Forum · variance in pressure capability

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[-] wiredgeorge +2 points · about 1 year ago Sleep Enthusiast

My machine is a ResMed AirCurve 10 Vauto. My prescription says to set it in the BiPaP mode to pressure 25/21. I believe the MAX pressure this machine can do is 25 and if it is set to max, and more pressure is needed to remain effective, I was wondering if there were other machines out there that were capable of higher pressures. I was a bit of an athlete when I was younger and my body fat was under 10 percent but I had a neck size over 20 inches and as I am now an old fat man, probably even thicker. The 25 air pressure may eventually have to be increased. is it possible with one of the other machines out there? I tolerate 25 easily. .

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[-] DanM +1 point · about 1 year ago Sleep Enthusiast

Hi wiredgeorge. There are some specialty machines out there that I am aware of that are capable of pressures up to 30 cm. ResMed has some in their lineup, but pressures that high are usually available in modes other than BiPAP and CPAP.

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[-] wiredgeorge +1 point · about 1 year ago Sleep Enthusiast

The machine I have has three modes and the BiPAP mode and APAP mode have the highest setting of 25 which I am currently prescribed. The CPAP mode max is 20 which is my exhale setting. I will discuss this with my PCP if I think a higher pressure ever becomes beneficial. Thanks

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[-] Verne7 +0 points · about 1 year ago

Just an idea here... I am an illegal. That is, I reset my machine myself. Mainly, because my sleep "doctor" started me at 5-15 and that led to some of the worst sleep I have ever had. At 5, the low pressure was like trying to breathe through a single straw. That first night, I slept 11 hours, and had to sleep 6 more after I took the mask off. I was ready to give up 4 days into it. But, with Afib and pretty uncontrollable high blood pressure it wasn't an option. My "dr" would not have given me ANYTHING without data to back it up, so I simply learned how to change them myself. I've ended up at 9-16.

Now, the last strange part is that in the data I noticed the low pressures also had low AHI's when I switched to my full face, which also ended most of the Large Leaks on the Sleepyhead chart. However, the fact that I had some low AHI's seemingly caused by low pressure, made me to look at the charts again. I certainly couldn't try the low pressure again, because that led to an Afib attack. The DME told me I could turn off the Pressure Relief when I got "used to" the machine. However, turning that off turns off the prescription EPR. So, possibly the DME confused me by talking about Ramp and Pressure Relief at the same time, and possibly he had only meant it was okay to turn off the Ramp. Anyway, I was curious and looking at the charts I had a lot of high respiration around the events. And, I thought, maybe Pressure Relief could stop all that high respiration I was seeing in the charts. So I turned the Pressure Relief back on and I went from AHI's in the 1.x range to 0.11 last night. I had one CA during 9:20 hours of sleep. Last night, my respiration's were without the spiky high readings.

The one good thing I can say about my sleep "doctor" is that her ignorance helped me learn things that helped me set up my own cpap. If my respirations continue low, I can probably change the upper number back to 15 as well.

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[-] wiredgeorge +0 points · about 1 year ago Sleep Enthusiast

The ramp function is a front end user configurable setting. It starts out at lower pressures when you first start therapy and ramps up the pressures(s) in the amount of time selected. On my machine, 5 minute ramp is the least amount of time and 20 minutes the most without turning it off. I have very high pressures and found when I turned it off, it took a bit longer to fall asleep than on the 5 minute ramp. I could turn it off with no ill effect probably but I have left it at 5 minutes and seldom, if ever, stay awake past 5 minutes.

As far as the other settings you refer to, these are on the back end and are not intended to be user configurable. Since my therapy is going very well for me, I haven't chosen to monkey with any of these settings but I understand where you come from as far as the pro med help you get (and are paying for). Best possible situation would be for medical professionals to be up to snuff on sleep therapy and the ins and outs. Surprised to not see MORE of them on sites like this as I think they would actually learn where patients are and what issues they face. Very thankful we have the pros on here who do take the time to immerse a bit in their field.

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[-] Verne7 +0 points · about 1 year ago

One thing I was talking about is a setting called Pressure Relief. It is on the front end, it is user configurable, and it turns off EPR. Which I find strange. Perhaps your machine is slightly different than mine.

