Newbie here looking for feedback and advice on hypertension

[ajack]

If it were my chart I'd have the min pressure on 10, around the median, or possibly up to 12, because the 95% number you have, is a consistent 14 on sleepyhead. See how it goes. There isn't going to be an instant fix for BP, but it will help over time. Why aren't you on meds that control it?

[kuk_sleeper]

Thank you for the reply Jason.

I am happy about the AHI numbers. It has been around 1.0.
But I have been waking up 3-5 times every night wanting to take off the mask. Sometimes it is the feeling of high pressure. Sometimes it is a mask leak which is making a sound or I feel the air escaping on my face. I am currently using a full face disposable mask.

I didn't have any Central Apnea in my sleep study. Does the Resmed system treat a mask off event as a CA or something?

[kuk_sleeper]

If it were my chart I'd have the min pressure on 10, around the median, or possibly up to 12, because the 95% number you have, is a consistent 14 on sleepyhead. See how it goes. There isn't going to be an instant fix for BP, but it will help over time. Why aren't you on meds that control it?

Thank you for checking the graph.

I didn't feel too comfortable raising the minimum to 8 from 5 yesterday. So I am going to try to bring it up slowly. But lack of any apena or hypoapnea at 8 makes me want to up the minimum pressure. But I guess I am going to do it slowly and in steps.

Why aren't you on meds that control it?

I wanted to try to get it under control without meds. I am not in great shape. I guess time is running out for me in terms of not taking meds.

[ajack]

By all means adjust it as you feel comfortable to do so. You may even want to put it past your doctor, he should know this stuff. If not, get a new doctor

[Julie]

Take a look at Padacheek.com for liners - you might be a good candidate for those (made by a member here) from the sound of it. Don't overtighten the mask trying to get it to fit either though as that can be counterproductive and trying other masks might be better if e.g. liners or sleep positioning don't work. I'm still a bit curious why you'd want to use Cpap though if it turns out you may not need it if you can learn to not back sleep. The tennis ball trick is not that effective, but things like wearing a back- or fanny pack stuffed with towels and/or purpose-made foam wedges in behind you can.

[kuk_sleeper]

Take a look at Padacheek.com for liners - you might be a good candidate for those (made by a member here) from the sound of it. Don't overtighten the mask trying to get it to fit either though as that can be counterproductive and trying other masks might be better if e.g. liners or sleep positioning don't work. I'm still a bit curious why you'd want to use Cpap though if it turns out you may not need it if you can learn to not back sleep. The tennis ball trick is not that effective, but things like wearing a back- or fanny pack stuffed with towels and/or purpose-made foam wedges in behind you can.

I will try out the liners.

I didn't mean I want to use Cpap even if I dont need it. What I meant was I would use it even if the alternatives given 75% of the benefits. I am fine tuning the cpap therapy to get a sense of how much I benefit from it. It would be easier to compare the efficacy of other measures when I have a sense of how much Cpap helps me.

Trying out other masks is not a option currently since I am waiting to return to USA.

[kuk_sleeper]

By all means adjust it as you feel comfortable to do so. You may even want to put it past your doctor, he should know this stuff. If not, get a new doctor

The system here is a bit different. I guess I can go back to my doctor but seems like I will have to do all the fine-tuning of the therapy.

[ajack]

Given that over 5 ahi is grounds for treatment, I guess this is the reason you are on CPAP
"I am 33 year old male diagnosed with mild OSA (AHI 10 event/hr)"

You can roughly set with min pressure at Med/meading pressure in sleepyhead, or 2cm under the 95% pressure. the max should be set 2-3cm above the 95%.
You can also titrate yourself, page 35
https://www.scribd.com/document/3534028 ... -Titration

[Pugsy]

95 % numbers....either pressure or leak from a ResMed machine (Respironics uses 90%).
The definition is "at OR BELOW" that number for 95% of the night. People tend to forget the "or below" part of the definition and think that it is the number where we spend 95% of the night and that simply is not true.

It is not the holy grail of numbers where we need to necessarily set our minimum pressure or what we might need if we were to switch over to a fixed pressure. Sometimes it can work out that way but it isn't the holy grail where we just automatically say that is the best guide line.
95/90% numbers are too easily skewed upwards by relatively short periods at higher numbers so we have to sort of take these numbers with a grain of salt.

