When to change pressure settings?

[avi123]

deleted

[palerider]

Who should not use an Auto CPAP.

you're really good at parroting things you don't understand, aren't you?

[threeforward_twoback]

Here's some info from my evaluation:

"Patient had an average of 17 apneas/hypopneas per hour of sleep associated with mild oxygen desaturations to a low of 90%."

"Patient was started on 5 cm of CPAP and the pressure was gradually increased up to a maximum of 8 cm. Collapsing across the different CPAP pressure settings, she had an average of 7 apneas/hypopneas per hour of sleep. Her AHI was 5 while on 8 cm of pressure. REM sleep was observed in the supine position on 8 cm of pressure. Her oxygen saturation baseline was in the upper 90's. Her lowest oxygen desaturation on 8 cm was to 93 %. She did not have significant periodic leg movements. Her arousal index on CPAP was 14, compared to an index of 12 in her diagnostic sleep study. Total sleep time was 6 hours and 3 minutes, yielding a sleep efficiency of 82%. She had a low percentage of REM sleep. Her respiration rate while asleep generally ranged from 6 to 20 and her heart rate averaged 69 beats per minute during sleep."

Millions and billions of dollars spent trying to improve sleep and it all isn't in the cpap part of things.

Ugh, yep. I spent money on two online CBT-I programs and neither of them really helped, hence why I went in to see the sleep doctor (I wanted to see if they could refer me to a sleep psychologist, but I don't think there are any practicing in my area anymore).

This is pretty unrelated to anything we've been discussing, but if there's water left over in a humidifier, do you dump it out? Going over the instructions from my sleep center, it says to change it every day, but don't some people on this forum just add more if it's really low, since it's just distilled water?

[avi123]

http://www.vanderbilthealth.com/sleepce ... 1144220450

[Pugsy]

I just top off the water chamber each night before bed and about once a month or so I dump it all and give the chamber a light washing and rinsing in hot water...either let it air dry or dry with a paper towel on the outside (the inside is going to get wet again anyway) and that's the extent of what little care the chamber gets. I also use distilled water. The distilled water is mainly to prevent mineral build up so that the chamber doesn't get all yucky looking but tap water can be used in a pinch and when I have had to do that I do empty the water chamber each morning and let it air dry until bedtime. I am on well water and here where I live the water could pump iron it is so mineral laden so I try to limit tap water usage because I am lazy.
Even if some mineral build does happen...easy to remove with a vinegar and water solution.

About your sleep study results..interesting that they were happy with AHI of 5 at the 8 cm point which I suppose is technically is acceptable but not what I would personally be all that happy with. Long story why not and I don't have time to go into it right now.

If you are comfortable proceeding with some ideas (ignore Avi) we can get on with trying some things to see if by chance we get lucky and stumble on something that will help the insomnia. If you aren't comfortable you can always discussed these ideas with your doctor first but they target AHI and if it is 5.0 or under most can't really see outside the box often to try to figure out the insomnia part of things. They tend to tell people to "give it time"....well that's all well and good but I figure that while we are "giving it time" we might as well do something useful. Might just get lucky.
The changes suggested...all are very, very minor and pose no risk to someone who is a normal health individual. I won't have my feelings hurt if you prefer to discuss all this with your doctor. I would totally understand. I don't ever want someone to do something they aren't comfortable with or don't understand what is being done. That's why I go into so much explanation instead of just saying "do this"...I prefer that people understand what we are trying to do and why.
I also tend to be really cautious with my ideas...maybe take longer...but that's just me. I am fearless with my own therapy but when it comes to someone else it's a different story.

[threeforward_twoback]

Sure, Pugsy, I'm open to ideas.

I've never even talked to the sleep doctor. It's just been the nurse practitioners and a respiratory therapist. They seem like nice people, but mostly of the "give it time" variety.

The first NP at my consultation also told me that insomnia is a symptom, not a disease, so as nice as she and the other staff members seem, I don't really care to spend money on an appointment that will most likely not get me anywhere.

