[Pressure] Need your opinion on possibly adjusting pressure range

[Rcgop]

I am convinced of two things. 
1. It takes “exhale” pressure to hold an airway open and thus controlling obstructive events, and
2. Adjusting minimum pressure changes “inhale” pressure. 

I think what I saw in the 2cm increase in inhale pressure resulted in little or no change in exhale pressure. 

I too have positional issues but have almost corrected them through minimum exhale pressure adjustments.

[wampeter]

Could you clarify what you mean by "inhale" and "exhale" pressures? I've never encountered that in the context of CPAP. Also, and I believe the issue was raised before in this thread, I don’t understand how possibly minimal pressure can change anything about the apneas that cannot be handled even by the maximal pressure. The only mechanism I can think of is that lower pressure is needed to prevent an apnea than is necessary to treat/handle an apnea once it occurs (if that makes sense).

[Gideon]

Look at the next level up in devices, a BiLevel or BiPAP.

The main controlling pressure is EPAP or Expiratory pressure, Pressure Support (PS) is added to that pressure to provide IPAP or inspiratory pressure.  PS is similar to EPR on  ResMed CPAP but is a decrease in pressure from inhale IPAP pressure so pressure manipulations are needed to match the effect of a BiLevel machine.

Expiratory pressure is used to manage obstructive events.  In BiLevel the Auto algorithms alter the EPAP pressure and the IPAP follows via PS.

Hope I didn't confuse you

[wampeter]

> Look at the next level up in devices, a BiLevel or BiPAP.
> Hope I didn't confuse you

Not at all, actually I think I’ve already heard about BiPAP or read about it somewhere. Anyway, the bottom line is that those remarks don’t apply to my current setup anyway, as I've got just a standard auto-CPAP DreamStation.

One more thing, just for me to make sure I'll buy a proper one tomorrow. By soft cervical collar you just meant something as simple as this, right? Nothing more fancy or advanced?

   

[Melman]

What you pictured is the type of collar we recommend. It's important that the collar be tall enough to prevent your chin from tucking but not so tall that it's uncomfortable. You want to wear it just tight enough so your chin can't drop inside the front. Any tighter will be uncomfortable.

[wampeter]

Ok, so here's the data obtained while I was sleeping with the collar. Well, I don't think that worked for me.   Found my apneas exactly where I left them the previous night.   And I'm pretty sure I prevented myself from pushing my chin towards the chest (as I believe that is what the collar trick is about, right?). Therefore in my case it has to be something else, maybe sleeping on my back despite having a tennis ball attached (still using that, still not verified enough), maybe REM. Any more possibilities?

One more thing. Could you clarify for me if I understand this correctly, as I study the wiki here on ApenaBoard and try to delve into the data a bit more. I assume the flat lines on the second chart attached are my breath pauses, so each of those OSAs on the chart was related to about 20 second timespan of not-breathing, right? How on earth that might be "not clinically relevant", as the doc says?! (Who is a pulmonologist by the way, so maybe he is too used to seeing patients that don't breath that well, but on the other hand he should be specially aware that breathing is hey, quite important). Pardon my sarcasm, I am a bit frustrated  at this point. Anyway, is there anything more I can do?

[Walla Walla]

Looking over your charts I see your around 9cm at the 95% mark. Normally with Dreamstation it's recommended to set the minimum pressure at 1 cm below what your 95% pressure is. So that's what I would do. I'd set minimum pressure at 8cm and maximum pressure at 12cm.

[wampeter]

Actually my average 95% pressure is now 7.9 (for the last month), the charts you saw are a little bit over the average. So I'd say that according to the rule it should be 7. But is it recommended to adjust both min and max pressures at the same time?

[Walla Walla]

There's no problem adjusting both pressures. You have to adjust them both if you want to keep a 4cm range between minimum and maximum.

[Dog Slobber]

The clustering and timing of the clusters of events suggests to me apneas brought on by sleep stage cycles, likely REM.

The clusters are about 90 minutes apart, this is consistent with REM.

The difference between 6 cm and 7 cm isn't all that great, but if you're concerned increase it in stages. You can also increase your maximum, but I don't think you'll need to. Increasing the minimum can often reduce the need to get to the maximum as the airway is kept open.