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[Pressure] Determining best pressure settings for APAP
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DOOM_NX Offline

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Posts: 155
Joined: May 2013

Machine: ResMed S9 AutoSet
Mask Type: Nasal mask
Mask Make & Model: Weinmann JOYCE SilkGel
Humidifier: ResMed H5i + ClimateLine (not using year-round)
CPAP Pressure: 5–16 cmH2O
CPAP Software: ResScan SleepyHead

Other Comments: 12/2011: Mild SAS (AHI 14.5) - 10/2013: Severe SAS (AHI 78.7) - Using AutoCPAP: AHI 1.4

Sex: Male
Location: Greece

Post: #21
RE: Determining best pressure settings for APAP
The lower setting determines your comfort levels when you don't actually need a higher pressure (eg. when sleeping on your side or with your upper body raised). The higher setting determines the headroom for rarer occasions, when you need a short boost in pressure to open a collapsed airway. Once it's open, it can stay open even with lower pressures.

My range is 5-16 cmH2O. And my latest pressure graph looks like this:

[Image: m3sz.png]

And this is one of the good days with a median pressure of only 6.6 cmH2O. However for 5% of my sleep time (that's 23 minutes) I needed a pressure higher than 10 cmH2O. Most probably I was sleeping in supine position. I even needed a spike at just over 12 cmH2O. Most importantly, I managed to score an AHI of only 1.4 while avoiding excessive pressure levels that can tire my diaphragm or dry the crap out of my nose (or mouth). This is the point of Auto-CPAP; delivering the right pressure every single moment.
12-24-2013 09:24 PM
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DOOM_NX Offline

Preferred Members-2

Posts: 155
Joined: May 2013

Machine: ResMed S9 AutoSet
Mask Type: Nasal mask
Mask Make & Model: Weinmann JOYCE SilkGel
Humidifier: ResMed H5i + ClimateLine (not using year-round)
CPAP Pressure: 5–16 cmH2O
CPAP Software: ResScan SleepyHead

Other Comments: 12/2011: Mild SAS (AHI 14.5) - 10/2013: Severe SAS (AHI 78.7) - Using AutoCPAP: AHI 1.4

Sex: Male
Location: Greece

Post: #22
RE: Determining best pressure settings for APAP
(12-24-2013 09:17 PM)DISleepApnea Wrote:  Here are some attachments that replace the original 2 and add more info. I think they will still view clearly enough.

Your screenshots show clearly that your pressure upper limit is inadequate. Moreover, graphs show it being only 13 cmH2O, but this could also be a SleepyHead bug.

Just watch how your instantaneous AHI score climbs to 30, while at the same time your snore levels skyrocket and pretty much every other graph becomes too unstable.

You need to raise your higher pressure setting. I'd set it to max to see if my apneas dissapear. This is your health we're talking about. Screw the doctors if they don't know what to do in the first place.
12-24-2013 09:35 PM
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me50 Offline

Advisory Members

Posts: 2,559
Joined: Aug 2013

Machine: resmed S9 VPAP Auto
Mask Type: Nasal mask
Mask Make & Model: Wisp and Silicone Head gear
Humidifier: resmed H5i
CPAP Pressure: 18/8
CPAP Software: SleepyHead

Other Comments:

Sex: Undisclosed
Location: USA

Post: #23
RE: Determining best pressure settings for APAP
http://www.apneaboard.com/forums/Thread-Membership-Levels-explained
12-24-2013 10:16 PM
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jgjones1972 Offline

Preferred Members-2

Posts: 516
Joined: Nov 2012

Machine: ResMed S9 AutoSet
Mask Type: Full face mask
Mask Make & Model: ResMed Quattro FX
Humidifier: ResMed H5i
CPAP Pressure: 18 - 20
CPAP Software: ResScan SleepyHead

Other Comments: CMS50I PulseOx

Sex: Male
Location: Ohio - USA

Post: #24
RE: Determining best pressure settings for APAP
I agree with DOOM_NX. Raising the max pressure to 20 doesn't mean the machine will run the pressure that high, it just means it can if it determines it needs to in order to clear obstruction - this is what the machine is designed to do. Why not let it do its thing? Limiting max pressure on an APAP is kind of like driving a car with the automatic transmission in 1st or 2nd gear; sure, there are some rare circumstances where it is beneficial to limit the range of the transmission, but most of the time and under most circumstances it's best to let the transmission operate the way it was designed to. Sure looks to me like you have your APAP running down the interstate stuck in 2nd gear.

