Newbie confused about pressure

[Esskay33]

Hi folks!

Newly diagnosed with 32 AHI. I have probably had some form of apnea since I was 14 and had no clue. I am 37 now. The last two years have been absolute hell trying to figure out what was wrong with me (I will post my symptoms in full if they get better as I would have been thrilled to find my sysptoms had been experienced and relieved by someone else.) and i finally got a sleep test. Position stats were much worse than 32 (87 I think.)

Anyway, other than saying hello, and introducing myself, I had a couple questions:

My process has gone as follows:

8/17/16 - Diagnosed and sent home with AutoPap at 4-16.
8/24 - Sleep Tech calls and raises the lower pressure to 6
8/31 - She changes from Auto to CPAP pressure with same machine to 9 CPAP

I have had some good nights and some bad ones but I did adapt to wearing my mask like I had been doing it all my life , so no issues there and no Major leaks in 21 days.

Questions:
1. Can I call them and ask to raise my pressure?
2. Can I just raise it myself?
3. SleepyHead has me around 4-6 AHI pernight and I am seeing some benefit. Is higher pressure always better? Why not go to 15?
4. Are hypopneas as bad as apneas?

Greatly appreciate any insight as I begin my journey and hope to get to know many of you over the years.

Best,
Esskay

[kteague]

Hi folks!...Position stats were much worse than 32 (87 I think.)...
Questions:
1. can I call them and ask to raise my pressure?
2. Can I just raise it myself?
3. SleepyHead has me around 4-6 AHI pernight and I am seeing some benefit. Is higher always better? Why not go to 15?
4. Are hypopneas was as bad as apneas?

Without knowing the specifics of your Sleepyhead data, I can only suggest that based on your mention of position making a difference, that taking measures to assure you stay off your back could help lower your AHI. Some on here have worn a small backpack stuffed with a pillow.
1. You can, but depending on what the doc's prescription says, they may have to contact the doc for approval.
2. You can just raise it yourself, but you might want to consider what impact that might have on your relationship with your doctor. Before taking any chances on making moves, do get copies of your sleep studies and prescriptions in hand. You should have those anyway. To be honest, 2 of my doctors' offices never even noticed I'd changed my pressure. Since you are still the mode of figuring out what works, yours will likely be more in tune. Some docs don't care. Some do.
3. The goal is to get the most effective treatment at the lowest effective pressure. With higher pressures one might run into issues like air in the belly, more mask leaks, or even central apneas. A conservative increase is usually recommended. More is not always better.
4. A hypopnea is like a partial obstruction, and can be a sign of an impending obstruction. Hypopneas can cause oxygen drops and sleep stage disruption so they need to be addressed when possible. Pressure increases in small increments can often resolve hypopneas. If in auto mode, the increase would be to the lower end of the range.

[ChicagoGranny]

Greatly appreciate any insight

We can make a lot of "guesses", or we can give you some good suggestions if you post a Sleepyhead chart of a typical night - https://sleep.tnet.com/resources/sleepyhead/shorganize

[ChicagoGranny]

8/31 - She changes to CPAP pressure with same machine to 9 CPAP not Auto

Does anyone else suspect he has been hacked by Wulfman?

[Pugsy]

4. Are hypopneas as bad as apneas?

They can be depending on how many and how long they last and the amount of air flow reduction and if they caused arousals or not.
There is a reason they are included in the AHI...it's because they are worth counting and keeping a watchful eye on.

What we can't see with the data from the machine is how much of a flow reduction is going on.
Example...To get a flag for Obstructive Apnea (OA) the flow reduction has to be at least 80% reduced and last a minimum of 10 seconds.
To get a flag for Hyponea the flow reduction has to be a minimum of40 to 50% (depends on the brand) reduction up to the line at 80% where it earns an OA flag...for at least 10 seconds.
So a reduction in air flow of 78% would be a hyponea and 80% would be an OA. Not really all that much difference except in the flag name.
Now of course there is substantial difference between a 40% reduction and 78% but the machine doesn't ever tell us the % of air flow reduction so we don't know how "bad" it is...we just know it was at least 40/50% for at least 10 seconds.

Is higher pressure always better? Why not go to 15?

Higher pressure isn't always "better". Are you talking about starting out at 15 or just allowing the machine to go to 15 in auto adjusting mode?
Higher pressures can cause problems for some people...from aerophagia (painful air in the belly) to triggering centrals in a small portion of people or making leaks harder to manage or making it hard to exhale and there's no guarantee that those higher pressures will reduce the AHI if the AHI is made up of something that we don't treat with more pressure.

Starting out the night at 8 cm is a whole lot more comfortable than starting out at 15. Now some people have to start out at 15 and they do get used to it but it's a much harder getting used to.

SleepyHead has me around 4-6 AHI

What is the breakdown into each event category of that AHI?
Is it primarily obstructive in nature (OAs and hyponeas) or is it central in nature (Clear Airway/Centrals)?
We can't reduce centrals with more pressure using regular cpap/apap machines unless by some remote chance they are post arousal centrals caused by OAs causing arousals. If that's the case we fix the OAs and the centrals reducing is a by product of OA reduction. That situation is relatively rare though.

If your AHI is primarily Hyponea...that's normally obstructive in nature and the usual fix for it is more pressure..
Normally it doesn't take a lot more pressure though. Usually 1 or 2 cm more pressure will get the job done.

2. Can I just raise it myself?

Yes, you can do it yourself if you feel comfortable doing it. The doctor and DME may not approve but you can do it.
That part is easy. Just make sure that if you do change the pressure that you understand why you are doing it and what your expectations are and you are increasing it to fight something that is fixable with an increase in pressure.
Under normal circumstances if the AHI is made up primarily of CAs/Centrals more pressure won't fix them and sometimes can make them worse.
So make sure that what you want to fix with more pressure is fixable with more pressure.

