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Advice on Pressures
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roady666 Offline

Members

Posts: 8
Joined: Dec 2012

Machine: Resmed Autoset Sprit 11
Mask Type: Nasal pillows
Mask Make & Model: Puritan Bennet Breeze
Humidifier: none
CPAP Pressure: 9 - 17
CPAP Software: ResScan

Other Comments:

Sex: Male
Location: Scotland

Post: #1
Advice on Pressures
Hi Everyone, wicked board!!!

Advice on Pressures:-

I live in the UK, I see the sleep clinic once per year to have the machine checked and a short chat with a nurse. My pressures have not been adjusted since I got this machine 3 years ago.
Only just discovered (from this board) how to gain access to the clinician's menu. I'm looking at obtaining a smart card reader. In the mean time.

cpap pressure 6 - 15

30 Day readings
Press 11.2
Leak .4 l/s
AHI 11
AI 1.7
HI 9.5
This past couple of years I tend to have broken sleep wakening briefly maybe 2 or 3 times a night can't pin down why!
Don't feel I have as much energy as I used to have.
After reading a number of posts I'm wondering if I should try adjusting the settings?
Any advice would be much appreciated!

Cheers
John
12-29-2012 06:21 PM
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hunningsedaniel Offline

Preferred Members

Posts: 28
Joined: Dec 2012

Machine: S9 VPAP Auto
Mask Type: Full face mask
Mask Make & Model: fisher & pakal flexifit 432 Humidifier: H5i
Humidifier: H5i
CPAP Pressure: 14 - 21 cm H2O PS=4
CPAP Software: ResScan SleepyHead

Other Comments:

Sex: Male
Location: United States

Post: #2
RE: Advice on Pressures
(12-29-2012 06:21 PM)roady666 Wrote:  Hi Everyone, wicked board!!!

Advice on Pressures:-

I live in the UK, I see the sleep clinic once per year to have the machine checked and a short chat with a nurse. My pressures have not been adjusted since I got this machine 3 years ago.
Only just discovered (from this board) how to gain access to the clinician's menu. I'm looking at obtaining a smart card reader. In the mean time.

cpap pressure 6 - 15

30 Day readings
Press 11.2
Leak .4 l/s
AHI 11
AI 1.7
HI 9.5
This past couple of years I tend to have broken sleep wakening briefly maybe 2 or 3 times a night can't pin down why!
Don't feel I have as much energy as I used to have.
After reading a number of posts I'm wondering if I should try adjusting the settings?
Any advice would be much appreciated!

Cheers
John
Hi John. Welcome to the board. You said that you visit the sleep center once a year. But when was your last sleep study done? Before I started changing the pressures inadvertently, I would try to get another sleep study done so that you have a good baseline to start from. If you start trying to make educated guesses at pressure settings, you could do more harm than good. I went for six years without a sleep study and boy was I glad to see my doctor. My old settings were so far out in left field that I could have done some real damage trying to guess at new ones. Well, that's my two cents. Good luck. Keep us posted.Oh-jeezSleep-well
12-29-2012 07:19 PM
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trish6hundred Offline

Advisory Members

Posts: 6,449
Joined: May 2012

Machine: Resmed S9 AutoSet for Her
Mask Type: Full face mask
Mask Make & Model: Fisher & Paykel Simplus
Humidifier: H5i Heated Humidifier
CPAP Pressure: 10 - 7-20 Cm H2O
CPAP Software: Not using software

Other Comments: I started CPAP in 2008. Totally blind since birth.

Sex: Female
Location: Missouri, USA

Post: #3
RE: Advice on Pressures
Hi roady666 and WELCOME! to the forum.!
Hang in there for more suggestions and best of luck to you.

trish6hundred
12-29-2012 07:26 PM
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JJJ Offline

Advisory Members

Posts: 751
Joined: Apr 2012

Machine: ResMed S9 Autoset
Mask Type: Nasal mask
Mask Make & Model: Most recent: Wisp, Pilairo, Mirage Vista
Humidifier: ResMed S9 Autoset
CPAP Pressure: 17-20
CPAP Software: SleepyHead

Other Comments:

Sex: Male
Location: USA 97217

Post: #4
RE: Advice on Pressures
(12-29-2012 06:21 PM)roady666 Wrote:  Advice on Pressures:-
I live in the UK, I see the sleep clinic once per year to have the machine checked and a short chat with a nurse. My pressures have not been adjusted since I got this machine 3 years ago.
Only just discovered (from this board) how to gain access to the clinician's menu. I'm looking at obtaining a smart card reader. In the mean time.
cpap pressure 6 - 15
30 Day readings
Press 11.2
Leak .4 l/s
AHI 11
AI 1.7
HI 9.5
This past couple of years I tend to have broken sleep wakening briefly maybe 2 or 3 times a night can't pin down why! Don't feel I have as much energy as I used to have.
After reading a number of posts I'm wondering if I should try adjusting the settings?