Of course, that's just my opinion.

Sleep-well
12-24-2013 11:15 PM
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DOOM_NX Offline

Preferred Members-2

Posts: 155
Joined: May 2013

Machine: ResMed S9 AutoSet
Mask Type: Nasal mask
Mask Make & Model: Weinmann JOYCE SilkGel
Humidifier: ResMed H5i + ClimateLine (not using year-round)
CPAP Pressure: 5–16 cmH2O
CPAP Software: ResScan SleepyHead

Other Comments: 12/2011: Mild SAS (AHI 14.5) - 10/2013: Severe SAS (AHI 78.7) - Using AutoCPAP: AHI 1.4

Sex: Male
Location: Greece

Post: #25
RE: Determining best pressure settings for APAP
Well said, jgjones1972 Smile
12-24-2013 11:48 PM
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DISleepApnea Offline

Members

Posts: 13
Joined: Nov 2013

Machine: Respironics REMstar 550P
Mask Type: Full face mask
Mask Make & Model: ResMed QuattroFX
Humidifier: Respironics
CPAP Pressure: 14 - 16
CPAP Software: SleepyHead

Other Comments:

Sex: Male
Location: New Albany, Indiana

Post: #26
RE: Determining best pressure settings for APAP
I have posted screenshots, the pressure range (14-16 or 14-15) shows in the name as well as on the graph. Doom, your post on 12-24-2013 09:24 PM, which may have taken place after I turned off the computer, was most helpful and I will try to learn how to scale down the image until the user clicks it. I assume this helps waste space for attachments?! Thanks to me50 for the link and to whomever moved me to a member.
I think the day had been long and I did not think through everything I read. I stated that my previous pressure had been at 17 at one time in history. I believe the resistance to move it high by the therapists was fear it would be uncomfortable for the user but I don't think that would be an issue.
Am I correct in feeling that, while the AHI is a beneficial stat, the amount of time in obstructive apnea may be more important in influencing how well rested I will feel the next morning?
In any case, once I submit this I think I will set 12 as the min and 18 as the max and see how it works. Please let me know if anyone thinks I am taking any chances. As Doom stated. "This is your health we're talking about. Screw the doctors if they don't know what to do in the first place. "


Attached File(s) Thumbnail(s)
           
12-26-2013 12:21 PM
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DOOM_NX Offline

Preferred Members-2

Posts: 155
Joined: May 2013

Machine: ResMed S9 AutoSet
Mask Type: Nasal mask
Mask Make & Model: Weinmann JOYCE SilkGel
Humidifier: ResMed H5i + ClimateLine (not using year-round)
CPAP Pressure: 5–16 cmH2O
CPAP Software: ResScan SleepyHead

Other Comments: 12/2011: Mild SAS (AHI 14.5) - 10/2013: Severe SAS (AHI 78.7) - Using AutoCPAP: AHI 1.4

Sex: Male
Location: Greece

Post: #27
RE: Determining best pressure settings for APAP
Hello again!

(12-26-2013 12:21 PM)DISleepApnea Wrote:  Doom, your post on 12-24-2013 09:24 PM, which may have taken place after I turned off the computer, was most helpful and I will try to learn how to scale down the image until the user clicks it. I assume this helps waste space for attachments?!
Regarding my screenshots, the forum platform automatically scales down large images. You don't have to do anything in particular. However, I'm not uploading the images as attachments when I make a post. I upload them to an image sharing website (in this case imageshack.us) and then copy/paste the direct link in IMG tags.
Code:
[IMG]http://this.is.an/example.jpg[/IMG]

If my screenshot doesn't contain any photos, I make sure to save it as PNG (lossless compression format), in order to retain every detail and make it even smaller in size (as in bytes, not dimensions).

