Opinions on self adjusting pressures without session data?

[ehusen]

Hello all,

So I've got my Autoset Respond and an Activa standard mask. I almost never have leaks and even then they are in the 0.02 or 0.04l/s state. But I'm still in the state of asking "is it working"?

I've been fully compliant for about 3 months now but still don't feel like it's "helping". I don't feel any better or worse but maybe its subtle. I would think that 3 months should be enough time to notice a significant difference. (Maybe I am expecting too much from it...)

Anyway, my range is set at 4-18cm, which strikes me as "oh just set it full open and see what happens" (I never had a second sleep study and don't plan too, thank you very much. ) It was clear to me, the DME kind of arbitrarily picked that range. My wife says I'm occasionally snoring for periods of time still. (Not the sonic boom inducing ones of yore but still noticable)

So, in the current unlikelihood of acquiring a xPAP with session data in the near future, is there any real issue with me tweaking the settings myself? I've noticed that my pressure seem to be close to 7 most mornings when I wake up and check it. So I'm thinking that maybe I should just set it at 7-18 instead. Then see if I feel any better/worse in the mornings. As no one knows what the magic algorithm does, I'm wondering if I'm still having a few events at night. I don't use the ramp up function and 4cm seems almost non-existant against my breathing.

Ack, sorry I'm rambling. So to sum up, any thoughts on just "mucking" with the levels to see if you feel better? Even without any actual empirical data? Are there real side affects to having too high a pressure setting? (Aerophagia, still no good sleep, etc. I assume)

Of course, after spewing all the above, you know I'm going to do it anyway. (I come from a family of stubborn people. We ask, analyze, and think. Then we do what were going to do in the first place. Part of the reason it took 10 years of my wife railing about my snoring for me to get treatment. I don't know how she puts up with me. )

[WillSucceed]

Did you ever have a sleep study? If so, what was the pressure that was recommended?

For most xPAP users, the pressures are set to 3-4 points below and 3-4 points above the titrated pressure. So, if your titrated pressure is 10, your pressures on xPAP could reasonibly be 7 and 13.

Are there real side affects to having too high a pressure setting? (Aerophagia, still no good sleep, etc. I assume)

Another problem with too high of a pressure is that of central apnea -high pressure can cause these.

my range is set at 4-18cm, which strikes me as "oh just set it full open and see what happens"

That is a pretty big range and it does seem like a 'let's see what happens' approach. It is entirely possible that you are having micro-arousals caused by multiple pressure changes during the night and/or the aggressiveness of the ResMed algorithm.
With my xPAP, I have arbitrarily chosen a small range (8-13) and have set the xPAP to function in .5 increments rather than in 1.0 increments. I spend most of the night around a pressure of 8.5 that periodically goes up to 11. So, I'm having few pressure changes that are small increments of change. The result, I'm comfortable and sleep well.

You might want to consider having a smaller range with your titrated pressure as the centre-point.

[ehusen]

Thanks much for the info. That is pretty helpful. I was thinking something like that might be happening. I was thinking that my pressure might be just a bit too low and to try moving it up to see what happens. (Like to 6-7 and not something crazy like 15 or so. )

In answer to the sleep study question. I did have one, and it was pure misery (thus is my reluctance to have another one). I did manage about 90 minutes of sleep at one point. It was enough to show I have severe apnea (70% pulse-ox - 95 AHI or so). The tech said if I had gotten to sleep earlier, they would have titrated me right away. But since I took so long to fall asleep they didn't have time.

So I got an APAP machine, but not one that records session data. No real option from the DME to get a different one without spending mucho $. So I eventually will get another machine as both a spare/travel machine and to read the real session data. But the cost is prohibitive in the short term.

[chrisp]

I agree with Will , but I'd raise the lower pressure just a bit more .

And make your 'Spare " a 420E . It will quickly become your 'Regular'

:twis ted:

[snork1]

My non-doctor personal unscientific and all other disclaimers opinion, is that its generally ok to mess around WITHIN the prescribed range and maybe a half cm or so above or below. But only in tiny increments. Although running blind without software to SEE how you are doing with each increment of change, I don't know how you can be SURE you are going in the right direction.

[ehusen]

All great information. Thanks again guys. Just a follow-up on my "totally unscientific approach to self-titration". I cranked it up to 6.8, figuring that is a fairly safe to level to jump up to since it is still pretty low pressure.

My wife said she didn't think I snored at all on Friday night. Of course she was fighting allergies and had taken 2 Benadryl so was pretty comatose all night.

Maybe psychosomatic, but the mask just "felt" like it sealed better on my face. It may have just been pressing harder due to the increased pressure. I didn't seem to have any higher level of "red mark" on my nose than before (I get it on the bridge of my nose, no matter what adjustments I make. It usually fades away after a time). Leakage was 0, but it usually is even at the lower pressure.

So I may tweak it just a little bit higher but without any true feedback I'm hesitant to push it too high. It does not seem to have affected me negatively so I think I will stick with the slightly higher pressure for now. Difficult to say at this point if I'm more "energized" or not yet.

Yes, I'm looking at he 420E. Might also get a swift mask and try alternativing between the Activa and the nasal pillows. There are nights when it is a bit warm that my face under the mask starts "sweating" a bit and it ain't very comfortable. Alternative interfaces seems like a good idea too.

Anyway, let me just re-inforce what everyone here usually says. Try your darnedest to get an APAP machine which records session data. Even if you wind up going at a straight CPAP pressure, an APAP machine can do that for you and you can find out what is going on. (Operating in the dark can be frustrating)

[Sergeant Bob]

Go for it! I've learned alot more and improved my treatment more from reading this board and fooling around with it myself than I probably ever would from my doctor or DME.