We have to look at the whole picture and see just how much time was spent at the higher pressures before we start assuming it is a good baseline to start with. Sometimes it is but most often it isn't.

Now long term...like 6 months of long term 90/95% averages...that gets us closer maybe but not nightly or even weekly averages especially when new to cpap therapy.

[klm49]

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?

[ajack]

It's not the holy grail, but 90/95% is a good place to start. Most people will find that having min on median or 2 cm below 90/95% will get them into the ball park, which the machine may be fine tuned from there. The titration guide can be a big help.

[Pugsy]

It's not the holy grail, but 90/95% is a good place to start. Most people will find that having min on median or 2 cm below 90/95% will get them into the ball park, which the machine may be fine tuned from there. The titration guide can be a big help.

It's not necessarily a good place to start and for SOME people it is way over kill. Using a lot more pressure all night than is really needed which can for SOME people open up a whole new can of worms.
Some people but not necessarily most people.
A lot depends on how much difference there is between the median average and that 90% number.

By your reasoning this person should use a minimum of 14.5 all night long? This person routinely saw 90% pressures higher than this but I didn't have an image of one of those reports handy.

[ajack]

That chart isn't the norm nor the same as OP. I still think my suggestion of "If it were my chart I'd have the min pressure on 10, around the median, or possibly up to 12, because the 95% number you have, is a consistent 14 on sleepyhead." is as good as it goes, start at 10 and see if it needs to go higher, possibly up to 12. After that it is almost a fixed pressure setting. not that fixed is bad, for some it works better.

In your example, it looks like the person was backsleeping or some other positional think in the early morning. The rest of the night 10 obviously wasn't enough to clear OA/H, with that chart I'd have min 12 at the median/average. 14 wouldn't be overkill either, if the 90/95% number was the only number available. The proof is in the pudding, as the pressure ranges are changed.
It seems Resmed will treat with a lower pressure setting than dreamstation that seems slower to respond and likes to be closer to the 95% of sleepyhead.

[Pugsy]

That chart isn't the norm nor the same as OP. I still think my suggestion of "If it were my chart I'd have the min pressure on 10, around the median, or possibly up to 12, because the 95% number you have, is a consistent 14 on sleepyhead." is as good as it goes, start at 10 and see if it needs to go higher, possibly up to 12. After that it is almost a fixed pressure setting. not that fixed is bad, for some it works better.

In your example, it looks like the person was backsleeping or some other positional think in the early morning. The rest of the night 10 obviously wasn't enough to clear OA/H, with that chart I'd have min 12 at the median/average. 14 wouldn't be overkill either, if the 90/95% number was the only number available. The proof is in the pudding, as the pressure ranges are changed.

Ahhh..but here's the rub..that was one night and actually a "bad" night. That person normally didn't have reports like that. In fact the usual report showed maybe 12 to 13 90% pressures and long term average 90% pressure was 12.4 and the overall average was 11.8. Long term like 6 months.

And it's not supine sleeping..it's REM. Why use a lot higher pressure all night just to cover 20% of the night in REM?
The person built a wall to force side sleeping just to make sure that supine sleeping was removed from the experiment....slept that way for 1 month.
And the in lab titration also confirmed that pressure needs didn't really change with sleeping position.

Anyway....my point is that people should look at a lot more than one or two reports before handing out "most people need to be within 2 cm of their 90/95%" numbers and the AHI is 0.32 just because a machine might want to go somewhere doesn't always mean it is a good idea.
Now if the AHI was a lot higher...yeah maybe go down that road.
The flow limitations are driving the pressure in the OP situation...it remains to be seen yet whether they really need to be killed or not.

[ajack]

we have been down this road before with exceptions to the rule. One of us could go back and see what chart was used last time.
As I said it looked like there was a positional obstructive event. If you are going chart by chart, the next night will show if this is a pattern. Obviously night two and 3 will show that. You make is sound as if pressure settings are set in stone. 14 still wouldn't be excessive for your chart and would probably be close to a fixed pressure setting.

So again, I'm comfortable with the min to be around the median pressure or 2cm under the 90/95% as a ball park figure to to get in range and be further evaluated. The manufacturers have these median and 90/95% numbers for a reason. After all a manufactures recommendation on how to set up an auto titrating cpap machine use these numbers to do so. They are given for a reason. Not every machine has sleepyhead data available.