Beth T. wrote:I started CPAP therapy on 2/2/12. I have an S9 autoset and my inital pressures were set at 5 and 8 by the titration study. ...
Then I went back on 3/6 and saw the doctor. I told him that my 95th percentile was always at 8 so he agreed that the pressure should be raised and said he would raise it to 6 and 9. ...
So I figured out with the help of this board and the apnea board how to get into the clinician's settings. Sure enough the pressure had not been changed. I changed it to 6 and 9.
Good for you for just deciding to do the authorized
pressure change yourself since the DME/doc didn't manage to get it done for you.
AHI still hovering in the high 3s and 4s. Better certainly than what it was before CPAP but I want to get the most bang for my buck! ...
(After increasing max pressure to 10cm) AHI of 2.5 and 3.1. Better certainly but - really - I want it to get as low as I can.
Keep in mind that there are things that are more important than trying to get the AHI as close to 0 as possible night after night. One of them is actually managing to get some high quality sleep
with the dang hose on your nose. And 'tis far better to have a slightly higher AHI and get a sound night of sleep than it is to have a near perfect AHI after a night with little or no quality sleep. (For me, I seem to feel best when my AHI is between 1.5 and 2.5. Any higher than that, and I tend to feel the apnea. Any lower than that and it often means my insomnia was a real issue.) So once your AHI is consistently running < 5, it becomes much more important to track How do you feel?
and How are you functioning
rather than just the AHI.
In other words, measure "bang for your buck" in terms of how you feel on a daily basis: If you're feeling lousy, you know your PAP therapy may need tweaking. If you're feeling fine, you know your therapy is going well.
And so I ask: How are you feeling these days?
However I kept it that way for 20 days to get used to it. I then changed it to 10 leaving the lower range at 6. Ramp is only 10 minutes but it is an easy way to get started every night. So for two nights I have had it at 10. THe 95th percentile pressure on both nights is 10. AHI of 2.5 and 3.1. Better certainly but - really - I want it to get as low as I can. However I will leave it at this to get used to it and see what happens.
It is important to let your body acclimate to any changes in therapy. But usually that only takes about 4--7 days or so. So leave max Pressure at 10 for the rest of this week and then evaluate both How do you feel?
data and the AHI numbers.
SHould I raise the lower pressure as well so it is in a 3 point range?
What's the breakdown of events from the machine? As in are most of the events OAs? Hs? CAs? As long as the CAI is the smallest, sure you can increase that min pressure a bit without any real concerns. I'd suggest only going up 1cm at a time and leaving it there for 4-7 days. Also watch for aerophagia. If aerophagia becomes an issue, back off on the pressure some.
How long should I wait before I raise it again if my 95th percentile keeps reaching the upper limits? Thoughts on staying with this practice or changing.
Whether you want to keep rasing the max pressure just because your 95% winds up equaling your max pressure is not a simply "Yes/No" question. The honest answer is "It depends."
It depends on: Why is the machine is increasing the pressure?
Are the pressure increases in response to clusters of apneas and hypopneas? If so, then yes, you might feel better with more pressure. Is it in response to snoring? Is it in response to flow limitations? In this case, the answer to "Should I raise the max pressure?" is "maybe." More pressure may help eliminate or minimize snoring and flow limitations. But higher pressure may also trigger problems with aerophagia and/or leaks, which in turn can cause problems with getting to sleep and staying asleep. And fragmented sleep usually leaves you feeling worse, not better in the morning.
For me: I consistently hit (and stay at) my max IPAP = 8 cm for very long stretches night after night. The pressure increases are mainly because of flow limitations and because snoring increases my EPAP, which in turn increases my IPAP. I'd actually like to my max IPAP a bit (to try to reduce the flow limitations), but that would also increase my maximum EPAP. And anytime my EPAP > 6 cm, I wind up with a great deal of aerophagia and fragmented sleep. So I've learned that I feel better with current settings even though they don't minimize my snoring or my flow limitations (or even my AHI).
I also told him I wanted to try a full face mask as I was having some congestion problems and mouth breathing even with a chin strap. They measured me and said they would have to order one and would contact me when it came in. 3 weeks and 2 emails later and still haven't heard anything.
This is simply unacceptable. Contact your insurance company and find out from them whether you really have to buy all your supplies from this DME. Chances are you can shop at other DMEs as well. But masks do require that you have a copy of your prescription.
They blah blah when you are on hold about how important you are to them and how they know the most important thing is their patient's satisfaction and the best compliment is a referral - and yet they really do not offer good support when that is what is most crucial for success.
Alas, this does seem to be par for the course. And then they wonder why so many people abandon therapy so early in the game.