How to have the S9 Autoset to react faster?

[robysue]

My wonder? In the above thinking, if the 95% rate is '10', why not set it to '11' - assuming it does not create any new issues like CAs and the like?

Because over titration can lead to comfort problems as well as increasing the probability of central apneas.

It's just not true that "more pressure" is always better.

[robysue]

First, I can't see the posted data.

Next you write:

Hi, first, thanks a lot for the insightful responses. My pressure varies quite a bit, but typically the Max stays between 10 and 15. 95% varies between 8 (rarely) and 14. For the last month or so the 95% has been 9-12.

A starting pressure of something in the neighborhood of 8-9 will probably be better than a starting pressure of 6.

Mostly the leak is low (way less than 10L/min), 95% mostly 1-5. The catch is that I have to strap the mask very tight to prevent leaks but sometimes it just hurts too much and I loosen them up and cope with waking up multiple times with leaks.

If the mask hurts, it's the wrong mask.

Seriously, if you have to tighten the mask to the point of pain, there's something wrong with the mask choice. And mask pain could be part of what's triggering the migraines rather than the stray H or OA getting by the PAP defenses.

[zonk]

My wonder? In the above thinking, if the 95% rate is '10', why not set it to '11' - assuming it does not create any new issues like CAs and the like?

95th percentile 10 does not mean pressure was 10 all night long, mean pressure was at or below 10 for 95% of the night
how long was at 10, cannot tell without seeing the detailed data graphs

i think, you need at least 3 months worth of data to make any sense of the data. in the past my 95th was about 18, now on average sit on 11
things take time just like good bottle wine, improves over time

[trish6hundred]

Hi jty, WELCOME! to the forum.!
Hang in there for more responses to your post and best of luck to you.

[diamaunt]

It's just not true that "more pressure" is always better.

what? you mean I shouldn't have set mine on 25 and left it there?

I'M JUST KIDDING!!!

[archangle]

My wonder? In the above thinking, if the 95% rate is '10', why not set it to '11' - assuming it does not create any new issues like CAs and the like?

Because over titration can lead to comfort problems as well as increasing the probability of central apneas.

It's just not true that "more pressure" is always better.

I agree with robysue. However, a higher pressure is sometimes worth trying. I'm convinced I feel better with my minimum pressure set a bit higher than the AHI numbers would suggest. I'm guessing that I get some distress from a partially compressed airway even if it doesn't trigger actual apneas. I guess this could also be some form of UARS or RERA's.

[Sleepster]

I'm guessing that I get some distress from a partially compressed airway even if it doesn't trigger actual apneas. I guess this could also be some form of UARS or RERA's.

Of course you have UARS (aka Flow Limitation). You have to have that to have hypopneas and apneas. It's not like your airway goes from fully open to fully closed. On the way it's first restricted enough to cause flow limitation and then hypopnea, even if they don't last long enough to score.

If the airway stops collapsing before it becomes restricted enough to become a hypopnea and stays there you've got flow limitation. It should show up on the flow limitation graph, you can see it in the waveform, and the fact that it triggers a rise in pressure makes it easier to find on the waveform.

How much distress this causes in terms of desat and arousal (RERA) is just about impossible to determine without sleep lab equipment. An oximeter might help.

The only way to have the S9 Autoset react faster to these events is if the pressure is already reasonably high when they occur. Then they are stiopped faster and are also less likely to occur.

All this has to be weighed against any issues such as aerophagia or centrals that might be caused by the higher pressure.

Stepping up to the S9 VPAP Auto might be worth a try, too.

[jty]

People, thank you for your insightful responses. I learned more about my specific condition here than visiting a specialist who did not bother to look into the details.

First, I can't see the posted data.

I apologize, the Forum did not let me add links to the images.
Attached the summary report, it takes up all my allowed attachment space.

The detail reports should be visible by copy pasting the links below to the web browser:
1drv.ms/1oyFD7j
1drv.ms/1jmHQWf
1drv.ms/1jmHWx8

[jty]

If you can't make peace with the full face mask, you might consider a pillows mask such as my favorite, the Resmed P10. Yeah, yeah, I know,,,, can't breath through your nose --- all of that. Me too. That was my battle cry clear up until I actually did use them. Will never go back!

if you have to overtighten the straps to get better seal, more likely the mask is the wrong size/type, not fitting correctly, or cushion worn out
try another mask, don,t torture yourself

I get a few apneas from leaky masks. I use a full face mask. Remzzs, chin straps and Geckos all work to reduce leaks and lower the number of events.

Thanks guys for the suggestions, I am working on my nasal issues to be able to use the nasal pillows with the chin strap. Looking forward for that to help

[robysue]

jty,

Could you zoom in on that cluster of events that took place between about 1:45 and 2:15 in the figure at

https://onedrive.live.com/?cid=67F09A01B...Fta_CI&v=3