Is my 95% pressure stat good or...?

[Hone]

Hi,
I pretty much understand what the 95% pressure stat means - what I don't understand is whether or not my 95% pressure stat is 'good'.
It is usually around 17.00 - 18.00. Pressure setting is 4.00 - 18.00. Am I correct in saying  that 95% of the time my pressure is at or below 18.00?
And  if so, is that good? What determines if the 95% stat is good? Is it acceptable for that number to be high, close to or at my max pressure?


Statistics                
Channel    Min    Med    95%    99.5%
Pressure    4.00    17.54    18.00    18.00
EPAP    4.00    14.54    15.00    15.00



Thank you very much!

[BoxcarPete]

I was going to come here to say that there is no "good" pressure, that it's the input to a good or bad output, but after hearing more details I have revised my opinion. That 95% pressure is not good considering that your minimum is only 4, because it means your machine is starting too low and ramping you way up. If you are able to post a full OSCAR chart for more details you will get more help, but I think some tweaking is due to get the best results for you. If you start at a higher minimum pressure, the machine may not need to raise it so high reactively to stop you from having events.

[Sleeprider]

Taken by itself, the 95% pressure is not particularly useful. That is the pressure equaled or exceeded 5% of the time during therapy. What matters is whether there are events, why they occur, and what is driving pressure. Oscar offers those answers, but since you didn't post the rest of the story, we may never know.

[Hone]

Thanks for your reply BoxcarPete - much appreciated. 

Here is an OSCAR screenshot - which I hope can be seen below. I can give more info as needed.




   

[Phaleronic]

Hello Hone, welcome to the forum.  Could you please go to the 'daily' tab and hit f12 to take a screenshot of your latest day as well?

Thanks!

[Hone]

Thanks very much Phaleronic - here are screenshots of the latest day.

[Phaleronic]

You're welcome! Thanks for the screenshots. I notice that your min pressure is set to 4cm, could you please raise it to 7cm (as BoxcarPete advised too)? Also, you have the mask type set on the machine to fullface, are you using a full face? Pressure is ramping up high in these charts too, with some leaks happening, do you notice that you're losing mask seal and then waking up during the night (there are rera flags there too)?

[Sleeprider]

You appear to have very high upper airway flow resistance (flow limitation). You probably need a bilevel machine to resolve this with pressure support during inspiration to offset the respiratory effort that it takes for you to take in a breath. First, let's read the Positional Apnea article. If you are sleeping inclined, with tall firm pillows, or in a position that restricts your airway due to poor cervical alignment, that is the first issue to address. https://www.apneaboard.com/wiki/index.ph...onal_Apnea

If that is not an issue, we need to discuss how to get you transitioned from CPAP to bilevel (Resmed Aircurve 10 Vauto). When you take a breath, your airway is restricting the maximum flow rate of air, which means you have to work hard (suck) to get a complete breath. We could see this in your flow rate graph with a zoomed image in the 2-3 minute time that shows the shape of the flow curve. It is likely very flat or downward sloping where a normal peak flow would be round. As far as settings, Resmed's auto CPAP algorithm is very sensitive to flow limitation which is why your pressure immediately rises to the maximum set pressure and stays there. Your chart demonstrates that even at maximum pressure and EPR, your CPAP cannot resolve this issue. With a bilevel, we could probably use a much lower minimum expiratory pressure, perhaps as low as 8.0 or 9.0 then use pressure support (an increase in pressure from EPAP during IPAP) to do some of the work of inspiration. This would normalize inspiratory flow and eliminate RERA (respiratory effort related arousal). In your case a PS of 5 to 6 cm might be needed. We can figure that out if you end up with a bilevel machine.

For now, set your minimum pressure to 9.0, Maximum pressure to 15.0 and use EPR full-time at setting 3. You will end up at maximum pressure due to flow limits, but that will be lower than your current pressure experience. We will work with you to further reduce that pressure until we see obstructive apnea or flow limitation increasing, and that will be the lower limit.