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Is there a benefit to increase my starting pressure?
#1
Question 
I need your advise !

Do you think it should be a good thing to increase my starting pressure?

Right now my starting pressure is at 7 but if you look at the graphic below my pressure is averaging around 10.5.

[Image: screenshot-20160207-172751_zpsron4adah.png]

I'm still tired and searching for reason why ... but maybe it's just get use to my new therapy Thinking-about

Al the help is very welcome Thanks
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#2
You are doing quite well. Still you might benefit from an increase in min pressure.
The benefit may show up as a smoother flow graph; and may reduce the hypos and flow limitation.

I would set it to 2 cm-H2O below your median pressure.
Your median is about 10.5, ergo set min to 8.5 (or closest increment -- I think ResMed can only be set to even tenths like: X.2, X.4, X.6 ...)
It's not a big jump up from 7; but it gives the machine a head start; and helps hold the airway open when the machine retreats from pressures above min.
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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#3
(02-07-2016, 05:50 PM)justMongo Wrote: You are doing quite well. Still you might benefit from an increase in min pressure.
The benefit may show up as a smoother flow graph; and may reduce the hypos and flow limitation.

I would set it to 2 cm-H2O below your median pressure.
Your median is about 10.5, ergo set min to 8.5 (or closest increment -- I think ResMed can only be set to even tenths like: X.2, X.4, X.6 ...)
It's not a big jump up from 7; but it gives the machine a head start; and helps hold the airway open when the machine retreats from pressures above min.

Thank you justMongo!

I will put it at 8.4 for tonight since it's even number like you said.

My EPR is at 3 should I lower it?
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#4
One change at a time. It's like making to many adjustments on a car with a carburetor.
See how you do with min pressure = 8.4 for at least a week.

Probably no reason to lower EPR with a higher floor pressure.
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
(02-07-2016, 06:31 PM)justMongo Wrote: One change at a time. It's like making to many adjustments on a car with a carburetor.
See how you do with min pressure = 8.4 for at least a week.

Probably no reason to lower EPR with a higher floor pressure.

You are right justMongo, I will just change my starting pressure for now.

Another question for you how do you like your Mirage Quattro?

I'm a side sleeper... What about leaks problem and is he really big?

It doesn't hurt your forehead?

Thank you for your feedback Big Grin
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#6
(02-07-2016, 06:55 PM)Rousseau21 Wrote: Another question for you how do you like your Mirage Quattro?

I'm a side sleeper... What about leaks problem and is he really big?

It doesn't hurt your forehead?

Thank you for your feedback Big Grin

When it comes to masks, just as every face is different, so is their need for the right mask.

I very much like my Mirage Quattro. I too side sleep. I have managed to use it successfully for 6+ years. I just last week started using a special pillow for side sleeping PAPers.

My leaks are well controlled; even at a pressure of 18.

I like the forehead brace. It actually helps keep the mask in place should some lateral force bump it. The brace permits a micrometer like adjustment of the upper mask seal. Some nights I have to turn it a click or two to tame minor leaks. I do not tolerate leaks well, the small leaks will awaken me.

Here's the statistics for a typical night for me:
Leak: Median 0.0, 95th percentile 0.0, Max 1.2 LPM

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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#7
(02-07-2016, 07:45 PM)justMongo Wrote:
(02-07-2016, 06:55 PM)Rousseau21 Wrote: Another question for you how do you like your Mirage Quattro?

I'm a side sleeper... What about leaks problem and is he really big?

It doesn't hurt your forehead?

Thank you for your feedback Big Grin

When it comes to masks, just as every face is different, so is their need for the right mask.

I very much like my Mirage Quattro. I too side sleep. I have managed to use it successfully for 6+ years. I just last week started using a special pillow for side sleeping PAPers.

My leaks are well controlled; even at a pressure of 18.

I like the forehead brace. It actually helps keep the mask in place should some lateral force bump it. The brace permits a micrometer like adjustment of the upper mask seal. Some nights I have to turn it a click or two to tame minor leaks. I do not tolerate leaks well, the small leaks will awaken me.

Here's the statistics for a typical night for me:
Leak: Median 0.0, 95th percentile 0.0, Max 1.2 LPM

That's amazing statistics!

Thanks for your feedback I appreciate like
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#8
I found I feel better if I put my minimum pressure a bit above where my AHI basically goes to zero. Not sure why, maybe flow limitations or something. In particular, I got less throat irritation.

YMMV.
Get the free SleepyHead software here.
Useful links.
Click here for information on the main alternative to CPAP.
If it's midnight and a DME tells you it's dark outside, go and check it yourself.
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#9
I agree, you need to raise the minimum pressure, doing so over a period of time so as not to upset your perception of excessive starting pressure.

From your flow rate, it is obvious that only get short intervals of relaxed sleep separated by bothersome pressure increases due to what is likely flow limitations. It would be useful to see the graph for flow limitations. The flat topped wave forms in there are of greater concern and especially their duration.

You may very well end up with a starting pressure around 12 cm H2O but it will take some time to increment up to that level without causing CA's and an inaccurate perception of inability to tolerate the exhalation pressure. That perception disappears eventually but causes anxiety in many users. It can be avoided all together by increasing the minimum pressure in small increment over an extended period of time. Keep the EPR set at 3 for the duration of these changes and possibly forever, generally it's a nice feature to have all the time.

The best way to get acclimated to any perceived exhalation problem is to wear the mask for an hour or so while awake and watching TV or reading. It's amazing how that works to reassure your mind that all is well with the therapy. Doing that daily for a few days will speed the acceptance along.

Dude
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#10
I think this is a good example of EPR working to undermine an otherwise effective CPAP pressure allowing OA to occur. At the current minimum CPAP pressure, Rousseau21 only receives an EPAP pressure of 4. The EPR in this case is acting like a bilevel. When we titrate bilevel, we begin with the minimum EPAP that will maintain the airway to prevent OA. Pressure support is then added for hypopnea and RERA. In CPAP we set the pressure at a level to prevent OA and H. When that pressure is relatively low, the Resmed EPR of 3.0 can drop the EPAP pressure low enough that OA occurs at or near the end of exhalation, because the airway is no longer supported. At the end of exhalation, during the ensuing OA, pressure rises to the set CPAP pressure (7-10), but it is no match to resolve the closed airway.

There is a choice here. You can increase CPAP pressure, leaving EPR at 3.0, but you must raise the pressure enough that your airway is supported during exhalation at the reduced pressure. OR, you can reduce the amount of EPR. This becomes a balancing act where CPAP pressure should be effective in preventing OA, and EPR is only enough to be "comfortable", but not so much as to allow airway collapse. Most people with relatively low pressure may not need EPR for comfort, but they use it because it's there. It would be really nice if Resmed allowed a setting for EPAP min, that would prevent pressure from falling below a set value. This would maintain airway integrity while allowing exhale relief when the auto machine reaches higher pressures. My $.02. In the real world, you need to take into consideration that the setup described in the first post means your pressure is 7.0/4.0, and may not be sufficient.
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