[Pugsy]

Okie dokie...Let's see what changing the minimum to 8.5 does...if anything.

I do wonder if you have some underlying UARS thing going on. Google Upper Airway Resistance Syndrome and see what you think.
CPAP is still the preferred treatment but it seems like when people have UARS they end up needing a little more pressure beyond what they might see as effective in terms of AHI being nice and low.

[threeforward_twoback]

Hmm, well, looking at the symptoms for UARS, I do seem to have most of the symptoms: daytime sleepiness, trouble maintaining sleep, arousals out of sleep. But I don't think I snore. One site I found says it's common in people with "a narrow face, a small or narrow jaw, or a thin neck." The NP did take a look at my mouth during my initial consult and said that my tongue is pretty wide for the size of my mouth, which is what she thought warranted a sleep study.

Still, nothing jumps out at me as a definite sign that I have UARS, as opposed to OSA.

I just top off the water chamber each night before bed and about once a month or so I dump it all and give the chamber a light washing and rinsing in hot water...either let it air dry or dry with a paper towel on the outside (the inside is going to get wet again anyway) and that's the extent of what little care the chamber gets.

Is it okay to wash the humidifier with dishwashing detergent?

Anyway, here are the numbers for last night.

[Pugsy]

Yes, it's okay to use a little bit of dish washing soap to clean the water chamber. Main thing is to rinse well no matter what soap. I use a little bit of whatever liquid hand soap I might be using at the time.
You can use whatever suits your fancy. Mine has a little scent to it but it really doesn't carry over to the plastic water chamber that I can tell but if it did it would be pleasing to my nose.

Use this setting for about a week and let's see how you do. I really didn't expect an overnight miracle as much as it would have pleased me to hear about one.
While we could probably increase the max a little...I don't see the need at this point and in your situation we want to remove as many potential disruptions to sleep as we can. And having the machine go up when it may not be critically needed and it is a potential for disruption. Right now the AHI is technically within acceptable limits..see if the 2 ish AHIs hold for a week...then we can try 9 minimum and see if we can bring the AHI down a little just in case these few events are maybe a factor in the arousals.
But if you wish to allow a little more max because you did top out the 10 max briefly a couple of times...go slow and just try 10.5.

[threeforward_twoback]

Sorry for dropping the ball on this! Here are the stats from my last three days. I've also found a psychologist who helps people with insomnia, so fingers crossed for that!

[Pugsy]

Technically I suppose these are acceptable in terms of cpap therapy but I see that sometimes you are maxing out the pressure at 10..also there are a few clusters of OAs..small but clusters nonetheless. While I have my doubts as to just how much these few OAs are having on the insomnia issue...there's always that remote chance that they are responsible for some of the arousals. Pretty sure they aren't totally responsible though.

I think if it were me I might open that max up a little(like maybe 1.0 cm) and see what the machine wants to do...that is of course assuming there are no problems with maybe using just a little more pressure only for short periods of time. I don't think the machine will want to go there every night though and for sure it won't stay up there very long. I can tell that by the short periods that you see it maxed out at 10.

I think I already mentioned that the saw tooth looking spikes are the normal pressure probes so those spikes in pressure aren't necessarily related to the machine sensing anything in particular....but will say it again just in case I didn't.

Also worth considering is another small increase in that minimum pressure. Maybe try to clean up those few OAs, hyponeas and FLs that are seen. They aren't horrible but maybe they are playing a small part in the arousals. If you were sleeping soundly and feeling great then we would probably say this is good enough but since you aren't...try everything we can think of just in case we get lucky and something helps.

Again...I have my doubts as to what we see here has much, if anything, to do with the insomnia but it wouldn't be totally impossible and when there is even a remote chance that a small change will make sleep quality better then I am all for trying it.

[threeforward_twoback]

You were right about the machine not wanting to go much higher, Pugsy. According to Sleepyhead, it was under 10.5 cm 95 percent of the time. I did wake up in the middle of the night but managed to go back to sleep pretty quickly last night.

