Could my "Pressure Needs" have changed?

[jabman]

I have been using My CPAP now for over a year with no complications until about 2 weeks ago. For toe past couple of weeks now I have been dosing off at work or generally feeling really tired at or around 1 or 2 pm. I have checked my data and my leaks and AHI's are still low ( I would post charts but I am at work right now). I usually get around 6 hours of sleep a night, this has been the norm all year long. I am wondering if maybe I need to up my pressure. Would it bee a good idea to switch to AUTO mode with a setting of 8 low, 13 high ( my current pressure is at 11) to see if I do better?
Any Ideas would be appreciated.

[rested gal]

Switching to auto mode for a few nights to take a look wouldn't be a bad idea.

If I were using a CPAP pressure of 11, and were going to try auto for awhile (and knew that leaks are not a problem) I'd set the range at 10 - 20.

Or, I'd just raise the CPAP pressure another cm or two, to see if that took care of it.

If neither of those experiments helps, I'd start thinking about the million things that can make a person feel sleepy in the daytime even if CPAP is doing its part of the job fine at keeping the airway open for breathing while sleeping. Things like other health problems, med side effects, sleep hygiene issues, more stress in life, changes in diet or exercise, needing a good vitamin/mineral supplement, possible GERD, mattress that's seen better days, the list could go on and on.

Hope a little pressure tweak takes care of it for you, jabman. Good luck.

Oh, and yes, pressure needs could change (as in needing more pressure) as we get older and tissues inside the throat get more lax with age. Good old gravity does take its toll.

[jabman]

Switching to auto mode for a few nights to take a look wouldn't be a bad idea.

If I were using a CPAP pressure of 11, and were going to try auto for awhile (and knew that leaks are not a problem) I'd set the range at 10 - 20.

Or, I'd just raise the CPAP pressure another cm or two, to see if that took care of it.

If neither of those experiments helps, I'd start thinking about the million things that can make a person feel sleepy in the daytime even if CPAP is doing its part of the job fine at keeping the airway open for breathing while sleeping. Things like other health problems, med side effects, sleep hygiene issues, more stress in life, changes in diet or exercise, needing a good vitamin/mineral supplement, possible GERD, mattress that's seen better days, the list could go on and on.

Hope a little pressure tweak takes care of it for you, jabman. Good luck.

Oh, and yes, pressure needs could change (as in needing more pressure) as we get older and tissues inside the throat get more lax with age. Good old gravity does take its toll.

Thank you for your reply rested gal, I think I will up my pressure to 12 for a couple of nights and see how I do then up to 13 if need be. if that does not work then try it in auto and maybe visit my doctor.

[archangle]

Thank you for your reply rested gal, I think I will up my pressure to 12 for a couple of nights and see how I do then up to 13 if need be. if that does not work then try it in auto and maybe visit my doctor.

If I were tweaking, I'd do auto with 11-13 and see what the machine does. I'd evaluate the results and probably try 12 and/or 13 as the lower pressure and see how I felt after a few days.

I'm suspicious that auto mode tends to settle out at a lower than optimal pressure. I like to set mine with the lower pressure at what seems to be optimal and have the upper pressure high "just in case." My machine never autos up for more than a few minutes during the night.

Also realize that you may take several days to feel better when you up the pressure.

[jabman]

Thank you for your reply rested gal, I think I will up my pressure to 12 for a couple of nights and see how I do then up to 13 if need be. if that does not work then try it in auto and maybe visit my doctor.

If I were tweaking, I'd do auto with 11-13 and see what the machine does. I'd evaluate the results and probably try 12 and/or 13 as the lower pressure and see how I felt after a few days.

I'm suspicious that auto mode tends to settle out at a lower than optimal pressure. I like to set mine with the lower pressure at what seems to be optimal and have the upper pressure high "just in case." My machine never autos up for more than a few minutes during the night.

Also realize that you may take several days to feel better when you up the pressure.

