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Reduce minimum pressure?
#1
Reduce minimum pressure?
I've been using a pressure range of 9.4 - 15 with EPR 3 for two months now.  Until two weeks ago, I had Response set to "standard."  Pressure curve typically peaked between 12.5 and 14.5.  Two weeks ago, I changed the response setting to "soft."  Pressure usually peaks between 11 and 12; AHI of 1.2 is about average.  I do have some intermittent problems with aerophagia and mouth leaks.  For the mouth leaks, I am trying to train myself to keep my tongue on the roof of the mouth, so that's not an urgent issue.  Most of my AHI is usually made up of  CAs.

With a minimum pressure of 9.4 and a typical peak of 11.5 to 12, the peak pressure is only about 2.5 cm more than the minimum pressure.

Might reducing minimum pressure be a good idea?  What might be a reasonable target, and what effects should I watch for?

Thanks!

   
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#2
RE: Reduce minimum pressure?
My minimum is 8.6... I'm not comfortable below 8.
Go ahead and drop it by .5 and monitor your flow limit graph and see how well it does. Resmed tends to respond more quickly than Respironics, so you'll probably be OK if you are comfortable at the lower pressures.
-- Rich
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#3
RE: Reduce minimum pressure?
I wouldn't drop the the minimum pressure any further. Your chart is showing some flow limitations at times and I think if you drop the pressure any lower and that might turn into obstructive events. If you want to try and get rid of CA events try reducing the EPR to 2cm.
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#4
RE: Reduce minimum pressure?
I don't see any harm in reducing pressure. If this is typical, you have no OA at these pressures. The flow limits that Walla is seeing are minimal, and the auto CPAP is increasing pressure where these occur. I think you can easily tolerate a minimum pressure of 9.0, and possibly lower, however it is your maximum pressure that will limit the pressures you encounter, and you don't need 15 cm. Based on this graph, your 95% pressure is 10.8 cm and that could be used as a maximum limit, and possibly a low as 10.4.
Sleeprider
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INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED AS MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEB SITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
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#5
RE: Reduce minimum pressure?
(08-24-2018, 08:23 AM)Sleeprider Wrote: I don't see any harm in reducing pressure. If this is typical, you have no OA at these pressures.  The flow limits that Walla is seeing are minimal, and the auto CPAP is increasing pressure where these occur. I think you can easily tolerate a minimum pressure of 9.0, and possibly lower, however it is your maximum pressure that will limit the pressures you encounter, and you don't need 15 cm.  Based on this graph, your 95% pressure is 10.8 cm and that could be used as a maximum limit, and possibly a low as 10.4.

Thaniks.  I have some questions about maximum pressure setting.  What difference does the maximum pressure setting make if the machine isn't going there anyway?  In my case, doesn't a max of 15 have exactly the same results as a max of 20?  Is there some advantage to setting the maximum lower than the machine wants to go to?

I'm trying a range of 9-15 now to see if there are any changes.  AHI last night was 0.49, split evenly between OA and H.

Perhaps coincidentally, this is only the second night I have had without CAs.  (The other was on a one-day test of the Autoset for Her mode.)
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#6
RE: Reduce minimum pressure?
If you are trying to limit how high the machine pressure will go, the maximum pressure is what needs to be reduced. The pressure will only go as high as you need, and that is clearly less than 15 cm; however that setting is not helping with your aerophagia or leaks at this point. For therapy, it's best to have your pressure higher than your needs, but there are many reasons we limit maximum pressure, and aerophagia is one of them. It may result in a compromise between events and comfort, but that's the game.
Sleeprider
Apnea Board Moderator
www.ApneaBoard.com

____________________________________________
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Optimizing Therapy
Organize your OSCAR Charts
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INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED AS MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEB SITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
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#7
RE: Reduce minimum pressure?
(08-24-2018, 08:23 AM)Sleeprider Wrote: I don't see any harm in reducing pressure. If this is typical, you have no OA at these pressures.  The flow limits that Walla is seeing are minimal, and the auto CPAP is increasing pressure where these occur. I think you can easily tolerate a minimum pressure of 9.0, and possibly lower, however it is your maximum pressure that will limit the pressures you encounter, and you don't need 15 cm.  Based on this graph, your 95% pressure is 10.8 cm and that could be used as a maximum limit, and possibly a low as 10.4.
I tried reducing my max to a couple of cm above my 95%, and it did result in an increase in events.
Whether positional, stress, or simply how tired I am, my AHI will vary from 0.0 to 2.0.  There are mostly "good" nights (0.0 to 0.4), with an occasional "bad" night.  When I cut my max, I found that I was getting more "bad" nights, so I put my max back up to 18 and have left it there.  If it's not needed, the machine won't go there.
-- Rich
Links to Download OSCAR here
OSCAR Installation and Setup

Using Attachments to Post Images on Apnea Board

INFORMATION ON FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED AS MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE WEB SITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.

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#8
RE: Reduce minimum pressure?
BD75, the chart you posted shows your pressure mostly between about 9.5 & 10.5. your leaks occurred at pressure above 10.5. IDK if leaks led to higher pressure or higher pressure led to leaks. either way, one way to help manage your leaks is to reduce max pressure. you can always push it up again if you get more oa. trial and error.
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#9
RE: Reduce minimum pressure?
I've now been using pressures of 9.0 - 15 for several days.  CAs have virtually disappeared and AHI has been less than 0.5 on each day -- both an improvement over when I was using 9.4 - 15.  Mouth leaks continue to be an intermittent problem, no less or no worse than before.

However, I have not felt as rested in the morning, even with the same number of hours of sleep as I usually get.  Does it make sense that I might feel more rested at a higher pressure, even if that also results in a higher AHI?  Maybe I am just going through another adjustment period?  I'm confused! Huhsign

Thanks.

   
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#10
RE: Reduce minimum pressure?
you can't do a whole heck of lot better than what's indicated in that chart. 1 hypopnea and some flow limitations. even your leaks were below the red line. I'm envious. give it some time.
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