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[Pressure] Pressure tics and awakenings, plus the 90% question
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Ailu Offline

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Machine: Philips Respironics System One (60 Series) RemStar Auto with A-Flex
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Location: Sierra Nevada Mountains

Post: #1
Question Pressure tics and awakenings, plus the 90% question
Okay, so I've been waking up about 2-3 times each night, with a kind of strange, panicky feeling. Interestingly, it always seems to be right after my System One has one of those "hunt & peck" 1.5cm pressure tics.

So that being said, I am going to try putting my machine on a fixed pressure, and see if that improves things while still keeping my AHI below 1.5.

Based on my average stats for the last 2 weeks, what should I consider putting my fixed pressure at?

My minimum pressure is set at 7cm (which is what I was titrated at)
My max pressure is set at 10.5cm

My Mean pressure was 8.2cm
My peak average pressure was 8.7cm
My 90% pressure was 9.5cm

Oh - and what does 90% mean?

Also, if you have any other suggestions regarding this, I'm all ears. Smile

Thanks folks!

-Ailu
Reformed CPAP Outlaw
07-14-2015 06:07 PM
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zonk Offline

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Machine: A10 AutoSet
Mask Type: Nasal mask
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CPAP Pressure: 9/13
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Sex: Male
Location: Australia

Post: #2
RE: Pressure tics and awakenings, plus the 90% question
(07-14-2015 06:07 PM)Ailu Wrote:  Oh - and what does 90% mean?
Pressure was at or below that number for 90% of the night

From the provider guide ...
90% Pressure - During any given night, the device recognizes the 90% Pressure achieved by the Auto Algorithm. 90% Pressure is defined as the pressure at which the device spent 90% of the session time at or below. For example, if the device recognized airflow for 10 hours, and 9 hours were spent at or below 11 cm H2O, and 1 hour was spent above 11 cm H2O, then the 90% Pressure would be 11 cm H2O. This screen displays the average of these individual nightly values of 90% Pressure over a 7 day and 30 day time frame (provided the device has at least 7 or 30 days of data respectively). If the device has only 5 days of data to use for the calculation, the 5 day average value will be seen under the 7 day display. This screen only displays in Auto-CPAP therapy.
07-14-2015 06:12 PM
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parkerdt Offline

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Machine: ResMed A10 AutoSet
Mask Type: Other
Mask Make & Model: WISP, Nuance
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CPAP Pressure: 9
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Other Comments: I alternate between WISP and fabric Nuance - like both!

Sex: Male
Location: Mebane, NC

Post: #3
RE: Pressure tics and awakenings, plus the 90% question
Hang in there, and adjust one thing at a time. Then try it for a few days,

Based on your few days of data, I think I would set 9 and an EPR of 1. Then not touch it for a week.

This is my opinion, I am no expert!
07-14-2015 07:29 PM
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Ailu Offline

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Posts: 159
Joined: Oct 2013

Machine: Philips Respironics System One (60 Series) RemStar Auto with A-Flex
Mask Type: Nasal pillows
Mask Make & Model: Fisher Paykel Pilairo Q
Humidifier: System One Heated
CPAP Pressure: Auto-CPAP: 8-9
CPAP Software: SleepyHead EncoreBasic

Other Comments:

Sex: Female
Location: Sierra Nevada Mountains

Post: #4
RE: Pressure tics and awakenings, plus the 90% question
Thanks Zonk & Dave!

Dave - sorry but what is "EPR"? I don't seem to have a setting for it on my machine....

