My numbers are "speaking" to me!

My Doc didn't indicate a pressure range on the prescription for my A-PAP, so the DME set it from 6 - 20. I've been gradually raising the minimum pressure and watching my numbers. My sleep study indicated a titrated pressure of 14. I've learned that a minimum pressure of 6 is quite low for a titration of 14. I haven't noticed any significant change in my numbers as I've gone from 6 to 8, to 9, then to 10. Last night I increased the pressure to 11. My 95th Percentile Pressure jumped from a range of 13 to 13.8 up to 16.6! My Maximum pressure jumped from a range of 14 to 16 up to 19! My AHI isn't changed much at 4.9 (it's generally hovering near 5), but I only had one apnea event last night. With the exception of one really good night where I had only 2 apnea events, all other nights I've had a minimum of 3 events, with 4 and 5 events not being uncommon and even had one night with 6 apnea events. I think getting my minimum pressure up closer to my titrated pressure is helping the machine better respond to my events.

Should I raise it to 12 tonight or leave it at 11 for a few nights to see how it goes? I'm feeling so much better since starting A-PAP, but I'm ready to feel great! I know it takes time to repay a sleep debt, but I think that eliminating the apnea events completely and reducing the hypopnea events will go a long way to helping me feel great. My AHI is still only borderline acceptable at 4.9.

Yesterday I went to the DME to see about a full face mask. My 95th percentile leak rate had been normally in the teens, but sometimes in the 20s. Last night it was 15.6. I think I may be leaking from the mouth a little, but not sure. He recommended I try a chin strap before I try a FFM because it's hard to get a good fit with the FFM. I tried the chin strap last night and it's a joke! It's difficult to keep in place and even when in place, the resistance received from it is so minimal, I don't see how it can help. I think it was just a way to put more $ in the DME's pocket!

I don't go back to the Doc for at least another 2 weeks (he initially said to see him after 4 weeks on A-PAP, then said to make it 6 weeks). I'm leaning more toward 4 weeks as I would like his thoughts and input.

Does anyone have any advice or comments to offer on my AHI, pressure and/or leak rate?

My latest report can be viewed here:

http://www.box.net/shared/671mdhz01b

Did you ever try a fixed pressure of 14?
I always recommend that people at least TRY their titrated pressure before trying Auto ranges, etc.

Also, you KNOW that the ResMed Autos will not pursue an apnea (NOT preceded by a snore or a flow limitation) above the pressure of 10.....don't you? That's the "safety feature" that ResMed built into their algorithm to prevent the machines from chasing or creating Central Apneas or pressure-induced apneas.

Also, due to the way ResMed machines count Flow Limitations (partial hypopneas), having an AHI below 5.0 is "very good".


Den

You could try a different chinstrap. I, too, had a problem with a slipping chinstrap when I first started xpap 15 months ago. After trying 3 different chinstraps I found the Tiara Ruby. Bingo, it worked like magic...and no slippage! I've been using a Ruby ever since...14 months now. If you want a Ruby be sure to located the measuring chart that's found on several of the online vendors websites. The Ruby is true to size!

First, I'm not any kind of expert on this, but I guess people here seem to suggest, that a rule of thumb
to start with APAP is to set the low pressure about 1 cm below the titrated pressure and the high pressure
about 2 cm above the titrated pressure and continue from there.

Thanks for the input guys!

I may try the Tiara Ruby. It looks like it would stay in place better.

No, I haven't tried straight CPAP at 14. I may try that real soon.

I decided to try a second night with a min pressure of 11. I slept well and didn't wakt until around 4:00 am. At that time my chin strap was completely off my chin. This morning I see my leak rate was basically a flat line at 0 (I understand my Resmed automatically adjusts for the intentional leak rate) until the one apnea event I had during the night which was right before 4:00 am and after which my leak rate is all over the place. Perhaps the chin strap stayed in place until an apnea interrupted my sleep.

I also notice my Median pressure for the night is 14.2 and my 95th Percentile pressure is 18.2. I'm thinking of raising my minimum pressure to 13. I would like to completely eliminate apnea events. After all, isn't that the purpose of CPAP? It's also looking like my titration pressure of 14 may be a bit low. It was reached during a split night study, so perhaps after a few more hours of sleep, I actually need a higher pressure?