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[Pressure] Pressure so high that it wakes me up: what should I do?
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xunlao Offline

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Posts: 4
Joined: Jul 2016

Machine: Philips DreamStation
Mask Type: Nasal mask
Mask Make & Model: Philips DreamWear
Humidifier: Philips DreamStation
CPAP Pressure: 4-10
CPAP Software: Not using software

Other Comments:

Sex: Undisclosed
Location: United States

Post: #1
Question Pressure so high that it wakes me up: what should I do?
Hi guys,

I just have CPAP for 2 months (Philips DreamStation with Philips DreamWear Nasal Pillow) in auto CPAP mode. It sometimes have the issue of staying so high pressure that I am waked up due to the high pressure (usually around 8cm-11cm H2O), and this has become a daily issue for me -- now I am not waked by sleep apnea but by the CPAP machine!

I woke up at night and taking off the mask, or I just found the mask is in bedside with CPAP still on in the morning.

The auto CPAP range is 4-10; should I change it to the default 4-20 or what? I am really not sure..

My current insurance doesn't cover another sleep study.. I probably have to wait 3 months for my new insurance for one Sad

Thanks in advance!Thanks
Sean
07-04-2016 12:57 AM
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pupcamper Online

Advisory Members

Posts: 401
Joined: Nov 2015

Machine: PR DreamStation CPAP Pro
Mask Type: Nasal pillows
Mask Make & Model: AirFit P10 Pillows; Quatro Air FFM
Humidifier: DreamStation Heated Humidifier
CPAP Pressure: 10.5 cmH2O; no ramp; no C-Flex
CPAP Software: SleepyHead EncorePro

Other Comments: Lung cancer survivor since 11/2004; CPAP since 11/2015

Sex: Male
Location: Van Buren, Arkansas, USA.

Post: #2
RE: Pressure so high that it wakes me up: what should I do?
Hello Sean. Welcome

I would suggest installing SleepyHead software and posting some charts so the experts on this board can help you with them.

You can use the information at this link to help better organize your charts in SleepyHead. Organizing charts in SleepyHead. There is a link on that page explaining how to take a screenshot in SleepyHead and a link on the second page on how to use imgur to post your charts on the forum.

You will need three more posts in order to post links.

Regards,

"....respiration,—a troublesome practice, but one which custom has rendered necessary to our easy existence...." Oliver Twist, Charles Dickens- 1837

I use FlashPAP to load data from a FlashAir III wifi sd card in my machine to my computer and display it with SleepyHead .
robysue's Beginner's Guide to SleepyHead
07-04-2016 04:50 AM
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trish6hundred Offline

Advisory Members

Posts: 6,450
Joined: May 2012

Machine: Resmed S9 AutoSet for Her
Mask Type: Full face mask
Mask Make & Model: Fisher & Paykel Simplus
Humidifier: H5i Heated Humidifier
CPAP Pressure: 10 - 7-20 Cm H2O
CPAP Software: Not using software

Other Comments: I started CPAP in 2008. Totally blind since birth.

Sex: Female
Location: Missouri, USA

Post: #3
RE: Pressure so high that it wakes me up: what should I do?
Hi xunlao,
WELCOME! to the forum.!
Hang in there for more answers to your questions and much success to you with your CPAP therapy.

trish6hundred
07-04-2016 03:38 PM
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PoolQ Offline

Advisory Members

Posts: 986
Joined: Jul 2015

Machine: AirCurve 10 VAUTO
Mask Type: Full face mask
Mask Make & Model: Amara View
Humidifier: Integrated
CPAP Pressure: 6.2, 15, PS4.0
CPAP Software: SleepyHead

Other Comments:

Sex: Male
Location: Sillicon Valley

Post: #4
RE: Pressure so high that it wakes me up: what should I do?
is it any and all pressure or exhaling into pressure? What is you flex setting?
07-04-2016 03:52 PM
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green wings Online

Advisory Members

Posts: 548
Joined: Feb 2016

Machine: Respironics System One RemStar Pro (460)
Mask Type: Nasal pillows
Mask Make & Model: AirFit P10
Humidifier: integrated humidifier
CPAP Pressure: 13.0 cm
CPAP Software: SleepyHead

Other Comments: using CPAP since Jan. 2016

Sex: Undisclosed
Location: US

Post: #5
RE: Pressure so high that it wakes me up: what should I do?
Hi, Sean. You have come to the right place for help with problem-solving your CPAP usage issues.

It sounds like you are having problems with what are known as "comfort issues". These are annoying problems that make it difficult to use the CPAP machine consistently.

You might want to check in the "Settings" for your machine and see if the "A-Flex" parameter is turned on. A-Flex can have values of 1, 2, or 3. It lowers the pressure when you exhale. The general term for this is expiratory pressure relief (EPR).

People most always find it to be more comfortable to use this setting when they first start CPAP therapy, so it would be helpful to know if you are using this and at what value.


Most of us on this forum use the SleepyHead software to look at the data from our CPAP machines. It's very helpful to be able to see a graph that will show what pressure values your machine was at while you were sleeping.

