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[Pressure] Pressure setings
#1
Pressure setings
I was recently diagnosed with mild sleep apnea and managed to get hold of a Resmed Machine that a friend is no longer using. Machine is S9 Autoset with H5i Humidifier and a nasal mask. Settings were already set on auto with min pressure 6 and maximum 20 and EPR on at level 3.

Breathing in is ok but I find it difficult to breath out. Can someone explain how the pressure settings work and why I am finding it difficult to breath. Is this normal when first starting? Over the first 4 days of trying it out I find that I am waking up starving for breath and need to take the mask off.

Would the problem be my settings or maybe an incorrect mask type?
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#2
RE: Pressure setings
What are your prescribed pressures from your sleep study?

The pressure range of 6-20 is pretty wide open and you probably want to set the range a little closer to your prescribed pressure.

Regarding the EPR, the setting of 1,2,3 is how many centimeters the pressure drops during the exhale. So if your pressure is at 6 with and EPR of 3, the pressure on exhale will drop to 4cm because that's the lowest it will go.

As far as starving for air, that could be because your pressure is too low to start. Most people can't tolerate a pressure as low as 6, so I would bump the bottom number up a bit and see if that helps.

As far as the mask issue goes, were you ever fitted for a mask? The mask is the hardest part of adjusting and everyone's needs are different. You should probably go to a supplier and get a proper fitting, and find out which style mask works best for you.

If you haven't already download the clinician manual at the top of the page and that will help with adjusting the settings. Best of luck with your therapy.
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#3
RE: Pressure setings
Hi Maverick70,
Do you know what pressure range your doctor prescribed? Your profile says 9-16, but you state that the machine is set on 6-20, which may be too low of a staring pressure.

If the EPR is set at 3, that is the highest setting to help you breath out easier.

If you can find out your titrated pressure from your sleep study, then we can help your set a more optimal pressure range, then you can download sleepyhead software to watch for awhile and be able to gauge what your needs will be.

OpalRose
Apnea Board Administrator
www.apneaboard.com

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#4
RE: Pressure setings
Hi Maverick70,
WELCOME! to the forum.!
You might move the minumum pressure, (6,) up a bit, maybe 7, and see if that works better for you.
Hang in there for more suggestions and much success to you with your CPAP therapy.
trish6hundred
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#5
RE: Pressure setings
Hi Maverick70, welcome to Apnea Board.

The Min Pressure is usually just a comfort setting, adjusted to whatever feels most comfortable.

Strange as it may seem, raising your Min Pressure to 7.0 will actually make it easier to breath out, but don't put Min Pressure higher than 7 for now, since you have no trouble breathing in, even when the Min Pressure is as low as 6. In future, if you ever find yourself feeling that inhaling is a little too hard, raising the Min Pressure would be recommended.

Yes, it is perfectly normal for new PAPers to feel the pressure is too high when breathing out. It feels strange and slightly suffocating at first, but in a couple days you will be more used to it and in a couple weeks your chest muscles will be stronger and you'll hardly notice the pressure when breathing out.

When the machine is producing an inhale pressure (IPAP) of 7 or lower, even when EPR is set to 3 the exhale pressure (EPAP) will be not lower than 4, because 4 is the lowest exhale pressure allowed.

A Min Pressure of 7 or higher allows the full EPR of 3 to be used, which will make exhalation easier.

On my ASV bilevel machine the difference between the inhale pressure and exhale pressure is sometimes as high as 9 or 10, and at these times absolutely no effort is required on my part during exhalation. For example, my inhale pressure might be 25 and my exhale pressure might be 15, but the drop of 10 during exhale will let the air out of my lungs with no effort at all on my part. This is how my Central Apneas get treated. To control my obstructive apneas my exhale pressure may be up at 14 or 15, and if a central apnea starts, the machine automatically will start cycling between 15 and a higher pressure like 25, keeping me breathing without any effort on my part. (During my central apneas, the machine will raise the inhalation pressure only as much as needed to keep me breathing close to my recent average amount of air volume per breath.)

Take care,
--- Vaughn


The Advisory Member group provides advice and suggestions to Apnea Board administrators and staff on matters concerning Apnea Board operation and administrative policies.  Membership in the Advisory Member group should not be understood as in any way implying medical expertise or qualification for advising Sleep Apnea patients concerning their treatment.
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#6
RE: Pressure setings
Thanks for all your replies. I am in Western Australia so you good folk in the US are likely to be tucked up in bed enjoying you CPAP'S. I adjusted min setting to 7 and max to 16. Found it easier to breath and managed to keep it on all night. I did have have some issues with the mask being uncomfortable and found myself trying to adjust it through out the night. I am getting small blisters around my nose.

I had a home sleep study done but because I scored the CPAP with all the gear free, I am trying it out on my own hence the reason I have not had a mask fitting or pressure settings prescribed. The report summary says Mild OSA, worse in REM sleep, with CPAP an option to consider. Not sure what part of all the numbers is titration?

I will down load Sleepyhead or Rescan software (which is better) so I can monitor my results. From what I have read on the forum this is the best way to monitor your progress and find optimum settings. (profile updated) Cheers.







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#7
RE: Pressure setings
Sounds likely that your sleep study was without a CPAP machine, so there was no "titration" - which basically means testing to determine which pressure level of CPAP takes away your obstructive apnea events.

QAL
Dedicated to QALity sleep.
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#8
RE: Pressure setings
G'day Maverick, welcome to Apnea Board

Getting a mask which fits comfortably and does not leak is more than 50% of the equation. You might find that a mask liner (eg Pad-a-cheek) will improve comfort and help control the nose-bridge problem.

If you did a home sleep test there is probably no titration information, just diagnosis. The good news is that your S9 Autoset will give you most of what you need to know when used in conjunction with the appropriate software. I find SleepyHead a lot more convenient and easier to use than ResScan, though it does have a few occasional hiccups. You can download both and see which you prefer.

Can you share the numbers from your sleep test? In particular the apnea hypopnea index (AHI), obstructive apneas, central (clear airway) apneas, hypopneas, RERA and RDI (if recorded). These will help define an optimal therapy regime.
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#9
RE: Pressure setings
Hi to Paul in Perth and others

I have attached my sleep report data from my test. No CPAP used in the testing, just a bunch of electrodes attached all over the place. I would like to understand my results if there are any tech heads out there.

I downloaded sleepyhead software with the last 4 days results. Saturday night I was hooked up for 9 hours with a total AHI of 0.55%. Pressure 7.00 - 10.88 (95% at 9.86%) EPAP 4.02% - 7.88% (95% at 6.88%) This seems almost too good to be true? Can APAP really work this well?



Attached Files
.pdf   Sleep Test.pdf (Size: 111.98 KB / Downloads: 66)
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#10
RE: Pressure setings
Looking at your report, the key things are the apneas and hypopneas. Hypopneas are a partial closing of the airway, which you have quite a lot of. The AHI is the total number of apnea and hypopnea events divided by the number of hours asleep. Your AHI was 13, which is moderate. You can also see that the rate of events was much higher during REM sleep.

Something doesn't make sense with your results. The Autoset doesn't report EPAP so something's wrong there. Are you sure it's an Autoset, or is something quoted wrong?

The units for pressure are centimetres of water (cm H2O) and the AHI is events per hour, not a percentage, though normally AHI is quoted as a number without units.

Hope this helps.





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