Newbie here looking for feedback and advice on hypertension

[Pugsy]

After all a manufactures recommendation on how to set up an auto titrating cpap machine use these numbers to do so. Not every machine has sleepyhead data available.

Tis true that not all auto adjusting machines are SleepyHead capable but they all have software available from the manufacturer. Somebody somewhere can get a detailed report.

I am okay with recommending something close to the median average as a starting minimum.
I am just not okay with saying that most people need 2 cm below the 90/95% number because most people don't. Some yes..most not necessarily.
I have seen it skewed high too many times from maybe 20 minutes at higher pressures to offer up a blanket "most do" statement.
At least until I see several reports from someone and I can see a trend or pattern start to develop and I get more history and ask more questions about what is going on.

90/95 % numbers....they are just numbers and numbers by themselves don't mean much. Sometimes a useful guideline for something...and sometimes not particularly useful at all.

[ajack]

You will see the significance of 90/95% on auto titration and the labs that use that and max pressure to be part of the final fixed pressure setting. You have helped a lot of people over the years, on this point you are simply wrong
https://aasm.org/resources/practicepara ... rating.pdf
APAP devices allow data transfer to computers. Some systems
provide the percentage time at each pressure while others supply
detailed pressure, leak, and sleep-disordered breathing event
information. The clinician can review data and decide on an
appropriate fixed pressure. Two commonly used indices are
maximum pressure and pressure only rarely exceeded. The 95th
percentile pressure (P95) is the pressure level exceeded only 5%
of the time. Most devices will graphically display the percentage
of time each pressure is applied and calculate pressure statistics
(such as Pmean, P95, and Pmaximum) over a selected time interval; this
allows several days worth of data to be used for selecting an
appropriate pressure. In most published studies, investigators
reviewed raw data to identify high mask leak occurrences. Many
devices respond to high leak with increases in pressure to a set
maximum.


If we want to be very precise, it is hard to screw an average. From my observations, for most people on resmed, the median number works fine. Dreamstations are slower to respond and need more than median, closer to 95% has been my observation. Minus 2, plus 2 is often recommended by numerous people on another forum and most of the time it doesn't need further tweaking.

I originally only knew about, just under 1 or 2cm of median for min and 2cm above 95% for max. No doubt we will disagree again about this, It is a very simply maths equation, that works for most people and is supported by the manufacturer. My advice to anyone is to start here and then make changes as needed. Nothing is written in stone

The other observation I have is that if the pressure isn't set in the first 2 pages, they odds are it won't be set in 10 pages. There are a few reasons for this and it's seldom the fault of the machine.

[kuk_sleeper]

Day 3: Minimum pressure 8 and maximum 20. EPR set to 3.
https://imgur.com/a/BMjjs

I felt much better with EPR set to 3 but AHI increase little bit. I will experiment with EPR and minimum pressure for a few days to get an accurate picture.

[kuk_sleeper]

W.r.t my BP I guess I was hoping to get it reduced without putting in the hard work (Diet changes, exercise) I guess I have to do the hard way.


One thing I am noticing with Cpap is that I am waking up around 3-4 times during the night. Sometimes I feel like taking off the mask, but I do put it back on quickly.

Maybe I missed something but I am surprised your Dr. hasn't prescribed a medication for your B.P. Did your Dr. think CPAP therapy would solve the problem or did you just not want to take it?

I wasn't clear in my first post. My doc has asked me to reduce the BP either my lifestyle changes or meds. He didn't recommend CPAP. Actually he didn't mention sleep apnea at all. I went and got a sleep study done since I felt that I was waking up because of my snoring and I felt tired even after sleeping an whole night.

[ajack]

I think the snoring and flow limits would benefit from more min pressure.

[kuk_sleeper]

Does EPR affect snoring and flow limit ?
Setting EPR to 3 made the minimum pressure more comfortable for me but it seems to worsen the AHI and snoring a bit. I know a single days data is not good to derive conclusions from. So I am going to keep the settings constant for few days and see if there is any trend.

