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juanalvaro
Unread post  Post subject: Pressure keeps at maximum with no events associated  |  Posted: Sun Jan 06, 2019 11:51 am

Joined: Mon Oct 01, 2018 4:19 pm
Posts: 5
Location: Leticia (Amazonas), Colombia
PAP Mask: Phillips Respironics Amara (full face)
PAP Machine: AirSense 10 (Autoset for Her)
Humidifier: Airsense 10 humidifier
Pressure Setting: 7-14 cm

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Hello, thanks for this forum. I've used a ResMed Airsense 10 machine for a couple of months now. I've changing the pressure settings, and currently I have them set to 7-12 cmH20. Reading the SleepyHead charts, I observe that pressure gets quickly to the maximum (12), when there are no events at all (and even when I'm still asleep). I attach charts of December 13 and 19, which have very low AHI (under 1.0) and last night chart (AHI: 5.17). Why is the pressure always at maximum? Would you recommend increasing maximum pressure, or any other adjustments?


Attachments:
Jan.5.2019_7-12.png
Jan.5.2019_7-12.png [ 207.88 KiB | Viewed 1772 times ]
Dec.19.2018_5-12.png
Dec.19.2018_5-12.png [ 209 KiB | Viewed 1772 times ]
Dec.13.2018_5-12.png
Dec.13.2018_5-12.png [ 205.5 KiB | Viewed 1772 times ]

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Pugsy
Unread post  Post subject: Re: Pressure keeps at maximum with no events associated  |  Posted: Sun Jan 06, 2019 12:53 pm
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Flow Limitations and snores will also drive the pressure up because they are the very earliest of warning signs that the airway is trying to collapse.
If you don't have any OAs or hyponeas getting flagged (or a small number) it means those FLs and snores are being prevented from worsening and growing up to become a full grown OA or hyponea.

How are you sleeping and feeling?

Are you having any nasal congestion? If so...that might be what is driving the FL graph upwards and more pressure (raising the max) might not help. The machine can't tell the difference between a stopped up nose and reduced air flow in the airway behind the tongue area.

If sleeping good and feeling good and you are having a little nasal congestion...I don't know that I would worry about hitting the max so often.

But you could try increasing the max just to see what happens if you wish.


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diamaunt
Unread post  Post subject: Re: Pressure keeps at maximum with no events associated  |  Posted: Sun Jan 06, 2019 3:08 pm
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juanalvaro wrote:
when there are no events at all

You need to expand your definition of "event", snores and flow limitations cause pressure to raise.
juanalvaro wrote:
Would you recommend increasing maximum pressure, or any other adjustments?

I'd go for min 10, max 20 if I were you.

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juanalvaro
Unread post  Post subject: Re: Pressure keeps at maximum with no events associated  |  Posted: Mon Jan 07, 2019 8:21 am

Joined: Mon Oct 01, 2018 4:19 pm
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Location: Leticia (Amazonas), Colombia
PAP Mask: Phillips Respironics Amara (full face)
PAP Machine: AirSense 10 (Autoset for Her)
Humidifier: Airsense 10 humidifier
Pressure Setting: 7-14 cm

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Thanks to both for your replies. I hadn't paid attention to Flow Limitations (FL) and snores (can the machine actually detect snoring?).
Answering to Pugsy, I sleep well but wake up drowsy, headaches. Yesterday I had a strong headache in the afternoon and went to sleep at 6:30 pm. Actually, since using CPAP I don't feel any better. I just look at those AHI numbers and assume I have a healthier sleep (because I have less Apneas).
I attach SH graph from last night. I tried to identify any correlation between FL and pressure increase. Snore seems to be very low.
I suffer nasal congestion very often, but believe that the CPAP machine helps to keep my nose open. But if nasal congestion is what is what's being identified as Flow Limitation, what could I do?
diamaunt suggests setting pressures to 10-20. I'll try it tonight to see what happens.


Attachments:
Jan.6.2019_7-12.png
Jan.6.2019_7-12.png [ 203.25 KiB | Viewed 1749 times ]

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Juan Alvaro Echeverri
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Full Professor
Universidad Nacional de Colombia
Amazonia Campus
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diamaunt
Unread post  Post subject: Re: Pressure keeps at maximum with no events associated  |  Posted: Mon Jan 07, 2019 11:20 am
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juanalvaro wrote:
(can the machine actually detect snoring?).


