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[Pressure] Reaching maximum IPAP - Time to change settings?
#1
Reaching maximum IPAP - Time to change settings?
Hi there!

First time posting, long time reader of the forum. You guys are great!

I was just Rx'd a new biPAP Resmed and for the most part, the adjustments which look very loose to me, have been taking care of my mild apnea. 

I have 2 questions:

1) Why the AHI in OSCAR is different from the AHI presented by the machine?

2) Because last night I had some hypopneas events, is this a sign that my pressures need to go up? My min EPAP is 5.0, max IPAP is 14.0 with PS = 4.0. Please let me know if you can see the screenshot from OSCAR for my last night sleep. Any extra recommendations? I am still damn sleepy during the days..... Sad

Thanks for all your help!
F.


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#2
RE: Reaching maximum IPAP - Time to change settings?
Welcome to Apnea Board.

I myself don't have the answer on differences in report numbers, I would trust OSCAR though. If you use too many data sources, it's just confusing the matter, and it's harder to decipher which to rely on.

You can edit settings if you choose to. In your present status, the reason to do so is to address results not so much numbers. If you felt the need to edit settings, maybe focus on moving the min pressure of 5 up a bit. ResMeds allow pressures for example of 5.0, 5.2, and so on up to 6.0, 7.0 etc. If you want to go up from 5.0, maybe try 5.4 and see what it changes.

You mention still being tired. Answer even if it's just to yourself, how long have you been on PAP therapy? how long did you have untreated apnea and fatigue? how long has therapy been helping? Suppose you have been on therapy for a week, but apnea was untreated or apnea symptoms were suspected for 3 years. Apnea damage and fatigue do not reverse overnight, nor in a week or a month. You have to continue to use PAP therapy, sometimes for months before you really notice. I think that if therapy is helping, you will start noticing some positive result within a month.
Dave

OSCAR
Standard OSCAR Chart Order
Mask Primer
Dealing With A DME
Soft Cervical Collar Wiki
INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEBSITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
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#3
RE: Reaching maximum IPAP - Time to change settings?
Thanks @SarcasticDave94.


Also for the encouraging words. I have been suffering from extreme fatigue and daytime sleepiness for about 5 years. Then 3 years ago I decided to invest on a Resmed Airsense 10 Auto and things didn't improve at all though my low compliance of about 66% must not have helped. 

I would not use it consistently as I should have because 1) I thought I would see results right away and then concluded it to be useless and 2), it was hard to handle the high pressure blowing all the time. That's when I did some research and my NP recommended a biPAP to alleviate this and improve compliance.

So now I have been using this biPAP for about 3 weeks. Much better tolerated. I just need to focus on your advice and have a little patience to see if things improve over time. I didn't know that "catch up lost sleep" was really a thing...

As far as adjusting the pressures go, do I need to adjust IPAP as well? To me, it looks like last night the machine "wanted" to pass over the limit and kind of flatten out but I could be wrong.

Thanks again for the help!
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#4
RE: Reaching maximum IPAP - Time to change settings?
I would raise both the min and max by 2 keeping the ps where it is. You were maxing out at 14 and 5 is to low for a normal adult.
Apnea (80-100%) 10 seconds, Hypopnea (50-80%) 10 seconds, Flow Limits (0-50%) not timed  Cervical Collar - Dealing w DME - Chart Organizing
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#5
RE: Reaching maximum IPAP - Time to change settings?
I saw a small section of pressure being flat topped due to the 14 that is set. If it's something you would feel better because of the adjustment, go ahead and change 14 to 15. I've found when I use the machine consistently, it takes less time to recover and begin feeling better for the therapy.
Dave

OSCAR
Standard OSCAR Chart Order
Mask Primer
Dealing With A DME
Soft Cervical Collar Wiki
INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEBSITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
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#6
RE: Reaching maximum IPAP - Time to change settings?
(12-01-2020, 01:32 PM)Frajola81 Wrote: 1) Why the AHI in OSCAR is different from the AHI presented by the machine?

There may be usually slight differences between the AHI reported by a ResMed CPAP machine and by OSCAR especially if there is more than one session in the night. The machine reading can be higher or lower than what OSCAR reports. This is caused by a difference in the way the machine and OSCAR compute AHI.

The machine rounds the length of each session to the nearest minute, then adds those together to get the total minutes for the night.  OSCAR doesn't round the session lengths and thus computes the total time for the night in seconds (or maybe milliseconds -- I don't remember which without looking). AHI is calculated as # events/total time, so OSCAR and the machine are using a slightly different denominator for total time.
The current version of OSCAR is 1.2.0.  We recommend upgrading from any earlier version.

Useful links
Download OSCAR
Best way to organize charts
How to attach charts to your post

Membership in the Advisory Members group does not imply medical expertise or qualification for advising Sleep Apnea patients concerning their treatment.
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#7
RE: Reaching maximum IPAP - Time to change settings?
Great information here. Thanks Stace and Dave. I will raise the pressure settings slightly and wait some time to judge the results. And have a little more patience Smile

@GuyScharf, it does make sense now. I was curious but not really paying much attention to the machine reports. From now on, I will only use OSCAR to assess my treatment parameters. Thanks for your explanation!

Thank you all for the replies!
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#8
RE: Reaching maximum IPAP - Time to change settings?
OH, one thing I forgot to ask is if the doctor/NP can do something against my treatment through my insurance if I adjust the machine settings myself?

In my last appointment with her, before I had upgraded to the biPAP, she mentioned that "she didn't want me messing with the machine pressures". Why is that? I feel like I am more informed than she is after spending hours reading this forum....    Big Grin

Since I will see her in about 10 days, I decided to hold off on the adjustments. My last night analysed with attached OSCAR screen occurred:

1) Pressure reaching maximum at several times
2) hypopnea events
3) And even one CA event showed up. Is this bad?

Please let me know your thoughts.....

--
F.


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#9
RE: Reaching maximum IPAP - Time to change settings?
No they can’t. It is your therapy and you can make ANY change you want. The only thing insurance will look at is hours used and if your AHI is under 5. 

Your top number is to low. I suggest you raise it by 3. You have it set to VAUTO and the machine will only go as high as needed so your change of high pressure may never reach the max number.
Apnea (80-100%) 10 seconds, Hypopnea (50-80%) 10 seconds, Flow Limits (0-50%) not timed  Cervical Collar - Dealing w DME - Chart Organizing
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#10
RE: Reaching maximum IPAP - Time to change settings?
What causes a ResMed CPAP machine to increase pressure?

  1. Flow limitations
  2. Snores
  3. Apneas
You have a lot of flow limitations and snores. Be sure to bring those to the attention of your doctor (in case he just sees the AHI and says "everything is fine").

Do you sleep on your back? That can be a source of both. Also sleeping with your head forward (your chin tucked in) will increase both.
The current version of OSCAR is 1.2.0.  We recommend upgrading from any earlier version.

Useful links
Download OSCAR
Best way to organize charts
How to attach charts to your post

Membership in the Advisory Members group does not imply medical expertise or qualification for advising Sleep Apnea patients concerning their treatment.
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