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Is it okay to set min and max pressure as the same number?
#1
Is it safe to set your machine at 6 or 7 for both min and max pressure?   Let me explain...

I started my initial titration study through Kaiser last week.  I didn't think I'd have enough hours/data in that first week so we extended the trial one week, so that means I have another 7 days before my next appointment.  They can't see me sooner.  So I've been waking up a LOT with the machine.   Settings are minimum 6 and max 20.  When I wake up, I'll check the machine and it will be up at 7 or 8.  Once I saw 9 like three night ago.  I think the increased pressure is waking me up due to mouth leaks, or maybe just the pressure jars me awake.  It will say anywhere from 1-3 events per hour.   (I had severe dry mouth four and five nights ago but the humidair attachment they gave me fixed that problem.  Now I'm just getting lip leaks.  I tried taping my mouth last night but still gotten woken up over and over.) 

I'm considering setting it at like 6.8 for both min and max, and see how I do.  It may not take away all the events, but still be better than my 15.5 events per hour from my initial sleep study.  Hoping this might allow me to sleep through the night. 

Thoughts? 

(I left a message at Kaiser's sleep center with this question but haven't heard back)
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#2
Hello Mr Zennie

Making the min and max pressure the same is using your machine as a Constant continuous positive airways pressure. It is alright to do that but what at what pressure can only be ascertain by analysing your data through the free software Sleepyhead.

However should you be changing the pressure yourself during the period of a titration trial which you are undergoing? I am not familiar with your system which I am sure others would chime into with their views.

I had a not dissimilar 2 week titration trial monitored by the Sleep Clinic here after which a pressure was advised. But my own journey only truly began after that.

I prefer the use of a neck collar over the chin strap to help keep my mouth closed in association with the tongue suck technique.
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#3
It is safe, to set minimum and maximum pressures the same, and we do it pretty often on the forum. Changing pressures can be disruptive. Your machine also has a CPAP mode where you can select one fixed pressure.
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#4
Hi Mr. Zennie

Welcome to the forum.

Others have already answered your basic question about setting min and max to the same value.  Can do no problem.

My question back to you is:  Why would you want to invalidate your ongoing titration study by resetting the parameters, especially to a fixed pressure?   Seems like you asked for the extension to collect more data.  Your machine is responding to apneas by adjusting pressures. It's also collecting more data every night that will help you make informed decisions. You are getting AHIs in the 1 to 3 range.  These are all good things.

If you have an air leak problem, you should deal with that.  It probably won't go away at constant pressure.  More likely you need to work on eliminating the leaks.  Maybe in some sleep positions you are a mouth breather. Sometimes when the jaw relaxes it falls open.  That is a common cause of waking up with a dry mouth. I had it happen a lot early on. Sometimes my tongue and teeth were so dry that it took minutes swishing water in my mouth to get them moist again.  

You have suggested that it's the pressure changes waking you up.  Maybe it's the apneas which the pressure change is responding to that is waking you up. Or maybe it's the rushing air going out when your mouth opens that is waking you up.  Or it could well be pressure changes waking you up.  

Rather than setting a fixed air pressure I would try to address the other causes first. Especially if the range is only 3 (from 6 to 9).  At least let your titration study finish before you start messing with the knobs.  Then you will have some data you can use.  Unless you are feeling just miserable.

There's a certain amount of getting used to that you can expect first starting CPAP therapy, and adjustments to find the sweet spot. Those adjustments can include: finding your best sleeping position, learning (yes learning) how to sleep with your mouth closed, getting a bit of help with a chin strap, changing type of mask that works better for you, tweaking the comfort settings on your awesome machine (you do have an excellent machine), and tweaking the air pressure.

check out this thread for info about training your tongue to reduce air leaks, a technique I first heard about from Opal Rose on this forum, and which has been very helpful ... http://www.apneaboard.com/forums/Thread-...ining-help

I had big problems with air leaks when I started therapy.  Used full face masks and tried a few different ones over a couple of months. One day I added a chin strap, and mouth leaks stopped virtually overnight.  I was happy at that point but in a few weeks I wondered if I could migrate to nasal pillows (like you have now) and would the chin strap and tongue technique prevent leaks.  Worked like a charm, and so I have been sleeping most comfortably with the really light weight nasal pillows and a comfortable chin strap (Ruby chin strap btw), and never looked back. 

