what are the goals of pressure vs OV events

[custom68]

I don't know that I worded the title very well but I am  curious on what is expected from the treatment?  Meaning, do we want to have the pressure high enough to never have a OA event (not sure that is possible) or lower allowing the autoset feature bump the pressures as needed when an event has occurred.  I guess I do understand the purpose is to limit or eliminate all apnea events so I may have answered my own question.  
I see folks on here with what I consider high pressures, I am new at the therapy at 3 weeks but at some point as I have increased it is uncomfortable for me to breath mainly when falling asleep.  I do have the ramp turned off as that seems to be the norm.  I am also chasing CA events but that is for another topic.  
Thanks,
Dave

[jdougc]

You need to get an sd card and to download Oscar, if you want detailed help here.
Your starting pressure of 6 cm is too low for and adult. Considers at least 7cm of pressure.
Do you use EPR?


ResMed machines tend to be reactive, they will increase the pressure after an event or Flow Limit and then slowly decrease the pressure for comfort. These changes can effect your seep, they did mine. I went to a constant pressure.
You can watch YouTube videos on interpreting Oscar charts.

Are you a side sleeper?
Do you have any other medical conditions that could effect your sleep?
Are you taking medications that could effect your sleep or breathing?

Don't start multiple posts as it would be beneficial to see your history.

[custom68]

Hi Jdougc
I apologize I do have another thread started for "help" on setup. I was just looking for generic information in this post as I try to learn. I thought it might be helpful across the board and I hadn't found this specifically in my search. If we want to merge this that is fine as well.
My goal was to understand if I am told to bump my pressures what to look for, do I keep going until I don't see any OA events? I can post daily OSCAR reports and I do want the advice from the boards but also wanted to understand the whys as well.
Thanks
Dave

[super7pilot]

Custom68, It's more a goal to lower/eliminate OA's while trying to make that treatment as comfortable as possible. So it's a compromise. but it should lean to the removal of OA's, then comfort.

And we do that by looking at our OSCAR charts and see at what average "median" pressure that treats our OA's. Then raise the minimum to that level and use 'as necessary' the EPR function to make exhaling a bit easier. The max pressure should be set substantial higher in case one has a particularly bad OA event. Otherwise the machine will never go to the higher pressure as a normal part of the pap cycle.

What I have seen as I have roamed this forum is that two things are mostly true.
1, Dr's send patents out the door with FAR too low a lower pressure setting. And this makes the new user feel like they have no oxygen. And also makes for some pretty disrupted sleep due to the pressure having to ramp up from 4cm up to 10-12. That is a 200% increase in air pressure from 4-12.
2, New users tend to not give their bodies enough time to get used to pap treatment and resist raising their lower pressure to their median treatment level. Likely thinking that breathing at the lower pressure is easier and let the machine do those big adjustments. Thus prolonging the larger than needed pressure differential sleep disruptions. I felt much worse on pap than before pap treatment started. that went 1.5 months before I improved, even though my AHI was low from the start. "My" body likes EPR2 and I can do EPR 1 or off. But, if I go to EPR3 my CA's go up quite a bit.

Of course all this is just my view and others may disagree.

[custom68]

It seems to be a fine line, after a bad night of sleep with higher pressures I decided to focus more on the comfort first. That was what I was looking for and didn't know where the point of demising returns was. If I cant sleep due to the higher pressures it didn't help me.
In my case it is the exhalation like you mention as my main issue. With using a nasal pillow it forces me to only breath thru my nose. Does a full mask allow you to breath thru your mouth as well? I have small nasal passages and had turbinate reduction done a couple of months before starting the CPAP. Unfortunately I cant say I see much difference how I breath.
I did quickly figure out that the low in my case of 6 left me starving for air.
This all give me something to think about on my journey.
Another question, is it correct to assume our bodies will acclimate to the added pressure over time? I am just 3 weeks into this and only a couple with the knowledge of this board and OSCAR.
I will also add I think there is a part of this that is mental, staying positive will certainly help. Thanks for taking the time to add to the information.
Dave

[jdougc]

I felt that the nasal cushions delivered air with much more "force" if that is that right word. I felt my nose billowing out. I watch a YouTube video that said to set the mask type to Full even though i was using A pillow mask, I think the reasoning was that the machine uses more pressure because of the resistance of the pillow mask. I found this more comfortable.
You can try using the cpap while you are reading or watching TV, to help get used to it.  If this session info bothers you, take the SD card our or uncheck the session in the lower left. You have to check the permissive mode under the clinical tab in the preference setting.

[custom68]

Thanks for those suggestions. I will give the change of mask settings a try to see if it makes any difference. I will also take your suggestion on sitting and watching TV with this on tonight. I had not done that even thou I saw that as a tip. I just jumped right in and seemed to do very well right off the bat however as I have made adjustments it is gotten a bit more difficult. This will help.
This is a great board for some good discussions.
Dave

[super7pilot]

there are exceptions. But the vast majority get used to or at least are able to tolerate treatment pressures. The diaphragm muscles are having to work a bit harder when under pressure and it feels like the air is at a million PSI. It took me 1.5 months.

And yes. One's attitude can be a key factor in getting over that last hurdle. Just think of all that wonderful sleep and the health benefits of pap. And keep at it.

Even with a full face mask you want to limit breathing through your mouth as much as possible. A FF mask only is there to help you from loosing your therapy and waking you should your mouth open, like with a nasal mask.

Sorry to hear that the nasal treatment didn't help. Mine (VivAyr) sure did in that I'm just SOOO much less stuffy. my Flow limits did go down, but not a whole lot.