New To Apnea Board [confirmation of my data analysis]

[Walla Walla]

The ramp is set for a certain time than the pressure goes to 10cm. The time is determined by what you set it to. It is just to help you fall asleep. Most people stop using it after awhile because it delays treatment. I'd turn it off. The reason for a fixed pressure of 10cm is you seem to be sensitive to pressure changes.
I'm thinking a fix pressure at 10cm will allow to sleep better and 10cm should be a good pressure to take care of your obstructive events.

[ajack]

You also need to fix some leaks, there is a mask fit link in my signature and lots of youtube video. It might be a bit soon to move to fixed pressure. If you want to move to fixed pressure, after any problems are sorted with cpap use. you get the average 95% over a couple of weeks, as a base to work from.

[jbuch002]

OK, understood. My impression was that ramp time was the time to go from your lowest setting (in this case 4 in CPAP mode) to the highest (in this case 10) from onset of an obstructive condition. What I believe you are saying is that ramp time in the AirSense - the one you can adjust - is distinct from what the machine is ramping the pressure to when it senses an obstructive condition. Do I have this correct? If so, and I turn ramp time off, then what I will be experience is a constant pressure at 4cm until there is an obstructive condition detected at which time the AirSense will then ramp up according to it's algorithm hopefully to clear the obstruction but not above 10cm. If I have this right, what you are recommending makes total sense. I might never have needed this higher pressure (18cm in Auto Mode) in the first place. I might be fine at 10cm.

[Walla Walla]

No. Lets try this again. On your last chart you have Ramp set for it looks like 30 minutes. After the 30 minutes it goes to your minimum pressure of 6cm.
Your actual settings 6cm minimum and 18cm max. If you look at the chart your pressure shot up from there. What I'm saying is turn off the Ramp So the pressure starts off higher right away. I think 10cm is a good pressure to keep your events down with the pressure going wild. Ajack has other ideas.

[Sleeprider]

OK, got it ....... let me make sure I understand why I'm doing this and what the goal is, Walla Walla.

I've changed my AirSense from Auto (min 6, max 18) to CPAP (10). It does not appear that with CPAP mode selected that I have auto start and stop or auto ramp features (no bid deal). On start, I get 4cm (very comfortable). I selected Run Mask Fit to test the 10cm setting and it feels fine.

I am assuming that if an airway obstruction is sensed in the AirSense, it is going to ramp to 10cm to try to eliminate it so there is no apnea or hypopnea. How fast in the CPAP mode is the ramp from 4 to 10? I'm assuming that the goal is to give this setting a try and see if we get AHI below 5, right? If not, we might step it up at 1cm increments each night until we do, right?

Thanks.

You can use fixed CPAP pressure and still get all the other features by using Auto mode with the minimum and maximum pressure set the same. This also has the advantage of reporting flow limitation which is disabled in CPAP mode.

[Walla Walla]

Thanks Sleeprider, I overlooked that.

[jbuch002]

Wala Wala, actually, on the AirSense, Ramp Time was set to Auto. Setting the AirSense to CPAP and pressure to 10cm with Ramp Time off, delivers a maximum pressure of 10cm right away and, I assume, keeps it there. To me that seems to defeat the purpose of allowing you to fall asleep on the lower pressures and then gently easing you into the higher pressures that the Auto setting produces. Per Sleep Rider, it also disables detection of Flow Limitation (thanks for that tip). Setting the AirSense to CPAP/Auto off also seems to defeat the purpose of the auto-sensing features of the AirSense device (i.e., it increases pressure according to it's algorithm when an obstruction is detected). In CPAP, if I understand it, that algorithm is eliminated and, in my case, it would keep me at 10cm throughout the night's sleep. Mehh.

ajack, I tend to agree with you based on my limited knowledge of making adjustments to the AirSense that going the CPAP mode right now may not be the best first step for me. Looking at SleepyHead data my 90% = 9.69, Avg is 8.06. I realize this is only 3w of data but my AHI is rarely above 4 and averages around 2-3. I'm at the point where I'd rather not wear the device and snore, as stupid as that is, than be woken-up by this blast of pressure to 17 to 18cm. TBH, I really don't think I need anywhere close to 18cm to clear an obstruction. I could be wrong, of course.

Here's what I'm going to try: I'm going to keep the AirSense in Auto, keep the Min pressure at 4.5 and set the Max at 8.5 fr now, titrating up from there PRN (I did home Plethysmography. No sleep lab and no titration). I know that range is small and it's possible that the Max pressure setting may not be enough to eliminate obstructive events/increased AHIs. I'll know objectively after tonight from the SleepyHead data and will know subjectively if I don't keep getting woken-up.

Also ajack, you mentioned working on the mask fit. I've really worked on the mask fit over the first three weeks of use using videos and reading the Apnea Board posts on that subject. I feel like I have a good fit but not at the higher pressures (>10) that appear to do little more than wake me up. Early in my experience, I tightened the Amara View way down - too tight - and that left marks on my face and soreness. So, I've been working on this. As well, I'm a side sleeper so, I know this can affect mask position and create leaks. I'm working on that too. My sense is that the really high leak rates you see on the graphs is partly do to me pulling the mask away from my face when awoken then trying to get it back in place/tighten it down or pulling the air hose off the mask using the disconnect. Maybe not, we'll see.

[Walla Walla]

Good luck.

[trish6hundred]

Hi jbuch002,
WELCOME! to the forum.!
Good luck with CPAP therapy and getting it fine-tuned.
Hang in there for more responses to your post.

[ajack]

Leaks are hard to chase down when you are asleep. You may also mouth breathe. Have a look at your leak chart in sleepyhead, you can see some large leak events. It's worth working on them with the forum.

There are lots of ways to skin a cat.
You are getting pressure induced CA. It's something that is not encouraged as we don't know if there is an o2 desaturation with them. Or the body getting use to cpap and just the body waiting for the co2 to build back up, to trigger a breath. Which can take up to 12 weeks to settle down. It is the reason I suggested min 8 max 12 and I think why walla suggested going to fixed pressure 10. I'm easy either way. Going fixed pressure 10 for a few weeks could be enough time for your body to get use to cpap and for most of the pressure induced ca to subside. You can then move to auto titration and let the machine find what it thinks is the best pressure for you. At a minimum I would use the 95% average over a couple of weeks, with all the leaks fixed. You could also have min pressure 8 and max pressure 10.

I would turn up the ramp pressure by 0.4 every day, you won't notice the pressure increase and be on your min treatment pressure 8 or the fixed pressure 10 in no time.