Thanks! Smile

-Ailu
Reformed CPAP Outlaw
07-14-2015 08:48 PM
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zonk Offline

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Posts: 7,908
Joined: Feb 2012

Machine: A10 AutoSet
Mask Type: Nasal mask
Mask Make & Model: Activa LT
Humidifier: Integrated /ClimateLineAir
CPAP Pressure: 9/13
CPAP Software: ResScan

Other Comments: CPAP since Nov 2010

Sex: Male
Location: Australia

Post: #5
RE: Pressure tics and awakenings, plus the 90% question
EPR (Expiratory Pressure Relief) available on ResMed machines and the not quite equivalent Flex available on Respironcis machines

I have no need for it, find it disruptive, but many folks like the idea of breathing out at lower pressure

EPR http://www.resmed.com/int/patients_and_f...c=patients
Flex http://www.healthcare.philips.com/main/h...efault.wpd
(This post was last modified: 07-14-2015 09:05 PM by zonk.)
07-14-2015 09:04 PM
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Sleeprider Online
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Machine: Resmed Aircurve 10 Vauto
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Sex: Male
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Post: #6
RE: Pressure tics and awakenings, plus the 90% question
(07-14-2015 06:07 PM)Ailu Wrote:  Okay, so I've been waking up about 2-3 times each night, with a kind of strange, panicky feeling. Interestingly, it always seems to be right after my System One has one of those "hunt & peck" 1.5cm pressure tics.

So that being said, I am going to try putting my machine on a fixed pressure, and see if that improves things while still keeping my AHI below 1.5.

Based on my average stats for the last 2 weeks, what should I consider putting my fixed pressure at?

My minimum pressure is set at 7cm (which is what I was titrated at)
My max pressure is set at 10.5cm

My Mean pressure was 8.2cm
My peak average pressure was 8.7cm
My 90% pressure was 9.5cm

Oh - and what does 90% mean?

Also, if you have any other suggestions regarding this, I'm all ears. Smile

Thanks folks!

Ailu, if you want to go to a single CPAP pressure, the 90% pressure is generally accepted as the best therapeutic pressure. It excludes those excursions Respironics machines like to probe, and is high enough to abate any events.

The 90% pressure (percentile) is the pressure that is not exceeded 90% of the time, or you were at or below this pressure 90% of the time. Same thing.

Great idea giving CPAP pressure a try. It works well for lots of people. You can do this by setting the machine in CPAP mode, or by setting the minimum and maximum pressure at 9.5 in APAP mode. The advantage of staying in APAP mode is that you will continue to record flow limitations and RERA that may not be recorded in CPAP mode.

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07-14-2015 09:47 PM
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Ailu Offline

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Posts: 159
Joined: Oct 2013

Machine: Philips Respironics System One (60 Series) RemStar Auto with A-Flex
Mask Type: Nasal pillows
Mask Make & Model: Fisher Paykel Pilairo Q
Humidifier: System One Heated
CPAP Pressure: Auto-CPAP: 8-9
CPAP Software: SleepyHead EncoreBasic

Other Comments:

Sex: Female
Location: Sierra Nevada Mountains

Post: #7
RE: Pressure tics and awakenings, plus the 90% question
(07-14-2015 09:47 PM)Sleeprider Wrote:  
(07-14-2015 06:07 PM)Ailu Wrote:  Okay, so I've been waking up about 2-3 times each night, with a kind of strange, panicky feeling. Interestingly, it always seems to be right after my System One has one of those "hunt & peck" 1.5cm pressure tics.

So that being said, I am going to try putting my machine on a fixed pressure, and see if that improves things while still keeping my AHI below 1.5.

Based on my average stats for the last 2 weeks, what should I consider putting my fixed pressure at?

My minimum pressure is set at 7cm (which is what I was titrated at)
My max pressure is set at 10.5cm

My Mean pressure was 8.2cm
My peak average pressure was 8.7cm
My 90% pressure was 9.5cm

Oh - and what does 90% mean?

Also, if you have any other suggestions regarding this, I'm all ears. Smile

Thanks folks!

Ailu, if you want to go to a single CPAP pressure, the 90% pressure is generally accepted as the best therapeutic pressure. It excludes those excursions Respironics machines like to probe, and is high enough to abate any events.

The 90% pressure (percentile) is the pressure that is not exceeded 90% of the time, or you were at or below this pressure 90% of the time. Same thing.

