Am I too early in treatment to change pressure??

I was diagnosed with OSA in March and had a titration in June. My untreated AHI was 14. I was prescribed 8 cm. I have had my Airsense 10 Autoset for 2 weeks. It is set in CPAP mode at a pressure of 8.

I have sleepyhead data, and my AHI is hovering around 4-6 per night. I am having OA events that last for up to 55 seconds. There are individual hours where I am having 17 events. I am very new to all of this and have tried to read as many threads on here as I can. Looking at the charts and seeing how my breathing stops is pretty scary.

I have read a lot of people on here tweaking their pressure and using the data to get great results. That is exciting to me. It makes me want to put my machine into APAP mode and see what happens, but I have a few concerns.

-I have used my machine every night and have 13 days of compliance. Should I wait until after the compliance period is over before tweaking with the settings?

-If I change the settings, will there be backlash from my doctor or DME?

I guess the main question is whether I should wait until my insurance pays for the machine (after compliance period?) before trying to change the pressure?

brad_0306 wrote:I have used my machine every night and have 13 days of compliance. Should I wait until after the compliance period is over before tweaking with the settings?

Insurance doesn't require any information about therapy except the hours of use....that's all they care about. Are you using it the minimum required amount of time so they will pay for it.

brad_0306 wrote:-If I change the settings, will there be backlash from my doctor or DME?

You might get your hands slap by someone or they might not even notice. When I showed my doctor why I changed my pressure and brought reports to verify my results I got a pat on the back and was told "you got a good head for it" "get back with me if you run into something you can't handle".
Haven't seem him since Aug 2009.

If the majority of your AHI is obstructive in nature (Obstructive Apneas and hyponeas) then a little more pressure or changing to apap mode would be in order. See where the machine wants to go.
If the majority of your AHI is central then more pressure won't necessarily fix those and there's a small chance it could make things worse.

If you do decide to try apap mode...set the minimum to what you are using now and set the max to 12 and see just where it wants to go...evaluate again after you have a full night with the new settings.

If the AHI is primarily Centrals/Clear Airway apnea events the post back here exactly what you are seeing and use available software to get more details. Let's try to figure out if the centrals are real or not first and go from there. Don't go increasing the pressure if about all you see is centrals.

It's not unusual for the titration study not not get things spot on accurate for any number of reasons. Mine didn't get it right either. But to be fair my OSA is much worse in REM stage sleep and I got crappy sleep the night of the titration and ended up with only 6 minutes of REM out of the entire 7 hour night. The simply didn't have enough time in REM to figure out that I need 6 to 8 cm more in REM than I do in the non REM stages.
I got it figured out on my own in just a couple of nights.

If you are seeing clusters of events it could be REM sleep or even supine sleeping where you may just need more pressure during those times and not others. Quite common.

If you want us to see what you are seeing...
thread with examples
viewtopic/t103468/Need-help-with-screen-shots.html
How to organize the graphs (we don't want all of them...just the basics
https://sleep.tnet.com/resources/sleepyhead/shorganize
how to use imgur
https://sleep.tnet.com/reference/tips/imgur

Thanks for the response, Pugsy!

I was told I must use it for at least 4 hours per night to be compliant. I have used it around 7-8 hours every night. Luckily I am a pretty heavy sleeper and am having no trouble getting used to having a mask on my face. I usually sleep on my stomach/side.

I tried to post a screenshot of my charts but I need to be registered first.

For the clear airway events, They have remained a pretty constant piece of the pie chart. Looks to be around 1/6th of the chart. Last night, for example: My AHI was 5.60
Large Leak 0.01%
Clear Airway 0.85
Unclassified 0.00
Obstructive 4.38
Hypopnea 0.37
RERA 0.37

That's interesting about the limited REM in the sleep study. I still need to request a copy of my results.

I may try putting it into APAP and using 8-12 pressure on of these next few nights....Do the doctors frequently check and adjust pressures for their patients or is it kind of a here is your prescription, good luck kind of deal?


Thanks again. It means a lot

LMAO xxyzx!!! Thanks for that! I have a lot to learn about this stuff.

Most of the doctors wouldn't know how to adjust the pressure if you paid them to do it, so I wouldn't worry too much about that.

Your AHI is primarily obstructive in nature. A random central here or there is normal and no big deal.
So I would change the pressures if it was me. Probably give apap mode a try with 8 to 12 or something like that and see where if wants to go.
Some doctors care if the patient does anything themselves. Those docs tend to be control freaks and I don't like control freaks...but most doctors won't care and if they do the worst they can do is yell at you for thinking for yourself. Is that the kind of doctor you want? Chances are he won't even notice...most of the time all they look at is AHI and hours of use and if those numbers look great they won't bother too look at anything else.

brad_0306 wrote:I am having OA events that last for up to 55 seconds. There are individual hours where I am having 17 events.

I would not tolerate that one more night. My preference would be APAP at 8.0 min and 20.0 max. The machine will not go any higher than your body needs. It's very unlikely it will get anywhere near 20.0.

Thanks for the advice, yall. I went ahead and adjusted the pressure last night. I set it to APAP with the pressure at 8-15.

My AHI was down to 2.35, the lowest I have seen so far.
8 Hours 5 mins.

Large Leak 0.03%
Clear Airway 0.87
Unclassified Apnea 0.00
Obstructive 1.36
Hypopnea 0.12
RERA 0.12

It says the Max pressure was 12.38.

I wish I could post the charts for yall. I'm trying to get registered but I haven't gotten a confirmation email yet.

Should I be worried that the clear airway events took up a bigger portion of the pie chart this time? It is usually around 1/6 of the chart, last night it was closer to 1/3. Although, the 0.87 is pretty close to where it usually is and the number of total clear airway events (7) was pretty consistent with other nights.

brad_0306 wrote:Should I be worried that the clear airway events took up a bigger portion of the pie chart this time?

No, not at all.
It was still less than one and pretty much exactly what you had on the other night but the slice of the pie is bigger because you had less of the other events.
If you had one event the entire night...and that one event was a central...you know what the pie would look like....the entire pie would be a central.
The pie chart is really not all that helpful except to give someone a brief comparison as to the make up of the pie. I don't even have mine turned on.
When posting images it gets in the way of the Statistics which are far more useful than the pie chart.
Turn it off when you post your images (once you are able to post image links) by going to Preferences/Appearance tab and removing the check mark for the pie chart. You can always turn it back on if you wish but it really isn't that useful.

Overall I would say last night was a success and I would suggest that you leave things alone for a bit and see if it holds.

Pugsy wrote:Overall I would say last night was a success and I would suggest that you leave things alone for a bit and see if it holds.

+1

Ok, that makes sense. That's what I was hoping. Thanks! I'll see how things go for the next few days/weeks.