[Pressure] Pressure Range Assistance

[Autarch]

New user here looking for assistance looking at the data and for settings range for an Auto. I was set with a prescription for a pressure of 7. This did lower my AHI to 9-12 from my sleep study of 25. After some reading here on the forum I changed the settings on my dreamstation to Auto and I have tried 5-10 & 6-13 both of which had improvements 5-10:5.92, 6-13:7.61

Edit1: Can't fit under 200k and can't post links. trying text link for copy and paste
Edit2: 3 images attached and png-8.

drive.google.com/open?id=0B9ZSlp-Tx7r8cThPcUlEbE10cGM

[attachment=3116]
   
   

[Cranberry Ray]

Autarch welcome to the board. I'm sure some of the more experienced members will be posting shortly to assist you with settings. A couple things that stick out to me is you have a very low leak rate and most of your OA's are taking place when you are at max pressure of 10. Also you median pressure is showing as 10 which would lead me to think you need more pressure, especially since the Dreamstations are a little slower responding. My guess would be others may suggest raising your min to 9 and letting the max go to 20 so we can see what pressures are really needed to treat the OA's.

Hang in there and good luck going forward.

[OpalRose]

You are bumping up against your max pressure of 10 for most of the night. You need to give the Apap room to work. Looks like you need a higher pressure to attack your apneas.
I would move the minimum pressure to 8cm and the maximum pressure to 12. Watch for a few days and see if AHI comes down.

[Autarch]

Thank you for the welcome.
I managed to get all 3 files with the ranes shrunk and I added them back to the original post. I did try 6-13 last night but the AHI increased from the previous night even though the machine did not max out at 13. Based on what you see from the 6-13 is that due to the range being so large?

[kwhenrykerr]

I agree with Ray on upping you settings. If the machine does not need more pressure to get the air flowing it will not raise it. By allowing the machine to find what works for you and tracking your breathing with Sleepyhead you can better understand your body. It will take some weeks of tracking to get a good pattern.

The two basic sensors in the machine are a pressure sensor and a flow sensor. The machine uses the information to adjust itself. You can limit what it will do with the settings. At the start of treatment with a fully Auto cpap I would let it do its job and look at the outcome.

Keep reading and learning to control your treatment. You are in good company here. We may express different ideas as each of us has our own history.

[justMongo]

The Dreamstation is slower than the ResMed machines to raise pressure. This is neither good nor bad; it's just how they work.
It may be necessary to raise the min pressure up from 6 cm-water to get the Dreamstation closer to therapeutic pressure.
I wouldn't jump on this immediately as changing too many things at once may cause one to lose the target.

[Galactus]

You might try 8-13 IMHO based on what I see. I'm not the best at it but the people here helped me a lot and that's based on my personal experience. Also, don't change too many things at once and try to get at least 5 days of data between changes, that's what helped me.

[Sleeprider]

I agree with the earlier post recommending a minimum pressure of 9.0 and maximum of 20. The machine should sort out much of the obstructive apnea. For now, your pressure is not very high, and we should try the higher pressure to see if that alone can control these events. If not, we can look at maintaining your airway through sleep position and neck support. First things first, this appears to be mostly related to too low pressure. The chart shows a lot of breathing effort and even hypopnea and OA as you begin therapy at 6 cm. You need to boost that minimum.

[Autarch]

Thank you everyone for your input. What about the Dreamstation FLEX settings? I have left them on their defaults but I have not felt discomfort at all even when it was set as a CPAP (although it was a low pressure). Is it better to turn FLEX off completely while trying to find correct pressure?

Edit: also how does one handle having to get up in the middle of the night to use the bathroom? I've just disconnected the hose gone and come back as I was afraid it would cause an overall break in the session. Is it better to stop the machine completely? Incidentally I no longer get up nearly as often as I did before I started therapy.

[OpalRose]

Thank you everyone for your input. What about the Dreamstation FLEX settings? I have left them on their defaults but I have not felt discomfort at all even when it was set as a CPAP (although it was a low pressure). Is it better to turn FLEX off completely while trying to find correct pressure?

Edit: also how does one handle having to get up in the middle of the night to use the bathroom? I've just disconnected the hose gone and come back as I was afraid it would cause an overall break in the session. Is it better to stop the machine completely? Incidentally I no longer get up nearly as often as I did before I started therapy.

Flex settings are there for your comfort and is chosen based on user preference, and how you feel using the feature.  You can receive "up to" 2cm pressure relief and is based on flow.

Here is a brief description of how AFlex works:
 Flex settings 1, 2, and 3. for PR machines
You can receive up to 2cm pressure relief, which is flow based.
• C-Flex – Provides pressure relief upon exhalation.
• A-Flex/C-Flex+ – Provides pressure relief taking place at the end of inhalation and at the start of exhalation.

Try all 3 settings to see what feels best.

As far as getting up, it is best to turn off machine, disconnect mask hose.  When you return, just connect you mask hose and turn machine back on.  Yes, it will show a break, but SleepyHead will average and add everything as one night.