Confused by sleep doc's attitude towards AHI

[rosevader]

So I tried 10.5-13.5 last night. Little bit of burpiness but not really uncomfortable. My AHI was 15, 8 hours 46 minutes usage, (CA 10, OA 82, Hyp 41). I really think the wide variation in AHI at the same pressure reflects how much time I am sleeping on my back. Really not sure what to do about that. Do you think I should inch up the pressures again? Thanks for any help!

[Pugsy]

You can try either 11.0 minimum and 14.0 max
or maybe just try 11.0 minimum and leave the max at 13.5.
I am hoping that if we inch up that minimum so it can do a better job that the need for the pressures over 15 for the max are reduced. Trying to limit your time at the higher pressures which don't do the belly any good

[brain_cloud]

Another strategy I can recommend to the OP is to try to use a mouthpiece in addition to your APAP. This should allow effective therapy at pressures lower than would be required without the mouthpiece. Personally, I've found I get about the same results when using APAP + mouthpiece with pressure set 12/15.5 as I do with APAP alone at pressure set to 15.5/20.

Just the common "boil and bite" mouthpiece should do for this.

[M'ohms]

I also have problems with air in my tummy. I find that elevating the head of my bed helps quite a bit. I started doing this after I had shoulder surgery as it took some of the pressure off my shoulder while laying on my side.

[rosevader]

Thanks for your ideas. I've been sleeping propped up on extra pillows for years since I have nonspecific gastritis, and that helps prevent the "burn" (and also helped me after my shoulder surgery last year).
I'm currently using a night guard for bruxism, as I'm under a lot of stress and tend to grind my teeth. Is this mouth device you use something that comes from a dentist? How does it differ from a nightguard? I find that my nightguard causes me to open my mouth while I sleep and is probably a factor in the extreme dry mouth/throat I get while wearing my full face mask (even at at max humidity)
I tried 11-14 pressures last night and got some bloating but not enough to cause more than slight discomfort. My AHI was 12 (CA 21, OA 54, Hyp 14) 7 hrs 32 min of usage, 90% pressure was 14, no leaks.
Should I inch it up again?
I'm going to phone around to look for a new sleep clinic tomorrow.
Thanks for any help!

[greatunclebill]

you need to pick a setting and stick with it for a couple weeks. then see if you're trending up or down and make a minor adjustment and try again. the trick to this is baby steps.

[Pugsy]

We already know that higher pressures are needed. No sense in spending an inordinate amount of time at these pressures unless it is to maybe help the GI issues. These small slow increases are just to see if there is maybe a lesser pressure that will get the job done and not cause the GI issues.

I would try another 0.5 increase in both min and max and see what happens.

[rosevader]

So I tried 11.5-14.5 two nights ago & that resulted in nasty painful bloating and I ended up taking off the mask after 2 hours. The next night I lowered it back down to 11-13.5, same result (I think after this happens once, its more likely to happen again). I'm very discouraged right now. Even if I use the higher pressures, I never get AHI lower than double digits. So what's the point? Maybe CPAP just doesn't work for me????
I have an appointment with a different sleep clinic tomorrow to see what a different sleep doc would suggest. Maybe he/she will actually look at the data and have something intelligent to say?