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[Pressure] Change in Pressure on CPAP
#1
I'm new to this forum and have lots of concerns about my Sleep Apnea. I was diagnosed about 8 or so years ago to having OSA. They set me at a pressure of 11 and I started using my machine nightly about 4 years ago as it was very hard to tolerate for those first few years. I wear a full face mask and I find that I'm spending a good part of the night adjusting it because of air leaks. Everyone said I'd feel so much better, well rested and have lots more energy and less tiredness during the day after beginning CPAP. That never happened - 4 years later I'm back to my Sleep Doctor and he set me up with a new machine that sends info to his office. After 6 weeks on the new machine/mask I'm told that I'm still getting 7 episodes every hour of apnea and that he would like it to be under 5. He's ordering me a chip that will increase the pressure to 12. Will this help me feel more rested and have less episodes of apnea at night and will there any risk to raising the pressure as far as my health goes? I have severe acid reflux and am about 40 pounds or so overweight. I also have a mitral valve problem - could these conditions be affected by raising the pressure on my CPAP or could using CPAP be making them worse? [/size][/font]
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#2
(05-19-2015, 07:55 AM)jennie54 Wrote: I'm new to this forum and have lots of concerns about my Sleep Apnea.

They set me at a pressure of 11
I wear a full face mask and I find that I'm spending a good part of the night adjusting it because of air leaks.

4 years later I'm back to my Sleep Doctor
After 6 weeks on the new machine/mask I'm told that I'm still getting 7 episodes every hour of apnea and that he would like it to be under 5. He's ordering me a chip that will increase the pressure to 12.

Will this help me feel more rested and have less episodes of apnea at night and will there any risk to raising the pressure as far as my health goes? I have severe acid reflux

Hi Jennie. Welcome to the forum.

Spending a lot of time fixing leaks definitely made me feel very bad the next day. My best solution for that so far has been to use a nasal pillow mask. It makes a _huge_ difference in how I feel the next day, not waking up over and over during the night. It was probably 20-30 times a night at the worst, and I felt terrible when that was going on.

Sounds like you do need some more pressure if your AHI is 7.
More pressure may make the leaks increase...
But if you need more pressure, then you need it.
A new pressure setting of 12 doesn't sound like much of a bump over 11, but it may be enough.

I'm not familiar with some of the aspects of your question about the effects of higher pressure.

I've read that reflux is sometimes caused by, or is worse with apnea. Because the extra vacuum created in the chest when you're trying to breathe in while obstructed, can also pull the stomach contents back up into the esophagus. So fixing the apnea (via higher pressure) may help the reflux get better.
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#3
(05-19-2015, 11:20 AM)worn_out_in_lebanon Wrote: I've read that reflux is sometimes caused by, or is worse with apnea.

I'm by no means an expert in sleep apnea, but I can say that since I've been using my machine I haven't had any issues with acid reflux. I used to have a bottle of TUMS in my desk at work, in my truck, and at home because I was constantly chewing on them. Now I can't even remember the last time I got reflux.
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#4
(05-19-2015, 11:20 AM)worn_out_in_lebanon Wrote:
(05-19-2015, 07:55 AM)jennie54 Wrote: I'm new to this forum and have lots of concerns about my Sleep Apnea.

They set me at a pressure of 11
I wear a full face mask and I find that I'm spending a good part of the night adjusting it because of air leaks.

4 years later I'm back to my Sleep Doctor
After 6 weeks on the new machine/mask I'm told that I'm still getting 7 episodes every hour of apnea and that he would like it to be under 5. He's ordering me a chip that will increase the pressure to 12.

Will this help me feel more rested and have less episodes of apnea at night and will there any risk to raising the pressure as far as my health goes? I have severe acid reflux

Hi Jennie. Welcome to the forum.

Spending a lot of time fixing leaks definitely made me feel very bad the next day. My best solution for that so far has been to use a nasal pillow mask. It makes a _huge_ difference in how I feel the next day, not waking up over and over during the night. It was probably 20-30 times a night at the worst, and I felt terrible when that was going on.