Finally it's the minimum pressure (when using auto adjusting mode) that is the most critical pressure setting and not necessarily the maximum setting (unless the max is being pegged out for long periods of time).
The idea is to better prevent the airway collapse, with an optimal minimum pressure, in the first place and not have to work so hard to fix things after they happen.

If you want some forum member input on your SleepyHead reports...you can share them and we will offer our thoughts.

[Esskay33]

Greatly appreciate any insight

We can make a lot of "guesses", or we can give you some good suggestions if you post a Sleepyhead chart of a typical night - https://sleep.tnet.com/resources/sleepyhead/shorganize

I will absolutely do this over the weekend. I travel 125 nights a year and have to wait until I am back at my home computer to do so. I appreciate it!

[Esskay33]

They can be depending on how many and ...

...

Higher pressure isn't always "better". Are you talking about starting out at 15 or just allowing the machine to go

What is the breakdown into each event category of that AHI?
Is it primarily obstructive in nature (OAs and hyponeas) or is it central in nature (Clear Airway/Centrals)?
We can't reduce centrals with more pressure using regular cpap/apap machines unless by some remote chance they are post arousal centrals caused by OAs causing arousals. If that's the case we fix the OAs and the centrals reducing is a by product of OA reduction. That situation is relatively rare though.


If you want some forum member input on your SleepyHead reports...you can share them and we will offer our thoughts.

Really appreciate the insight. I will share some Sleepyhead data over the weekend once I am back home.

Best to start a new thread or reply here?

[palerider]

Best to start a new thread or reply here?

keep it in one thread, that way people can look back and see what else has been said.

you can go back and edit the first message in the thread to change the subject line if what you're asking about changes.

[Pugsy]

Best to start a new thread or reply here?

I like it when it is all kept in one thread when possible. That way we can see what has already been explained and we don't have to keep telling you the same thing over and over again. Makes it easier for everyone to follow.
Especially during the learning stage. Now later if something should happen or you have totally different question about something then maybe a new thread then depending on how old this one is.
Plus it's easier for you to find instead of having to search for various threads you may have started.

[Esskay33]

If you want some forum member input on your SleepyHead reports...you can share them and we will offer our thoughts.

OK my new found helpful friends. This is my first time using Imgur for anything, so hopefully it works.

To add to my original post, I think this therapy is working as I am starting to feel a bit better after 3 weeks, but I am still not the old me and in looking at my graphs each night, I think I can do better.
I have had no problem at all adjusting to wearing the nasal pillow and other than very occasionally waking up with air shooting out of my mouth, I think I am good on equipment. I do still have “bouts” of time where I have very fragmented sleep and think it probably shows on my graphs as to why, but alas, I am new. I am however, having dreams for the first time in a long, long time and know I am getting “better” sleep.

Any help would be appreciated. I have attached two pretty standard nights.

[palerider]

most likely, you should be on auto mode, with a minimum of 10, your doctor/tech is doing poorly (typical)

[Pugsy]

In CPAP mode the FL (Flow Limitation) flagging is turned off so the lack of FLs on the Events graphs is meaningless. We don't know if they didn't happen or the machine just ignored them.
You need to be in auto (apap) mode for FL flagging to be turned on.

So at a minimum change it to auto mode so that you can see if there are any FLs. I suspect a few will show up.
If you want to keep the current pressure of 9 fixed..and not let it auto adjust then must set the minimum to equal the maximum. FLs flagging will be turned on and the pressure won't change.

I agree with PR about maybe trying auto mode...don't know about the minimum yet since we don't know where the machine wants to go. It might clean up things with the minimum left at 9 and just letting the machine go up a little (or it might want to go up a lot).
So I don't know that I would make the switch and change the minimum at the same time. I probably would just try auto first and see where the machine wants to go before deciding on changing the minimum.
PR is a bit more aggressive about changing things than I am. I tend to be more conservative but I don't see it hurting to try a minimum of 10.
As far as the maximum...maybe 13 or 14 if you want to be conservative or just open it up to 20 and let the machine sort it out. It won't go where it doesn't think it has a good reason to go. If it doesn't want to go past 12 it won't go past 12 but I suspect it will. If it goes higher and the higher pressures cause a problem with leaks or aerophagia then the max could be dialed back if needed.

So for sure turn on FL flagging by going to auto mode.
Your choice if you want to continue to use the same fixed pressure but you need more pressure. How much more we don't know at this point.
Or you can wait and talk to your doctor about increasing the pressure.

[palerider]

I agree with PR about maybe trying auto mode...don't know about the minimum yet since we don't know where the machine wants to go. It might clean up things with the minimum left at 9 and just letting the machine go up a little (or it might want to go up a lot).

he was in auto mode at first (with the nearly guaranteed fail default 4 minimum). got switched over to cpap mode at 6 then 9, maybe that was a screwup, or maybe whoever's picking pressures is just stupid.

[Pugsy]

he was in auto mode at first (with the nearly guaranteed fail default 4 minimum). got switched over to cpap mode at 6 then 9, maybe that was a screwup, or maybe whoever's picking pressures is just stupid.

Ahhh...stupid would be my guess.
Wanna bet they picked the 90% pressure? After all it's the holy grail of numbers.

[palerider]

he was in auto mode at first (with the nearly guaranteed fail default 4 minimum). got switched over to cpap mode at 6 then 9, maybe that was a screwup, or maybe whoever's picking pressures is just stupid.

Ahhh...stupid would be my guess.
Wanna bet they picked the 90% pressure? After all it's the holy grail of numbers.

well, it *is* easier than thinking, isn't it?