Strange Corelation Between Fitness and Machine Pressure

[BanjoPaterson]

Hi. I haven't posted for a while, but have a curious situation. When I started CPAP I was 108kg (180cm tall, which put me into the obese classification). I started running and, a bit later, Tae Kwon Do (which I'd done to a senior belt in my youth back in the early 80s).

Fast forward eighteen months. I went through the C25K (couch potato to 5km) programme, but over a long time where a week equaled a month because of my tendency to shin splints). Now I weigh 87kg, which is still classified as overweight, but am going for my brown belt and am running about 30km a week (3 x 1 hr runs at about 10km/hr). I am fitter than I've been for over two decades! My resting heart rate has gone from over 70 bpm to 48 bpm, and my recovery rate is 25-30bpm the first minute after stopping my run.

I'm still on CPAP, but the pressure reading has been increasing, not decreasing. When I started CPAP my 95th percentile was on the APAP was between 10 and 10.8 (my starting pressure is 9.8 and my titrated pressure was 10.6 from a sleep study). Now my 95th its rarely below 12?! What gives? On the plus side, my AHI is, and thankfully has been low: my AI is often zero, so I'm certainly not complaining. But I thought the CPAP would have to work less the fitter I got.

A final observation. If I get up during the night and go back to bed I find the starting pressure of 9.8 is not enough and I have to breath through my mouth for a few seconds to get enough air. If any of you were ever started on 4 ("let the machine find the correct pressure" philosophy), you'll know the feeling. Again, thought being fitter would mean being able to use less oxygen.

Any insights gratefully received.

Thank you.

[Julie]

Hi - you may have lost weight, may feel 'fit' (and most likely are), but have you seen a doctor in a while? And is he/she aware of your work-out program? What else can you think of in terms of changes - diet, bedtimes, stress, anything - that could account for the change? What are the chances you're now mouth breathing when asleep whether or not you did it previously?

[The Choker]

When I started CPAP my 95th percentile was on the APAP was between 10 and 10.8 Now my 95th its rarely below 12?!

The "new you" is probably sleeping more minutes with better sleep architecture. The 95th percentile statistic is inversely related to minutes awake and directly related to minutes in REM.

But in any case, I personally would not consider the quoted difference in pressure data statistically significant!

You are doing great with your fitness and body weight! Relax and enjoy! F--- the machine data!

[-tim]

How do the graphs look of today compared to long ago? Are you spending more time at lower pressures? Is it showing your sleep patterns are much different? How has your blood pressure changed?

[tschultz]

Sleep position may also affect your numbers. For many sleeping on your back will usually result in more obstruction than sleeping on your side. Now that you are more active and feeling better you may be moving around more during your sleep also.

I know this is one of the changes I have seen. When I first started I always slept on my back and never moved much. Once I was diagnosed with OSA and put on CPAP I was able to train myself to sleep mostly on my side. However now that I am feeling better and more active I am moving around much more in my sleep. The more time I spend on my back the more events I tend to see, and correspondingly the higher pressure that is needed to control them. I also attribute some of these changes to recovering from the long term sleep deprivation. There was zero REM or deep sleep measured in my sleep studies but after starting treatment my REM and deep sleep both returned which also impacted how much I moved around during sleep.

I have certainly learned that this is a much more complex issue than simply CPAP as a treatment. Sleep is a primal need and impact everything in our bodies. Hours sleep, sleep architecture, and AHI are all intertwined with many factors impacting each. Nothing can be taken in isolation as a measure of how one is doing or how effective treatment is.

[jweeks]

I'm still on CPAP, but the pressure reading has been increasing, not decreasing. When I started CPAP my 95th percentile was on the APAP was between 10 and 10.8 (my starting pressure is 9.8 and my titrated pressure was 10.6 from a sleep study). Now my 95th its rarely below 12?! What gives? On the plus side, my AHI is, and thankfully has been low: my AI is often zero, so I'm certainly not complaining. But I thought the CPAP would have to work less the fitter I got.