Sounds like you do need some more pressure if your AHI is 7.
More pressure may make the leaks increase...
But if you need more pressure, then you need it.
A new pressure setting of 12 doesn't sound like much of a bump over 11, but it may be enough.

I'm not familiar with some of the aspects of your question about the effects of higher pressure.

I've read that reflux is sometimes caused by, or is worse with apnea. Because the extra vacuum created in the chest when you're trying to breathe in while obstructed, can also pull the stomach contents back up into the esophagus. So fixing the apnea (via higher pressure) may help the reflux get better.
I am not able to use the nasal pillows as I'm a mouth breather for the better part of the time so I need the full face mask. Also, my report showed that I'm using the CPAP about 7-8 hours a night but I tried to explain to my Sleep Doctor that I also have insomnia and sometimes lay awake for maybe 1-2 hours after putting the mask on and turning on the machine - so would that in all actuality make my apnea episodes average out to more than 7? I also have nasal allergies and a narrow esophagus and I'm wondering if these could also add to my daytime sleepiness and the sleep apnea itself. Thanks for replying


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#5
(05-19-2015, 11:20 AM)worn_out_in_lebanon Wrote: So fixing the apnea (via higher pressure) may help the reflux get better.

(05-19-2015, 12:43 PM)jennie54 Wrote: I am not able to use the nasal pillows as I'm a mouth breather for the better part of the time so I need the full face mask. Also, my report showed that I'm using the CPAP about 7-8 hours a night but I tried to explain to my Sleep Doctor that I also have insomnia and sometimes lay awake for maybe 1-2 hours after putting the mask on and turning on the machine - so would that in all actuality make my apnea episodes average out to more than 7? I also have nasal allergies and a narrow esophagus and I'm wondering if these could also add to my daytime sleepiness and the sleep apnea itself. Thanks for replying
[/size][/font]

Yep yep, on the acid reflux thing. I took Prilosec daily for years and still had many nights happily standing around the kitchen sink drinking water as hot as I could take it to try to get the pain to stop.

Once I started CPAP therapy, all that silliness stopped. I do not take Prilosec anymore, and I have not had any occasion of acid reflex. Well, maybe once. That happened when I inadvertently swallowed several slices of pizza just before bedtime.

As to not being able to use nasal pillows because you are a mouth breather? Don't necessarily buy into that. I am the poster child for mouth breathing. Yet, once I began to use the pillows, with proper sleep position and even a chinstrap to encourage my jaw to stay forward, I successfully became a nose breather. That transition is another of my "most favorite things." ... and they say old dogs can't learn new tricks.......... Hah!

So I would very much encourage you to try a set of Resmed P10's or a Pilario. They're great masks, and the ones that sooner or later everyone will use. Resistance is futile.

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#6
Hi jennie54,
WELCOME! to the forum.!
You might try a different type of mask and see if that helps you.
Much success to you as you continue your CPAP therapy and fine tuning it.
trish6hundred
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#7
(05-19-2015, 07:55 AM)jennie54 Wrote: I'm new to this forum and have lots of concerns about my Sleep Apnea. I was diagnosed about 8 or so years ago to having OSA. They set me at a pressure of 11 and I started using my machine nightly about 4 years ago as it was very hard to tolerate for those first few years. I wear a full face mask and I find that I'm spending a good part of the night adjusting it because of air leaks. Everyone said I'd feel so much better, well rested and have lots more energy and less tiredness during the day after beginning CPAP. That never happened - 4 years later I'm back to my Sleep Doctor and he set me up with a new machine that sends info to his office. After 6 weeks on the new machine/mask I'm told that I'm still getting 7 episodes every hour of apnea and that he would like it to be under 5. He's ordering me a chip that will increase the pressure to 12. Will this help me feel more rested and have less episodes of apnea at night and will there any risk to raising the pressure as far as my health goes? I have severe acid reflux and am about 40 pounds or so overweight. I also have a mitral valve problem - could these conditions be affected by raising the pressure on my CPAP or could using CPAP be making them worse? [/size][/font]

Jennie, from your profile it appears you have a Philips Respironics 60-Series Pro CPAP model 460P. Please confirm or if you have an older model, provide the model number from the bottom of the blower unit next to the letters REF, or let us know if it is a M-Series which does not do data. If you are using an 8-year old M-series, you are way over-due for a new machine.

