Experiment with pressure

[KATHRYN]

Hi, I have been on cpap for almost a month using a Mseries Pro cpap with software & reader. I am using a Mirage Quattro ffm and am on a prescribed pressure of 15. I have been having trouble with masks leaking and making noise and not resting. I have ordered a new mask which has not arrived yet.

Last night I decided to try an experiment. I lowered my pressure to 10cm. I slept almost 10 hours as I didn't sleep much the night before. I was not bothered by the mask leaking or noise. So, I was curious to see my report this am.

NR: 0
FL: 0
OA: 1.2
H: 0.5
VS: 0
AHI: 1.7

Large leak: 0
Avg leak: 36

I slept soundly and felt rested. My AHI at the 15cm pressure averages 2.7 over the course of treatment. I think I would like to keep using the 10cm for a week to get a weeks worth of reports, maybe my prescribed pressure is too high? I can tolerate the 10cm so much better. Can't hurt right, since the numbers are good?

Any thoughts appeciated. Also, no puffy eyes this morning.

[boston]

I've been on cpap for 2 weeks, and I'm thinking about the same thing. My max is also 15, thinking of lowering it to 12.
My DME called for a follow up and just acted like it was normal for the higher pressure to wake me up, and I thought I was doing this for a better nights sleep.

[BeanMeScot]

I haven't been doing this long myself but it's all about the numbers and how you feel. Pressure too high can be as bad as pressure too low so as long as the numbers are good and you feel good, then I say go for it!

[2girlsmom]

Wow. I am thinking my pressure is too high as well but I see the sleep doc soon so I'll ride it out until then. I started at 10cm, but had EDS come back so was titrated again and am a 14. Sometimes it's hard to sleep well, I wake up a lot from the pressure and then hit ramp to go back to sleep.

[roster]

.......
............ maybe my prescribed pressure is too high? .........

My own SWAG estimate says that a sleep lab conducting a one night titration will prescribe an optimal pressure less than 50% of the time. You have the right idea, that is, to find the optimal pressure by experimenting at home.

Also think about your sleeping position. Often individuals will require a higher pressure sleeping on their back as compared to sleeping on either side. I need 19 cm on my back while 8.5 cm is fine for side sleeping. You probably were titrated on your back and maybe you are side sleeping at home?

[ClayL]

I had something similar happen. I was at 13 for over a year and then began to get some AH spikes up in the 8 to 10 range and my AHI went from 4.3 to about 4.6. I had had an oxygen study done before this and had two occurrences of less than 90 % - an 88 and an 86. The Doc put a note on the study saying that depending on how I felt I could raise the pressure to 15. So when the AHI went up I did. I tried it for about three months and the AHI did go back down to 4.3, however I didn't rest well for the same reasons stated above. Mask leaks woke me and my wife up and I felt rocky in the daytime.

I got fed up and decided to go back to 13 but decided to take it down to 12 to see what would happen. I am sleeping great, feeling much better and my AHI has gone down to 3.2 - for three months.

I have an appointment with the Doc in a couple of weeks and it will be interesting to see what he has to say.

[KATHRYN]

Thank you for all your encouragement to experiment. My AHI last night was 2.3, a little higher, but I do remember waking up on my back once last night. Again woke up rested.

ClayL, hope you get your pressure sorted out too. During my titration I was only on one side or the other. But, the Dr. did prescribe a 5mg valium for me to take before the study and the titration, so that may have made my pressure needs increase and possibly my apneas/hypopneas. She did this because I had been unable to sleep, (less than an hour) in a previous sleep study.

I am going to keep at 10cm for a full week to see how things go.

Thanks,
Kathy

[Wulfman]

Your results don't surprise me at all. I was prescribed almost twice as much pressure as I really needed.

Den

[Craig-Tx]

My first titration sleep study, they went up to a whopping 6.5 cm H2O and I still had an AHI of slightly above 5. Still having never been titrated above 6.5, they prescribed 7. Over several weeks, with a data capable machine, I found that around 8 or 9, my numbers got much better. I stuck with that for a while.

My second titration (about 18 months later), they went up to 12, and prescribed 12. However when I looked at the full report, I noticed that my AHI @ 10 was about 5... but that was from 1 central over the 12 min I was at 10 cm H20. At 11 cm H20 (for 5 min) I didn't have any apneas or hypopneas. And yet they still bumped my to 12.

After reading that and having more difficulty with mouth breathing and leaks, I dropped my pressure to 10. I started feeling much better!

Then... the Dr. (Well person in the Dr.'s office) found me out! OK, I told him. I was severely chastised. I asked him to explain why they believe 12 would be better, he explained that I had an AHI of 5 at 10. I had to explain that that was from only 1 central... and higher pressure doesn't exactly help centrals. I don't think he got it.

I ended up taking a pulse ox meter home for 2 nights, so they could see if I was doing ok at 10.

I now have an AUTO... and my 90% is hovering right around 10. (a number I found myself, despite my Dr.'s objections.)

-craig

[Snoredog]

Hi, I have been on cpap for almost a month using a Mseries Pro cpap with software & reader. I am using a Mirage Quattro ffm and am on a prescribed pressure of 15. I have been having trouble with masks leaking and making noise and not resting. I have ordered a new mask which has not arrived yet.

Last night I decided to try an experiment. I lowered my pressure to 10cm. I slept almost 10 hours as I didn't sleep much the night before. I was not bothered by the mask leaking or noise. So, I was curious to see my report this am.

NR: 0
FL: 0
OA: 1.2
H: 0.5
VS: 0
AHI: 1.7

Large leak: 0
Avg leak: 36

I slept soundly and felt rested. My AHI at the 15cm pressure averages 2.7 over the course of treatment. I think I would like to keep using the 10cm for a week to get a weeks worth of reports, maybe my prescribed pressure is too high? I can tolerate the 10cm so much better. Can't hurt right, since the numbers are good?

Any thoughts appeciated. Also, no puffy eyes this morning.

Your numbers look fine at 10 cm, but keep in mind positional changes, allergies, glass of wine with dinner can all change your nightly outcome. Very few nights turn out the same, so you should take an average of 7 to 30 days to determine if those new settings are correct once things are shown well under control.

Also keep in mind, that the night in the lab is just one 8 hr snapshot, again, allergies may have been worse for that night, they may have forced you to sleep in supine position where at home you never sleep in that position. As a result, you may prefer to sleep on your side, then pressure needs would change. This is another reason the autopap excels over CPAP, it adjusts to your sleeping position on the fly.

But Increased Pressure nearly always leads to more noise and greater leak. In fact in the Respironics Remstar Auto machines when large leak is detected the machine automatically drops pressure by 2 cm to assist in resolving the leak.

Your numbers look good, keep track of how long you sleep, try to make that consistent each night if you can.