Pressure change

MaskedMan · Post by **MaskedMan** » Sun Aug 21, 2005 6:53 pm

I know things like weight change and sleep position changes could impact the most effective pressure for a CPAP. What other things could impact this?

Here's my deal - been on CPAP w/a pressure of 10 for a year. I felt great the first several months, but then the next few I felt I physically was declining back to a pre-CPAP feeling.

My CPAP didn't collect data so I decided to get a data collecting APAP. I've only used it a few days, but I feel physically much better again. I see the APAP data shows I spend most of the time at a pressure of 14.

So it sure feels and seems like my old CPAP and pressure were declining in effectiveness. However, I haven't had weight changes, sleep habit changes, using the same masks as always, etc So, if nothing has changed I'm wondering what else could make a pressure become ineffective?

TXKajun · Post by **TXKajun** » Sun Aug 21, 2005 8:16 pm

Did you ever go in for a follow up in the year you've been on CPAP?? I've been using an APAP since January and in my finagaling with it, I seem to have 90% results at about 11 cm using my UltraMirage FF mask (the same one used in the sleep study). With my new DreamFit, my 90% pressure is 9 cm. However, my titrated pressure during my sleep study was 16!!

In my opinion, which is not a medical professional opinion whatsoever and probably should be totally blown off by you, I think that the results of a sleep study are definitely biased, to say the least. A totally strange environment, wired up to the max, this strange new beast strapped to your face, different pillow than you're used to, nervous (heck, I was just plain scared!), etc, etc, etc, cannot, IMHO, possibly give an accurate picture of what happens to us on a night to night basis in our own bed. BUT...and this is a big but!....I think (again only my opinion) that it can give a great starting place. Then, it should be up to us to do our best to optimize things by being provided an APAP with software and given instructions on how to monitor, change settings and educated on the effects that changes could possibly have.

I think most of us kind of flail through things until we find this board and then our treatment starts to become truly effective through our own efforts with the help of the knowledgeable folks here (and there are some great folks here!!).

Hope this rant helps a little. Hang in there and keep asking questions of us, your Dr. and your R/T. You deserve to feel better!! And you're paying big bucks for it.

This therapy WORKS!!!

john5757 · Post by **john5757** » Sun Aug 21, 2005 8:22 pm

Some of the things I can think of that may effect pressure needs are smoking, drinking, pollen, dust, medication, diet, old mask leaking more, stuffy nose, leaks in hoses and in my case humidity. Too much humidity will cause my pressure needs to go way up but for some not enough humidity is the problem. These is some of the things I can think of at the moment that may affect pressure needs. Since you feel better at 14 using the auto CPAP and that says the Auto CPAP is correctly sensing yours needs for more pressure. Are we gald to have a CPAP that can collect data?

john5757 · Post by **john5757** » Sun Aug 21, 2005 9:48 pm

TXKajum,

While I tend to agree for the most part what you said I believe that the situation with MaskedMan is a lttle bit different, quote:

Here's my deal - been on CPAP w/a pressure of 10 for a year. I felt great the first several months, but then the next few I felt I physically was declining back to a pre-CPAP feeling.

This sorts of indicate that pressure indicated by the sleep study was correct and he feel fine for a few months and then started to feel bad and by all indication his pressure needs changed. In order to be retitrated by another sleep study while using CPAP you have to stop using CPAP for a few days because of the "splint memory effect" on the body using the CPAP.
It can take a few days before the body completely loses any pervious CPAP effect. Otherwise retitrated by a second sleep study while still using CPAP could result in the indicated titrated pressure being to low for one needs.
This happens to me at one time and I had to lower the pressure from 11 to 10 to deal with a underlining condition. The doctor ordered another sleep study just after the pressure change and it indicated that 10 was fine but it was not. I was getting weaker during the week and when I resolved the underlining issue I adjusted my CPAP back to 11 and feel so much better. Shorty after that I got my Auto CPAP since I never wanted to put myself in that situation again.

neversleeps · Post by **neversleeps** » Sun Aug 21, 2005 10:11 pm

john5757 wrote:... In order to be retitrated by another sleep study while using CPAP you have to stop using CPAP for a few days because of the "splint memory effect" on the body using the CPAP.
It can take a few days before the body completely loses any pervious CPAP effect. Otherwise retitrated by a second sleep study while still using CPAP could result in the indicated titrated pressure being to low for one needs.

Wow, I didn't know that! So if someone's been using cpap and they're scheduled for a titration study, they should discontinue use for 4 or 5 days prior to the study?