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[-] DanM +0 points · about 1 year ago Sleep Enthusiast

Hi Verne7 and wiredgeorge. Some machines do allow the user to adjust the pressure relief settings. This is specific to machine brand and model, and on some machines must be activated by the equipment provider. Hope this helps!

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[-] Roy +0 points · about 1 year ago

Hi all, I too have Afib and because of it I am very committed to making my cpap treatment work. I had my first follow up, at six weeks with my sleep Doctor (well his under study but she was/ is good also) two days ago. Anyway two weeks ago I also raised my starting pressure from 5 to 7 on my own and saw a 40% improvement in my ahi to around an average of 7 still not where it needs to be. My doctor was fine with my having raised my starting pressure on my own. I personally won't mess with the high end (15) and she said that still looks fine since my machine in 6 weeks has never gone over 14 and my nightly average is 9. She raised my starting pressure to 8 and shut off the ramp on startup (which is fine with me) I can still hit the ramp button and it will kick in then but I have yet to feel the need for that. The first night (2 nights ago) at the new starting pressure my Ahi was 4.7 good for me but last night it was 8. No large leaks at all so i'll stay the course here 8 - 15 thru vacation and see what happens then revaluate in mid October. My machine does allow me to adjust the pressure relief setting and currently I'm using the most relief I can but since I'm more use to it now I probably could reduce it without it bothering my much and see if my Ahi scores improve. As with most things in my life anymore it's progress not perfection.

Roy

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[-] DanM +0 points · about 1 year ago Sleep Enthusiast

Hi Roy. Happy to hear treatment has improved your AHI and your are more comfortable with the higher starting pressure. Persistence is key, and please keep us posted! I actually found that I liked the EPR on my machine at the lowest setting. It would be great to know what your thoughts are as you lower or turn your EPR off. Best wishes!

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[-] Verne7 +0 points · about 1 year ago

I just recently found that turning my EPR back on, allowed the machine to go below 6 (on exhale)- even though my low setting was at 9. 6 is too close to the number that causes afib, and yesterday, I was in afib when I woke, with a pulse of 80 and blood pressure of 164/115. My blood pressure goes up when I sleep badly. The therapy worked, and those numbers dropped quickly. But, my blood pressure dropped too much when I took my meds. When I've been having good pressure recently, it's normally 134/88. So, I finally had recreated the CPAP therapy that was so good for my blood pressure, I think I was really close to some good numbers and didn't want to lose that benefit. I wasn't sure whether to change the EPR from 3 to 2, or to raise my lower setting from 9-10. Either one would keep that EPR pressure from going to 6. Also had to change my meds, because evening my blood pressure dropped to 111/64 and worst was my pulse was 40-42, per doctor I need to be above 50. So, I took half of my next ration of bp meds (2) of them anyway, and set my machine at 10-16, because I still do get up to 15, and a EPR 3. My last 3 days I've had an AHI of 0.11, 0.44, and 0.39 last night. I had CA's the first two nights, but not a single one after the last settings change. And, my waking bp showed no sleep problems at 140/85 pulse 64. I think I see a connection to respiration rate. Last night, my respirations went up only into the 30's as opposed to nights the charts show I can close to 50. The CA's I get seem to be getting, are a period where I stop breathing for about 16 seconds or so. There was something about a Clear Airway pulse being generated, but I'm not sure what that means. I'm thinking this last pressure change might be enough pressure to keep the airway open and prevent CA's. That's a guess from last night's charts.

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[-] wiredgeorge +0 points · about 1 year ago Sleep Enthusiast

Roy, by chance, are you getting feedback on leaks as you seem to get feedback on the AHI? What is the L/min rate when the AHI is highest and what is it when it is lowest. Just curious...

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[-] ABklynKindaGuy +0 points · about 1 year ago

Straightforward.........same problem here with waking up and not able to put the mask on when I go back to sleep. But I also have a serious problem with dry mouth, to. A double wammy, if you will. Don't know the answer but just so you know your not alone.