John,

If your machine is set to 6-15 cm. H2O that is close to wide open. Most people find that narrowing it to a range of 5 or 6 works better.

Also, if your AHI averages 11, you need some kind of adjustment, and that probably means a higher bottom pressure. However, it looks like most of your events are hypopneas rather than obstructive apneas, and hypopneas are not as detrimental.

Does your machine indicate what range the machine ran over the course of a night? If it gives you figures for a night of, say, starting at 6 and peaking at 12, then, for at least that night, having the upper limit higher than 12 was unnecessary. Look at every day and take note of the highest pressure it got to. Then set your maximum a bit higher.

Once you know the maximum it gets to, then you know for sure that such a pressure will not harm you, so you can safely increment the lower pressure. I'd start by raising the lower pressure by just 1 cm. H2O and leave it at that for at least a couple weeks to see the trend. If your overall AHI goes down, consider increasing by another 1 cm. H2O, and so on every couple of weeks.

Above all, be scientific. Don't make two or three changes at once, because even if you get better results, you won't know which change made the difference. Make just ONE change and leave it for a couple of weeks to see what trend develops.
12-29-2012 07:58 PM
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zonk Offline

Advisory Members

Posts: 7,908
Joined: Feb 2012

Machine: A10 AutoSet
Mask Type: Nasal mask
Mask Make & Model: Activa LT
Humidifier: Integrated /ClimateLineAir
CPAP Pressure: 9/13
CPAP Software: ResScan

Other Comments: CPAP since Nov 2010

Sex: Male
Location: Australia

Post: #5
RE: Advice on Pressures
95% percentile pressure - at and below 11.2 for 95% of the time, indicate to me ... leave the maximum pressure unchanged

maybe increase the minimum pressure and see what happens
it ADVISED to do any adjustment in small increment over period of time

S9 measure leak in L/min _________ .4 L/s = 24 L/m

95% percentile leak ... at and below 95% of the time
Resmed define acceptable leak at and below 24 L/m
cannot tell how long stayed there without looking at the graph but might not be big deal
12-29-2012 07:58 PM
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Sleepster Offline
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Moderators

Posts: 4,995
Joined: Feb 2012

Machine: ResMed AirCurve10 VAuto
Mask Type: Full face mask
Mask Make & Model: F&P Simplus
Humidifier: HumidAir and SlimLine Hose
CPAP Pressure: MaxI 13.6 | MinE 5.2 | PS 4.4
CPAP Software: ResScan SleepyHead

Other Comments: Diagnosed Nov 2011. Conquered aerophagia.

Sex: Male
Location: Houston, Texas

Post: #6
RE: Advice on Pressures
I agree with zonk. Your hypopnea index is high, which is an indication that the pressure is too low.

Sleepster
Apnea Board Moderator
www.ApneaBoard.com


INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED AS MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEB SITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
12-30-2012 12:36 AM
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roady666 Offline

Members

Posts: 8
Joined: Dec 2012

Machine: Resmed Autoset Sprit 11
Mask Type: Nasal pillows
Mask Make & Model: Puritan Bennet Breeze
Humidifier: none
CPAP Pressure: 9 - 17
CPAP Software: ResScan

Other Comments:

Sex: Male
Location: Scotland

Post: #7
RE: Advice on Pressures
Thanks for the advice!!!

Just before getting this machine I requested they check me out again, their idea of a check was to send me home with an oximeter for one night!!!

I am going to slowly increase the lower setting and see what happens over a period of time. It would appear the only place I can obtain a data card reader is from Israel as trying to get an acr38 with the right firmware version will be difficult.

Cheers
John
12-30-2012 10:06 AM
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Shastzi Offline

Advisory Members

Posts: 1,174
Joined: Dec 2012

Machine: ResMed S9 Autoset
Mask Type: Full face mask
Mask Make & Model: FitLife Total face mask
Humidifier: F&P HC150 with Hybernite heated hose.
CPAP Pressure: 15cm-20cm H2O (auto)
CPAP Software: SleepyHead Other Software

Other Comments: CMS50-F wearable Oximeter; Software: SPO2 Assistant

Sex: Undisclosed
Location: Florida, USA.

Post: #8
RE: Advice on Pressures
Hi Roady666!
Every group has a heretic and that is me. =^.^=
All I have is a RemStar Plus (yes. dumb as a brick)
(when I can save up more I'll snag a better device but I need something *NOW*)
(I'm doing it this way since I need more time to shop for insurance and I can't afford the thousands
of $$$ required for formal studies just yet)
So I use that with a CMS50-F wearable oximeter *every night*.
I adjust pressure using a portable digital manometer so I know what I am getting as far as actual output.
I set the pressure based on number & severity of actual oxygen desaturation events.
This is harder & takes more time to deal with but... it works!
(as long as one does not suffer from neurological based central apneas!)
The folks here that run on monitoring pressures every night are experienced and wont steer you wrong.
The key word here is *nightly monitoring*.

