[Health] sleep study results and setting pressures

[MastiffMom]

Something weird that happens. When he first comes to bed and puts the mask on the ipap immediately goes close to max IPAP. We aren't sure why.

Respironics has a feature called "mask check" or "fit check" (don't remember) that lets you look for leaks by jacking the pressure all the way up when you first turn it on. I'm guessing it's on yours too.

You should be able to turn it off.

Thanks, I will look into that.

[Whitewabit]

When he had the issue with his lungs he said his chest felt phycially pumped up like he had been lifting weights all day and that his lungs felt like they were filled up and he could not get all the air out yet he felt dizzy and lightheaded and that needed to get oxygen.

New user, only a week, having the same feeling with the over inflation .. I have a ResMed VPAP Adapt, and started out with pressures in ASV Mode of EPAP-5, Min PS-5, and Max PS-15,. Now today doctor lowered it to EPAP-4, Min PS-3, Max PS-8.
haven't been able to use it the past 3 days because of discomfort/pain in chest and lungs. At the higher pressures I also felt I couldn't exhale the air in my lungs before the machine tried to breath again.

I also have asthma which is also lumped into the COPD category previously talked about and have the same symptoms.

[Ghost1958]

The mask check feature on the PRS1 machines isnt automatic. You hit the ramp button and hold it down a moment before starting therapy and it will run the mask check. Otherwise it wont

They also have at least on PRS1 auto machines something called Optistart. Every 30 hours it will automatically reset itself to the optimum starting pressure on the low side. If nothing happens for a little while itll drop to the original preset pressure.

When the machine starts it will display Optistart and whatever pressure its reset as its minimum so you can change it to that if you want too.

You can turn that feature off in clinical if you want.

[PhyllisBalboa]

Great, more conversations about this issue. I was going to run over to Whitewabit's thread to tell him about this one, but he found it on his own.

Same problem with me, started wide open on vpap adapt asv mode by doctor at epap 8, min ps 10, max ps 15. Blasted my lungs wide open, sore as anything. I've been thinking I get air shoved down while trying to move all that air out, but then a fresh blast to cram more in. So anyway, after adjusting downwards for a month I'm at epap 6.4, min ps 1, max ps 6. Getting better all the time. Still going down, I think.

And now slowly bringing hubby down since he now has more centrals than obstructives after being too high as well.

I truly think doctors should do the reverse, start out on the low side and move up if needed. People newly on their PAP's need to watch out for this. Or at least know that some prescribed pressure used for 20 minutes in a sleep study might not be the one to get them through the night.

[MastiffMom]

I truly think doctors should do the reverse, start out on the low side and move up if needed. People newly on their PAP's need to watch out for this. Or at least know that some prescribed pressure used for 20 minutes in a sleep study might not be the one to get them through the night.

So true! All the DME providers keep saying is that the machine can't do that ... yes, it can! The machine *may* only give you what it thinks you need but that doesn't mean your body can handle it. Hubby had the epic fail with an Autoset CPAP. He now has the ResMed 9 Auto BiLevel with the Max IPAP set to 13, PS 6 and min EPAP at 4. DME recommended machine have no limits set. Needless to say, after what he went through before, that was not going to happen so max IPAP was set.

He's been using this machine for about 3 weeks and it is working. He has felt a very small bit of soreness when he's been on the machine for more than 7 hours a night, normally he's only on it 4-6 hours a night. He has not been drowsy during the day and has more energy. Yes, the machine runs close to the max IPAP of 13 most of the night and yes, he still has some events, mostly when he's on his back or if the mask is leaking a lot. Can't wait to check last night's data because he was talking in his sleep (with the mask on) LOL. On a good night his AHI has been as low as .3. The worst night his AHI was 8. The main thing is that he is using the machine and it is making a huge difference, the rest is still a work in progress. His inital sleep study had the AHI at 77 so even an 8 looks good for now.

[PhyllisBalboa]

Well, .I'm still having trouble with my VPAP. I keep thinking about what another member said about centrals need ventilation, not pressure. My obstructives are managed at a pressure of 8, but I'm still running at close to 13, despite bring my settings way down. I think I have to be more aggressive about the changes. Chest is really sore still after 4 months of therapy, and body is still cramping with all the swallowed air. I don't need blasts, I just need to breathe.