Snoring causes a particular disturbance in the airflow. It's not the sound that the machine detects, but that airflow disturbance... with bad snoring, it can show up as a sawtooth pattern where it should be a nice round inhale hump. They can detect snoring long before it gets loud and disturbing to the neighbors.

https://www.youtube.com/watch?v=-gie2dhqP2c

juanalvaro wrote:
But if nasal congestion is what is what's being identified as Flow Limitation, what could I do?
diamaunt suggests setting pressures to 10-20. I'll try it tonight to see what happens.

raising the pressure may help, and doing something about the nasal congestion may help.. (I use a combination of real sudafed, afrin and nasal rinse, as needed, when I've got bad congestion.)

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Pugsy
Unread post  Post subject: Re: Pressure keeps at maximum with no events associated  |  Posted: Mon Jan 07, 2019 11:32 am
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Getting nice low AHI numbers is the easy part.
Feeling them is a whole different story...trust me I speak from personal experience in that area and a LOT of it. :lol:

How many hours of sleep...real sleep and not tossing and turning time with cpap on...are you getting on average?
Are those hours of sleep fragmented with a lot of wake ups?

Do you take any medications of any kind? If so, what?

Any other physical or mental health problems that could impact sleep quality and how you feel?
Pain, other health issues, had some recent routine labs to rule out hormone or other factors?....you get the drift...anything else going on that might impact sleep quality.
Drink alcohol routinely or use recreational drugs?


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rickyjoe
Unread post  Post subject: Re: Pressure keeps at maximum with no events associated  |  Posted: Mon Jan 07, 2019 2:46 pm

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diamanté

Sudafed and Afrin at the same time… What does that do you do to your blood pressure?


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juanalvaro
Unread post  Post subject: Re: Pressure keeps at maximum with no events associated  |  Posted: Mon Jan 07, 2019 4:31 pm

Joined: Mon Oct 01, 2018 4:19 pm
Posts: 5
Location: Leticia (Amazonas), Colombia
PAP Mask: Phillips Respironics Amara (full face)
PAP Machine: AirSense 10 (Autoset for Her)
Humidifier: Airsense 10 humidifier
Pressure Setting: 7-14 cm

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diamaunt wrote:
(I use a combination of real sudafed, afrin and nasal rinse, as needed, when I've got bad congestion.)
rickyjoe wrote:
Sudafed and Afrin at the same time… What does that do you do to your blood pressure?

I prefer not to use any of those by now. I was reading about the "rebound" effect of decongestants.
Pugsy wrote:
How many hours of sleep...real sleep and not tossing and turning time with cpap on...are you getting on average?
Are those hours of sleep fragmented with a lot of wake ups?

Sometimes I take quite a lot to get asleep, but then I just wake up a few times during the night. I guess my average (real) sleep time may be 5-6 hours.
Pugsy wrote:
Do you take any medications of any kind? If so, what?

No medication at all.
diamaunt wrote:
I'd go for min 10, max 20 if I were you.

I am reconsidering this, and I will rather set it to minimum 10 and maximum 15 (i.e. raising 3 cmH20 from my current settings: min. 7 max. 12)
diamaunt wrote:

Thanks for this video. Although, I couldn't anything of a sawtooth pattern in the flow rate graph, associated with snoring events.

_________________
Juan Alvaro Echeverri
Anthropologist
Full Professor
Universidad Nacional de Colombia
Amazonia Campus


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diamaunt
Unread post  Post subject: Re: Pressure keeps at maximum with no events associated  |  Posted: Mon Jan 07, 2019 7:10 pm
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rickyjoe wrote:
diamanté

Sudafed and Afrin at the same time… What does that do you do to your blood pressure?

Less than choking to death in my sleep.

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diamaunt
Unread post  Post subject: Re: Pressure keeps at maximum with no events associated  |  Posted: Mon Jan 07, 2019 7:12 pm
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juanalvaro wrote:
I prefer not to use any of those by now. I was reading about the "rebound" effect of decongestants.

Sudafed doesn't have a 'rebound' effect, and Afrin only has one if you use it as directed. If you use it only at night, there's no rebound effect.
juanalvaro wrote:
diamaunt wrote:
I'd go for min 10, max 20 if I were you.

I am reconsidering this, and I will rather set it to minimum 10 and maximum 15 (i.e. raising 3 cmH20 from my current settings: min. 7 max. 12)

*shrugs* whatever. I've offered my suggestion.