[RogerSC]

Okay, well, so it goes...there's no easy way to get to a lower blood pressure other than drugs that have their own side effects. Just before I started on cpap, one of the things that I saw was that my blood pressure was creeping up to at least 135+/90+-ish. I started cpap in January of 2012, and started taking walks the day after I retired in October 2012. I've continued taking about 5 walks a week, about 2 miles each for the intervening years. And my blood pressure went down to less than 120/80 fairly soon after getting into walking as a habit. I honestly don't know what part of that is due to cpap, and what part of it is a result of taking 5, about 40 minute walks each, a week. I live in an ideal area for daily morning walks, right by the ocean, so my walks are right above the ocean, lots to look at and experience. Anyways, been doing the walks and cpap for about 6 years now, and my blood pressure is staying low, my pulse rate is normally fairly close to 60.

I don't know if this would work for you, but I get enough extra energy from the walks to make it worthwhile for me. And I do some stretching while I'm warmed up after a walk. This has helped keep my feet, that were receding further and further away, within reach...the stretching has been good for keeping myself flexible enough. I've also lost about 50lbps on a low-carb diet since I started cpap, and have been toying with the horrifying idea of having a new sleep study to see where I stand at this point with sleep apnea. Especially since I've been seeing some interesting everyday results from the cpap. My original sleep study was terrible, figured I'd never have another one without the use of Ambien *smile*.

But enough about me *smile*. I just wanted to give you some idea of how things might be for you if you are willing to do a little work. Walking is low impact, so it doesn't cause problems. In fact, exercise like walking is often cited as good for the circulatory system, brain, etc. Worthwhile as far as I'm concerned.

Good luck! If you're willing to put in some work, things can be a lot better with less drugs. Which I view as a good thing.

[kuk_sleeper]

Okay, well, so it goes...there's no easy way to get to a lower blood pressure other than drugs that have their own side effects. Just before I started on cpap, one of the things that I saw was that my blood pressure was creeping up to at least 135+/90+-ish. I started cpap in January of 2012, and started taking walks the day after I retired in October 2012. I've continued taking about 5 walks a week, about 2 miles each for the intervening years. And my blood pressure went down to less than 120/80 fairly soon after getting into walking as a habit. I honestly don't know what part of that is due to cpap, and what part of it is a result of taking 5, about 40 minute walks each, a week. I live in an ideal area for daily morning walks, right by the ocean, so my walks are right above the ocean, lots to look at and experience. Anyways, been doing the walks and cpap for about 6 years now, and my blood pressure is staying low, my pulse rate is normally fairly close to 60.

I don't know if this would work for you, but I get enough extra energy from the walks to make it worthwhile for me. And I do some stretching while I'm warmed up after a walk. This has helped keep my feet, that were receding further and further away, within reach...the stretching has been good for keeping myself flexible enough. I've also lost about 50lbps on a low-carb diet since I started cpap, and have been toying with the horrifying idea of having a new sleep study to see where I stand at this point with sleep apnea. Especially since I've been seeing some interesting everyday results from the cpap. My original sleep study was terrible, figured I'd never have another one without the use of Ambien *smile*.

But enough about me *smile*. I just wanted to give you some idea of how things might be for you if you are willing to do a little work. Walking is low impact, so it doesn't cause problems. In fact, exercise like walking is often cited as good for the circulatory system, brain, etc. Worthwhile as far as I'm concerned.

Good luck! If you're willing to put in some work, things can be a lot better with less drugs. Which I view as a good thing.

Thanks for sharing your experience. I need to put in the work, both in exercise and in reducing my weight. Do you mind sharing the highlights of the low-carb diet?

[Arlene1963]

Hi Kuk_Sleeper,

Just chiming in here re the hypertension issue and mild OSA. I probably had mild OSA like yours for a very long time prior to my sleep study. I had almost exactly the same BP as yours in my early 30s (I'm 54 now) and it steadily crept up until in my mid forties it was around 170/80 ... and that was on 3 BP medications at max dose.

A lot has changed since then including reducing my medication to only 2, at the lowest dose.

My morning BP is now on average around 105/65.

So what changed?