[retired_guy]

Phyllis, I know I have been seriously overruled about my feeling your pressure is to high. But what are your current numbers? CA's in particular? Yes, it is true that many people will see an increase in CA's if their pressure is lower. But it's also true that many people will see an increase in CA's if their pressure is too high. So, which is it for you? I don't know, but it doesn't sound like you're at that sweet spot yet.

Mom, it sounds like your husband is doing well. I think I'd very slowly, as in 1/2 a point at a time, try to reduce the range a little between the minimum and maximum. Min 4 is really too puny to be comfortable, so raising it a little should be ok. My opinion is the best results are usually found in a range of pressures but a fairly narrow range. Also, the "only on it 4-6 hours a night" needs to change. Anytime he's asleep, he needs to have the mask on and the machine running. Otherwise he's really compromising his body's ability to heal from the years of abuse.

But both of you are doing very well! Just keep up the good work and continue to refine gently until you arrive at cpap nirvana.

[PhyllisBalboa]

Phyllis, I know I have been seriously overruled about my feeling your pressure is to high. But what are your current numbers? CA's in particular? Yes, it is true that many people will see an increase in CA's if their pressure is lower. But it's also true that many people will see an increase in CA's if their pressure is too high. So, which is it for you? I don't know, but it doesn't sound like you're at that sweet spot yet.

Hmmm, I don't quite know who's overruling your feeling that my pressure it too high, because that's what I think, too! I think the main idea was for me to slowly, incrementally, lower pressure while I want to lower it faster and in bigger chunks. And, of course, my selected pressures are now quite lower than what my doctor ordered.

So all along this 4 months of VPAP, I have had no obstructives, and maybe 1 or 2 centrals the first 2 months. This past month I have hypopneas only, with AHI's of under 1, usually .2. Last night after dropping EPAP substantially, which lowered IPAP max, I had 1 hypopnea lasting 20 seconds. I could breathe better, but still having air forced down my throat. So I'm lowering EPAP pressure again tonight.

I have a new response from vsheline on my own thread, very detailed, so I'll reread it about 3 more times and follow his advice as well.

Thanks, retired guy, for giving me added support for my approach in lowering pressures.

[Whitewabit]

Retired_Guy .. don't think you have been over ruled! .. With my very limited experience with CPAP I also feel doctors should start on the lower settings for people who's Hypopnea's are more central in nature then obstructive. And people with other breathing conditions should be given lower pressures to allow their weaker the normal lungs a chance to respond to treatment without causing the patient soreness to their chest muscles.

I am having a terrible time with my machine. Settings were first set in the ASV mode for EPAP 5 Min, PS 4, Max PS 15, these made my chest/lung muscles very sore to the point it hurt to take a breath . Even a shallow breath hurt somewhat. I am now some what gun shy because of this. where if my setting would have been set to the lower setting so I could get use to them .. it seems would have been much better and much less painful!

My settings have been lowered to EPAP 4 Min PS 3, Max PS 8, but have been so sore have not use it at these settings yet. Waiting to recover to start with it again without having discomfort, which will be this evening . Can't go much lower on the settings so I have to make this work.

Last time I used it was for 52 minutes with 38 minutes of it I was in sound asleep. and must say was sleeping good, levels were all low and flat, when the power went out in a thunderstorm, and was quickly awaken because of lack of air coming from the machine. Power didn't come back for 5 hours so went to sleep with out it for the rest of the night.

So am hopeful now with the lower settings, and not using it2 days to allow recovery of soreness, I will be able to use it without it causing the discomfort it had been causing..

[retired_guy]

Oh it's ok to be overruled... By that I mean from the beginning I have felt Phyllis belonged at a setting very near 8 for epap and ipap. It was pointed out, and rightly so, that such a low pressure might not address her CA's. But I still have this nagging doubt that her difficulties are with CA's, other than pressure induced CA's. So I'm pleased to see her pressures being modified gently lower.

But let me say Vaughn is a really sharp cookie! His advice (albeit a little wordy) is top of the line around here. We're really blessed to have him as a resource for us.

And rabbit? Do you have a nice "comfy chair" you could sleep in when the power goes gunny sack? That would be a help at least. Other than that, maybe a loving spouse with a bicycle pump? Just a thought.