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Pressure settings
#1
Hi, I am a new member. I have been using an s9 resmed for a long time. I have been exhausted intermittently. I took my machine in and the rt said I was using 11.9 just like six months ago but this time he changed my upper setting from 12 to 14. Still tired I found out to check my readings and I was requiring 13.9 so I changed my upper setting to 20. I require usually from 12 to 19.4 but usually around 14. My leakage last night was zero and my apneas were .4
I am confused as to why my pressure requirement goes that high and is it bad for me. I think my pressure goes higher when I get a deeper sleep nif I use a nasal mask my pressure is only 8. I had to use one recently due to gum surgery. Any input is appreciated.
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#2
Hi Vesta,
WELCOME! to the forum.!
Hang in there for answers to your questions and best of luck.
trish6hundred
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#3
You have the S9 Autoset then?

How long did you wait between when the RT changed it to 14 and you changed it to 20?
PaulaO2
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#4
If you are running Sleepyhead and monitoring everything you most likely wont hurt anything by going with 20 cm for max.
There may even be transient occasions where the machine would schedule that much.
(like changing masks too)
Reading the datalogs will show you the answer.

Good Luck!

Sleep-well
"With ordinary talent and extraordinary perseverance, all things are attainable." - Thomas Foxwell Buxton

Cool
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#5
(06-10-2013, 11:29 PM)PaulaO2 Wrote: You have the S9 Autoset then?

How long did you wait between when the RT changed it to 14 and you changed it to 20?

Several days later
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#6
(06-10-2013, 08:57 PM)Vesta flaggert Wrote: ... I took my machine in and the rt said I was using 11.9 just like six months ago but this time he changed my upper setting from 12 to 14. Still tired I found out to check my readings and I was requiring 13.9 so I changed my upper setting to 20. I require usually from 12 to 19.4 but usually around 14. My leakage last night was zero and my apneas were .4 ...
I recently joined the board, which is why I am responding late to your question.

My doctor told me that the correct adjustment is the lowest pressure that delivers good therapy. Apparently there are problems that can occur with long term use of high pressures. My physician mentioned increased central apneas as one.

From 14 to 20 is a very large increase. It may be necessary, but I would not make such a change to my machine without a physician's guidance.
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#7
(06-28-2013, 08:46 AM)JerryG Wrote: My doctor told me that the correct adjustment is the lowest pressure that delivers good therapy. Apparently there are problems that can occur with long term use of high pressures. My physician mentioned increased central apneas as one.

What your doctor told you is completely correct. The point that you may be missing is that Vesta uses an AutoSet machine. That machine automatically and dynamically adjusts the pressure up or down as required to provide that minimum pressure that combats the apneas. There are many things that can change the pressure setting you require during the night: rolling from your side to your back is going to tend to increase your pressure requirements, any alcohol or other medications that increase your relaxation would require additional pressure until they wore off, etc.

If you have a straight CPAP machine, the (single) pressure setting should be a compromise for how you normally sleep, rather than the worst case setting, as you point out. However, what Vesta changed was the upper limit to which the AutoSet machine was permitted to go. From what I understand of AutoSet machines, I'm not sure I see a down side to always having that upper limit set to 20 (the maximum that the machine can support). The lower limit does want to be tuned, since the machine starts its treatment at the lower limit. If you _know_ you will need a pressure setting of at least 10 (say), why waste the potential sleep time while the machine works its way up from a lower value? Plus, when you get used to higher pressures, significantly lower pressures start to feel like there's not enough air being delivered.
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#8
(06-28-2013, 11:47 AM)RonWessels Wrote: [quote='JerryG' pid='39361' dateline='1372427172']
... I'm not sure I see a down side to always having that upper limit set to 20 (the maximum that the machine can support).

... Plus, when you get used to higher pressures, significantly lower pressures start to feel like there's not enough air being delivered.

If there were no downsides to a high upper pressure-limit on APAP machines, then manufacturers would ship them all preset to the machine's maximum pressure, and only the lower limit would need be "personalized."

I'm no physician but it is my understanding that factors other than AHI come into play in deciding on an upper pressure limit. When I got my first CPAP the doc set it for 10cm saying that although I did a little better breathing-wise at higher pressures, she didn't feel the small reduction in breathing events was worth the trade off.
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#9
My Dr. set my at EPAP 13cm and IPAP at 17cm on my BiPap s/t..my CA's and OA's and hypopneas were thru the roof the whole 3 years he left me on it despite my repeated ignored pleas for help.

I Finally bought myself an autosv advanvced...I have the Epap set lower to 10cm and raised the max ipap to 25 (machine max) I have 1 CA and one OA a night..MAYBE,if even that.... the rest of my low low AHI is made up of all Hypopneas (apnea wanna be's the machine stopped before they started?)
I have found my machine has hit 22cm to 24cm on IPAP several times a night for me...but stays at the lowest set pressures for most of the evening....So raising you max does not mean the machine will stay there but will give it enough headroom to go that high if it senses it needs to..as mine does
I don't believe anything I hear and only half of what I see
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#10
(06-30-2013, 12:55 PM)JerryG Wrote: If there were no downsides to a high upper pressure-limit on APAP machines, then manufacturers would ship them all preset to the machine's maximum pressure, and only the lower limit would need be "personalized."

I'm no physician but it is my understanding that factors other than AHI come into play in deciding on an upper pressure limit. When I got my first CPAP the doc set it for 10cm saying that although I did a little better breathing-wise at higher pressures, she didn't feel the small reduction in breathing events was worth the trade off.

Difficulty acclimating is the only "downside" to higher pressures for an otherwise healthy person with simple Obstructive Apnea. Pressure induced Central Apneas caused by hyperventilation and Aerophagia are a couple of the main culprits - along with ears popping, having a hard time exhaling against the pressure and just plain discomfort. These go away for most PAPers with time to adjust and with proper management; but, for many it is a rough ride for a while and some may find it too difficult to adjust to the pressure level that provides the best statistical results - finding it more desirable to find a sweet spot that provides pressure high enough to get adequate therapy, but low enough to tolerate it. This is why Autos don't just come with the max pre-set to 20 and no way to adjust it down. PAP therapy has a notoriously low compliance record and blasting people with optimal pressure from the get go would make the compliance rate even worse.

Unless somebody has other medical issues at play, the only danger of the maximum pressure being set too high is the danger of it causing non-compliance.

Let us also realize that most of the people making the claim that auto machines can't be relied upon to find the proper pressure and that max pressure set too high could kill you and then go after your family (ok, that's a slight exaggeration) are the very same people who make a large part of their pay check deciding what pressure range to prescribe.
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