Hi,

I also have had a more difficult time with treatment since losing weight. My doctor suspects that losing weight had resulted in a bit of loose tissue in my airway, and it is sagging a little more when I sleep. I did go see an ENT (ear nose throat doctor) who confirms that I had some extra tissue in my upper airway, but not enough where they would recommend surgery on it. My doctor suggested that I continue to lose weight and do as much exercise as I can to strengthen the muscles that support breathing.

The type of breathing and sleep issues has changed for me. Before losing weight, OSA was my challenge. Now, I no longer have OSA events, and I can again sleep on my back. However, I struggle with RERA breathing, something that auto machines cannot effectively treat. As a result, I am back to the same high pressures as before, but now running in fixed mode rather than auto-adujusting.

-john-

[jen4700]

I'm glad you're fit and feeling better.

Just goes to show - yet again - that weight and/or weight loss don't affect OSA as people "would" think.

[BanjoPaterson]

Thank you to everyone that replied. You've all given me a different insight and good causes. Particularly with the idea of additional tissue inthe throat left over from my weightier days, sleeping differently with more movement, and the idea that I should be less concerned simply because treatment is still working.

With respect to my fitness programme, at first it was by myself, but when I got shin splints early 2011, I engaged the services of a physio/professional trainer. Since then training has been a more gradual build up, with exercises to help running form and buildingcore strength. Getting to where I wanted to be was much slower, but with no injury. So I am fitter, but still a long way from being as fit as I want to be (ie be able to run a half marathon, let alone a marathon). However, my indicators (resting hr, better blood pressure, no longer in the red zone for my waist size) seem to show it's working.

But as the data shows, I still need the CPAP. As one poster reminded me, OSA is a complex, multi variable condition. Right now I'm just glad I'm living in days where treatment exists.

Once again, thank you.

[chunkyfrog]

Good for you!
Keep plugging away.
The more we learn, the more we realize how little we really know.
Kind of blows me away, sometimes.

[Matty332]

I can't believe it! Another Canberrian, what is it about this bizarre secluded city that attracts people to this forum - there are only 350K people here! I have also seen another Canberrian and one person from Sydney on this forum.

Canberra is this strange secluded place that seems to be insulated from the rest of the world. I like it .

Good work on the fitness BTW, 48 resting heart rate is REALLY fit! Man you must be working it is all I can say. Which Teakwondo club are you with? I did some with Master JN KIM ages ago, a little bit with Impact and I have tried National Teakwondo.

[BanjoPaterson]

I can't believe it! Another Canberrian, what is it about this bizarre secluded city that attracts people to this forum - there are only 350K people here! I have also seen another Canberrian and one person from Sydney on this forum.

Canberra is this strange secluded place that seems to be insulated from the rest of the world. I like it .

Good work on the fitness BTW, 48 resting heart rate is REALLY fit! Man you must be working it is all I can say. Which Teakwondo club are you with? I did some with Master JN KIM ages ago, a little bit with Impact and I have tried National Teakwondo.

Thanks.

Yep, Canberra's odd in a good way. Or good in an odd way... Bit of both.

With the running I've been following the Dr Jack Daniel's method, although my VDOT barely registers. Last weekend ran around the trail base of Red Hill and then up it from the Garran side, but I wouldn't break any speed records. Have entered City2Surf for the first time, so got to do hills. When I was recently working out my HR zones using estimated max and resting HR, I was surprised my resting HR that low considering I'm only now starting to do real distance work. Still, not complaining. Mind you, a colleague of mine who runs sub 3 hour marathons has a resting HR in the 30s! Now that's a goal.

I do Rhee at Yarralumla primary. Oddly, back in 1982/3 I did Rhee TKD at Manuka under the instruction of Allen Byrne when he was with Rhee. It seems after I left he broke away to start National TKD. Despite the schism he created, my memories of him and his instruction are positive. He was a superb technician at TKD, but I'm back at Rhee and thoroughly enjoying it. More board breaking than I remember from before, but the free sparring is great fun. A little impact, but lots of emphasis on technique and control.

Any how, good to see another Canberran.