Raise max pressure or leave it alone?

[big_dave]

       

I replaced my 60-series System One Autos (I had two) with a new Airsense 10 Autoset, and began using it on February 1. On 5 out of 17 nights, my pressure has maxed out for 30-60 minutes before dropping. Also, on 3 of those 5 nights, I had substantial snoring at that time. Last night (Sunday, February 18) was the worst one, with the pressure running high for an unusually long time. On about half of the nights, the pressure stayed near the bottom of the range for most of the night. I am leaning toward increasing the maximum pressure but I would like to hear other opinions first.

The 12-16 range I have been using is far lower than the 15-20 I was using on the System One. A minimum of 12 was entirely ineffective on the System One, but mostly works well on the Airsense 10. I will say that my sleep quality has improved noticeably with the Airsense 10, although I woke up a bit groggy this morning.

You may notice that February 5 is missing. I used an S8 Autoset II that night while trying to decide whether to use it as a backup machine, or purchase a second Airsense 10 Autoset. I switched to the second Airsense 10 on February 8.

Thanks in advance for your insight!

[PeaceLoveAndPizza]

Good to hear you are enjoying the Airsense 10 Autoset. It is a quite solid machine.

Before raising your maximum pressure, try increasing your EPR from 2 to 3. The pressure is increasing in response to flow limitations in an attempt to stop apnoeic events from occurring. A bit more pressure support may be enough.

Your grogginess is likely from your pressure swings, snores, and arousals. Let’s see how the additional pressure support helps before trying to change too many things at once.

[TexasDon]

Good to hear you are enjoying the Airsense 10 Autoset. It is a quite solid machine.

Before raising your maximum pressure, try increasing your EPR from 2 to 3. The pressure is increasing in response to flow limitations in an attempt to stop apnoeic events from occurring. A bit more pressure support may be enough.

Your grogginess is likely from your pressure swings, snores, and arousals. Let’s see how the additional pressure support helps before trying to change too many things at once.

But doesn't raising EPR from 2 to 3 decrease exhale pressure ?  My understanding is that EPR is subtracted from the "current at the moment" pressure to lessen the pressure during exhale.  So, if your at a pressure of 10 and your EPR is 2 ... then your pressure during exhale would be 8.  

I say all this because I just went from EPR 3 to EPR 2 to allow a higher pressure to support throat tissues during exhale.   Fighting flow limits.

[PeaceLoveAndPizza]

Yes, it does decrease EPAP (exhale pressure) by subtracting EPR from IPAP (inhale pressure). Which will typically reduce flow limitations and should help with the pressure swings. There are times it is appropriate to increase pressure when increasing EPR, but until we know how he responds to more pressure support best to change one thing at a time.

The goal here is to first manage FL’s, then based on the results determine whether increasing or decreasing pressure will help without causing other issues.

[TexasDon]

Yes, it does decrease EPAP (exhale pressure) by subtracting EPR from IPAP (inhale pressure). Which will typically reduce flow limitations and should help with the pressure swings. There are times it is appropriate to increase pressure when increasing EPR, but until we know how he responds to more pressure support best to change one thing at a time.

The goal here is to first manage FL’s, then based on the results determine whether increasing or decreasing pressure will help without causing other issues.

Oh gotcha.   I am struggling with FLs too.   Time to share ... I snore while using my cpap machine.   Yet some nights I hit an AHI of 0.2.   I've even scored an AHI of 0.0 a few times.   But typically I am worse and between 0.7 and 1.5.   Trying to convince my wife to make a sleep tape.    I'd like to know what I sound like and where the noise is coming from and how hard the machine is struggling.   Oscar data just isn't enough for me.  An Oscar user bootcamp would be pretty sweet.  

Thanks for the clarification.   I saw an EPR of 3 producing big pressure swings between EPAP and IPAP.   But this board has really been talking about IPAP swings due to circumstances like leaks and flow limits.   Big AHH HAA  moment for me.   I had it totally wrong. 

-d