Anyone do better with lower pressure?

[Pugsy]

Maybe someone can explain how to look at wave flows on SH to determine whether a person is having events that start on exhale?

I have never seen it myself so I can't really say but I think...note I said I think..what happens is that the airway collapses and because these machines won't actually do anything when the collapse is in progress the machine sits by and twiddles its little thumbs while. So it does a lot of thumb twiddling.
Now I have read that having the airway collapse during exhale...it common.. I have never seen it myself but I have read about it.
As to what it looks like on SH I have no idea except the AHI would be a bit higher than we would want. It's not so much that little drop during exhale as it is the overall average simply isn't holding the airway open optimally.

[Jay Aitchsee]

An interesting read.

Expiratory and Inspiratory Positive Airway Pressures in Obstructive Sleep Apnea: How Much Pressure is Necessary? A Different Point of View

http://medcraveonline.com/JLPRR/JLPRR-02-00065.pdf

Implies one may do better, or at least as well, with EPAP alone, or with EPAP greater than IPAP.

[Rainmom17]

Thank you for all the responses.

Because some people wanted to see it, here's my most recent attempt at minimum of 8 pressure:


Then last night I decided to go back to 7.5 minimum and turn Flex down to 2 rather than the 3 it's been at since I started. Here's report:


I had no comfort difference with lowering Flex - it's comfortable either way - so I'm going to continue to lower it and see what happens.

Chicago Granny :

No need to get frustrated - you have a lot of things going well.

BTW, your equipment profile needs updating.

The source of my frustration is that I don't feel any better after 5 months of total compliance. Actually that's not entirely accurate. I do feel pretty good mentally. However, I feel worse physically. Having a hard time understanding why this is so, and I'd sure love for cpap to be helping me feel some improvement physically. I am still so tired and my family is still laughing at me for falling asleep when we watch TV at night. I'm tired of still wondering when I wake in the morning if I'll have the energy to get through the day. I know I need to be patient and change takes time, but I'd expect some improvement after 5 months.

My equipment is listed at the bottom of my posts and is accurate. Is there something that seems off?

TedVPap:

The problem that many people have is as they are getting adjusted to the alien, they are also changing treatment settings so it is nearly impossible to separate the causation. As you said, you feel better even though your numbers are not better. You credit the improvement to less mask leaks and less awakenings - makes sense to me.
I would want to see to see your sleepyhead data before advising on any pressure changes.

I have tried to be really methodical about this whole thing. For instance, when I make a pressure adjustment I make sure I don't change anything else and I give it several days at that pressure to look for any patterns. I think the reverse of what you said is actually the case: I don't feel better but my numbers are getting better (for the most part). Maybe I didn't explain that well in my original post.

[Julie]

Have you recently had other things checked, like thyroid, sugar, hormones, etc?

[Rainmom17]

Yes everything. Also head to toe neuro exam. Will get vestibular physical therapy starting in 3 weeks although neuro concluded there isn't anything really wrong with me. Vitamin D and ferritin are low-ish so I'm working on both of those. In perimenopause and progesterone is also low-ish, so that may be impacting my sleep and daytime energy levels.

[Pugsy]

I don't blame you for not wanting to do 8 cm...neither would I with those same results.
It doesn't make any logical sense that things would get worse with more pressure (especially since it is the obstructive stuff getting worse) but I think you have enough experiments in that area and logic doesn't always work out anyway.

Interesting that the reduction in Flex may have made some impact on things. I think if it were me I would look along those lines a little further to see if it holds or not.

[ChicagoGranny]

My equipment is listed at the bottom of my posts and is accurate. Is there something that seems off?

SH says you are using APAP, but you have Pro CPAP in your equipment profile.

[Rainmom17]

Ok. I think I picked the right one now from the few options.

[ChicagoGranny]

OK, check tonight to see if that brings your AHI down.

[Rainmom17]

If only that's all it took!

[TedVPAP]

If it were me and I felt like I was still not sleeping well after many months of trying, I would try a higher minimum. An increase of 0.5 is not a lot. There is still a fair amount of OSA events in your data. It looks like the number of CA increased at 8cm-H2O. I would try 9 or 10 for a few days to see if I felt better (regardless of the AHI).
Maybe it will help, maybe not. Since PAP is safe, I would try and see.
Some people do better with straight CPAP as auto disturbs them.
Good luck and keep trying.

[Rainmom17]

Ok, TedVPap, your reply inspired me to just go ahead and try a higher minimum pressure. I've got a few more days off work so it's the best time to try it out. I never had much luck at 8, so I decided to try 8 1/2 instead. Happy to report it was just as comfortable as 7 1/2 and my ahi was 2.0, so not too bad. Will go ahead and try 9 now and see how it goes.

[ChicagoGranny]

my ahi was 2.0, so not too bad. Will go ahead and try 9 now and see how it goes.

You are wanting to feel better, and increasing the pressure is not dangerous, but is chasing a statistic lower than 2.0 AHI going to help?

Here is a general checklist you might want to consider:

- Practice good sleep hygiene (Google it and read several sources)
- Eat a good diet
- Have a regular, moderate exercise program
- Try to avoid daytime naps
- Practice total abstinence of caffeine including sources like chocolate (sigh)
- Review all medicines, vitamins and supplements you are taking to make sure none are interfering with sleep
- Use the bedroom for sleeping (and sex) only, and make sure the bedroom and bed are comfortable.
- Learn to appropriately handle emotional stress in your life
- Do not listen to your breathing or the sound of the machine as you are falling asleep.
- Distract your mind by thinking of a pleasant, relaxing activity that you enjoy. Thinking of sitting under an umbrella on a quiet beach with a warm gentle breeze works for me.
- Use CPAP software, such as the free SleepyHead, to make sure your therapy is optimized
- If you still don't feel or sleep well, make sure you have regular medical checkups to confirm there are no other medical problems

CG

[Rainmom17]

Thanks for the list. I do most of those things. Suppose cutting down on chocolate would help.
It seems that everyone on here who says they feel good routinely have ahi below 2, often below 1. Seems like a worthy goal to strive for.
Yes, how I feel is most important. Haven't felt good in a long time. I'd sure love to find out if a routinely lower ahi equaled feeling better.

[ChicagoGranny]

everyone on here who says they feel good routinely have ahi below 2, often below 1.

Yes, I like to keep mine below 2.0. AHI last 30 days 1.2, 90% leak level 0.69.

So, I do chase that statistic. But still, the other factors should not be ignored.