APAP to CPAP?

General Discussion on any topic relating to CPAP and/or Sleep Apnea.
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Pugsy
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Re: APAP to CPAP?

Post by Pugsy » Tue Sep 16, 2014 5:14 pm

Something is causing the higher pressure needs for those clusters. The usual suspects are of course supine sleeping and REM stage sleep. The pattern of the clusters screams REM to me. I have seen it often. My OSA as 5 times worse in REM stage sleep when compared to non REM stage sleep.

If a higher base pressure (more minimum or fixed cpap) is used there's a good chance that whatever is causing the higher pressure needs may not be quite so bad to deal with. Better prevent the airway collapse in the first place instead of trying to fix it later.
Wulfman... wrote:And, you know me.......one of the reasons I like straight pressure is that it's a "constant". It eliminates some of the variables that ranges of pressures can cause. In other words, if that one thing isn't moving, it's something else.
Yeah, I know and I have no problem with attacking things from that aspect either but when we do fixed cpap that means a person HAS to use full time a pressure that is only maybe needed for a short period of the night. It could be a deal breaker for someone with aerophagia issues.

Whatever she wants to try is fine by me though. There's no law that says she can't try your way and my way and decide what she feels suits her own particular needs. We are both right...both ways will get the job done. She may be like me and pressure changes don't bother her at all or she might be like you and find that she does better with fixed pressures.
I won't have my feelings hurt at all if she ends up preferring fixed pressures. I was just trying to lessen the chance of aerophagia rearing its ugly head.

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Re: APAP to CPAP?

Post by Wulfman... » Tue Sep 16, 2014 5:28 pm

Pugsy wrote:Something is causing the higher pressure needs for those clusters. The usual suspects are of course supine sleeping and REM stage sleep. The pattern of the clusters screams REM to me. I have seen it often. My OSA as 5 times worse in REM stage sleep when compared to non REM stage sleep.

If a higher base pressure (more minimum or fixed cpap) is used there's a good chance that whatever is causing the higher pressure needs may not be quite so bad to deal with. Better prevent the airway collapse in the first place instead of trying to fix it later.
Wulfman... wrote:And, you know me.......one of the reasons I like straight pressure is that it's a "constant". It eliminates some of the variables that ranges of pressures can cause. In other words, if that one thing isn't moving, it's something else.
Yeah, I know and I have no problem with attacking things from that aspect either but when we do fixed cpap that means a person HAS to use full time a pressure that is only maybe needed for a short period of the night. It could be a deal breaker for someone with aerophagia issues.

Whatever she wants to try is fine by me though. There's no law that says she can't try your way and my way and decide what she feels suits her own particular needs. We are both right...both ways will get the job done. She may be like me and pressure changes don't bother her at all or she might be like you and find that she does better with fixed pressures.
I won't have my feelings hurt at all if she ends up preferring fixed pressures. I was just trying to lessen the chance of aerophagia rearing its ugly head.
My "chicken or egg" comment was sort of from looking at the clusters and wondering if the pressure was trying to address them or if the pressure was causing them. Some of the old GERD threads and reports make me wonder. Aerophagia could be called a "stepchild" of that category of issues. I see the clusters and wonder if the person is having a subconscious reflex reaction to the pressure increases, which causes more pressure increases.

As previously stated, I'd just like to see a night of fixed pressure (maybe 9 cm.) and see what that looks like.


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Re: APAP to CPAP?

Post by Sleepysuz » Tue Sep 16, 2014 6:11 pm

Thought I replied right away but post hasn't shown up. I am a side sleeper since getting the memory foam mattress. Hardly move off my left side if that means anything. That being the case it may rule out the supine positional piece

Just picked 8-12 as a range. Don't think it should be hard to adjust to this as is felt like I was suffocating at 4 anyhow Or perhaps it would be better to try 8-10 for tonite.

Is it easier to ramp up than back down? You folks are the pros.

Suz

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Re: APAP to CPAP?

Post by Wulfman... » Tue Sep 16, 2014 6:18 pm

Sleepysuz wrote:Thought I replied right away but post hasn't shown up. I am a side sleeper since getting the memory foam mattress. Hardly move off my left side if that means anything. That being the case it may rule out the supine positional piece

Just picked 8-12 as a range. Don't think it should be hard to adjust to this as is felt like I was suffocating at 4 anyhow Or perhaps it would be better to try 8-10 for tonite.