I would not change the MAX pressure setting on your machine until you get some more information about what's going on now when you are waking up in the middle of the night and taking off your mask. That is a very normal thing for a person to do when they have recently started using CPAP, by the way. It takes time for us to become used to the feel of the mask on our face and to the feeling of breathing in and out while air is whooshing past the end of our nose.

Welcome to Apnea Board.
07-04-2016 05:41 PM
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xunlao Offline

Members

Posts: 4
Joined: Jul 2016

Machine: Philips DreamStation
Mask Type: Nasal mask
Mask Make & Model: Philips DreamWear
Humidifier: Philips DreamStation
CPAP Pressure: 4-10
CPAP Software: Not using software

Other Comments:

Sex: Undisclosed
Location: United States

Post: #6
RE: Pressure so high that it wakes me up: what should I do?
Hi Mitch,

Thanks for your tutorial! I just upload some of my report:

Can't post image.. post count not enough.

The report is below:

imgur>com/something
(replace '>' with '.')
And the something is:

gFCbZ0D
7OtHyHP


(2 report, 1 for 2016-7-1, another for 2016-7-2)
07-05-2016 12:01 PM
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PoolQ Offline

Advisory Members

Posts: 986
Joined: Jul 2015

Machine: AirCurve 10 VAUTO
Mask Type: Full face mask
Mask Make & Model: Amara View
Humidifier: Integrated
CPAP Pressure: 6.2, 15, PS4.0
CPAP Software: SleepyHead

Other Comments:

Sex: Male
Location: Sillicon Valley

Post: #7
RE: Pressure so high that it wakes me up: what should I do?
two more posts and you will be able to post the pictures, this is to keep spammers out-the computer is not so good at deciding that you are not a spammer Smile
07-05-2016 12:15 PM
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woozie38 Offline

Advisory Members

Posts: 248
Joined: Jan 2013

Machine: Fisher & Paykel Icon + Auto
Mask Type: Full face mask
Mask Make & Model: F&P Simplus
Humidifier: Integral
CPAP Pressure: 8 to 14
CPAP Software: SleepyHead Other Software

Other Comments: 17 years of CPAP + supp. oxygen @ 3 L/min

Sex: Male
Location: Toowoomba, Queensland Australia

Post: #8
RE: Pressure so high that it wakes me up: what should I do?
(07-04-2016 12:57 AM)xunlao Wrote:  Hi guys,

I just have CPAP for 2 months (Philips DreamStation with Philips DreamWear Nasal Pillow) in auto CPAP mode. It sometimes have the issue of staying so high pressure that I am waked up due to the high pressure (usually around 8cm-11cm H2O), and this has become a daily issue for me -- now I am not waked by sleep apnea but by the CPAP machine!

I woke up at night and taking off the mask, or I just found the mask is in bedside with CPAP still on in the morning.

The auto CPAP range is 4-10; should I change it to the default 4-20 or what? I am really not sure..

My current insurance doesn't cover another sleep study.. I probably have to wait 3 months for my new insurance for one Sad

Thanks in advance!Thanks
Sean

Hi Sean, Both my brother & I experience the same problem. In our case the APAP machine has raised the pressure in response to airway restriction & it's that restriction of breathing that causes us to wake, not the rise in pressure. On waking we then become aware that our masks are lifting off our faces & air is escaping from all points. My solution is simply to turn off the machine, then restart it & go back to sleep. This works & appears to have no effect on data recording etc. It's the best I could come up with & I hope it helps. However I suggest your raise your min pressure to 8 (4 is too low) & max to 14. You may need to change to a FFM. Nasal masks are known to produce unhelpful effects such as "mouth breathing".

[Image: signature.png]Keep on breathin'
(This post was last modified: 07-05-2016 03:57 PM by woozie38.)
07-05-2016 03:55 PM
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green wings Online

Advisory Members

Posts: 548
Joined: Feb 2016

Machine: Respironics System One RemStar Pro (460)
Mask Type: Nasal pillows
Mask Make & Model: AirFit P10
Humidifier: integrated humidifier
CPAP Pressure: 13.0 cm
CPAP Software: SleepyHead

Other Comments: using CPAP since Jan. 2016

Sex: Undisclosed
Location: US

Post: #9
RE: Pressure so high that it wakes me up: what should I do?
Hi, Sean. I really only looked at your second set of graphs. The first set says "Breathing Not Detected" for most of the night. I'm hoping someone else will explain why that happened.

I see one spot just before 2 am on your leak rate graph where it looks like you lost your "tongue seal" and experienced air rushing out of your mouth. Other than that, though, your leak rate is zero or low. That's good. I am going to write a section about "tongue seal" and leaking air from your mouth in a separate post. It discusses the when and whys of using a full-face mask vs. a nasal mask or nasal pillows.

If you wake up now, and the pressure feels uncomfortable to you, you can either turn the machine off then back on, or if you are using the "Ramp" function, then you can hit the ramp button on your machine and it will drop to a lower pressure and repeat the ramp-up.

