[Pressure] ResMed S9 max pressure of 20.0 possibly problematic

[welshmike]

My backround:
I believe that the reasons I have had sleep apnoea are:
1. I have a severe overbite
2. I have broken my nose several times playing Rugby causing a deflected septum and have had two septoplasty operations.
3. I am a mouth breather and snored while asleep.
4. My natural sleeping position has been on my back.
A video I took of myself overnight while wearing my backpack, not using the APAP device and sleeping on my side showed that I breathed normally mostly through my nose and there were no snoring or snorting sounds.
I believe that the only cause for my sleep apnoea is the collapse of the soft tissues in my throat that occur only while I am sleeping on my back.
A bonus of being free from sleep apnoea is that my regular episodes of atrial fibrillation have stopped.

My current problem:
I have been having pain and bruising on the left side of my nose possibly due to the tightness of my Quattro Air mask even when wearing a Gecko Nasal Pad that I replace regularly with a new one.
I believe that I may be tightening the mask straps too much so that I do not get air leaks when the S9 detects apnoeas and pumps up the air pressure. Recently leaks only happen up to two or three times per night when I find myself sleeping partly on my back instead of sleeping on my side.
I wake up at those times and recollect that the S9 shows at those times that the air pressure has gone up from 4.0 to 20.0.

So I am suggesting that I reduce the maximum air pressure to 10.0 and also loosening my mask straps.
What opinions do members have about my suggestion please?

[me50]

my suggestions are to look at the software and see what your pressure is the majority of the night. I agree your pressure range is wide open and that could cause some issues. Post your pressure graphs for the night so we can see them. I wouldn't drop your pressure down to 10 right now. Show us your graphs so we can better help you. I would think raising your lower number a bit is an option but we can better help when we see your graphs of your pressure, AHI and leaks would help a lot.

you might consider changing to a nasal mask or nasal pillows and use a chin strap to help with mouth breathing. YOu can elevate your head to help when you sleep on your back.

Others will have more suggestions for you.

[justMongo]

For most of use, sleeping on the back does worsen our apnea as gravity does add to airway collapse.

Make pressure changes in small increments and follow with your software. ( I would not jump down to 10)
4 cm-H2O is a little low for a starting pressure.
Rig yourself such that you cannot sleep on your back. One trick is a nightshirt with tennis balls sewn into the back.
(Or, for you ... perhaps a Rugby ball.)
Once you rig it so you cannot sleep on your back, you can decrement pressure every few days, by about 0.5 cm-H2O until you're comfortable; and your apnea events are still well controlled. I'd say 0.5 -- but I know the ResMed only dials in even increments.

Your autoset is in what user Retired_Guy calls Magpie Mode (4 and 20 blackbirds baked...); it's running "wide open."
Dialing it in (narrowing down the limits) generally better suits a person.

[retired_guy]

Yes.. As our flyguy suggests dial it down from the top a bit and dial it up from the bottom a bit. What is your "normal" running pressure? For instance if it's 10, I'd shoot for a min of 8 and a max of 14. That'll help with the leaks and will allow you to loosen the straps a bit on your mask making your cute little nose a happy camper.

[Galactus]

Just to add to everything else, that machine has a mask fit option, that will adjust the pressure to the average setting and allow you to fit your mask at that pressure. That will make it so you don't have to over tighten at the low pressure just to compensate when there is high pressure. I don't have that machine, but I see that mask fit mentioned many times.