I've gone through menopause (obviously not relevant in your case! ), I weigh about 20 pounds less, exercise much more every day, and also discovered I have OSA (just on the cusp of mild/moderate with AHI 16) and now use CPAP everynight.

In my case, CPAP was not a magic bullet re hypertension unfortunately. The minute I go off my BP medication my BP starts creeping up again. However, OSA or some form of sleep disordered breathing is definitely part of the puzzle I'm convinced of why I developed hypertension in the first place.

Good for you that you are on top of this early, in your 30s and didn't wait until you were much older.

So, yes, also focus on exercise and diet along with CPAP, they all work together. This might be enough to reduce your hypertension and will certainly benefit your overall health and well being, and maybe you won't need medication at all. I hope so!

[Julie]

EPR does raise AHI a bit, but unless it's enough to affect therapy, how you feel, it shouldn't be a problem... you need to find your own balance.

[Pugsy]

Going from AHI of 0.32 to 0.95 could have easily happened without the addition of EPR into the mix so I wouldn't be real quick to blame EPR on that little increase. We don't always sleep the same each night and sometimes things can vary widely and we never change anything.

But yes...sometimes when we add in EPR that drop during exhale can somethings let apnea events form that wouldn't form at the slightly higher pressure.
This is mainly for when someone's minimum pressures is right down at the line where the airway is just barely held open and the least little bit less pressure will let the airway collapse.
When this does happen and the number of apnea events it lets sneak past the defenses is a problem (and yours really isn't) and someone really prefers to use EPR the fix is easy...just a little more minimum pressure to compensate for the drop and it doesn't always have to be a per cm trade off with EPR either. It all depends on where that little line is in terms of pressure where the airway will stay open for the most part.

To give you an example...I am using 7 cm minimum and 3 EPR and 80% of the time my AHI is below 1.0 and 15% of the time below 2.0 and the other 5 % below 3.0 but sometimes it is higher and I haven't changed a thing...sometimes a lot higher and all I can do is scratch my head as to why. Couple of weeks ago it was 4.6 with a bit of clustering of both centrals and OAs...I have my suspicions that I was most likely awake or semi awake when the clusters were flagged. The centrals I have to ignore as I can't do anything about them anyway with my machine even if they are real...and it was about half and half central vs OA...and it was a couple of pretty dense clusters. As to what happened for sure...I dunno but it is such a rare thing for me that I won't spend any time worrying about it. This is the first time I have had it happen in nearly 4 months on this machine at these settings.

If you like EPR and you feel it offers a more comfortable breathing arrangement for you so that you can more easily get to sleep and stay asleep then by all means use it. Should it happen that the drop during exhale consistently allows too many apnea events to happen then we just increase that minimum a bit (which you were planning to do anyway to see if the FLs reduce). The change you saw from AHI 0.32 to 0.95 may or may not be related to adding EPR into the mix. It might have happened anyway. It's not enough of an increase to worry about if the using EPR lets you sleep better.
Sometimes the fact that we sleep better itself means a few more apneas happen just because we are sleeping more soundly which can increase the chance of the airway collapsing. Sort of where the increase in the apneas coincide with the increase in deeper or REM sleep type of thing.
My OSA is worse in REM and the nights where I don't get much REM because I don't get good sleep..my AHI is almost always nothing but it isn't because my OSA was so greatly treated ..instead it was because I didn't sleep so great and that's always a bad thing for me. We have to get the good solid sleep first before we start worrying about AHI. Without good solid sleep that AHI doesn't mean a whole lot.

[kuk_sleeper]

Hi Kuk_Sleeper,

Just chiming in here re the hypertension issue and mild OSA. I probably had mild OSA like yours for a very long time prior to my sleep study. I had almost exactly the same BP as yours in my early 30s (I'm 54 now) and it steadily crept up until in my mid forties it was around 170/80 ... and that was on 3 BP medications at max dose.

A lot has changed since then including reducing my medication to only 2, at the lowest dose.

My morning BP is now on average around 105/65.

So what changed?

I've gone through menopause (obviously not relevant in your case! ), I weigh about 20 pounds less, exercise much more every day, and also discovered I have OSA (just on the cusp of mild/moderate with AHI 16) and now use CPAP everynight.

