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pressure question
#1
my sleep study pressure was a straight 9cm cpap. they werent too sure that was accurate because i had no REM sleep. i had been on CPAP at 9cm for one month, and recently got sleepyhead and encore basic, and learned that i had very few osa's, mostly hypopneas and centrals, although my AHI has been consistently under 3. The crazy thing is that the flow limitation chart was WILD, and although i feel much better than pre-cpap, there is room for improvement. So, under another persons advisement (I dont have a sleep doc at the moment-long story), I went to auto mode and set it at 7-10. The pressure kept bumping up to 10 all night, so again, under advisement of a knowledgeable person, I again raised the pressure, this time at 8-11.

i have been at 8 minimum and 11 maximum for two nights and i had no osa's and a few hypopneas, mostly all centrals. still, not very many centrals.Smile the flow limitation chart still looks WILD, and the machine pressure stayed nudging at the 11cm mark both nights all night. i dont know if i should increase the max pressure again or just leave it since i dont really understand flow limitations. i mean, i feel good, but i have felt lousy for so long i am not sure i really know what feeling good is like, ya know? is it possible i could feel even better if the flow limitations got under control? ps I am going to see a sleep doctor (finally) in Sept
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#2
Post a screenshot, please?

http://www.apneaboard.com/forums/Thread-...ttachments
PaulaO2
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#3
(08-17-2013, 07:34 PM)PaulaO2 Wrote: Post a screenshot, please?

http://www.apneaboard.com/forums/Thread-...ttachments

[Image: FlowlimitationGraphAugust1_zps82ef498d.png]
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#4
(08-17-2013, 06:28 PM)oak Wrote: i have been at 8 minimum and 11 maximum for two nights and i had no osa's and a few hypopneas, mostly all centrals. still, not very many centrals.Smile the flow limitation chart still looks WILD, and the machine pressure stayed nudging at the 11cm mark both nights all night. i dont know if i should increase the max pressure again or just leave it since i dont really understand flow limitations. i mean, i feel good, but i have felt lousy for so long i am not sure i really know what feeling good is like, ya know? is it possible i could feel even better if the flow limitations got under control?

Hi Oak,

Flow Limitation is an early indication that the airway needs more pressure. ResMed will increase pressure when FL occurs, even if there is no apnea or hypopnea yet, to prevent apneas or hypopneas from occurring.

Unless the central apneas are lasting a long time (like 45 seconds) the doctor might not see any cause for concern, since you are having less than 5 per hour. Some insurance companies will not approve payment for an ASV machine (which can treat/prevent centrals) unless the number of central apneas is at least 5 per hour or at least 15 per hour, or are lasting a long time.

Higher pressure can often cause more centrals, but, for some people who are having centrals, I think high pressures do not cause more centrals. It varies from person to person.

You may be able to avoid needing to increase the Max Pressure if you are able to make sure you never spend time on your back while sleeping, by wearing a snug teeshirt with tennis ball in a pocket sewn right between the shoulder blades, or by wearing a light knapsack with a couple cartons of tennis balls inside.

Take care,
--- Vaughn
Membership in the Advisory Member group should not be understood as in any way implying medical expertise or qualification for advising Sleep Apnea patients concerning their treatment. The Advisory Member group provides advice and suggestions to Apnea Board administrators and staff on matters concerning Apnea Board operation and administrative policies - not on matters concerning treatment for Sleep Apnea. I think it is now too late to change the name of the group but I think Voting Member group would perhaps have been a more descriptive name for the group.
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#5
(08-17-2013, 07:34 PM)PaulaO2 Wrote: Post a screenshot, please?

http://www.apneaboard.com/forums/Thread-...ttachments

[Image: Capturelastnitepressure_zpsbd0cacfa.png]
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#6
(08-17-2013, 07:41 PM)vsheline Wrote:
(08-17-2013, 06:28 PM)oak Wrote: i have been at 8 minimum and 11 maximum for two nights and i had no osa's and a few hypopneas, mostly all centrals. still, not very many centrals.Smile the flow limitation chart still looks WILD, and the machine pressure stayed nudging at the 11cm mark both nights all night. i dont know if i should increase the max pressure again or just leave it since i dont really understand flow limitations. i mean, i feel good, but i have felt lousy for so long i am not sure i really know what feeling good is like, ya know? is it possible i could feel even better if the flow limitations got under control?

