Good reports (I think), yet extremely tired

[Sleeprider]

You are using a Resmed S9 Elite, which provides fixed pressure. If you were on an autoset CPAP the flow limitations would quickly raise pressure to top of your pressure settings, or until the flow limits were reduced. Since you are already using maximum EPR, your current pressure of 9.6 cm provides bilevel pressure of 9.6/6.6 (IPAP/ EPAP). Short of getting a bilevel, you would benefit from titrating pressure higher, and I could actually see you somewhere around 14/11 if you want to address the flow limitations.

A lot of people will say your AHI is fine, so don't worry, but you need to judge whether you are sleeping well and therapy is optimized. Flow limitation is the parent of RERA, Hypopnea and obstructive apnea in order of severity. Go ahead and zoom into your flow rate chart and look at the mess it causes. You will see that instead of rounded peaks of inspiration, you have flattened, squashed and downward sloping inspiration. That means you are WORKING for every breath because it takes a lot of respiratory effort to overcome the upper airway resistance that causes that. It's exhausting. Higher pressure will help to open your airway and should reduce that flow limitation, but let's talk about what bilevel can do. Your OA is fully controlled so you don't need higher EPAP pressure from your current 6.8 cm. With bilevel we use pressure support, or the difference between IPAP and EPAP to assist breathing and overcome flow limitation, a.k.a. airway resistance. As you inhale, pressure support comes behind each breath and replaces respiratory effort with positive pressure. The difference is amazing. Meanwhile, use higher pressure, but be aware that a tool exists to make your sleep respiration effortless, which pays back in how you feel.

[ppca]

I'll try raising pressure. I suppose increments of 0.2, maybe 0.4 would be the way to go. Thanks!

[Gideon]

For your first increase I would be aggressive, Raise your Pressure to 11, though I'll agree that slow and steady will also work. That is only a 1.6 increase.

[ppca]

And while I was replying to bonjour, Sleeprider's post came in. Thank you, guys!

Again, do you think it may be worth raising the pressure, as the first step, and see if that makes any difference. I am at 9.6 now...so what should I raise it up to?

Since I am not covered by insurance, getting a APAP, or a BiLevel machine, will be directly out of my pocket. And as we know, these things are not cheap. Is it worth a shot?

---

Oh OK, your guys are fast.

I'll try 11. Thanks bonjour!

[Gideon]

Do Note: BiLevels are not created the same. Please validate the model you are getting before you pull the trigger if it is anything but a ResMed VAuto.
Different models of BiLevel, different modes, are designed to treat different conditions. We want you to get the right model, the first time.

[ppca]

I'd rather see if raising the pressure on my CPAP machine can help. Other than the obvious "feeling better", I suppose that I should be looking into Flow Limits, as far as the report goes, and see if I can lower those...right?

Also, once I decide to pull the trigger, could an APAP be a good solution, instead of a BiPAP machine? Still a significant difference $$$ wise, if I'm right.

[Gideon]

we can accomplish the same thing an APAP can with your Elite, and yes a cost difference is there.

[Crimson Nape]

A bi-level machine is about your only choice.  A regular auto adjusting CPAP is alomost going to have the same problem as your Elite.  The difference is an auto CPAP is going to sense the flow limitations and increase its pressure, up to its set limit, trying to overcome the flow limitations.  Based on my experience, you can't set the pressure high enough to overcome these limits.  If an EPR of 3 isn't getting the job done, then a Bi-level is the only way to go.

[ppca]

So, an APAP wouldn't do me any good? Damn!

[Crimson Nape]

I was just making it by with an S9 Autoset using an EPR setting of 3.  I had a chance to pick up a Resmed AirCurve 10 VAuto. Boy!, did it make a difference.  After tweaking it, I no longer experience flow limitations or snoring . . . Zip! . . . Nada! . . .Zero!