Newly Diagnosed - Questions About Self Titration et al.

Hello everyone!

I was recently diagnosed with severe OSA after doing a take home test with a measured AHI of 40-something. My doctor ordered an autoPAP, and I've been using it for about 2 weeks now. Since there was nothing done in-lab, he left the pressure range wide open 5-20. I have a follow up scheduled for 11/7, and my guess is that he'll review the data then and try to narrow the pressure range to get me headed towards that sweet spot for optimal treatment. I've done some reading on here about self-adjusting the pressures and changed the min pressure to 10 about a week ago. My AHI has stayed in the 5-10 range, mostly showing obstructive apneas as opposed to clear airway apneas and hypopneas. I'm not seeing anything being flagged in the large leaks category, and I'd obviously like to get it as low as possible. I've also played around with SleepyHead, but I'm not sure what info is most helpful in tweaking my pressure settings. Also of note, my 90% pressure data is right around 13. My questions are:

1) Is 2 weeks of data considered sufficient to start adjusting the settings, or should I be waiting longer?

2) If so, what key data should I be focusing on that will help me adjust my settings optimally? I can post graphs later tonight for review--I just need to know which one(s) to post.

3) Somewhat unrelated--I'm a back and side sleeper. Most everything I've seen says back sleeping generally makes OSA worse than side sleeping. So far, my experience has been just the opposite based on numbers. My AHI tends to be on the higher end and require a higher max pressure on the nights I'm more aware of sleeping on my side. Any ideas on why that may be?

Thanks in advance! I'm really happy to have found a place for support online. I can't remember a time in my adult life when I haven't been overwhelmingly exhausted, and I'm hoping to get the most out of my therapy! In just this first 2 weeks use, I've noticed I'm sleeping through the night without the need to get up and pee multiple times, and it's been much easier to get out of bed immediately in the morning instead of snoozing my alarm 2 or 3 times.

2 weeks is plenty of time to get an idea where to fine tune the pressures.

Take a look at this thread for examples of what we like to see
viewtopic/t103468/Need-help-with-screen-shots.html
You can get everything on one screen shot and we don't need or want all the graphs that SH gives you.
Hide the calendar and turn off the pie chart (Preferences/Appearance tab and remove check mark).
How to organize the graph explained here...3 pages so be sure to read all 3 pages
https://sleep.tnet.com/resources/sleepyhead/shorganize

Just do the basics and pic a typical night or two and if we want or need anything else we will just ask.
The 90/95% numbers don't necessarily mean a whole lot because they are easily skewed and really all they are by definition is
where we were AT OR BELOW for 90/95 % of the time. People tend to forget the "or below" part of the definition.
It doesn't necessarily mean that is where the minimum pressure should be.

xxyzx wrote:i woudl start at 10 myself and then lower or raise as needed to get to the sweet spot faster

Maybe you need to take a little more time and read what was already said.

Sunnymuffins wrote:changed the min pressure to 10 about a week ago.

xxyzx wrote:you need 13 to keep your ahi at 5-10

And you know this how?

The minimum may or may not need to be 13. If you are going by the 90/95% numbers then you don't fully understand 90/95% numbers.

Pugsy wrote:

xxyzx wrote:i woudl start at 10 myself and then lower or raise as needed to get to the sweet spot faster

Maybe you need to take a little more time and read what was already said.

But, reading is haaaaaard!

palerider wrote:

Pugsy wrote:

xxyzx wrote:i woudl start at 10 myself and then lower or raise as needed to get to the sweet spot faster

Maybe you need to take a little more time and read what was already said.

But, reading is haaaaaard!

Only read the last posts, don't want to read stale info. Jim

I forgot I had my laptop in the trunk for class tonight. I hope these show up correctly. I just chose 3 random nights. Please let me know if any additional information might be useful.







Thanks again!

Your leak graphs are excellent....better than mine most likely. I haven't had time to review my data lately but I almost always have a little large leak and sometimes more than a little.

Don't need the snore graph because snores are shown on the Events graph on top. So just resize the other graphs and move the snores off screen. No need to re do these images though.

I would try 11 cm minimum and see what happens. You are real close to having optimal settings.
Try 11 and give it 3 or 4 nights and see what the AHI does. Might need a little more...might not.

How are you sleeping and feeling?? That's even more important than the numbers.

xxyzx wrote:
because 13 *IS* keeping it at 5-10

they may need more to improve it

No it's not.

You don't understand what 90/95% mean. I suggest you read up on interpreting results before you go advising stuff you don't understand.

The Sat Oct 7 report shows an AHI of 3.68. You might want to look at the report...for well over half the night the pressure was at 10 with essentially nothing going on of any consequence. Earlier in the night the pressure went up some...probably related to supine sleeping.

You are totally wrong here.

Pugsy wrote:Your leak graphs are excellent....better than mine most likely. I haven't had time to review my data lately but I almost always have a little large leak and sometimes more than a little.

Don't need the snore graph because snores are shown on the Events graph on top. So just resize the other graphs and move the snores off screen. No need to re do these images though.

I would try 11 cm minimum and see what happens. You are real close to having optimal settings.
Try 11 and give it 3 or 4 nights and see what the AHI does. Might need a little more...might not.