Is it easier to ramp up than back down? You folks are the pros.

Suz
Don't know. I've never used Ramp. Lots of people skip it and just "go for the gusto".

Personally, I don't think I'd let it go over 10 cm. It appears to me that that's where things start to get crazy. I think the main question you need to find the answer to is what is the threshold of your aerophagia. I think limiting the pressures will help determine that.
Along with seeing how those pressures treat your other events.


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Re: APAP to CPAP?

Post by Sleepysuz » Tue Sep 16, 2014 6:22 pm

Great advice. I will change the auto to 8-10 and see how it responds. This is my GUT feeling

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Re: APAP to CPAP?

Post by Sleepysuz » Tue Sep 16, 2014 6:30 pm

Oh didn't mean ramp up as in the ramp feature. My question was is it better to try a lower number and tweak up when that doesn't do the trick vs picking a setting that is too high and backing down the next nite

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Re: APAP to CPAP?

Post by Wulfman... » Tue Sep 16, 2014 6:37 pm

Sleepysuz wrote:Oh didn't mean ramp up as in the ramp feature. My question was is it better to try a lower number and tweak up when that doesn't do the trick vs picking a setting that is too high and backing down the next nite
Oh, I think the 8 - 10 will be fine for a trial run. You've definitely had a much wider range than that. You're now in the "self-tweaking" phase.


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Re: APAP to CPAP?

Post by Pugsy » Tue Sep 16, 2014 6:40 pm

I find it easier to go up myself in stages. Big changes either way can be uncomfortable. I have done both and a 3 cm increase or decrease is getting close to the noticeable area where it can start to become be uncomfortable. We do get used to it but I see no sense in being uncomfortable when trying to fall asleep. We don't have to pick perfectly in one fell swoop. We can take our time getting things figured out.
You have several options. The 8 to 12 is a good one...8 to 10 is an option..Den's 9 cm (but use apap mode with minimum to equal max to attain the 9) is a good option too. There's going to be pros and cons with just about anything you try.
Heck, 8 cm fixed is also an option.

For the bulk of the night the 5 cm minimum does a pretty good job...it's just when you see the clusters that the machine can't handle the situation. Since you say you pretty much stay on your side all night then I suspect that it is REM stage sleep stubborn events that we are seeing needing more pressure. It fairly common for REM stage sleep to cause the airway to get more floppy and need more pressure to hold it open. Your clusters are occurring in the time frames that we would expect a person to be in REM sleep.

If it were me and I was having the aerophagia issues....I think I would do 8 to 10 and see if I got lucky and didn't have those clusters and have aerphagia stay away.
Den likes using a single pressure because he found that the least little change in pressure in apap mode disturbed his sleep and he just didn't rest as well.
I sleep through 9 to 24 cm every night and often during the night and never know it happens until I see my report and my sleep quality is very good.
I don't know if you are going to be like me or like Den... but you have been sleeping through some really wild changes as it is.

The pros to using a single fixed pressure...eliminates the chance that the pressure changes might disturb sleep at some level.
The cons to using a single fixed pressure..you have to use a higher pressure all night to deal with the stubborn higher pressure needing events.

The pros to using an auto adjusting pressure...enables a person to use a lower pressure for the bulk of the night and the higher pressure for only a small part of the night. Comes in handy with a person has potential aerophagia issues.
The cons to using an auto adjusting pressure...if someone is sensitive to the least little change in pressure it can potentially impact sleep quality. Some people are sensitive and some people aren't.
Wulfman... wrote:My "chicken or egg" comment was sort of from looking at the clusters and wondering if the pressure was trying to address them or if the pressure was causing them.
The pressure is trying to address them and not causing them. This I am pretty sure of. The machine is working its little butt off trying to do a better job but it just can't quite get the job done and the pressure isn't even dropping to the minimum.

We are close enough in our ideas that we are really splitting hairs here. 9 cm or 8 to 10....very minor differences and unless someone was ultra sensitive to variations in pressure it really isn't going to make much of a difference and besides...we just want to get close anyway...see what happens with the clusters and the aerophagia and then re-evaluate as needed.

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Re: APAP to CPAP?