Unfortunately most doctors and clinics dont realize this or just dont care once they have had a go at your wallet.
(Pathetic)
A yearly checkup for your machine is good, but only you can make a difference in keeping a watch over how well the machine is working for YOU.
I don't tink SleepyHead software works with the ResMed S8 so you might want to push for getting an S9 so you can start monitoring pressures and airflow.
If you can't get the S9, you might want to pick up a CMS50-F and use that for montoring how well things are going each night.
People DO change over time and their pressure needs will change accordingly.

The price for a good nights sleep is eternal vigilence.
Hang in there and keep up the good fight!

Cheers!

=^.^=
12-30-2012 11:04 AM
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zonk Offline

Advisory Members

Posts: 7,908
Joined: Feb 2012

Machine: A10 AutoSet
Mask Type: Nasal mask
Mask Make & Model: Activa LT
Humidifier: Integrated /ClimateLineAir
CPAP Pressure: 9/13
CPAP Software: ResScan

Other Comments: CPAP since Nov 2010

Sex: Male
Location: Australia

Post: #9
RE: Advice on Pressures
(12-30-2012 10:06 AM)roady666 Wrote:  Thanks for the advice!!!

Just before getting this machine I requested they check me out again, their idea of a check was to send me home with an oximeter for one night!!!

I am going to slowly increase the lower setting and see what happens over a period of time. It would appear the only place I can obtain a data card reader is from Israel as trying to get an acr38 with the right firmware version will be difficult.

Cheers
John
S8 autoset respond to snore or flow limitation but not to hypopnea
S8 does not differentiate between different types of apnea
hypopneas that are central in origin (not obstruction) should not be treated with increased pressure

I would suggest save your money on getting the S8 smart card reader and put towards getting an S9 autoset
if for some reason there is no hope of getting one thru NHS

probably you can get low hours used S9 autoset with humidifier and both hoses (climateline and slimline) delivered at your door US$600
see Supplier #2 http://www.apneaboard.com/forums/Thread-CPAP-Supplier-List
12-30-2012 02:59 PM
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vsheline Offline

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Posts: 1,908
Joined: Jul 2012

Machine: S9 VPAP Adapt (USA Model# 36007, not better 36037 or 36067)
Mask Type: Full face mask
Mask Make & Model: F10 or SimPlus w/ 2Liners. MirageQuatro & Gecko gel pad
Humidifier: H5i
CPAP Pressure: 15 EPAP, PS 5-10
CPAP Software: ResScan

Other Comments: Marfan Syndrome, chronic bradycardia, occasional Cheyne-Stokes Respiration

Sex: Male
Location: California, USA

Post: #10
RE: Advice on Pressures
(12-30-2012 02:59 PM)zonk Wrote:  S8 does not differentiate between different types of apnea
hypopneas that are central in origin (not obstruction) should not be treated with increased pressure

Well, actually, although the S8 AutoSet II does not report obstructive versus non-obstructive events and does not support waveforms (plots) of the air Flow into and out of the lungs, and therefore is missing important tools which can help us figure out our breathing problems, it *does* distinguish between obstructive apneas versus non-obstructive apneas.

Although the S8 AutoSet II (unlike the S9 AutoSet) does not *report* a breakdown showing the number of obstructive events versus Unknown or Central events, the S8 AutoSet II (like the S9 AutoSet) only raises the pressure when it classifies an event as being obstructive in nature.

I know this because I have Complex Sleep Apnea and for years I used an S8 AutoSet II with the special card reader and ResScan software sold me by my doctor, and the machine would often decline to raise the pressure in response to clusters of apnea events. With my S9 machine, I now can see that when this occurs these are clusters of what the S9 reports as being Central Apnea events. Looking at the high rate Flow waveforms using ResScan or SleepyHead, I can now see that I often have long periods of Periodic Breathing or Cheyne-Stokes Respiration.

I have been working for 4 months on getting my Complex Sleep Apnea documented and diagnosed, getting an "ASV Titration" done and getting an Adaptive Servo Ventilation machine ordered, and I expect to receive an S9 VPAP Adapt machine soon.

I have been successful in getting a prescription for an ASV machine because of the more complete data reported by the S9 system compared to the S8 system (and because of the knowledge gained from Apnea Board), but my old S8 was not mistreating my Central Apneas by treating them like Obstructive Apneas.

Take care,
Vaughn

Membership in the Advisory Member group should not be understood as in any way implying medical expertise or qualification for advising Sleep Apnea patients concerning their treatment. The Advisory Member group provides advice and suggestions to Apnea Board administrators and staff on matters concerning Apnea Board operation and administrative policies - not on matters concerning treatment for Sleep Apnea. I think it is now too late to change the name of the group but I think Voting Member group would perhaps have been a more descriptive name for the group.
(This post was last modified: 12-31-2012 06:50 AM by vsheline.)
12-31-2012 05:47 AM
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