EPR is not required.
Ideally, IPAP = EPAP with EPR = 0.
PRS1 Auto & Dreamstation Auto w/ P10 and straight pressure of 8cm