Post by Pugsy » Tue Sep 16, 2014 6:50 pm

I once did an experiment where I changed my APAP settings....was using 10 min and 20 max (often would see brief needs for 17 or 18) and I had nice acceptable reports.
I originally started with 8 minimum but my reports looked a lot like yours do now with the 5 minimum.
Anyway I settled on 10 minimum for a while but decided to experiment (I love to do that) to see if more minimum would do much in terms of reducing the AHI any...So I worked my way up to 13 minimum...did 1 cm increase in minimum for 4 or 5 nights and worked my way up to 13 minimum...Absolutely no change in my AHI or sleep quality or anything. So I decided that experiment was over and went back to 10 cm minimum. I didn't go down in stages...I made a big 3 cm drop and it was uncomfortable for a couple of nights. I actually felt like I was suffocating for a short period of time.

You probably won't have any trouble with 8 cm minimum but if you do...try 7 and then see what happens.
3 cm increase in one big step is really all I would recommend a newbie do unless there was something special going on that warranted it. Anything more than that I would suggest go up in stages.

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Re: APAP to CPAP?

Post by Wulfman... » Tue Sep 16, 2014 7:33 pm

Pugsy wrote:I once did an experiment where I changed my APAP settings....was using 10 min and 20 max (often would see brief needs for 17 or 18) and I had nice acceptable reports.
I originally started with 8 minimum but my reports looked a lot like yours do now with the 5 minimum.
Anyway I settled on 10 minimum for a while but decided to experiment (I love to do that) to see if more minimum would do much in terms of reducing the AHI any...So I worked my way up to 13 minimum...did 1 cm increase in minimum for 4 or 5 nights and worked my way up to 13 minimum...Absolutely no change in my AHI or sleep quality or anything. So I decided that experiment was over and went back to 10 cm minimum. I didn't go down in stages...I made a big 3 cm drop and it was uncomfortable for a couple of nights. I actually felt like I was suffocating for a short period of time.

You probably won't have any trouble with 8 cm minimum but if you do...try 7 and then see what happens.
3 cm increase in one big step is really all I would recommend a newbie do unless there was something special going on that warranted it. Anything more than that I would suggest go up in stages.
Except, looking at her report, she didn't stay at the lower pressure for long.......and then it shot up from there. So, I would think that any pressure between 8 and 15 (gulp) would be "familiar territory" for her.

Oh, well. Good luck Sleepysuz.


Den

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Re: APAP to CPAP?

Post by Pugsy » Tue Sep 16, 2014 7:46 pm

Wulfman... wrote:Except, looking at her report, she didn't stay at the lower pressure for long.......and then it shot up from there. So, I would think that any pressure between 8 and 15 (gulp) would be "familiar territory" for her.
Oh, I am thinking awake comfort...that's what I am thinking about when I talk about those changes and comfort. Not what is happening while asleep.
From 5 to 8 while awake and trying to go to sleep and that comfort time. It's going to feel like a bit of a hurricane to go from 5 to 8 while awake unless someone uses the ramp.

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Re: APAP to CPAP?

Post by Sleepysuz » Wed Sep 17, 2014 6:55 am

Update: Had NO problem going to sleep with 8! Stayed on side with auto setting 8-12 rolled onto supine in early morning which is when mask leaked a little
Best night I can remember thanks to you all. Feel refreshed this morning.

Do I keep it the same to get a few days sample or possibly increase the numbers a little to see if I still have a big cluster?
Doc said she'd order a bipap if things weren't resolved. Is there any reason I'd be a candidate for one?
You are all the best!

BTW tried to shrink this with .png instructions but it wouldn't work right. Is there a place in forum with step by step for loading a screen shot?
Image

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Re: APAP to CPAP?

Post by Pugsy » Wed Sep 17, 2014 7:09 am

When were you on your back? Maybe when that one cluster is around 1:30 to 2 AM?
If it wasn't for that one cluster...nice report and you slept well.

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Re: APAP to CPAP?

Post by palerider » Wed Sep 17, 2014 8:33 am

Sleepysuz wrote: BTW tried to shrink this with .png instructions but it wouldn't work right. Is there a place in forum with step by step for loading a screen shot?
change the link to http://i.imgur.com/bmyuG77l.png

like I said before, put a l (lower case ell) before the .png

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Re: APAP to CPAP?

Post by Sleepysuz » Wed Sep 17, 2014 9:14 am

Was on my side till about 5:30 AM. This big cluster was when I was on my left side
Suz

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