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Pugsy
Unread post  Post subject: Re: Pressure keeps at maximum with no events associated  |  Posted: Mon Jan 07, 2019 7:16 pm
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5 or 6 hours of sleep simply isn't enough sleep for most people.
My butt is dragging big time if I don't get at least 7 hours of decent sleep with minimal arousals....I feel the best if I get close to 8 hours with minimal arousals.

So it's not just hours of sleep...it's sleep quality that is also a big factor in how you feel during the day.

As for sudafed and Afrin...not everyone has a problem with it or with their blood pressure with it.
I don't do the sudafed though....that stuff wires me up something awful and I am wide awake all night if I take it.
I will use something else that doesn't wire me up if I need a decongestant. There are other alternatives.
Afrin...last resort when nothing else opens up the nose well enough so I can move air enough to use my nose. I can't sleep if I can't breathe through my nose....just can't do it. Doesn't matter what mask I use or not use.


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juanalvaro
Unread post  Post subject: Re: Pressure keeps at maximum with no events associated  |  Posted: Tue Jan 08, 2019 9:52 am

Joined: Mon Oct 01, 2018 4:19 pm
Posts: 5
Location: Leticia (Amazonas), Colombia
PAP Mask: Phillips Respironics Amara (full face)
PAP Machine: AirSense 10 (Autoset for Her)
Humidifier: Airsense 10 humidifier
Pressure Setting: 7-14 cm

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Thanks Pugsy and diamaunt for all your feedback. I do appreciate your willingness to share your longer experience with CPAP with newbies like myself. This is what I've learned in this couple of days, and my remaining thoughts and doubts:
- Pressure settings: last night I set the machine to min. 10 max. 15. Time above leak threshold was 0.00%; AHI 2.23; time with the machine 7:10 (of which about 6:30 asleep, one interruption). I just want you to look at the graph 'Time at pressure' (attached): with pressure settings 7-12, the greatest time was at pressure 12; now with pressure settings 10-15, most of the time the machine was in pressures 11-12-13 (although still almost 40 min. in pressures 14-15).
- Flow limitations and nose congestion: It seems clear from SH graphs that higher pressures are related to starker Flow Limitations. And it appears also that part of that flow limitations comes from nose congestion -- the first half hour I was awake and pressure escalated quickly from 10 to 15; one of my nostrils was almost blocked, and noticed that the ResMed was noisier than usual. I stopped the machine to clean my nose (just with water), and checked the CPAP: the filter (that had been placed in October) was very dusty; I changed it. The machine ran smoothly and quickly I fell asleep. So, it is evident that if I do something to decongest the nostrils, Flow Limitation Index will reduce and the machine pressure will (hopefully) diminish. Now, I'm considering, with caution, Sudafed and Afrin. diamaunt mentioned also "nasal rinse" and Pugsy wrote that "There are other alternatives" -- I'd like to learn about those other alternatives before deciding (I have previously used Afrin and nasal spray because I had a septoplasty in 2005).


Attachments:
Jan.7.2019_10-15.png
Jan.7.2019_10-15.png [ 205.29 KiB | Viewed 1703 times ]

_________________
Juan Alvaro Echeverri
Anthropologist
Full Professor
Universidad Nacional de Colombia
Amazonia Campus
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Pugsy
Unread post  Post subject: Re: Pressure keeps at maximum with no events associated  |  Posted: Tue Jan 08, 2019 10:50 am
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PAP Machine: ResMed AirSense 10 AutoSet for Her
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Pressure Setting: Depends on the machine as I actually have more than one

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The time at pressure graph was never polished by SleepyHead's creator.
It was more of an after thought that wasn't thought through very well.
I don't even bother looking at it because it doesn't really tell you much of anything that you can't deduce other ways.

Other alternatives...whatever it takes to open up the nose.
Lots of various OTC oral meds. If one medication is a problem or doesn't help..you try something else.
Various types of nasal rinses which usually involve some sort of saline solution...neti pot or similar kind of thing.

Flonase is now OTC....sometimes that's enough to help out with the congestion.

But when actually ill like a bad cold...a teeny tiny squirt of Afrin still offers me the greatest chance of success.
If people are worried about rebound from excessive use...just do one nostril. Believe it or not we can breathe well enough through just one nostril to sleep decently....and often the added humidity will help out.
If a hot steamy shower helps open up the nose...increase that humidity setting.


