Should I be raising or lowering my pressure, charts included

General Discussion on any topic relating to CPAP and/or Sleep Apnea.
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Lantech19446
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Should I be raising or lowering my pressure, charts included

Post by Lantech19446 » Sat Feb 04, 2017 11:26 pm

I've been using 11cmH20 per my doctor and up until I began losing weight my AHI was consistently 0.0 to 0.2 almost never having OA's usually just 0 or 1 Hypopneas a night after 42 days at 11.5cmH20 (the pressure I had arrived at pre doctors appointment) my average AHI was .16 and until last week I was seeing similar numbers at 11.0cmH20 but I've lost 20 pounds over the last week and suddenly I'm getting OA's again. If I'm reading my statistics correctly my thought is I need less pressure but I'm told that usually if I'm getting OAs it means I need more but that this is the expert forum to ask. Following are my statistics and pictures of some of the more disturbed nights.

[statistics](http://i.imgur.com/9Rno0ay.png)
[1/26](http://i.imgur.com/hcxs6Uh.png)
[1/28](http://i.imgur.com/PChQaZZ.png)
[1/29](http://i.imgur.com/Dep2m9s.png)
[1/31](http://i.imgur.com/eaPI85u.png)
[2/3](http://i.imgur.com/aDUIYHM.png)
Last edited by Lantech19446 on Sun Feb 05, 2017 12:51 am, edited 1 time in total.

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Re: Should I be raising or lowering my pressure, charts included

Post by palerider » Sun Feb 05, 2017 12:30 am

what's the problem you're trying to solve here?

only one night with an AHI over 1....

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Re: Should I be raising or lowering my pressure, charts included

Post by Lantech19446 » Sun Feb 05, 2017 12:50 am

I'm trying to get back to a point where I wasn't having obstructive apneas and an AHI of .16-.20. I understand that mine is better controlled than a lot of peoples but I know that the machine is capable of stopping my OA's and intend to use it to do that. I didn't think losing weight was going to cause me to start having them again and need to know which direction I move to correct it.

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Julie
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Re: Should I be raising or lowering my pressure, charts included

Post by Julie » Sun Feb 05, 2017 5:15 am

First of all, no one loses 20 lbs in a week. You may have lost a good amount of water, but unless in the desert with no liquid at all (including any from food) you won't have lost close to that much. Secondly, chasing zero is a waste of time and energy with no useful point. If you're feeling ok and numbers are relatively good, find something else to worry about. If you don't feel well, get checked out for the thousand other things that might be going on (such as what extreme dieting might be doing to your system) and get routine labwork.

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Re: Should I be raising or lowering my pressure, charts included

Post by Jay Aitchsee » Sun Feb 05, 2017 6:36 am

palerider wrote:what's the problem you're trying to solve here?

only one night with an AHI over 1....
Agree, and that one night had only 2 obstructive apneas. It also had several breaks in therapy which should be more of a concern than the OA's. As far as the overall AHI is concerned, the number computed by SleepyHead for that night may be in error due to the therapy breaks (I didn't bother to check). This night, as well as the others you put up, only had 1 or 2 OA. Really insignificant. You are correct in that raising the minimum pressure should result in fewer OA, but it may not. Sometimes OA are due to other causes and sometimes may not be OA at all, but rather misinterpreted irregular breaths and your machine may not be able to prevent these few, regardless of pressure. Your machine doesn't appear to sense the need to increase the pressure much over the minimum you have set now. Watching for an increasing trend in Flow limitations and hypopneas might be better as an indicator for the need to raise minimum pressure than watching the number of OA. Striving for 0.0 OA isn't realistic. A person without sleep apnea likely would not achieve that and obtaining it could result in disturbed sleep.

Don't obsess over the AHI number, it will be counter productive. As long as your apnea is well controlled, as yours is, a better metric is how you feel in the morning when wake. Do you feel rested? Keep a log and write down how you feel, say on a scale of 1 to 3 or so, before you look at your AHI. Then compare the numbers over time. You may find that you feel better with a little higher AHI, or by lowering the pressure rather than raising it. And go slow. One night does not constitute a trend. If any changes are made, allow at least three nights to see if a trend is developing.