Hi Oak,

Flow Limitation is an early indication that the airway needs more pressure. ResMed will increase pressure when FL occurs, even if there is no apnea or hypopnea yet, to prevent apneas or hypopneas from occurring.

Unless the central apneas are lasting a long time (like 45 seconds) the doctor might not see any cause for concern, since you are having less than 5 per hour. Some insurance companies will not approve payment for an ASV machine (which can treat/prevent centrals) unless the number of central apneas is at least 5 per hour or at least 15 per hour, or are lasting a long time.

no, they are lasting about 10 seconds.

Higher pressure can often cause more centrals, but, for some people who are having centrals, I think high pressures do not cause more centrals. It varies from person to person.

You may be able to avoid needing to increase the Max Pressure if you are able to make sure you never spend time on your back while sleeping, by wearing a snug teeshirt with tennis ball in a pocket sewn right between the shoulder blades, or by wearing a light knapsack with a couple cartons of tennis balls inside.

actually, at least during my sleep study, i did better on my back than on my side. go figure.

Take care,
--- Vaughn

what do you think about raising the min to 10 since i seem to need at least that pressure, and the max to 14? or am I worrying about the flow limitation unnecessarily? i do have short frequent awakenings.
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#7
(08-17-2013, 07:53 PM)oak Wrote: what do you think about raising the min to 10 since i seem to need at least that pressure, and the max to 14?

Yes, if it were me, I would probably do something like that if using a machine like yours, which distinguishes between Central Apnea and Obstructive Apnea and which only raises the pressure as much as needed to treat obstructive events.

But I would also zoom in (using 1 minute full scale) on the Flow during each central apnea to keep track of how long they are lasting, and I would do something to make sure I stay off my back the whole night.

Take care,
--- Vaughn
Membership in the Advisory Member group should not be understood as in any way implying medical expertise or qualification for advising Sleep Apnea patients concerning their treatment. The Advisory Member group provides advice and suggestions to Apnea Board administrators and staff on matters concerning Apnea Board operation and administrative policies - not on matters concerning treatment for Sleep Apnea. I think it is now too late to change the name of the group but I think Voting Member group would perhaps have been a more descriptive name for the group.
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#8
If it were me, I would set it to 10min - 20max and see what shakes out. If it goes too high to tolerate or so high that CAs go unreasonably high, you can always go back in and dial back the max pressure until CAs subside. Turning the machine loose and letting it raise as high as it wants to for a night will at least let you see how high the machine wants to go in order to defeat flow limitation.

Just my two cents.

Sleep-well

Note: I would only do this using an S9 AutoSet or PRS1 Auto.
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#9
I agree with JG. Let the machine figure out what's best for you by setting the upper limit to 20.
Worst that can happen is some pressure effects. (air in stomach etc)
In order to minimize discomfort just bump the pressure up by 1-2cm at a time and run for a week so you can adapt in a gradual way.
When you get to 20cm, let it run a week or two like that and check your sleepy head results.
If you peak at a lower value than 20 than you're ok.
It you run a plateau at 20cm for a major part of the time you can start looking for causes.
You can always back the pressure down a notch at a time.

Cheers & good luck!
"With ordinary talent and extraordinary perseverance, all things are attainable." - Thomas Foxwell Buxton

Cool
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#10
Agree with others that you should figure out if the machine plateaus at 20 or somewhere before then.

Could this flow limitation be a sign of some kind of obstruction in the airway such as a deviated septum or nasal polyps?
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