So be encouraged that the air leak / mouth breathing issues are workable.  Let your autoset machine do its thing to keep your AHI down, and you tackle the leaks.  You will surely make pressure adjustments based on data and good advice from experts in this forum over time.  For now I would suggest you take on the air leaks using other means described above. 

And celebrate your good fortune.  We all know what it takes for most of us to finally get evaluated and diagnosed with sleep apnea.  We know how miserable you must have felt. You have pretty good indications from the data that your AHI has come down significantly and best wishes that you feel as much better as the data suggests.  If you don't (yet) don't despair. Sometimes it takes a while for your body to adjust, plus you probably have a huge sleep debt from an extended time of poor sleep. 

The best part is (at least in my case) here comes a life changing therapy that doesn't involves drugs or surgery. Just a little boost in air pressure to keep your pipes open while you sleep.  I count my blessings every day for this amazing therapy, and for this community of generous experts who taught me how to get the most from my therapy. 

Saldus Miegas

p.s. download and install Sleepyhead software. You will have lots of actionable data and Sleepyhead will help you make sense of it. Plus sharing Sleepyhead reports here will make it possible for you to get some expert advice. You are on a good path with an excellent data capable machine. We would all encourage you to take charge of your therapy, learn how to understand your data, and get help from the folks in this forum who are all fellow apnea sufferers with lots to offer you.
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#5
Personally I didn't feel like my first week was super helpful to determine the correct pressure, it seemed like most of that was just getting used to the machine and whatnot. So I would encourage you to give it a little longer without going straight to a single fixed pressure.
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#6
(05-15-2018, 08:18 PM)SaldusMiegas Wrote: Hi Mr. Zennie

Welcome to the forum.

Others have already answered your basic question about setting min and max to the same value.  Can do no problem.

My question back to you is:  Why would you want to invalidate your ongoing titration study by resetting the parameters, especially to a fixed pressure?   Seems like you asked for the extension to collect more data.  Your machine is responding to apneas by adjusting pressures. It's also collecting more data every night that will help you make informed decisions. You are getting AHIs in the 1 to 3 range.  These are all good things.

If you have an air leak problem, you should deal with that.  It probably won't go away at constant pressure.  More likely you need to work on eliminating the leaks.  Maybe in some sleep positions you are a mouth breather. Sometimes when the jaw relaxes it falls open.  That is a common cause of waking up with a dry mouth. I had it happen a lot early on. Sometimes my tongue and teeth were so dry that it took minutes swishing water in my mouth to get them moist again.  

You have suggested that it's the pressure changes waking you up.  Maybe it's the apneas which the pressure change is responding to that is waking you up. Or maybe it's the rushing air going out when your mouth opens that is waking you up.  Or it could well be pressure changes waking you up.  

Rather than setting a fixed air pressure I would try to address the other causes first. Especially if the range is only 3 (from 6 to 9).  At least let your titration study finish before you start messing with the knobs.  Then you will have some data you can use.  Unless you are feeling just miserable.

There's a certain amount of getting used to that you can expect first starting CPAP therapy, and adjustments to find the sweet spot. Those adjustments can include: finding your best sleeping position, learning (yes learning) how to sleep with your mouth closed, getting a bit of help with a chin strap, changing type of mask that works better for you, tweaking the comfort settings on your awesome machine (you do have an excellent machine), and tweaking the air pressure.

check out this thread for info about training your tongue to reduce air leaks, a technique I first heard about from Opal Rose on this forum, and which has been very helpful ... http://www.apneaboard.com/forums/Thread-...ining-help

I had big problems with air leaks when I started therapy.  Used full face masks and tried a few different ones over a couple of months. One day I added a chin strap, and mouth leaks stopped virtually overnight.  I was happy at that point but in a few weeks I wondered if I could migrate to nasal pillows (like you have now) and would the chin strap and tongue technique prevent leaks.  Worked like a charm, and so I have been sleeping most comfortably with the really light weight nasal pillows and a comfortable chin strap (Ruby chin strap btw), and never looked back. 