If you do not feel rested and your apnea is well controlled, then you need to start looking for other causes. Driving the number of OA to zero is not likely to help.

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Re: Should I be raising or lowering my pressure, charts included

Post by Lantech19446 » Sun Feb 05, 2017 8:01 am

Julie maybe YOU don't lose 20lbs in a week but plenty of people do and do it safely, effectively especially when they're close to 400lbs or even more. The first time i had to lose this weight was 5yrs ago and i lost 85lbs in 2mos and kept it off until last year. Furthermore if you are properly hydrated you won't have 20lbs in water weight to lose. The only 0 I'm chasing is OA's which 60+ days of data says is possible.

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Re: Should I be raising or lowering my pressure, charts included

Post by Lantech19446 » Sun Feb 05, 2017 8:46 am

Jay Aitchsee wrote:
palerider wrote:what's the problem you're trying to solve here?

only one night with an AHI over 1....
Agree, and that one night had only 2 obstructive apneas. It also had several breaks in therapy which should be more of a concern than the OA's. As far as the overall AHI is concerned, the number computed by SleepyHead for that night may be in error due to the therapy breaks (I didn't bother to check). This night, as well as the others you put up, only had 1 or 2 OA. Really insignificant. You are correct in that raising the minimum pressure should result in fewer OA, but it may not. Sometimes OA are due to other causes and sometimes may not be OA at all, but rather misinterpreted irregular breaths and your machine may not be able to prevent these few, regardless of pressure. Your machine doesn't appear to sense the need to increase the pressure much over the minimum you have set now. Watching for an increasing trend in Flow limitations and hypopneas might be better as an indicator for the need to raise minimum pressure than watching the number of OA. Striving for 0.0 OA isn't realistic. A person without sleep apnea likely would not achieve that and obtaining it could result in disturbed sleep.

Don't obsess over the AHI number, it will be counter productive. As long as your apnea is well controlled, as yours is, a better metric is how you feel in the morning when wake. Do you feel rested? Keep a log and write down how you feel, say on a scale of 1 to 3 or so, before you look at your AHI. Then compare the numbers over time. You may find that you feel better with a little higher AHI, or by lowering the pressure rather than raising it. And go slow. One night does not constitute a trend. If any changes are made, allow at least three nights to see if a trend is developing.

If you do not feel rested and your apnea is well controlled, then you need to start looking for other causes. Driving the number of OA to zero is not likely to help.
The breaks in therapy are usually my wife coming home or a short nap before she goes to work, sometimes waking up to care for her if she's having a fibro flare up, even with that I feel well rested etc. The only reason I'm making a big deal out of this is 60 days without a single OA and all of a sudden they're coming back. I want them gone, I still had hypopneas almost nightly and i get that 0 isn't really going to happen even if i was getting 3 nights a week where it was at one point I just don't want to cause central apneas with to much pressure and looking at the statistics it looks like i really don't need it that high anymore.

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Re: Should I be raising or lowering my pressure, charts included

Post by LSAT » Sun Feb 05, 2017 8:56 am

Lantech19446 wrote:
Jay Aitchsee wrote:
palerider wrote:what's the problem you're trying to solve here?

only one night with an AHI over 1....
Agree, and that one night had only 2 obstructive apneas. It also had several breaks in therapy which should be more of a concern than the OA's. As far as the overall AHI is concerned, the number computed by SleepyHead for that night may be in error due to the therapy breaks (I didn't bother to check). This night, as well as the others you put up, only had 1 or 2 OA. Really insignificant. You are correct in that raising the minimum pressure should result in fewer OA, but it may not. Sometimes OA are due to other causes and sometimes may not be OA at all, but rather misinterpreted irregular breaths and your machine may not be able to prevent these few, regardless of pressure. Your machine doesn't appear to sense the need to increase the pressure much over the minimum you have set now. Watching for an increasing trend in Flow limitations and hypopneas might be better as an indicator for the need to raise minimum pressure than watching the number of OA. Striving for 0.0 OA isn't realistic. A person without sleep apnea likely would not achieve that and obtaining it could result in disturbed sleep.

