Question about PS

I started treatment for the first time at the beginning of August and my numbers initially were horrible. Pugsy helped me by suggesting to lower my PS down from 8 to 4, which really cleaned up my results and resulted in a lower AHI.

A couple days ago, I changed my PS to 3, just to see how it would impact my numbers. It seems like my results are nearly the same. Does this mean I should keep lowering it until I get to a "sweetspot"?

Ideally, what should an AHI be when on bipap treatment? I mean, ideally I would like it to be zero, but is 1-3 AHI acceptable? I am just trying to understand.

Here is last nights results.

zrob wrote: ↑

Mon Aug 23, 2021 9:25 am

Ideally, what should an AHI be when on bipap treatment? I mean, ideally I would like it to be zero, but is 1-3 AHI acceptable? I am just trying to understand.

Get that "I would like it to be zero" notion right out of your head. That is an unrealistic expectation.
Your AHI for last night...is less than mine was for last night. I had a 1.4 AHI last night. I haven't bothered to look at the details because 1.4 is good enough.

The lowering of the PS was just for central apnea reduction in your situation.
It's normal to have a few centrals but not in the number you were having with the PS of 8.

If you want to try to lower the OAs/hyponeas....you will need to increase EPAP and IPAP and lowering PS to 3 wasn't the way to go because that act also lowered IPAP. Raising EPAP a little bit would better prevent the OAs/hyponeas which is primarily what you are having now. EPAP and IPAP are what deals with OAs/hyponeas and holds the airway open to better prevent the collapse.

BUT....big BUT....there comes a point where we can't expect to lower the numbers because sometimes there are false positive flagging happening and sometimes we just can prevent ALL events anyway. The goal is to get the numbers down to manageable numbers and sleep good and feel good. The goal is NOT to get 0.0 numbers for AHI.
AHI of 0.0 doesn't guarantee that we feel good or sleep good and sometimes in our effort to get 0.0 we end up using pressures that actually disturb our sleep more.

Some years ago I did an experiment just to see if more pressures would actually lower the AHI or improve my sleep.
So over a period of 6 weeks I increased my minimum pressure (think IPAP for comparison to your machine setting and IPAP is nothing more than EPAP plus PS) from 10 cm to 13 cm over that 6 weeks. Increased 0.5 cm each week all the time monitoring the AHI AND my sleep quality and how I felt.
At the end of the 6 weeks my AHI was still between 1 and 2 which was what it was before I started the experiment.
I wasn't sleeping any longer or better...I abandoned the experiment at that point because nothing was changing.

Don't go down the road chasing 0.0 AHI. It will drive you crazy. It's not needed anyway.

If you do wish to experiment...EPAP and IPAP is what deals with OAs/hyponeas but be warned that you may be at a point where it won't make much of a difference and don't ever evaluate a change in settings based on one night's results.
We don't sleep the same each night and we don't know if one night's results is a fluke off night or not.
Need to keep a setting for at least a week to see if any patterns or trends are developing.

Thanks for the info Pugsy. I will abandon the dream of reaching 0.00. I think my best was a 0.5. I play too many video games, so I guess I was equating it to treatment, i.e. a perfect score.

I'll look into altering my EPAP and IPAP. I think your suggestion of the initial lower of PS might have been that sweetspot.

Thanks again, Pugsy!

I have learned that 75% of any AHI I might get is going to be false positive arousal related events and no amount of pressure will fix that. Instead I have to fix my poor sleep quality that is responsible for the arousals in the first place....easier said than done.

So you might first learn how to spot arousal breathing flagged events so you know if you stand a chance of reducing the AHI anyway.
http://freecpapadvice.com/sleepyhead-free-software
I have done it so many times now I pretty much know what I will see.
It is normal to wake a few time each night anyway...like after REM stage sleep it is normal. Now we don't always remember the awakening but we do it.

Just make sure that you aren't trying to kill something with more pressure that can't be killed with more pressure.
Arousal/awake events can't be killed with more pressure. Instead you have to try to kill whatever is causing the arousals/awake events and that is much easier said than done.

Don't feel bad if your sleep hygiene is less than perfect...most of us are guilty of it myself included.
Stay up way too late on the computer.

Pugsy wrote: ↑

Mon Aug 23, 2021 10:16 am

Don't feel bad if your sleep hygiene is less than perfect...most of us are guilty of it myself included.
Stay up way too late on the computer.

it's a choice. and it takes discipline, which i sorely lack. i've never stopped and said to myself"zonker, that plate of lasagna you're eating here at 6pm is going to wake you up several times tonight and screw with your ahi.".

no. little piggy zonker will never think that and dive right in.

it's just so hard to realize that what i do during the course of the day is going to impact my ahi that night. BUT i DO try to keep "movement" during the day as my goal. the more walking and spin bike pedaling i do, the better i sleep that night.

<sigh> but it ain't easy.

can't i just sit here and type nonsense in forums?