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+--- Thread: seems like I need to raise max pressure? (/Thread-seems-like-I-need-to-raise-max-pressure)
seems like I need to raise max pressure? - yankees123 - 02-26-2018
I have been using a resmed airsense 10 autoset for the past 4 months. My recent settings for the past 6 weeks are: epr 3
min 11
max 15
no ramp.
I have been getting ahi for past 30 days of 1.38.
The reason I felt I had to change pressures is I have not been waking up rested since I have been on therapy for about 2 years. Had a recent sleep lab which showed that the settings are controlling my osa.
I have noticed that my 95% pressures were close to the max setting so I decided to raise my max pressure to 16 and my min pressure to 15.4. The last 3 nights show again that my 95% pressure is close to max setting.
Please help as I don't know where to go from here.
Thanks
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https://i.imgur.com/mm9DctC.png
https://i.imgur.com/nD4yxL6.png
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RE: seems like I need to raise max pressure? - dwd1249 - 02-26-2018
I would just set it to 20 and see where it goes from there.
RE: seems like I need to raise max pressure? - Sleeprider - 02-26-2018
I disagree your maximum pressure is a problem. Your fatigue may not come from apnea, but from a fragmented night of sleep that never approaches a total of 8-hours. You tend to sleep less than 7 hours and that is broken into at least 3 sessions. Everytime your pressure goes higher, you break therapy, indicating an arousal, so higher pressure may not be your answer. Your AHI is consistently less than 2.5 and often less than 1.5. Pressure is not the answer, sleep is.
You consistently break therapy and turn off the machine when the pressure goes above 12-cm, so increasing your potential pressure to 20 is hardly a solution. I think you need to limit maximum pressure to 12, and turn EPR down to 2. That should reduce CA and OA without crossing that pressure border that seems to disrupt your sleep. I actually think you can trade events for more sleep if necessary. The point of this therapy is to restore your sleep, and if pressure wakes you up, then that's working against the goal. If you have difficulty remaining asleep, you might want to talk to your doctor about a sleep aid that is safe and helps you get at least the 7.5 to 8-hours of sleep you probably need without interruption. A low AHI like yours is not the problem. Sleep disruption and arousals are.
RE: seems like I need to raise max pressure? - Gideon - 02-26-2018
What I see are great numbers, but pressure is responding to and following Flow Limits.
I think you should raise min pressure slowly and monitor. Increase min pressure by .4 cmw. The purpose is to see if the Flow Limitation is the cause of your restlessness.
Fred
RE: seems like I need to raise max pressure? - yankees123 - 02-26-2018
I agree a lot with what you are saying sleeprider. I would like to sleep a straight 7 or 8 hours without waking up that is disturbing my sleep. If I set my maximum pressure to 12 and epr to 2,what should I set my minimum pressure to?
You are correct that raising the pressure could be the problem because I suffered from aerophagia when the pressure was set to high.
Thank you for your advice.
RE: seems like I need to raise max pressure? - yankees123 - 02-26-2018
Sleeprider do you agree with bonjour that flow limitations are a problem?
RE: seems like I need to raise max pressure? - Gideon - 02-26-2018
(02-26-2018, 09:59 PM)yankees123 Wrote: Sleeprider do you agree with bonjour that flow limitations are a problem?
I was proposing a test to see if, in your case, FL was increasing your restlessness. I do noknow.
Fred
RE: seems like I need to raise max pressure? - yankees123 - 02-26-2018
Bonjour you are correct that flow limitations have been a problem in the past. I would like to first try what sleeprider says and reduce my max pressure and see if I can sleep without interruptions.
I would like to start new pressures tonight but need help what my min pressure should be since I reducing epr from 3 to 2.
Thanks for all your help.
RE: seems like I need to raise max pressure? - Sleeprider - 02-26-2018
I don't see significant flow limitations in your case, and they don't provide particularly good warning of impending OA events. Pressure does rise for flow limitation, but just as often, OA is present before a flow limitation is recorded. I am usually an advocate of using EPR, but in your case, I see a starting pressure of 11/8 (IPAP/EPAP), that seems not to rise, even when obstructive events occur. When pressure does rise, I see breaks in therapy.
There are alternative ways of getting to where these pressure increases are not as disruptive, and one is to increase overall pressure; and another is to cut some EPR. I don't honestly know what will work best for you. I see a need for a bit higher EPAP for the obstructive events, so the approach of increasing pressure looks equally promising. You really don't have a CA problem. Fred's proposal to increase minimum pressure actually achieves the same effect as reducing EPR. I think the real question is what will make you sleep most soundly and prevent the pressure increases that disrupt your sleep.
I would say, you do NOT want to increase maximum pressure, but either reducing EPR or increasing minimum pressure should address the bumps in the road that seem to wake you up. I still think there is some merit in limiting maximum pressure to 13 or so. Dont be discouraged, that you still feel tired. You are really in the fine-tuning stage and getting pretty close. We want to find the least disruptive settings that preserve your good results. In that regard, Fred and I are on the same page.
RE: seems like I need to raise max pressure? - yankees123 - 02-26-2018
Thanks sleeprider. I will set 8/11 with epr 2 and post data in a few days.
Again thanks so much for all your help.