Disappointed

[Clementine]

My pressure was upped to 11/5 from 10/4 a few days ago. I have had not good results since then; at least not really any better than before. last night my ahi was 12.

Am I being too impatient? I was so thrilled that it only took me 2 weeks to get used to the nasal pillows mask and I no longer rip it off my face in the middle of the night.

I've noticed that with the higher pressure (I know, it's increased very little) that the nasal pillows move around more. Have had more leaks. I anticipate that the dr will up the pressure even more --- and then I don't know how the nasal pillows are going to stay in place.

I think I need to try the nasal mask rather than the pillows. I move a lot and the pillows just don't want to stay in place very well.

tired and frustrated and impatient . . . I don't see the dr. until the end of August. Wish it were sooner.

[robysue]

My pressure was upped to 11/5 from 10/4 a few days ago. I have had not good results since then; at least not really any better than before. last night my ahi was 12.

One night does not a trend make.

But even so, it's worth asking: What's the distribution of events? In other words, what's the OAI? the HI? and the CAI?

Am I being too impatient? I was so thrilled that it only took me 2 weeks to get used to the nasal pillows mask and I no longer rip it off my face in the middle of the night.

Perhaps. It takes some people several weeks to sort out learning how to sleep with the equipment. And it takes many people a few more weeks of sleeping well with the equipment before they notice much difference in how they feel during the daytime.

What was your AHI running when the settings were 10/4?

And why were you switched from plain CPAP/APAP to the VPAP?

And are you running in fixed VPAP mode with IPAP = 11 and EPAP = 5 all the time? Or are you running in VPAP Auto with max IPAP = 11 and min EPAP = 5 and PS = WHAT?

I've noticed that with the higher pressure (I know, it's increased very little) that the nasal pillows move around more. Have had more leaks.

Are the leaks still under 24 L/min? And how much are the leaks waking you up? With the higher pressure you may need to tighten the head gear somewhat. Are you using the P10 that has no head gear adjustments (except for how far apart the straps are) or are you using a nasal pillow that has an adjustable headgear?

I anticipate that the dr will up the pressure even more --- and then I don't know how the nasal pillows are going to stay in place.

Has the doc actually looked at the daily data report from your VPAP? Or did he bump the pressure up based on nothing but summary data?

I think I need to try the nasal mask rather than the pillows. I move a lot and the pillows just don't want to stay in place very well.

There are a lot of people who prefer nasal masks over nasal pillows masks. And there are some very minimalistic nasals with minimalistic headgear out there on the market.

Wish it were sooner.

Ask to be put on the cancellation list. Also be very specific in explaining why you want to see the doc sooner than your current appointment. In other words, don't just be vague and say, "I'm still not feeling very good." Give the doc something to work with: "I'm still not feeling very good and I think it's because I'm waking up too many times adjusting the mask and I'm having trouble getting to sleep" gives the doc a lot more to work with.

[Clementine]

ach -- just typed several things and lost it all.....

trying again. Here is my data from last night:
Details Last Session July
CPAP Usage
Average Hours per Night 08:41 05:32
Compliance 100% 73%
Therapy Efficiacy
AHI 12.20 11.03
Obstructive Apnea Index 11.17 9.15
Hypopnea Index 0.23 0.14
Clear Airway Apnea Index 0.81 1.69
Leak Statistics
Average Leak Rate 4.31 0.99
90% Leak Rate 10.80 3.60
% of time above Leak Rate threshold 1.21% 0.09%
Pressure Statistics
Average EPAP 5.00 1.24
Min EPAP 4.02 0.00
Max EPAP 5.00 5.00
Average IPAP 10.99 10.20
90% IPAP 11.00 11.00
Min IPAP 9.30 9.02
Max IPAP 11.00 11.00

I have the p10 airfit mask. I worry that with even more pressure, the thing will inflate and fly off my nose. That's what it feels like now.

Vpap because I could not tolerate the constantly blowing air with the regular Cpap during my titration.
No idea if it is in fixed Vpap mode. How do I tell?

At 10/4, the AHI was running an average of 13 --- anywhere from 11-16.

so tired --- cannot think very straight these days.

[retired_guy]

I have the p10 airfit mask. I worry that with even more pressure, the thing will inflate and fly off my nose. That's what it feels like now.

Not gonna happen....

Clem, are you sleeping on your back? If so, let's not do that for now.

Your leak numbers look fine at this point, so I would not worry about that even if you do up the pressure a bit more.

There is a sweet spot. You just haven't found it quite yet.

[Galactus]

Just want you to know i am at 18 with nuance pro, same type of mask, and it works just fine. Hang in there it will get better.

[Moriarty]

I would be more interested in seeing the reason for the very low start pressure. With a low start pressure you will get OA's that cause the machine to step up. That goes on until the OA's stop or the top pressure setting for the machine is reached.

Also - your 90% pressure is equal to your top pressure. That seems to indicate that the machine is never stepping back down because the OA's aren't stopping even at 11. I suspect that indicates that it needs to be higher yet.


As others have said : there is a sweet spot. I found it for myself with the Doc's blessing. (He is happy for me to experiment because he understands that I know how to take a proper experimental approach)

My original script was 5/20 but I did not like the low start. The unit registered stacks of OA's as it worked its way up to the 8.5 to 9 area.
The average AHI was around 5.

I reset the unit to 7/20 - then 8/20 and eventually 8.5/20 where it stayed for the last 12 months. The AHI is now drifting between about 0.8 and 1.3 with the 95% pressure sitting around 9.5.


I don't think you need to worry about your pressure causing problems with the mask - most nasal pillow masks actually seem to work better at higher pressures than at very low pressures - although I'm sure there is a practical maximum that is probably a bit below 20. There are people on the forum using P10s and Pilairos at 15+.

Good luck with it. I'm sure it will get better as time goes on.

[Clementine]

thanks for all the info. I sure have a difficult time understanding all the numbers and nuances of these machines, the pressure, etc. I don't have a head for numbers, unfortunately. I won't be the one dinking with the machine pressure --- I'll have to rely on the dr. for the numbers.

The reason for the low pressure numbers --- the dr. chose to start me that low because of anxiety about the whole thing, claustrophobia, etc. I flunked my first titration (altho the tech that night tried to blow me away with a regular Cpap --- there was no mask in all the world that was going to work for me that night).

Last night I slept better/longer, but my AHI was 11. How long do I give this current pressure before I ask the doc for something higher? It seems like --- if the pressure is not correct, one night will tell me that, or just a couple of nights, anyway. No point waiting around for a week or more?

[NickDanger]

Moriarty, you would be right on the money if she were using APAP. She reported that she is using VPAP - which means the higher number is the pressure upon inhale and the lower number is the pressure upon exhale. With an APAP, the two numbers would be interpreted as you have said - but VPAP is different. The range between minimum and maximum IPAP is about 9 to 11: this suggests the VPAP machine is either set to automode with that range or that she is using a ramp feature that begins at IPAP = 9.

[Clementine]

i am using the ramp ---
?

[NickDanger]

i am using the ramp ---
?

Using the ramp is fine - if it helps you get to sleep. That isn't what is causing the AHI of 11. I don't think the ResMed machines even measure AHI during the ramp period.