So be encouraged that the air leak / mouth breathing issues are workable.  Let your autoset machine do its thing to keep your AHI down, and you tackle the leaks.  You will surely make pressure adjustments based on data and good advice from experts in this forum over time.  For now I would suggest you take on the air leaks using other means described above. 

And celebrate your good fortune.  We all know what it takes for most of us to finally get evaluated and diagnosed with sleep apnea.  We know how miserable you must have felt. You have pretty good indications from the data that your AHI has come down significantly and best wishes that you feel as much better as the data suggests.  If you don't (yet) don't despair. Sometimes it takes a while for your body to adjust, plus you probably have a huge sleep debt from an extended time of poor sleep. 

The best part is (at least in my case) here comes a life changing therapy that doesn't involves drugs or surgery. Just a little boost in air pressure to keep your pipes open while you sleep.  I count my blessings every day for this amazing therapy, and for this community of generous experts who taught me how to get the most from my therapy. 

Saldus Miegas

p.s.  download and install Sleepyhead software.  You will have lots of actionable data and Sleepyhead will help you make sense of it.  Plus sharing Sleepyhead reports here will make it possible for you to get some expert advice.  You are on a good path with an excellent data capable machine.  We would all encourage you to take charge of your therapy, learn how to understand your data, and get help from the folks in this forum who are all fellow apnea sufferers with lots to offer you.

Excellent post.
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#7
Wow, thanks for the supportive replies everyone.  This forum is great.  

Saldusmiegas and Apnea Infant, you're right, I shouldn't mess with the pressure settings.  To be honest I've already messed with the "min" one.  I left the initial class with it set at 5.  The teacher recommended 7.  So I ended up changing it around between 5 and 7 over the past week. I haven't touched the "max" yet, and don't plan to.  

I'm going to try the ruby strap you mentioned, and study all the other info y'all mentioned.  I really want this thing to work.  I strongly suspect I've got some centrals happening and will need an ASV.  We'll see!

I'm skipping the machine tonight.  I've surely got enough data already (as long as messing with the min pressure setting didn't invalidate everything) and really don't want to stress on it tonight.  

Thanks again!
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#8
(05-16-2018, 03:29 AM)MrZennie Wrote: Wow, thanks for the supportive replies everyone.  This forum is great.  

Saldusmiegas and Apnea Infant, you're right, I shouldn't mess with the pressure settings.  To be honest I've already messed with the "min" one.  I left the initial class with it set at 5.  The teacher recommended 7.  So I ended up changing it around between 5 and 7 over the past week. I haven't touched the "max" yet, and don't plan to.  

I'm going to try the ruby strap you mentioned, and study all the other info y'all mentioned.  I really want this thing to work.  I strongly suspect I've got some centrals happening and will need an ASV.  We'll see!

I'm skipping the machine tonight.  I've surely got enough data already (as long as messing with the min pressure setting didn't invalidate everything) and really don't want to stress on it tonight.  

Thanks again!

I realise you don’t want to stress with the machine but using it when you can is the best way to get used to it.
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#9
Don't skip using the machine. You need to get used to it and that requires regular usage. If I dose off without mine I wake up immediately I am so use to it.

Best of luck

Sleep-well
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#10
(05-16-2018, 03:29 AM)MrZennie Wrote: I'm going to try the ruby strap you mentioned, and study all the other info y'all mentioned.  I really want this thing to work.  I strongly suspect I've got some centrals happening and will need an ASV.  We'll see!

I'm skipping the machine tonight.  I've surely got enough data already (as long as messing with the min pressure setting didn't invalidate everything) and really don't want to stress on it tonight.  

Thanks again!

MrZennie, the SleepyHead program is free and will quickly tell you if CA is a problem, and at what pressures it occurs.  It is the fast-track to optimizing your therapy.  If you don't have a computer, even the on-screen therap data on the Airsense 10 Autoset will tell you the AHI and breakdown of events, but the Essentials settings need to be changed from ON to PLUS in the clinical menu.  Check the data or therapy information and lets see if centrals are a problem. It invokes a whole different strategy. Posting a Sleepyhead detail chart will immediately let us interpret exactly what is happening and why.
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