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diamaunt
Unread post  Post subject: Re: Pressure keeps at maximum with no events associated  |  Posted: Tue Jan 08, 2019 11:20 am
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Pugsy wrote:
The time at pressure graph was never polished by SleepyHead's creator.
It was more of an after thought that wasn't thought through very well.
I don't even bother looking at it because it doesn't really tell you much of anything that you can't deduce other ways.

I'm wounded, the TAP graph was my idea... not quite exactly what I envisioned... but, yeah, you can figure the same thing looking at the pressure graph.

But, in this case, it shows that the max should be raised, since he spent a lot of time at the max pressure setting.
Pugsy wrote:

But when actually ill like a bad cold...a teeny tiny squirt of Afrin still offers me the greatest chance of success.
If people are worried about rebound from excessive use...just do one nostril. Believe it or not we can breathe well enough through just one nostril to sleep decently....and often the added humidity will help out.
If a hot steamy shower helps open up the nose...increase that humidity setting.

The trick to avoiding problems with Afrin is to only use it at night.

Don't use it "as directed" (every 12 hours) just use it once a day, when you go to bed, and the 'off time' during the day allows your nose to avoid the rebound effect.

I was told this by a top of her class ENT, and she was right, I've used afrin several times since then for extended periods, without any rebound congestion when I stopped.

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Pugsy
Unread post  Post subject: Re: Pressure keeps at maximum with no events associated  |  Posted: Tue Jan 08, 2019 12:24 pm
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diamaunt wrote:
I'm wounded, the TAP graph was my idea... not quite exactly what I envisioned.


I know it was your idea...but sometimes...like some of my ideas...maybe sounds great in my head and not so good in real life. :lol:
To be fair though...Mark dropped the ball with it and didn't really do with it what could/should have been done with it....so it was half assed done.
It's way to confusing as it is right now for newbies. IMHO.... Heck, I have to look at it a second and third time to come to grips with it and I had years of looking at the same thing on the Encore reports. So I know what I am looking at.

As for seeing if the pressure needs to be raised...a quick millisecond look at the pressure graph will also point that need out and much easier to understand. You know me...and my rational...always take the easiest way out of any needed work when at all possible.


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diamaunt
Unread post  Post subject: Re: Pressure keeps at maximum with no events associated  |  Posted: Tue Jan 08, 2019 3:28 pm
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Pugsy wrote:
diamaunt wrote:
I'm wounded, the TAP graph was my idea... not quite exactly what I envisioned.


I know it was your idea...but sometimes...like some of my ideas...maybe sounds great in my head and not so good in real life. :lol:
To be fair though...Mark dropped the ball with it and didn't really do with it what could/should have been done with it....so it was half assed done.
It's way to confusing as it is right now for newbies. IMHO.... Heck, I have to look at it a second and third time to come to grips with it and I had years of looking at the same thing on the Encore reports. So I know what I am looking at.

As for seeing if the pressure needs to be raised...a quick millisecond look at the pressure graph will also point that need out and much easier to understand. You know me...and my rational...always take the easiest way out of any needed work when at all possible.

I can't argue with your points... the TAP graph is really a half formed idea, and he went and put faint other lines in there, without any explanation... so.... yeah.

My idea was to have a curve, that would show someone "ok, I spent most of the time between 12 and 15 pressure, so having the min at 10 is too low... and that sharp cutoff at 15 would be an indication that 15 is too low too"

but, it was never explained in the program, so it's quite confusing.

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juanalvaro
Unread post  Post subject: Re: Pressure keeps at maximum with no events associated  |  Posted: Wed Jan 09, 2019 12:28 pm

Joined: Mon Oct 01, 2018 4:19 pm
Posts: 5
Location: Leticia (Amazonas), Colombia
PAP Mask: Phillips Respironics Amara (full face)
PAP Machine: AirSense 10 (Autoset for Her)
Humidifier: Airsense 10 humidifier
Pressure Setting: 7-14 cm

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Being a total newbie to CPAP (and SH) I could understand the TAP graph very well and I think it's a nice and helpful summary. The faint lines inside the major curve, I deduce, are the events (OA, H, CA) that occurred at each of the pressures.
The only thing that makes it confusing is that in all the other graphs the X-axis is time, whereas in TAP the X-axis is Pressures.

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Universidad Nacional de Colombia
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diamaunt
Unread post  Post subject: Re: Pressure keeps at maximum with no events associated  |  Posted: Wed Jan 09, 2019 9:19 pm
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Location: Dallas(ish)
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You're my new favorite person.

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