Don't obsess over the AHI number, it will be counter productive. As long as your apnea is well controlled, as yours is, a better metric is how you feel in the morning when wake. Do you feel rested? Keep a log and write down how you feel, say on a scale of 1 to 3 or so, before you look at your AHI. Then compare the numbers over time. You may find that you feel better with a little higher AHI, or by lowering the pressure rather than raising it. And go slow. One night does not constitute a trend. If any changes are made, allow at least three nights to see if a trend is developing.

If you do not feel rested and your apnea is well controlled, then you need to start looking for other causes. Driving the number of OA to zero is not likely to help.
The breaks in therapy are usually my wife coming home or a short nap before she goes to work, sometimes waking up to care for her if she's having a fibro flare up, even with that I feel well rested etc. The only reason I'm making a big deal out of this is 60 days without a single OA and all of a sudden they're coming back. I want them gone, I still had hypopneas almost nightly and i get that 0 isn't really going to happen even if i was getting 3 nights a week where it was at one point I just don't want to cause central apneas with to much pressure and looking at the statistics it looks like i really don't need it that high anymore.
Have you looked at the length of your OAs...remember <10 seconds not counted ....>10 seconds counted as an OA. You could be having 12-15 second OAs which I consider insignificant. There is a reason for not treating people that have AHI of <5.

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Last edited by LSAT on Sun Feb 05, 2017 8:57 am, edited 1 time in total.

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Re: Should I be raising or lowering my pressure, charts included

Post by linuxman » Sun Feb 05, 2017 8:56 am

Lantech19446 wrote:Julie maybe YOU don't lose 20lbs in a week but plenty of people do and do it safely, effectively especially when they're close to 400lbs or even more. The first time i had to lose this weight was 5yrs ago and i lost 85lbs in 2mos and kept it off until last year. Furthermore if you are properly hydrated you won't have 20lbs in water weight to lose. The only 0 I'm chasing is OA's which 60+ days of data says is possible.
I really don't think it's worth chasing those zeros. If anything, I would say that what you're seeing is just misinterpreted OA events due to awake breathing, or sleep/awake transitions, if you're seeing more. You can take a close look at the actual events in sleepyhead and see what they look like (feel free to zoom in on those two events on the last screenshot for us to take a look at). I really doubt any weight loss would increase the number, but when you're talking 2 events per night, you're really down in the noise here. You can also try a subtle bump in pressure just to see how it goes. Just make sure you do it slow and get a few day's data (at least) to make sure you're not just seeing statistical junk. If it was me, I'd turn off auto as well, and just set a fixed pressure - probably at 11.5 to start, them bump up .5cm at a time to see if anything changes. I don't expect you'll see any change, however.

On the weight loss, it's not possible to loose twenty pounds of actual non-water weight in a week..just do the basic math. A 35 year old 400 lb man that is doing extremely heavy exercise would have a daily caloric burn of around 5300 calories, give or take some (see any caloric calculator to verify that). Your entire caloric expenditure for one week would be 37,100 calories. So if you ate nothing for the entire week the maximum you could burn would about 10 pounds ( each pound of fat has around 3600 calories of chemical energy). Of course it would be extremely difficult (and likely very dangerous) to sustain heavy exercise for a week while eating zero calories, so actual upper limit is lower than this. Anything above that is probably measurement error combined with weighing at different times of day, and thus different amounts of food "in process" in your digestive track. Water is around 8.3 lbs/gallon, so it's not inconceivable that you might see a few pounds of loss due to hydration, particularly if you've done extensive excise without eating! Now, 85 lbs in two months.... eh, that's still on the high side, but I'll concede it might be possible, combined with some measurement error.

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Last edited by linuxman on Sun Feb 05, 2017 9:27 am, edited 1 time in total.

