What to do if you wake up due to pressure?

[drmaestro]

Hi,

I sometimes wake up during nights and generally find that the mask pressure has increased and it started leaking. OSCAR charts generally demonstrate a hypopnea or obstructive apnea episode before the event, so it increased the pressure. While the mask sealing is fine at my default pressures (around 5 cmH2O EPAP and PS of 3.4), if it startes leaking if it goes around 12-13 cm H2O. Now, the question is, what should I do after I wake up. My actual preference is to stop the device and restart it. That way, it goes back to the default pressures. If I don't do that, I need to remove the mask and try to reseal it, and also it is harder to go back to sleep on higher pressures. Do you think it is logical to reset the therapy at that point, because you are already awake, so there is no need for the higher pressures anymore or does it hurt the therapy? The question can be generalized to should you reset your device everytime you wake up in the middle of the night? My observations show that the AHI calculation isn't affected if there are multiple sessions, as the device calculates tha AHI from noon to noon. Also if you act fast in resetting, it doesn't consider it as a new session (I am not sure what is the required time gap for it to be considered a new session).

Thanks...

[optimalsleep]

test mask at higher pressure, preferably at that pressure it woke you up at, and adjust it. Find the instructions if Res Med has that option, my dreamstation does.

[drmaestro]

I use the mask fit option on the Resmed. I think it blows with the maximum pressure, so there is no problem when I start the night, however the mask might change position due to morphological changes to your face during sleep, so it isn't always helpful.

[Sleeprider]

Restrict maximum pressure to what you need, not the limits of the machine. Once events are resolved, it doesn't need to go higher. Choose your 90% pressure on an average night and set that as the maximum pressure setting.

[OpalRose]

I use the mask fit option on the Resmed. I think it blows with the maximum pressure, so there is no problem when I start the night, however the mask might change position due to morphological changes to your face during sleep, so it isn't always helpful.

Right... the mask fit test is fine initially and I believe it starts testing at your highest pressure set, but as the night wears on, whether from mask movement or the relaxation of facial muscles in deep sleep, the fit can change and leaks occur.

I'm not sure of your pressure range, but it seems to be set at default 5-20???  You may be sensitive to pressure changes and should try to narrow that range, which is what SleepRider is basically suggesting.  Bring the max pressure set down to the 90% reading or 1 to 2cm above that at most.

I would also move the minimum up to 6cm.  You might find a narrowed pressure range more comfortable, and limiting the max pressure will prevent the machine from raising the pressure unnecessarily, thus causing leaks and waking you.

Of course, my advice is coming without seeing your data.

[optimalsleep]

if you have low AHI below 3 or 2, or even lower.... and you feel good, feel good meaning energy level up, not tired during the day, says everything. Large mask leaks are the issue. Without OSCAR to show you this, then it's hard to tell where you are in that regard, How you feel is. You auto machine will compensate for these leaks. I tried to bring down max pressure to where it is normally to manage events, however, from time to time, I needed more pressure than where I lowered it too, so I put it back to the max for the machine. When I lowered it, I had excess events.

[SarcasticDave94]

I'd agree with lowered Max pressure as Sleeprider made mention. If you don't need maximum machine pressure, you should enter a lower pressure number. If left unchecked by way of going with the highest available machine pressure, large leaks can drive pressure up unnecessarily, creating sleep disturbances.

I liken setting max machine pressure to a car's throttle pedal. You don't drive with the pedal on the floor all the time, but that's where your PAP machine can end up if default max pressure is not adjusted to your needs. One mask leak or event can push some PAP machines to floor the pedal unnecessarily.