In my case, CPAP was not a magic bullet re hypertension unfortunately. The minute I go off my BP medication my BP starts creeping up again. However, OSA or some form of sleep disordered breathing is definitely part of the puzzle I'm convinced of why I developed hypertension in the first place.

Good for you that you are on top of this early, in your 30s and didn't wait until you were much older.

So, yes, also focus on exercise and diet along with CPAP, they all work together. This might be enough to reduce your hypertension and will certainly benefit your overall health and well being, and maybe you won't need medication at all. I hope so!

Thanks for sharing your experience Arlene. My hope is that by catching the OSA early I will be able better deal with its effects.

[kuk_sleeper]

Thanks Julie, Pugsy.

EPR is definitely helping me. So I am going to try it for some days and check the AHI and sleep quality.

[Muse-Inc]

My BP story. At new PCP visit, my BP was 215/110...yikes! My family's BP all low as was mine, 65-70/55-60. At least my systolic was that high before when we trying to find the right dose of T3 (Cytomel) thyroid med, lasted 4-5 days. He tentatively diagnoses me with OSA. Okay, so off to sleep doc & test. Yup, severe. Get dataless CPAP...I was too dumb to know I had choices *sigh*. Stated taking Maxzide and Cozzar...hated 'em both. Started seeing improvements within days BUT it took me 18 months to be able to drop the Cozzar with BP staying 128/70...18 months! Of course, it took me that long before I was able to exercise >5 mins without having really shaky legs & getting light-headed. Sleep doc and cardiologist both kept saying, "Keep the faith, baby, it'll start working." They were right, seems like my body is one of those that is really slow to change and slow to heal re OSA. After losing more weight, I was able to drop the diuretic. I have been 100% compliant since 8/20/07. Found this great forum when I was about 15 months into being a hosehead and got learned up real quick re sleep apnea LOL! I upgraded pillow mask to Hybrid when chronic congestion make me a mouth breather (thanks for convincing me Rooster & LinkC), got an S8 APAP, then an S9 APAP, and added an S9 for Her APAP (really weird grayish pink color, no wonder it was on sale) for backup. I use my old dateless CPAP as a hose dryer: 18 mins at pressure 20 completely dries it.

Give CPAP therapy some time. Heck , my brain takes 3 weeks to accommodate to a change.

[kuk_sleeper]

My BP story. At new PCP visit, my BP was 215/110...yikes! My family's BP all low as was mine, 65-70/55-60. At least my systolic was that high before when we trying to find the right dose of T3 (Cytomel) thyroid med, lasted 4-5 days. He tentatively diagnoses me with OSA. Okay, so off to sleep doc & test. Yup, severe. Get dataless CPAP...I was too dumb to know I had choices *sigh*. Stated taking Maxzide and Cozzar...hated 'em both. Started seeing improvements within days BUT it took me 18 months to be able to drop the Cozzar with BP staying 128/70...18 months! Of course, it took me that long before I was able to exercise >5 mins without having really shaky legs & getting light-headed. Sleep doc and cardiologist both kept saying, "Keep the faith, baby, it'll start working." They were right, seems like my body is one of those that is really slow to change and slow to heal re OSA. After losing more weight, I was able to drop the diuretic. I have been 100% compliant since 8/20/07. Found this great forum when I was about 15 months into being a hosehead and got learned up real quick re sleep apnea LOL! I upgraded pillow mask to Hybrid when chronic congestion make me a mouth breather (thanks for convincing me Rooster & LinkC), got an S8 APAP, then an S9 APAP, and added an S9 for Her APAP (really weird grayish pink color, no wonder it was on sale) for backup. I use my old dateless CPAP as a hose dryer: 18 mins at pressure 20 completely dries it.

Give CPAP therapy some time. Heck , my brain takes 3 weeks to accommodate to a change.

Thank you for sharing your experience Muse-inc. Glad that the therapy is working for you..
I saw in a different thread a study which says that damage caused to brain was completely reversed in 1 year of CPAP usage.