How are you sleeping and feeling?? That's even more important than the numbers.

Sounds good, thank you very much! I'll try bumping it up to 11 tonight and see what happens.

I'm still tired, but I didn't/don't expect magic as long as I've been undiagnosed. (I'm also on Modafinil, so that is definitely helping some too!) I've read it may take 1-2 months+ depending on how long a person has had OSA and what damage it has done. As mentioned previously, I did see a few noticeable improvements immediately such as not getting up multiple times a night to use the bathroom, not snoozing the alarm as much, and generally taking less time to "wake up" once I'm out of bed.

I went into this with cautious optimism, so I'm not worried about starting small if it eventually gets me to my goal.

Sunnymuffins wrote:, I did see a few noticeable improvements immediately such as not getting up multiple times a night to use the bathroom,

This was my first sign that the therapy was working. Didn't have to get up and pee every hour or two. That alone was worth it to me.
I also saw my morning killer headaches go away.
The other stuff like sleeping longer and more soundly and more energy took some time to materialize.

You are still having enough apnea events that it could be a factor in maybe not having as much energy as you like and it might also be simply that you need to take some time for the body to adjust. There is some truth to the "give it time" thing.

You are doing really well. If you get a chance get a copy of your sleep study and see if it mentions anything about your OSA being worse on your back or during REM sleep. That might explain why some parts of the night the machine doesn't want to increase the pressure and other parts of the night it will. It's quite common for OSA to be worse when we are on our backs or during REM stage sleep and thus need more pressure for those times.

Once the minimum pressure is set more optimally you may find that the maximum pressure will reduce a little. These machines work best when preventing the airway from collapsing instead of trying to fix it after the fact. You are real close though so I don't think you are going to need much more minimum.

xxyzx wrote: i went by what he said

it is set at 13
whatever it is set at is keeping his ahi at 5-10

No...that's not what was said. You might want to reread what was said. Obviously you are having a bit of a problem comprehending what has been said.
All that was said about 13 was that it was the 90% pressure statistic. The settings were 10 minimum and 20 max and clearly stated in the first post.
You might also take the time to actually look at the reports posted and try to understand them before spouting off about stuff you don't understand.
There is actually one night where the AHI was less than 4.0.

Why not just keep your mouth shut when it comes to stuff you don't understand instead of spouting off junk?
I have years of experience with this very type of machine so I am very familiar with the reports and how it works.

xxyzx wrote:i can read

i know what it said

i said that what it said is what it said

Well you were wrong. You might want to read it again and see where you went wrong.

xxyzx wrote:i can read

i know what it said

i said that what it said is what it said

You are an idiot. You don't have a clue how to help someone. Have you noticed that no one ever connects with you for advice? Have you noticed that the only replies you ever get are from people saying you are wrong? Have you ever paged through the threads you are posting in and noticed all you are doing is stinking them up?

I fear you are scaring off people who badly need help. Google "hobbies", pick a couple, take them up and get out of here.

https://en.wikipedia.org/wiki/List_of_hobbies

xxyzx wrote:

Pugsy wrote:

xxyzx wrote: i went by what he said

it is set at 13
whatever it is set at is keeping his ahi at 5-10

No...that's not what was said. You might want to reread what was said. Obviously you are having a bit of a problem comprehending what has been said.
All that was said about 13 was that it was the 90% pressure statistic. The settings were 10 minimum and 20 max and clearly stated in the first post.
You might also take the time to actually look at the reports posted and try to understand them before spouting off about stuff you don't understand.
There is actually one night where the AHI was less than 4.0.

Why not just keep your mouth shut when it comes to stuff you don't understand instead of spouting off junk?
I have years of experience with this very type of machine so I am very familiar with the reports and how it works.

i can read

i know what it said

i said that what it said is what it said

Oy - to the OP...PLEASE listen to Pugsy. If she tells you, you can trust it.

Madalot wrote:

xxyzx wrote:

Pugsy wrote:

xxyzx wrote: i went by what he said

it is set at 13
whatever it is set at is keeping his ahi at 5-10

No...that's not what was said. You might want to reread what was said. Obviously you are having a bit of a problem comprehending what has been said.
All that was said about 13 was that it was the 90% pressure statistic. The settings were 10 minimum and 20 max and clearly stated in the first post.
You might also take the time to actually look at the reports posted and try to understand them before spouting off about stuff you don't understand.
There is actually one night where the AHI was less than 4.0.

Why not just keep your mouth shut when it comes to stuff you don't understand instead of spouting off junk?
I have years of experience with this very type of machine so I am very familiar with the reports and how it works.

i can read

i know what it said

i said that what it said is what it said

Oy - to the OP...PLEASE listen to Pugsy. If she tells you, you can trust it.

Absolutely! I noticed that in browsing through some different threads/topics before I even joined.

I tried 11 as suggested last night and ended up with AHI of 8.3--10 CA / 37 OA / 8 H. I haven't looked at the SleepyHead data for max pressure yet, but my 90% was 15.5. Definitely not worried based on 1 night at the new setting, but interestingly I recall sleeping more on my side than back. Still trying to figure out the correlation with that bit. I'll give it a week and then start bumping up in .5 increments until I get it right.