I was orignally going to set the pressure 3 below and 3 above my normal pressure and try that for a week as 11 is my normal pressure. But I am leery to switch to auto so I will up my pressure for a few days to see how I do. I agree that I will need s few days to see how I am doing.

[Otter]

I have been using My CPAP now for over a year with no complications until about 2 weeks ago. For toe past couple of weeks now I have been dosing off at work or generally feeling really tired at or around 1 or 2 pm. I have checked my data and my leaks and AHI's are still low ( I would post charts but I am at work right now).

Post the charts when you get home. Maybe someone will see something. When you say your AHI is low, what do you mean? Three or four is still too high for some people.

I usually get around 6 hours of sleep a night, this has been the norm all year long. I am wondering if maybe I need to up my pressure. Would it bee a good idea to switch to AUTO mode with a setting of 8 low, 13 high ( my current pressure is at 11) to see if I do better?

If you want to go auto, I'd try maybe 10-15 cm h2o to start with. If you set the minimum pressure too low, the odds go up that you'll get launched from the bottom of your range all the way to the top, and since you're not used to 20cm and your mask might not be adjusted for it, that could wake you up. The s9 can be a bit enthusiastic about increasing the pressure. If the machine jacks your pressure up until all warning signs disappear, that will prevent apnea, but you might not actually need that much pressure, and the sudden increase could bump you out of deep REM. Also, if you cap the top end, you might actually get a better idea of how much pressure you really need, because you'll see if you actually have apnea when it's forced to stop at 15cm. You can always shift the range upward if that's not enough.

Of course, your sleep could be disturbed even without apnea or hypopnea. If you suspect RERAs are keeping you from getting the rest you need, you can experiment with pressures beyond what it takes to keep you breathing. Given that you're already very tired, though, I'd go for small changes that aren't likely to put you a night deeper in sleep debt than you already are.

[Otter]

I'm suspicious that auto mode tends to settle out at a lower than optimal pressure. I like to set mine with the lower pressure at what seems to be optimal and have the upper pressure high "just in case." My machine never autos up for more than a few minutes during the night.

I have some nights where my machine hugs the bottom until something happens, then spikes the pressure and lets it go back down to the bottom again. Usually, though, it lifts off the bottom sometime in the first hour and wanders around the range most of the night. Still, now that I'm used to the pressure and am sleeping longer, I may configure it as you have.

[jabman]

Post the charts when you get home. Maybe someone will see something. When you say your AHI is low, what do you mean? Three or four is still too high for some people.

Here is my chart, this is a typical night though this night seems a little worse.


Here is the stats.

[greg-g]

You haven't shown the most important (In this case) Graph.
The Flow limitation graph will give you an idea of what the machine would like to do. If the flow limitation is staying on the baseline with occasional spikes the pressure is probably OK. If the graph is spending appreciable time above the baseline, the machine would like to increase the pressure. The snore index will also show some useful information.
Unless you have issues with changing pressure I think the automatic mode is generally preferred as long as the minimum pressure isn't too low. If you current pressure is 11, I would probably try 9 - 15 and see what happens.

[Otter]

Please show flow and pressure as well. Snore would be worth a look too.

[jabman]

Here is my flow limitation.

[greg-g]

My interpretation of your results while disregarding your symptoms is that the results are very good.
The flow limitation and snore index are low hence I suspect that if anything if you were to go to Automatic mode the pressure may actually at times reduce. It would still be interesting to try though.
Hopefully someone else can offer some other suggestions.

[sol]

Here is my flow limitation.

This is as good as it can get , i would not change a thing . I agree with the first reply from rested gal that CPAP doing its job look for other reasons .

[jabman]

I know that my charts look as I said in my OP. That is why I am wondering if maybe my pressure needs have changed. I have been doing nothing different then from a year ago (since changing my life style to fit treatments for Diabetes and OSA). My BG numbers are still good. I just am starting to feel tired at work again like I did before starting CPAP. I will play with my pressure foe a month to see if it doesn't make a difference.

[Otter]

Why are you only getting six hours of sleep? If you can get a couple more, that might take care of the EDS.