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How do I know if pressure is too high?
#1
How do I know if pressure is too high?
So, I've used BiPap for a few years but over the last year and a half I've noticed that I'm feeling pretty bad. So I got a new machine and I'm actually looking at my data again. However, it's been so long that I can't remember how I can tell if my pressures are too high or low. My AHI was under 1, but I had a ton of vibratory snores and my IPAP was on average right at 20cm. And my EPAP was on average above 16cm Does this mean that I should increase my IPAP and EPAP a smidge? Also, any idea on how to decrease leak rate? I had a leak rate of 20%. Any advice for an old newbie would be appreciated. 

                                                                                 Thanks
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#2
RE: How do I know if pressure is too high?
You have the DS760 auto BiPAP, so it will respond to snores by increasing pressure. It would be very helpful if you could upload your daily detail chart to Imgur and post a link here (you may need to add a space in the link until you become a Member at 4+ posts. Instructions for posting are in the first two links in my signature.

We sometimes recommend limiting the upper range of pressure on auto machines where residual snoring is present. It might be possible to find a lower EPAP pressure that controls obstructive apnea, and use pressure support to resolve flow limitation and snores. All we know from your profile is 16-20. Your machine should have a setting for mode, EPAP minimum, PS minimum, PS maximum and IPAP maximum. I will assume you are in BAuto mode since the pressure is increasing uncomfortably.

Please post back with a chart or more details, and we'll try to work it out.
Sleeprider
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#3
RE: How do I know if pressure is too high?
(09-15-2017, 08:15 AM)Sleeprider Wrote: You have the DS760 auto BiPAP, so it will respond to snores by increasing pressure.  It would be very helpful if you could upload your daily detail chart to Imgur and post a link here (you may need to add a space in the link until you become a Member at 4+ posts.  Instructions for posting are in the first two links in my signature.

We sometimes recommend limiting the upper range of pressure on auto machines where residual snoring is present. It might be possible to find a lower EPAP pressure that controls obstructive apnea, and use pressure support to resolve flow limitation and snores. All we know from your profile is 16-20.  Your machine should have a setting for mode, EPAP minimum, PS minimum, PS maximum and IPAP maximum.  I will assume you are in BAuto mode since the pressure is increasing uncomfortably.

Please post back with a chart or more details, and we'll try to work it out.

https://imgur.com/a/GJCLX

Thanks for the reply. I've included the link. Let me know if you need the rest of the charts as well. I should clarify that I am on BAuto mode. Also the pressure isn't uncomfortable so the title to my post is misleading. I was curious if it was too high or too low. Should have included that. Sorry. But thanks again.
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#4
RE: How do I know if pressure is too high?
It would help for you to post a complete daily graph with the summary statistics in the left column.  In Sleepyhead, the screenshot can be taken by pressing F12 and the screenshot will be saved in your My Documents/Sleepyhead/Screenshots directory.  

Let's start with this:  Here we see in the flow rate that you are starting out with a ramp pressure of 8.0/4.0 at 10 minutes, and the machine is increasing immediately to 20/16.  During ramp you have numerous apenea and hypopnea until the pressure reaches approximately 16/12, so we know that if you want to continue using ramp, you will need to reset the minimum ramp pressure to 10 or 12 to avoid those events just as you fall to sleep. Once you are at pressure, all we see is snores with a single hypopnea.  Snores tend to cluster and the flow rate irregularity suggest some possible posture issues may be playing a role. Note it makes a differnce if those snores are VS2 or VS. Without the event chart we don't know, but we can pretty much disregard VS2 events.

[Image: gx6i1LP.png]

Moving on, we see that during ramp you have an abundance of snores, and your leak rate is less than ideal through the night.  These leaks are disturbances in the FFM seal and may be related to movement, or perhaps your cushion needs cleaned or replaced, or a different size and model may even be needed.

[Image: BImEIPn.png]

Your graph does not include the machine settings, but if your are in auto mode, then it appears your settings preclude any movement of pressure, and my guess is that EPAP is set at 16.0, PS min 4.0, PS max 4.0 and IPAP max at 20.  Overall, your therapy is working well, and if we clean up the period during ramp, you really don't need other changes other than for comfort.  I think  you might benefit from a soft cervical collar with a relatively loose fit to prevent your head and neck from going out of alignment which might be affecting snores and mask fit.  If you want to try that, they range from $10 to $20 and you want to allow for a fit 2 inches larger around than your neck measurement, and an inch  so shorter. than your measurement from the base of the neck to the base of your chin just above the adam's apple.

