panic at pressure of 4?

[joem18b]

4 months of c-pap, 7.5 hours/night, AHI < 1, ramp of 45 minutes because i don't like the higher pressures.

After 6.5 hours on the machine last night, I got up for a bit, then restarted it, so the pressure was at 4. Then i noticed that was I was breathing hard, seemed that i couldn't breathe. Tried slowing down. Didn't help. Turned off the ramp but then I was at 12 pretty quick with air puffing out my mouth.

Is it possible to suddenly become intolerant of that 4 pressure? I guess I'll see tonight if this was a one-time event.

[BlackSpinner]

Almost nobody feels like they get enough air at 4. Make it start at at least 6.

[jagzoo]

4 is way too low. You can try 6. But don't be afraid to increase even more. I'm not really comfortable until around a pressure of 8, otherwise I have real air hunger. Obviously the people responsible for such low settings have never tried to breath with those settings themselves.

What is your starting pressure - -after ramp?. Maybe try turning ramp off if your starting pressure is high enough so that you don't get air hunger. Or try a 5 minute ramp at 6. That is often long enough to ease one into a higher pressure.

Good luck finding what works for you. And hang in there.

[kteague]

How soon do you usually fall asleep? Just wondering if early on you were so exhausted from when you were untreated that you could sleep through nearly anything, and that as your exhaustion has lifted you're more aware of things you feel. I agree with the others regarding ramp. The best thing I ever did for myself regarding treatment was decreasing my ramp time and increasing my starting ramp pressure. These moves made my treatment improve by leaps and bounds as I could fall asleep without a sense of suffocating. Even if changes are not an acute need, they shouldn't hurt anything so it shouldn't hurt to give it a try. Ramp is an optional comfort feature for those who benefit from easing into treatment pressure. How you utilize it is your choice.

[Julie]

Turn off the ramp - at such a low setting it's keeping you from full therapy for 45 mins and as the other poster said your setting's so low that the ramp is literally worse than pointless. Raise your pressure instead.

[Pugsy]

Here's a theory as to what may have happened.
You had been using the current 12 cm for over 6 hours and you stopped and then you started again but back at the 4 cm and you felt a bit air starved at 4 cm because the body was used to the 12.
It's common to feel air starved at 4 cm and some people can't even start out the night with pressures that low.
Maybe you are okay with it at the beginning of the night and not in the middle of the night when you have been using more pressure.

Solution if it happens again...maybe set the ramp to start at something around 6 cm. You can change the ramp starting pressure easily in the clinical menu.

[Bons]

Yup. Increase the pressure or do away with the ramp all together. The first couple of nights starting at 12 may be uncomfortable but you should adapt quickly.

After a titration before getting my new ASV the doctor had my minimum Epap set at 5. There was no way I was going to fall asleep at that so I bumped it to 7. She went ballistic even though I pointed out that it quickly raises to 8 anyway. 4 is not therapeutic for you in any way and is strictly for comfort while falling asleep. Since it is no longer comfortable do away with it.

[Uncle_Bob]

I agree with the other posters regarding the pressure of 4cm being too low to tolerate.
I can get 0.0 AHI with 4cm but it feel like its too much work so I went back to my titrated pressure of 7cm.
I'm wonder if the sleep labs even start a titration study with a pressure as low as 4cm for adults

[OkyDoky]

I'm wonder if the sleep labs even start a titration study with a pressure as low as 4cm for adults

The answer to your question is probably that it varies just like we do. Here is a statement from the Resmed titration guide.

Set mode to CPAP
Initial pressure: 4–5 cm H2O
A higher pressure may be required for
re-titrations, patients with a higher BMI
or patients complaining of air hunger or
suffocating sensations.
For re-titrations, it is recommended that
the pressure be started 2–3 cm H2O
below the patient’s current pressure.

And they may increase after 5 mins if apneas appear. So probably not many at 4cm for long periods like some ramps are set.

[The Latinist]

I wasn't on therapy very long before I turned the ramp right off. I start the night at 13.