I meet with the psychologist Friday. I might have an initial meeting with her and then see how I do for another week before I take the plunge and try sleep restriction again. (gulp)

[Pugsy]

Yep...it barely kissed 11 cm once.
You have bigger cajones then I do when it comes to considering trying restrictive sleep. I know RobySue did it...have you read her struggles with insomnia?
But then I have never really had sleep maintenance insomnia where I couldn't get back to sleep fairly easily.
I have it because of the arthritis pain but the majority of the time when I wake up during the night all I do is change position and go right back to sleep. Now sometimes it hurts so bad can't initially move but eventually I make the effort and turn over and go back to sleep.
Since I know the cause of my sleep maintenance insomnia (the pain) I have elected to try to reduce the pain with meds and go about fixing the gazillion wake ups I might have without meds that way.
Last summer I tried going without the bedtime meds and my sleep quality went down the toilet.

It's really tough when we don't have a name and face to the cause of any type of insomnia. I am lucky in that I know who my foe is and have a way to deal with him.

At some point in your cpap experiments you might want to go back to a fixed pressure but at a higher pressure than what you originally used which I think was 8 cm. While I doubt that these tiny pressure changes you are seeing along with the pressure probes are going to impact sleep quality much (be responsible for the wake ups) it wouldn't be impossible for them to be causing some sort of low level arousal or impact. Some people find that the least little change in pressure during the night can affect sleep quality. If you do elect to try a higher "fixed" setting...just do it in apap mode with minimum equaling maximum so that you get the FL flagging ability. Maybe something around 9.5 or 10 fixed.
It's more than you need for some of the night but there are times when you would need that much.

There are people who find that they simply sleep better when using a pressure setting 1 or 2 cm above what the reports show is a technically acceptable setting. As long as the pressure being higher doesn't create a problem (like aerophagia) it hurts nothing to use a little more than might be really needed.

Since your insomnia issues predate cpap use...I have my doubts as to cpap use being totally responsible for the insomnia. Insomnia of any kind can have any number of culprits to blame and sleep apnea/cpap therapy are just a couple of possible culprits in a long list.
But it hurts nothing to try to tweak the settings as best as we can in an effort to optimize our sleep quality.

[threeforward_twoback]

I know RobySue did it...have you read her struggles with insomnia?

I have! I am impressed that she stuck with it and was successful. I...cannot say the same for myself when I tried it, though hopefully working with another person will help me.

Here are my stats for the last two nights. I think I'd prefer to have my minimum set to 8.5...9 just seems a little high to me. What do you think?

[Pugsy]

If you find the 9 cm uncomfortable then you can sure use 8.5 but just bear in mind that the AHI probably will stay up around 4 to 5 because even with the max being more open the machine isn't really making much use of its ability to go higher. For whatever reason it just isn't responding with higher pressures.

It isn't the end of the world to have the AHI in this range...it's still acceptable and the name of the game is to improve your sleep...not get a good math score. The main idea behind trying to reduce the AHI with more minimum was to see if it helped with the insomnia issues by reducing potential events that could be contributing to your wake ups. We don't know for sure that these events are related at all to your insomnia issues. It was something to try just to see if the insomnia improved or not.

If the higher minimum of 9 is uncomfortable and maybe the discomfort is also impacting sleep quality then by all means back off to something more comfortable. You can always revisit it later if you wish. There's not an urgent critical need to use the 9...it was just something to try in case we got lucky and reducing those events reduced the wake ups. We sure don't want to trade one problem for another though.
My personal opinion...I suspect that the sleep maintenance insomnia isn't hugely related to those events. I wouldn't be surprised if you got an AHI of 0.0 and you still had the insomnia issues. While insomnia is often associated with sleep apnea...it's not a given that if you fix the OSA that the insomnia will get fixed at the same time. I wish it were that easy but it's jut not. Not all bad sleep is fixable by a cpap machine..