Wulfman · Post by **Wulfman** » Sun Aug 21, 2005 10:42 pm

MaskedMan,

Since you had no way of collecting data on your previous machine, the only way for you to judge your therapy was by the way you felt. It's possible that your initial setting was a little too low. It helped some, but you may have still been having a higher number of apneas and hypopneas than what you would have had at a higher setting. Your blood oxygen may have also been too low. You might want to have an overnight test done on that, too. It won't cost anything if you ask your doctor to order one through a DME (any local DME should have the equipment).
I presume that you now have some software to analyze the data, which is very good (since you mentioned what your current pressure has been).

There may have also been other things that could have affected your therapy....but without any previous data, it would probably be too hard to guess.

Good luck,

Den

rested gal · Post by **rested gal** » Sun Aug 21, 2005 11:28 pm

Your blood oxygen may have also been too low. You might want to have an overnight test done on that, too. It won't cost anything if you ask your doctor to order one through a DME (any local DME should have the equipment).

Great suggestion by Wulfman!

As many of you know, I have never had a sleep study. Based on how much better I felt every morning I figured the autopap was taking care of me well for almost two years now.

Earlier this year I had a chance to use a recording pulse oximeter at home for several nights.

With no machine (gosh, it felt strange to lie down in bed without the mask on!) my SPO2 levels dropped down into the low 80's.

With autopap, the SPO2 level stayed well up in the 90's as it should.

I continued using my autopap along with the recording pulse oximeter for a week. Each morning the printout showed averages of 95 and above; lowest dips being 91 - 93. It was very reassuring to get that confirmation of "good treatment" beyond just the fact that I feel good and that my AHI always looks fine.

More importantly, had there been dropping oxygen levels showing that autopap treatment wasn't going as well as I thought, it would have been a wake-up call that I needed to rethink my "self-treatment" and/or hie myself on off to a sleep doctor.

As it turned out, thankfully, all I have to do is keep turning that good old autopap on and plunking what's left of my Aura mask on my face.

MaskedMan · Post by **MaskedMan** » Mon Aug 22, 2005 5:56 am

Thanks for all the info. I appreciate the feedback.

I am very happy with the APAP. I got it mostly for the data recording because lately I'd wake up tired every morning again and I'd run through the list of - did I go to bed late? did I get up too early? what did I do that is making myself tired? It can't be OSA related because I'm on CPAP, so what have I done to myself? I was not doing anything different those last few months compared to the previous several. I couldn't come up with any reason why I was feeling horrible again. So I needed something to show me what was going on. I've only used the apap a few days so far, but I feel better again, but really its the data I was after and its great having it. IMO, while maybe not everyone should have an APAP - most definately everyone should have a device that records the data. It seems like a waste to have a followup visit with a doctor without any data. Then again, my lifelong experience with docs is not good.

I think the original CPAP of 10 was probably right for me since the first several months were great. At some point and for some reason it seems evident though that my pressure needs changed. I'd like to collect some data for a while then head to the doc with it and see what can be said for the change. I'm hoping he will actually review the data too.

WAFlowers · Post by **WAFlowers** » Mon Aug 22, 2005 6:31 am

MaskedMan wrote:using the same masks as always

This is after a year. Check the reported leak rate on your (new) APAP. What might be happening is the seals of your mask are degrading causing the leak rate to climb. This would mean that your treatment is less effective.

Just speculating, but raising the pressure might be compensating for leaks.

If your mask is that old, it could be time to replace it (or at least the seals if that is possible).

MaskedMan · Post by **MaskedMan** » Mon Aug 22, 2005 1:09 pm

WAFlowers, sorry, should have been more clear. I am using the same make, model, etc of masks as always but I've replaced either the whole mask or seals - just with the same ones

WAFlowers · Post by **WAFlowers** » Mon Aug 22, 2005 2:19 pm

OK, forget what I said. Obviously it doesn't apply.

I'm out of ideas. I hope you find what is causing your need for higher pressure to achieve effective treatment.

MaskedMan · Post by **MaskedMan** » Mon Aug 22, 2005 2:28 pm

Wa, I thank you for the idea though!

WillSucceed · Post by **WillSucceed** » Mon Aug 22, 2005 2:49 pm

Masked Man:
There is another possible factor -->age. I realize that it was only a year gone by, but as we age, we lose muscle tone, even in our airway. Sadly, you are perhaps, not spring-chicken anymore; gladly, you have found a solution that seems to be working.

MaskedMan · Post by **MaskedMan** » Mon Aug 22, 2005 3:51 pm

I'm happy I have the data now and going forward I can start to make notes on things that are different on days when I see difference in the data.

sleep less · Post by **sleep less** » Wed Aug 24, 2005 8:42 pm

when u start cpap lower pressure may show lower OSA. after using the CPAP ur body now gets used to it and wants pressure that is more perfect. That is why the first few years sleep study us good to tweek the pressure. As soon as you feel CPAP not working as ussed to -- one check to make sure pressure is given out by machine -- then get study to mak sure pressure is still good for you

Its norm to get pressure increase over the years

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