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Re: Should I be raising or lowering my pressure, charts included

Post by Lantech19446 » Sun Feb 05, 2017 9:01 am

They range sometimes it's only like 30 seconds over the whole night which doesn't really concern me much, i've had nights it's reported then and said i was in apnea for 7 seconds but some of the nights where it was like .3 and people are saying oh no big deal that's still really good i was in apnea for 1.5 minutes one night was close to 2. I haven't had numbers like that since I settled in on the right pressure.

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Re: Should I be raising or lowering my pressure, charts included

Post by linuxman » Sun Feb 05, 2017 9:23 am

Lantech19446 wrote:They range sometimes it's only like 30 seconds over the whole night which doesn't really concern me much, i've had nights it's reported then and said i was in apnea for 7 seconds but some of the nights where it was like .3 and people are saying oh no big deal that's still really good i was in apnea for 1.5 minutes one night was close to 2. I haven't had numbers like that since I settled in on the right pressure.
So yes, a 1.5 - 2 minute apnea is a concern, assuming it is real and not due to very shallow awake breathing. It's possible that an event like that could be position related. Maybe you had your head tilted down really far and compressed your airway more, etc. It's really hard to say.

Also, you do need to be a bit careful when looking at the detailed flow graphs for an event. What you're looking at there is a rate of airflow. It's not a measure of lung movement. As such, you can be inhaling/exhaling very very shallow, and it looks "flat" on the graph. So take a look at the actual flow numbers as you sweep the cursor line over the event on the flow graph. You may well see positive and negative flows there that are just very shallow. That's still not a good thing if it happens while you're actually sleeping. If you happen to have an IR capable camcorder, you might try filming yourself overnight (with a time stamp turned on), to see if you can catch what's happening when these longer events occur.

One other thing you might try is to turn off the EPR, if you can tolerate that, to see if that makes a difference.

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Re: Should I be raising or lowering my pressure, charts included

Post by Lantech19446 » Sun Feb 05, 2017 9:31 am

I know there are times it registers a hypopnea right when i wake up and sometimes when i sleep 9-11 hours i may very well wake up multiple times in the morning hours so screw it roll over and sleep some more but you may be on to something with the head position i have back problems and tend to sleep with a lot of pillows to avoid stressing my lower back. If I'm sliding down in bed my head would become downturned. I just dont get why its happening more now unless it's the size ive lost despite what people above want to say I'm still down a pants size and about 20lbs over the last week or so this tuesday will mark 2wks

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Re: Should I be raising or lowering my pressure, charts included

Post by linuxman » Sun Feb 05, 2017 9:37 am

Lantech19446 wrote:I know there are times it registers a hypopnea right when i wake up and sometimes when i sleep 9-11 hours i may very well wake up multiple times in the morning hours so screw it roll over and sleep some more but you may be on to something with the head position i have back problems and tend to sleep with a lot of pillows to avoid stressing my lower back. If I'm sliding down in bed my head would become downturned. I just dont get why its happening more now unless it's the size ive lost despite what people above want to say I'm still down a pants size and about 20lbs over the last week or so this tuesday will mark 2wks
Yeah it's really tough to say..but my bet would be something positional. If your head gets tilted down very much, it can make a big difference. Maybe a neck collar might help? It sounds like you might want to look at an adjustable bed (I mean one that tilts at the head and feet not a softness adjustment). My wife and I recently got one because she has to be tilted up due to an esophegectomy. My side tilts as well, and it's pretty nice. You can give your torso bit of tilt if you feel like it, but do the same for your feet/legs so you don't slide down. Not cheap, but worth it.

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Re: Should I be raising or lowering my pressure, charts included

Post by Lantech19446 » Sun Feb 05, 2017 9:46 am

I wish i could i just spent 2700 on a bed that wont break under me and will support my back i just don't have the money for it right now. I wonder if there's something i can put in the bed that would help

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Re: Should I be raising or lowering my pressure, charts included

Post by Cardsfan » Sun Feb 05, 2017 11:11 am

Put bricks under frame at the head of the bed. (my friend is a nurse, and she told me this)

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