The Pro series CPAP is capable of fixed pressure from 4.0 to 20.0 cmH20. There is no need to "order a chip" to change the pressure. The pressure menu is access by dialing the machine to Setup, pressing the control knob and ramp button at the same time and using the setup menu. You can order a complete manual for that machine here: http://www.apneaboard.com/adjust-cpap-pr...tup-manual

If the machine is what I guess, it will have a SD card in the back left top corner that you can read the data an get a better understanding of not only how many events (AHI) you have, but what kind of events they are. Not all events are created equal, and it's important to determine that you are not experiencing a lot of central apnea, which the machine can detect. Centrals do not respond to pressure, and can be made worse with higher pressure. If your apnea is obstructive (OA) or Hypopnea (H), then pressure is the correct solution.

As your pressure is increased, if your aerophagia gets worse, the better solution for you is a bilevel device that provides exhale pressure relief. I really recommend you try downloading the Sleepyhead software here http://www.sleepfiles.com/SH2/ and loading it on a home computer and taking an active role in your own therapy.
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#8
(05-19-2015, 12:57 PM)retired_guy Wrote:
(05-19-2015, 12:43 PM)jennie54 Wrote: I am not able to use the nasal pillows as I'm a mouth breather for the better part of the time so I need the full face mask.

Yep yep, on the acid reflux thing. I took Prilosec daily for years and still had many nights happily standing around the kitchen sink drinking water as hot as I could take it to try to get the pain to stop.

Once I started CPAP therapy, all that silliness stopped. I do not take Prilosec anymore, and I have not had any occasion of acid reflex. Well, maybe once. That happened when I inadvertently swallowed several slices of pizza just before bedtime.

As to not being able to use nasal pillows because you are a mouth breather? Don't necessarily buy into that. I am the poster child for mouth breathing. Yet, once I began to use the pillows, with proper sleep position and even a chinstrap to encourage my jaw to stay forward, I successfully became a nose breather. That transition is another of my "most favorite things." ... and they say old dogs can't learn new tricks.......... Hah!

So I would very much encourage you to try a set of Resmed P10's or a Pilario. They're great masks, and the ones that sooner or later everyone will use. Resistance is futile.

Retired Guy is right. Acid reflux and mouth breathing can be cured with CPAP.

Being a long standing mouth breather (read SCUBA diver), and am on Acid Reflux medication. As long as I don't accidentally swallow several pieces of Pizza before bed, I am feeling lots better and Reflux and apnea are way better.

I would recommend trying either a home made or commercial chin strap. I used one for one about 2 weeks and don't mouth breath at night.

Keep up your treatment and you will get results. Machines and support are FANTASTIC now as opposed to years ago.

RAH

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#9
(05-19-2015, 03:07 PM)Sleeprider Wrote: ........If your apnea is obstructive (OA) or Hypopnea (H), then pressure is the correct solution. .......

Hypopnea can be either obstructive or central in nature!

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#10
(05-19-2015, 04:29 PM)PaytonA Wrote:
(05-19-2015, 03:07 PM)Sleeprider Wrote: ........If your apnea is obstructive (OA) or Hypopnea (H), then pressure is the correct solution. .......

Hypopnea can be either obstructive or central in nature!

Totally agree, but without looking at the data, who knows? My bigger concern is she is on an old M-series or earlier Pro, and doesn't have the best solution to treat her problems, nor get the best sleep. 8-years, and someone finally decides to increase the pressure by 50%.
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