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[-] Roy +0 points · about 1 year ago

Wiredgeorge, I'll have to get into sleepyhead to get the information and I'll do that later today. The only information leak wise I get from the machine app shows only a 0.2% large leak for the night with a 100% mask fit, but no correlation to Ahi event occurrences. Last night I turned my EPR down one and the humidity down one from 5 to 4 (I have a Respronics DreamStation and it's humidifier settings are 0 to 5 plus I have a hose cover on my tubbing to help prevent rainout). I was getting a whistling from the diffusion holes and mostiure in my mask (I too use a F & P Simplus) since the nights are now getting cooler. Last night my Ahi was a little bit better 5.7 and the whistling and mostiure were gone. My mouth and nose were a little bit dryer but not bad by any means. So we'll see. Baby steps are better than no steps right?

Roy

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[-] Roy +0 points · about 1 year ago

Wiredgeorge, here's the info as best as I can interpret. My best night three nights ago (Ahi 4.78) was a minimum of 24 l/min the 95% was 36 l/min and the max was 40 l/min with a leak rate of minimum of 0.0 the 95% was 0.0 and the max was 4.

Two nights (Ahi 8.02) went 23 l/min 42 l/min and 51 l/min with a leak rate of 0.0, 0.0 and 20 respectively.

Now last night (Ahi 5.7) I have what I would assume are my worst leak numbers minimum of 24 l/min, the 95% was 41 l/min and the max 168 l/min and the leak rate was 0.0, 0.0 and 168!

Being new to all this not real sure what this is telling.

Roy

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[-] Verne7 +0 points · about 1 year ago

I thought this was going to be easier to answer. Like I haven't a clue how to interpret those numbers. :) But, then point you to myAir Web... but, you have a Respironics... lol The myAir Web has that chart of your daily L/per minute. But, I looked around, and my L/m is 5, or 7, way below the 24L/m boundary. You can also see the info on the Leak Rate chart. Each tic on the left hand chart appears to be 7.5, so the second tic from 0.0 is 15.0. My line is below the 1st tic. Hope that helps.

I just saw my Doctor, and she approved my changes. Now, to see the sleep dr. If she doesn't approve, I get a new one.

I also believe I heard someone reference 1.0 or below to be the desired Ahi. I don't know if that's actually possible or true, just something I heard. My Ahi has never been above 4.51 so far as I know, so I tried for the less than 1 Ahi, and actually have made it there the last 4 days. Even previous 4.51 (somewhat low) Ahi has been crippling as far as the high blood pressure and Afib. Untreated for 50 years or so. Today my blood pressure was 116/72 and a pulse of 62 when I saw my Doctor. Before, going below 140/90 was not a usual thing for me and it was 140/90 when I was 35. Those low numbers scared the crap out of me, but my Doctor was very happy.

Hope you can glean some good info there, PS I had to shave my beard to achieve a good seal on my facemask... ;)

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[-] wiredgeorge +0 points · about 1 year ago Sleep Enthusiast

Roy, I don't know what to make of the numbers. On my Resmed machine, I get a daily feedback report I look at online and the L/Min is average over the night as is the AHI. I can definitely see that the higher the leaks, the more AHI events. Maybe someone else can help with your numbers.

As far as Verne shaving off his face whiskers... I tried this early on and found it made no difference with mask seal (FOR ME). Using mask liners solved the small leak issue and I now use a mouthpiece to keep my jaw from sagging.

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[-] Roy +0 points · about 1 year ago

I did trim my whiskers very close and it did help which my seal but my Ahi last night was 6.4 better than the night before but not where it needs to be yet. I'm going on vacation Friday for 10 days so I'm going to stay the course for now after I get home I'll try some pressure adjustments.

Thanks all Roy

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[-] Verne7 +0 points · about 1 year ago

wiredgeorge's suggestion of a mask pad might help us keep our beards :)

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[-] Roy +0 points · about 1 year ago

Yea pads probably would help save the beards not sure my wife would argue for the pads and beard lol. I said I was going to stay the course on pressure adjustments till after vacation but I couldn't I raised my minimum pressure one to nine last night and had my best Ahi to date 3.5 so hopefully it continues I'm still on the middle EPR setting I think I will leave that till later.

Sweet dreams and good Ahi's to all

Roy

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[-] Verne7 +0 points · about 1 year ago

Congrats on the lower reading! There must be a learning AI in the machine, because you set the machine, sleep great, and then over the next couple days you see the charts have changed again. Plus, your own body is adjusting as well.

My adjustments have kept my Ahi's to: 2 readings of 1.05 and 6 readings 0.11-0.81, over the last 8 days, so I'm getting close.

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