Does 10-15cm seem like a good pressure range for me?

First of all, I want to thank everyone on this forum who has been nice enough to give me advice. Living with sleep apnea here in Korea can be rather isolating as there is little information or support from the local medical community.

I have just completed my first two weeks of using my APAP set between 6-16cm to get an idea of my average pressure and it looks like my 95% pressure rate has hovered around 10.5cm. Last night I set the range between 10-15cm and achieved an AHI of 0.84. Here is my chart from last night:



Here are the link to all of my SleepyHead Charts:
http://imgur.com/a/pLzuW
and my original sleep test:
https://www.dropbox.com/sh/mdcubyrmb50l

I was originally diagnosed with an AHI of 90, so the machine is definitely working. Just as an experiment, I took a 45 minute nap with the machine set on CPAP mode with a constant pressure of 4cm and I registered an AHI of 12. It probably would have been much higher if I had tried to sleep for longer and reached deeper levels of relaxation. Even though my AHI is low, when I zoom in tight I can still see areas on the flow chart that look like apneas but occur for less than 10 seconds so they are not flagged in the software. Also, the sine wave pattern can get disrupted at times and these occurrences are not flagged either.

The good news is that I have been 100% compliant with the therapy thus far and have mostly gotten AHI's under 2.0. However, I am still waking up multiple times during the night due to mask leaks, mouth breathing or other annoyances and this is making me feel exhausted during the day. I just recently duct-taped my hose up and around my headboard as a very cheap and crude form of hose management and it worked great. Now that my AHI numbers seem to be reasonable, I am going to work on fixing mouth leaks to see if that will help me sleep better during the night.

My AHI score was quite low using a minimum pressure of 10cm, but perhaps the higher pressure is causing more leaks and thus waking me up more during the night. I am an active sleeper and find that my nasal mask will slightly leak when I turn on my side and the headgear strap creates tension against the pillow. I didn't notice this quite as much at lower pressures. I have ordered the Contour CPAP pillow to see if this helps with mask leaks when I sleep on my side.

Both my girlfriend and I have noticed that I am sometimes exhaling air through my lips, and I have a long history of mouth breathing. I have been using medical tape to tape my lips closed at night, which has been working well, but I have read that this is not a recommended practice for longterm use. I have ordered both a chinstrap and the Mirage Quattro FX FFM from eBay and they should be arriving sometime next. I will experiment to see which combination both fixes my mouth breathing and mask leaks. By the way, I would like to give a shout-out to Grayghost4 for selling and shipping my S9 Autoset quickly and without any hassles. Buying from him saved me over $2,000 than buying from my DME here in Korea.

So, do you all think that I should begin with 10cm-15cm as my pressure range for a few weeks and see what happens? Please let me know if you would like me to post any zoomed-in SleepyHead charts or any other information. Thanks!

Ansan wrote:
So, do you all think that I should begin with 10cm-15cm as my pressure range for a few weeks and see what happens? Please let me know if you would like me to post any zoomed-in SleepyHead charts or any other information. Thanks!

Yes

Glad I was able to help and that it got there without any trouble.
I am also a mouth ex-haler and get dry mouth ... I find a cervical collar helps me keep my jaw closed.
Since you are not even using EPR ... it appears the pressure is not a problem for you ... I would try increasing the lower pressure by .2 cm every few days to see if you do not sleep better , I find a constant pressure better for me.

I would set the pressures at 7 Min and 12 Max b/c there are no reasons to use higher pressures.

avi123 wrote:I would set the pressures at 7 Min and 12 Max b/c there are no reasons to use higher pressures.

more correctly, there's no reason to reduce the max pressure if the machine isn't going there. as pugsy pointed out, you could set the max to 100 (if the machine allowed it) and it wouldn't make any difference.

keeping a tight upper pressure just sets you up for failure if for some reason you need more pressure for part of the night, and you've hobbled the machine.

Ansan-

Just curious as to the recommended fixed pressure in your sleep study. I could not access it on dropbox.

Sonds like your mask leaks and resultant awakenings are much more bothersome to you, right?

I was started out with the Mirage FX and it was OK, but I hated leaks into my eyes, woke me up several times a night.

Also had mouth leaks.

Went through several masks, same problem with leaks into eyes with every nasal and full face mask I tried. Changed to nasal pillows with a chin strap, which was my best solution.

Eventually I managed to get rid of the chin strap, as my mouth leaks went away. Practice I guess!

Everyone is different in the mask department. But if leaks in the eyes are a problem, try a nasal pillows mask.

Here is my chart from last night. I set the pressure between 8cm-15cm and also used medical tape to try and keep my mouth shut. As you can see, I had some pretty major leaks:



TedburnsIII: You are correct that there isn't a prescribed pressure setting on my sleep test evaluation. They would like me to come in again for a titration test, but I am trying to avoid that since I have an APAP machine and the test would cost another $600 out of pocket.

Palerider: Yes, I have also read that modern APAP machines will only reach the maximum pressure setting if they really need to so therefore it's better to keep it rather high. The older machines were much worse at detecting leaks and would quickly ramp up to maximum pressure just to compensate for a leaky mask.

SleepDisturbed: I've ordered a Mirage Quattro FX on Ebay and I am going to buy a Swift FX nasal pillow mask from my DME. Between all three mask types and the Respironics Premium Chinstrap arriving next week, I should be able to figure out the best mask/chinstrap combo that eliminates both mask leaks and mouth leaks.

I still don't see any reason to change anything. You might want to get a handle on the leaks though.

Thanks, LSAT.

So you think 10cm is a better minimum pressure for me than 8cm?

Ansan wrote:Palerider: Yes, I have also read that modern APAP machines will only reach the maximum pressure setting if they really need to so therefore it's better to keep it rather high. The older machines were much worse at detecting leaks and would quickly ramp up to maximum pressure just to compensate for a leaky mask.

I've heard stories of old machines doing that, and i have to wonder if what was happening was just people THINKING the machine had increased pressure... there's no reason whatsoever for a machine to increase pressure in response to a leak... however the machines (all of them) will increase flow in an attempt to maintain the pressure to compensate for the leak, and maybe people mis-interpreted that as an increase in pressure.

that said, the modern machines will sometimes even reduce pressure when confronted with excess leaks to help to get the mask to seal again... I've also seen traces of machines that sat at minimum pressure because the mask was too leaky.

Ansan wrote:So you think 10cm is a better minimum pressure for me than 8cm?

10 would probably result in a lot less pressure variation.