Philips Respironics machines have a button to activate ramp. Even if you have the ramp function turned on, it will not happen automatically when you start the machine unless you hit the ramp button. (Right now, ramp is not available to you because your minimum pressure value is set at 4.0, which is the lowest pressure the machine offers.)

How does the pressure from the machine feel to you when you are awake and it's at values of say, 6-8 cm? I ask because it sounds like you are fairly sensitive to the sensation of pressure coming from the machine right now. Have you had any problems with swallowing air? How long does it usually take you to fall asleep with the machine on?

I ask these questions because I see two pathways that you can take for your early days of adjusting to CPAP therapy. The first path is to use your machine in Auto mode and to use settings that are likely to give you effective therapy (maybe 8-12 cm) with a ramp-up in the pressure starting at 5-ish.

The other option is to set the minimum and maximum pressures at the same value right now (say, 6, 7, or 8 cm) for an adjustment period. What pressure you choose would depend on how much you can tolerate right now. You could set a ramp starting at 4-5 cm for 20-30 minutes if you want.

If you go with the second option, you would be deciding to work on getting used to the sensation of pressure and the feel of the mask on your face and watching your leak rate graphs to see how you're doing with the tongue seal. Your AHI values will be higher with this choice than if you go for auto mode with pressures at 8-12 right now.

Either choice will get you away from the very low pressures like 4.0 cm. That is not enough to prevent obstructive events, and you can probably tolerate a higher pressure than that comfortably. (If you can't, then you know that.)

You may decide that you don't want to try either of these options. If you do continue as you are with your maximum pressure at 10.0, I would urge you to increase your minimum pressure to at least 6.0. Even though your machine's pressure is auto-adjusting, you have to select a minimum pressure value that's not too far below the pressure that you will need when you have obstructive events. Choosing a minimum pressure that is too low will result in more obstructive events happening than is necessary.
07-05-2016 06:45 PM
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green wings Online

Advisory Members

Posts: 548
Joined: Feb 2016

Machine: Respironics System One RemStar Pro (460)
Mask Type: Nasal pillows
Mask Make & Model: AirFit P10
Humidifier: integrated humidifier
CPAP Pressure: 13.0 cm
CPAP Software: SleepyHead

Other Comments: using CPAP since Jan. 2016

Sex: Undisclosed
Location: US

Post: #10
RE: Pressure so high that it wakes me up: what should I do?
Tongue Seal/Preventing large leaks from your mouth while using CPAP therapy.

Finding out if you are going to be able to use a nasal (or nasal pillows) mask without excessive large leaks is very important. If it does turn out that you leak air from your mouth frequently, you will need to either switch to a full-face mask or try a chin strap with your nasal mask to see if that will help your jaw to stay in a position to keep your tongue from moving forward and letting air escape from your mouth. People who like using a nasal mask or nasal pillows but who leak air from their mouths usually try the chin strap to see if it will stop the large leaks. If it doesn't, they end up switching to a full-face mask.

You will read comments about "tongue seal" where people are talking about preventing leaking air from the mouth during CPAP therapy. You can get an idea of what this is by inhaling (without CPAP) machine) and then opening your mouth while you exhale. Put your hand in front of your mouth. Normally, no air should escape from your mouth while you exhale through your nose. You can then consciously relax the base of your tongue and move it forward while exhaling, and you will begin to feel air coming from your mouth.

You want to keep your tongue in a position while using CPAP so that air can't escape from your mouth. The higher your treatment pressure, the more difficult it becomes to do this for most people. If you look at the user profiles for people who use pressures of 15-20 cm, most of them use full-face masks. With a full-face mask, your mouth is included in the CPAP/human pressure circuit, so it doesn't matter if air leaks from your mouth.

Some people are able to use nasal masks or nasal pillows at higher treatment pressures. I think this really depends on the anatomy of your jaw and tongue. You don't really know whether you will need a full-face mask until you see how you react to the pressure.

Some people say that they have been able to successfully train themselves to keep their tongue in place.

You will notice that people tend to be boosters for the type of mask that they like.

I have been talking about "large leaks". If a leak is less than a certain amount (I think it's 34 liters/min), it doesn't count as a large leak. Your machine gives values for "total leak" and "unintentional leak". The "total leak" number includes the air vented from your mask. "Unintentional leak" is the number that you want to keep an eye on to make sure it isn't having a negative effect on your therapy. If "unintentional leak" goes over 24 L/min, it will be flagged as "Large Leak".

The amount of "large leak" that you can have and still have effective therapy isn't a hard and fast number. The ResMed CPAP machines give a smiley face when Large Leak happens for less than 30% of your sleep time. 30% of the time seems like a huge number to me. I think you just have to ask the opinions of people on this forum about your graphs if they are showing very much large leak. And, as always, be guided by how you feel when you wake up in the morning (assuming you felt the effects of untreated sleep apnea before you were diagnosed. If you didn't, then how you feel may not be a helpful guideline.)
(This post was last modified: 07-05-2016 10:40 PM by green wings.)
07-05-2016 07:08 PM
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