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[Pressure] Determining best pressure settings for APAP
#1
Question 
I need help with the settings on my APAP, a REMstar APAP 550P. I had a recent sleep study because my previous mask was tearing up my nose bridge and leaking air into my left eye. Before the study I found a newer mask, probably my 6th since 2000, that seemed better, a ResMed Full Face Quattro FX, and it did well in the sleep study.
When I got a notice that my results were being sent to the equipment provider I went there and found out both the minimum and maximum settings were at 14. When I said something to the sleep specialist there he said he was also surprised because this basically turned it into a CPAP.
I stopped in to ask the sleep study director and he said the test showed I did fine with both set at 14. I got my new mask and settings on 11/19/13 and in the first 6 days my AHI (over last 7 days)rose from 5.5 to 6.9.
On 11/24/13 I revisited the sleep specialist and told him what was going on and that I knew how to change the settings. He thought it was worth a try. I probably overshot by raising the max to 16 but the AHI started dropping into the 2 - 3 range and large leaks dropped to 0% to 2%.
My concern is that my "90%" pressure has risen to almost 16. I have now lowered it to 15. I am worried that I do not understand the true meaning of the maximum setting. I thought it was the maximum amount of pressure the APAP would exert in an effort to prevent blockage of airflow. Therefore, it was an advantage to have it higher. Originally, I was at 17 in 2000.
I should state I know I am probably not supposed to be doing my own testing but in the last 2 years I have gone through 3 changes of doctors because the previous one left and each has their own ideas. I have been doing this for 13 years and feel I have learned some things and that I am not making radical changes.
I am sorry for giving you my life story but I felt it was important to know the "backstory".

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#2
The purpose of the Auto is to adjust as needed throughout the night. A setting of 14-16 is a very, very tight range so the 95% is going to be hard for the machine to determine since there's not much room.

My suggestion is to drop the lower number to13 or even 12. And raise the upper number to 17. Then collect data over the next ten to 14 days. You need trends, not one or two nights' worth. By then, you would have a more accurate 95% rate and can determine if that range is good for you.
PaulaO2
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#3
Hi DISleepApnea, welcome aboard
You need to check whats AHI events made up of (numbers of obstructive and clear airways events)
imo, the minimum pressure is most important, the criteria for me to feel comfortable and keep airway open and the maximum a bit more pressure when needed like if rolled on my back or/and Rem sleep where pressure increase most needed
90% pressure means pressure was at or below for 90% of the time and at or higher for 10% of the time
SleepyHead pressure graph shows what pressure was at throughout the night

I have not seen good explanation for large leak other than the machine can no longer possible determine events accurately. Your machine report total leak (vents leak plus mask/mouth leak), vents leak of Quattro FX at pressure 14 about 44 L/m so assume leak above 70 L/m or whereabouts is considered large leak territory



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#4
Hi DISleepApnea,
WELCOME! to the forum.!
What Paula said.
Hang in there for more responses to your post and best of luck to you.
trish6hundred
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#5
welcome, DISleepApnea, I agree with the other's your high and low pressures can have a greater distance between them, mine is set at 5-15 and 95% of the time it is 10 or less. Try it at what Paula has sugeested and leave it for a couple of weeks and see how you go.
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#6
Thanks
Wow! I sure feel like I am getting more help than I have from some of the "professionals" with whom I have dealt over the last 13 years. I am not sure how many attachments I can send but I am going to try some screenshots. SleepyHead-Report (Summary) 12-24-13 (Highlighted and reduced) is a report I ran today after making the last adjustment, which Tez, Trish and Paula have indicated might be too tight. I have boxed in green the change I made in A-Flex and wonder if I went the wrong way.
OK, I now know I will have to reduce photo sizes and possibly send a second response to get them all in.
Next is Overview 12-23-13 (Highlighted and Reduced), which shows results since 2-18-13. I apologize for the lack of sharpness but I think it will show what you want to see. The boxed area show recent activity with high OA levels if I interpret this correctly.

I will try to send another post with more graphs
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#7
OOPS! I have reached my limit of attachments so I guess I will not send the others.
I hope this is enough to help.

Thanks for the responses.
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#8
I cannot make up the graphs even with reading glasses, but you need to post a daily charts (not summary) so we can see what goes on through the entire night, also events breakdown of AHI
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#9
Zonk, I was surprised when I went to view them myself. I found I could right click on the thumbnail and copy to my desktop. Once there, it viewed fine, considering the reduction in size. I might need to adjust my settings when I take the screenshot. The next graph I was going to send was of a single night's report but I had used my quota. I will try to find a way to take the screenshots. I am assuming that if I delete the images I have already sent from my quota it will delete them from the post.
Thanks for the feedback and I hope the idea will help you read them better.
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#10
There was only 2 days in one of your screenshots but it looks like that your AHI was better when your pressures were 16 as the max. Two days isn't enough to determine that though. I would say that I agree with the others that you should change your pressure settings to the numbers PaulaO2 suggested and watch your data for a few weeks.
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