When to increase pressure

[PaulaO2]

I've had my Autoset since November. My pressure with the Escape was 12 so I started out with the pressure range of 10 - 16. Two weeks later, after collecting data, I narrowed that range from 11.6 to 16. Two weeks after that, I went to 12-17 which is where it has stayed.

But looking at the data, the max is hitting 16 to 16.98 a lot. And the only time it is at 12 is before I go to sleep. Usually the median is 13.5 or higher. The 95% is 15 or higher.

I'm considering raising the pressure to be the range of 14 - 20. My AHI is great (6 months' is 1.48).

Until lately, it was just a "what if" in terms of raising the pressure but I am considering it now due to a recent change in my anti-depressants. My AHI has been rising since then. I used to normally stay between .5 to 2 but it's been 2-3 since the medication change. I know 2-3 is still great but it's higher than I usually go. Not only has the number of events changed, but the length of them has increased. I've had obstructive events as high as 22 seconds and a 45 second hypopnea event. The central events have increased in number and time as well but only by a few seconds.

I'm also more tired during the day. I hate to take naps but I am feeling that urge a lot which is unlike me.

On the one hand, the medication change is only into day 5 so it's not enough data to base any conclusions. It may calm down in a few days.

On the other hand, I know what is "right" for me each night and this isn't right.

So any opinions on what to do?

[Kadenz]

Well, you could try putting it on auto-adjust mode and see what happens to the average, 95th percentile and max pressure for a week or two.

Just a thought, though I'm not an expert in such matters.

---

Ps

And to your ahi of course.

[DocWils]

Paula - the massive adjustment your body and psyche go through with a change in meds would account for a lot of your tiredness, since your AHI doesn't seem to be at the level that would cause day time tiredness, even with the length of events that you mention. I agree that going to autoset would be a good idea,let the machine find the right level. But also give it time for your body to adjust to the new med regime.

[PaulaO2]

It is in auto mode. 12 - 17.

[Kadenz]

Sorry, I should have read your post more carefully...

I also have my machine in AutoSet mode (4 to 20) and, funnily enough, my average, 95th percentile and maximum pressures have been much higher in recent weeks compared with the previous six months. I have no idea why, though, and can't think of any significant change in my routine, health, diet etc that might account for that. Yet my ahi has not changed and is invariably less than 0.6.

I realise that that info was probably neither helpful nor interesting, but it was prompted by your post.

[PaulaO2]

It's actually not a good idea to keep the auto "wide open" as you have it. The narrower the gap, the better. It gives the machine better ability to adjust to your needs. Which is why I evaluate mine each month, to see if it could be made different and, therefore, better.

BTW, there is no way I could sleep with just 4cmH2O of air! I'd feel like I was suffocating! When I first got the Autoset and put it on the lower end at 10, I felt smothered for several days until I adjusted.

[zonk]

imo there is nothing wrong if pressure hit the maximum, if the maximum enough to control apnea, overall AHI below 5 and not seeing any clusters of events when at the maximum

the S9 increase pressure in response to snoring and flow limitation and pressure increase can trigger problems to some people such as aerophagia, discomfort during the night which can lead to feeling lousy during the day

for me more is not necessary better but your mileage can vary
I can feel that hammer swinging my way ... I,m out of here

[GaryG]

Paula, funny you mention that. My initial setting from the doc was 4-15 on my S9 Autoset. Well, my 95% pressures were around 11, so I knew that it made sense to up the minimum. So I've raised the minimum to 7, and could go higher (as my 95% pressures now are around 12-13 but I'm getting some mild aerophagia. Yes, I've tried playing with EPR with minimal success, My AHI numbers are good - under 2 for the last month.

But the thing is, that damn aerophagia is keeping me from increasing my minimum. Gas-X and Beano don't seem to help. After all I think they would "prevent" gas ahead of time, and in the morning, well its too late,

So yeah, I'll probably increase my minimum at some point, but this aerophagia thing - will it go away?

Also just switched masks from Mirage Nasal FX to Activa LT and my leaks are down to 0.0. So I think I found my mask.

[DocWils]

Alas, most anti-gas pills won't do a thing (ovol is my fave for that) - they are to minimize gases from digestion and not air swallowing - so no luck there. I wish it would work, coz I also suffer from swallowing a ton of air, leaving me bloated during the day and even creating reflux, but there is nothing on the market that I know of that will work.

the only thing I have seen work a little bit is to burp yourself like a baby does when you get up in the morning - it relieves some of the air bloating.....

[zonk]

Also just switched masks from Mirage Nasal FX to Activa LT and my leaks are down to 0.0. So I think I found my mask.

me too. at times swap with the SoftGel cushion which fit on the same frame as Active LT but prefer the LT, feel lighter

last night 95P leak was 8 and max 14 .... median zero which is good indication that the leak (95p and max) was not that significant
looking at the leak graph, shows almost flat line for most of the night but for few seconds hit 14, probably a bit of mouth breathing

I wear chinstrap which helps keep mouth closed but as wear it loosely mouth can open at times but not enough to impact on the therapy