For capturing I use either the Snipping Tool of Windows 7/8 or press the PrtScn key on my keyboard and then paste the image in Paint (or Paint.NET) to do the cropping and any other editing necessary. Save as PNG, this is important.

(12-26-2013 12:21 PM)DISleepApnea Wrote:  Am I correct in feeling that, while the AHI is a beneficial stat, the amount of time in obstructive apnea may be more important in influencing how well rested I will feel the next morning?
Moving on to the more important stuff. The duration of each sleep apnea episode is not that important, as long as it lasts more than 10 seconds (in order to qualify as sleep apnea) and manages to wake you up. The number of apneas and hypopneas per sleep session is important because it shows how many times your sleep pattern is disturbed. If you keep waking up when entering Stage 3, your sleep will consist mostly of Stage 1 and Stage 2, regardless of the time it takes you to wake up during an apnea episode. This is bad. You want to maximize the time you spend in Stage 3 and REM in order for your body and mind to truly regenerate. While the AHI measurement by a CPAP machine doesn't really show us how many times our sleep is disrupted, it's a much more important indicator than the duration of apnea episodes themselves. Your AHI number together with your total sleep time are going to influence how rested you feel in the morning. Remember, it's not only about quality (apnea-free sleep) but also about quantity (how many hours you sleep). Most sources suggest getting at least 7 hours of sleep per day.

(12-26-2013 12:21 PM)DISleepApnea Wrote:  In any case, once I submit this I think I will set 12 as the min and 18 as the max and see how it works.
If I were you and was going to mess with the settings, then I would try the full range of the machine to see what its algorithm will decide and whether it's successful at eliminating my apneas. Then I would collect this data for a month and compare with the month before. Then I would schedule an appointment with my doctor and show him the improvement. Or I would keep my money and never bother with the same doctor again. But I am not you and I haven't seen your sleep study results and I don't know if you have any special conditions that might require the settings you were prescribed with. In any case, this would be a good topic to discuss with your doctor (or maybe a new one).
(This post was last modified: 12-26-2013 09:20 PM by DOOM_NX.)
12-26-2013 09:17 PM
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DISleepApnea Offline

Members

Posts: 13
Joined: Nov 2013

Machine: Respironics REMstar 550P
Mask Type: Full face mask
Mask Make & Model: ResMed QuattroFX
Humidifier: Respironics
CPAP Pressure: 14 - 16
CPAP Software: SleepyHead

Other Comments:

Sex: Male
Location: New Albany, Indiana

Post: #28
RE: Determining best pressure settings for APAP
Just to let you know I am still working on this. I have my appointment with the Doctor on 1-23-14 and intend to be upfront with what I have been doing. I will take in the card for them to download but will also take some printouts of what I have in the way of stats, both from the screen on the machine and from the software. I intend to report the results of our discussion and what I intend to do next. Thanks for all the help so far.
01-16-2014 05:21 PM
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DISleepApnea Offline

Members

Posts: 13
Joined: Nov 2013

Machine: Respironics REMstar 550P
Mask Type: Full face mask
Mask Make & Model: ResMed QuattroFX
Humidifier: Respironics
CPAP Pressure: 14 - 16
CPAP Software: SleepyHead

Other Comments:

Sex: Male
Location: New Albany, Indiana

Post: #29
RE: Determining best pressure settings for APAP
Yes, I am still working on it. After discussions with the sleep therapist and my doctor I am trying different settings. I am currently on 14 - 20, but have also tried 10-20 and 12-20. I have been on the current setting for 25 days and the AHI is 2.94, the lowest for the three sets of settings. There is a good chance this is about as good as I am going to get but I doing it with a mask that is not causing problems with my nose bridge, the Res-Med Quattro FX. Using the current settings with my previous mask produce a lower AHI but also tore up my nose to the point I would skip nights. So, I think I am ahead of the game.
For being "retired" it seems I have had much happen since my last post. I will try to get a better system of posting graphs, as was suggested earlier if things slow down. Thanks for all the guidance.
05-19-2014 10:48 AM
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