Increase ramp pressure to at least 12.  If you want to try some other things, lets go with EPAP min of 14, PS min 3, PS max 5 and IPAP max 22.  That will retain most favorable features of your current therapy and allow pressure to fluctuate to address hypopnea and snores.  I will be curious to see how the machine responds.
Sleeprider
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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.
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#5
RE: How do I know if pressure is too high?
Thanks so much for the help. I feel foolish. I thought I had it set to auto,  but doh!. I went ahead and went with your suggestions. I was just speaking with my wife and I do believe you're correct about the posture being responsible for the leaks. My wife says that I "tuck my chin" so I'll try and work on that. I included the full screenshot. It has the pressure that I used to start the day which was far too low and doesn't show the updated pressure of 16. Let me know if you have any other suggestions. Thank you so much for your help.

https://imgur.com/a/Rkvxw
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#6
RE: How do I know if pressure is too high?
Also. both the PS min and max were set to zero. The max for both is 3.5 should I set the max at 3.5 and the min at 2?
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#7
RE: How do I know if pressure is too high?
Now we're talking!  Your settings are on FIXED bilevel (BiPAP-S) at 20/14 for a huge PS of 6.0, we want to switch to AUTO and make things a bit more comfortable.  The snores are VS2 which are not a significant concern and won't affect your therapy.  Note that your settings show 20/14, but the chart and stats clearly show 20/16.  One last little detail, if you turn off the pie chart in the Sleepyhead menu File/Preference/Appearance and uncheck the pie chart, we will see more respiratory statistics.

[Image: n3IrQSV.png]

I'm sticking with my original suggestions for Auto mode, EPAP min at 14, PS min at 3, PS max at 5 and IPAP max at 20.  If this avoids OA and hypopnea, we might try a lower EPAP Min pressure.  This should give you some relief from your current pressure and I think we can consider lowering that again. It's interesting, I think I picked the settings you were intended to have since EPAP is set at 14 and PS at 3.5. The problem here is the use of fixed BiPAP mode.

On your pressure support settings, I think minimum PS 3 will be more comfortable than 2, and I would like to let the machine increase that based on the auto algorithm.  It may not change much considering you don't have much hypopnea once we get out of ramp. These setting will start you at 17/14 (IPAP/EPAP). That is a bit lower than the 20/16.5 if your PS was 3.5. Pressure support serves the purposes of increasing comfort, and higher pressure support will treat hypopnea and flow limitation. So starting you off at a PS of 3 allows us to see if the machine algorithm detects issues that cause a pressure support increase. It's up to your if you want to continue using ramp. It didn't work out so good for you in the session shown here. Starting at the higher ramp pressure should help, but it really depends on whether you tolerate the therapy pressures or need ramp to get there.
Sleeprider
Apnea Board Moderator
www.ApneaBoard.com

____________________________________________
Download OSCAR Software
Soft Cervical Collar
Optimizing Therapy
Organize your OSCAR Charts
Attaching Files
Mask Primer
How To Deal With Equipment Supplier


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.
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#8
RE: How do I know if pressure is too high?
(09-15-2017, 10:42 AM)Sleeprider Wrote: Now we're talking!  Your settings are on FIXED bilevel (BiPAP-S) at 20/14 for a huge PS of 6.0, we want to switch to AUTO and make things a bit more comfortable.  The snores are VS2 which are not a significant concern and won't affect your therapy.  Note that your settings show 20/14, but the chart and stats clearly show 20/16.  One last little detail, if you turn off the pie chart in the Sleepyhead menu File/Preference/Appearance and uncheck the pie chart, we will see more respiratory statistics.

[Image: n3IrQSV.png]

I'm sticking with my original suggestions for Auto mode, EPAP min at 14, PS min at 3, PS max at 5 and IPAP max at 20.  If this avoids OA and hypopnea, we might try a lower EPAP Min pressure.  This should give you some relief from your current pressure and I think we can consider lowering that again.   It's interesting, I think I picked the settings you were intended to have since EPAP is set at 14 and PS at 3.5.  The problem here is the use of fixed BiPAP mode.

On your pressure support settings, I think minimum PS 3 will be more comfortable than 2, and I would like to let the machine increase that based on the auto algorithm.  It may not change much considering you don't have much hypopnea once we get out of ramp.  These setting will start you at 17/14 (IPAP/EPAP). That is a bit lower than the 20/16.5 if your PS was 3.5.  Pressure support serves the purposes of increasing comfort, and higher pressure support will treat hypopnea and flow limitation.  So starting you off at a PS of 3 allows us to see if the machine algorithm detects issues that cause a pressure support increase.  It's up to your if you want to continue using ramp.  It didn't work out so good for you in the session shown here. Starting at the higher ramp pressure should help, but it really depends on whether you tolerate the therapy pressures or need ramp to get there.

You're absolutely right! Huge help. I should have come here sooner. I've actually been a BiPap patient for 8 or so years and have had an auto machine for the majority of the time that I never thought to use because by and large I felt fine. Complete waste of money. If it's there I might as well use it. Thanks again for your help!
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#9
RE: How do I know if pressure is too high?
Hi gimmedaREM,
WELCOME! to the forum.!
Good luck as you continue CPAP therapy and also with getting your settings find-tuned to meet your needs.
trish6hundred
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