Great idea giving CPAP pressure a try. It works well for lots of people. You can do this by setting the machine in CPAP mode, or by setting the minimum and maximum pressure at 9.5 in APAP mode. The advantage of staying in APAP mode is that you will continue to record flow limitations and RERA that may not be recorded in CPAP mode.

Ooooh! Awesome idea! I will do just that. Almost beddie-bie time! :grin:

-Ailu
Reformed CPAP Outlaw
07-14-2015 10:12 PM
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Ailu Offline

Preferred Members-2

Posts: 159
Joined: Oct 2013

Machine: Philips Respironics System One (60 Series) RemStar Auto with A-Flex
Mask Type: Nasal pillows
Mask Make & Model: Fisher Paykel Pilairo Q
Humidifier: System One Heated
CPAP Pressure: Auto-CPAP: 8-9
CPAP Software: SleepyHead EncoreBasic

Other Comments:

Sex: Female
Location: Sierra Nevada Mountains

Post: #8
RE: Pressure tics and awakenings, plus the 90% question
(07-14-2015 07:29 PM)parkerdt Wrote:  Hang in there, and adjust one thing at a time. Then try it for a few days,

Based on your few days of data, I think I would set 9 and an EPR of 1. Then not touch it for a week.

This is my opinion, I am no expert!

Thanks Dave! Yeah, I have it on A-Flex, setting of 1. That seemed the most comfortable to me.

-Ailu
Reformed CPAP Outlaw
07-14-2015 10:23 PM
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tedburnsIII Offline

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Machine: 3B RESmart APAP
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Humidifier: came with unit-I vary it, currently set at '3', '5' is max
CPAP Pressure: 10 cm CPAP
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Other Comments: Dx moderately severe OSA. Overnight pulse oximeter-CMS50D Plus

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Location: San Diego

Post: #9
RE: Pressure tics and awakenings, plus the 90% question
If 7cm was the recommended optimal titrated pressure AND the sleep doctor's report on the study so recommended and prescribed it, if it were me I'd go no higher than 7cm and see how that goes for a few days. You can always adjust up from there, and it seems you may be having awakenings due to auto mode pressure variations.

I switched over to straight CPAP after months on auto. My optimal titrated pressure was 12cm and was the sleep doctor's recommendation in his written report.

I've never exceeded 11.5cm straight CPAP, and now I've dropped down to 10cm the past few days with no adverse effect. I try to sleep on my side at this lower pressure.

Initially, I see no reason to start any higher than 7cm, which is your 'cover all' pressure if indeed optimal, and supposedly good even supine in REM.

How sleep centers manually titrate to optimal pressure:

[Image: CPAP%20TITRATION%20EXPLAINED_zpswpt5uay1.png]
(This post was last modified: 07-15-2015 01:42 AM by tedburnsIII.)
07-15-2015 01:13 AM
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Ailu Offline

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Posts: 159
Joined: Oct 2013

Machine: Philips Respironics System One (60 Series) RemStar Auto with A-Flex
Mask Type: Nasal pillows
Mask Make & Model: Fisher Paykel Pilairo Q
Humidifier: System One Heated
CPAP Pressure: Auto-CPAP: 8-9
CPAP Software: SleepyHead EncoreBasic

Other Comments:

Sex: Female
Location: Sierra Nevada Mountains

Post: #10
RE: Pressure tics and awakenings, plus the 90% question
Thanks Ted. So glad the sleep study's pressure worked out in your case.

I would defintiely have done the same. But in Sleepyhead, the data clearly showed me having apneas at 7cm. When it would see an apnea, my System One would raise the pressure to prevent more of them. I must have had an unusually good night when I was titrated, because it surely does not represent what I am seeing in Sleepyhead.

But who knows? I am a scientist at heart, so I know I will keep experimenting. I am going to keep lowering the pressure until I have a fantastic few nights of sleep. Maybe 7cm is where I will have the least amount of issues. I'll keep reporting back here and let you know. Smile

-Ailu
Reformed CPAP Outlaw
(This post was last modified: 07-15-2015 08:16 AM by Ailu.)
07-15-2015 07:51 AM
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