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[richart]

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[Dog Slobber]

"We never really discussed how low I should actually go with the pressure so I think as long as the 90 day AHI average stays below 5 I will keep reducing it monthly."

Why would you use some arbitrary some number like 5, as your metric? And yes, I'm very aware of the under 5 is considered treated chart.

Keep reducing your pressure until you start to see your AHI increase.

[richart]

Why would you use some arbitrary some number like 5, as your metric? And yes, I'm very aware of the under 5 is considered treated chart.

Exactly because of how the number 5 is considered by the medical community. If AHI increased from 2 to 3, I don't know that I would consider it an issue that requires treatment.

[NoOnesPerfect]

Remember that the AHI you are seeing is the treated value. Odds are the value would be much higher without the xPAP machine. In other words, you might be able to say that an AHI of 3 when using the machine is an acceptable level of therapy (assuming you feel rested in the morning), but it would not be accurate to say that it means you no longer need the therapy.

[Miss Emerita]

In your place, I’d want to keep my AHI under 2-ish. This may all be moot pretty soon, though, because I think you’ll find you don’t like having your pressure at less than 7. Many people feel starved for air when the IPAP is less than that.

Congratulations on the weight loss, by the way! Any tips on how you did it?

[Dog Slobber]

Why would you use some arbitrary some number like 5, as your metric? And yes, I'm very aware of the under 5 is considered treated chart.

Exactly because of how the number 5 is considered by the medical community. If AHI increased from 2 to 3, I don't know that I would consider it an issue that requires treatment.

And that arbitrary number is a disaster.

This forum is full of people who were abandoned by the medical community, or who the medical community was content because they were at or near an AHI of 5, but came here and are experiencing better sleep with AHI's consistently under 1.

Given the choice of a pressure of 13 with an AHI of 1.5, or a pressure of say 8 with an AHI of 4.5, your strategy seems to favour the latter.

Why would you think being woken up once every 13 minutes is preferable to once every 40 minutes?

[TropicalDiver]

Exactly because of how the number 5 is considered by the medical community. If AHI increased from 2 to 3, I don't know that I would consider it an issue that requires treatment.

Disclaimer: I am not a clinician. First, congrats on the weight loss and being able to reduce the pressure a fair bit. Second, I think the best way to determine whether you no longer need treatment is a sleep study. Like others, I think I would keep going down (maybe now in increments of 1 rather than 2 until I saw my AHI start to creep up OR I felt less rested.

I would determine how well the therapy is going using at least three (and ideally four) measures.
1) Subjective view of quality/quantity of sleep. Also, do feel well rested? Any daytime sleepiness?
2) AHI. Please note that many posters tend to report feeling better with an AHI well below 5 -- it seems like many report feeling best somewhere under 2.5 (but that does vary a fair bit -- for me anything 2 and up I subjectively notice).
3) Subjective tolerance of xpap. Just like super high pressures can be difficult to adjust to, so can super low pressures. Again, subjectively, some posters have felt "air hungry" at lower pressures (for some, this is around 7 or less)
4) Ideally -- O2 sats.

[TropicalDiver]

After a month with the pressure at 13, I reduced it to 11 and after 30 days my 90 day AHI average was 1.5.
Now a month later the 90 day AHI average is 1.6 so I am going to reduce the pressure to 9 and see what happens.

You should be looking at the 30 days figures rather than the 90 day figures. Your 1.5 reading was 30 days at 15, and 30 days at 13, and 30 days at 11. That really doesn't tell you what your AHI is at a pressure of 11.

[richart]

Why would you use some arbitrary some number like 5, as your metric? And yes, I'm very aware of the under 5 is considered treated chart.

Exactly because of how the number 5 is considered by the medical community. If AHI increased from 2 to 3, I don't know that I would consider it an issue that requires treatment.

I asked a couple of basic questions in my OP. You are making some presumptions about my experience that have not even been discussed. Thanks for your input but I really don't want to get into a discussion about the medical community, other people's sleep quality or the pressure and sleep quality that I prefer. To each their own.

To reiterate, the questions that I asked were:
Do people actually use CPAP with pressures as low as 5 or 7? Or is there a lower range where CPAP is no longer generally effective?

[Dog Slobber]

Under the Statistics page on S.H./OSCAR in the Changes to Prescriptions Settings section, he should be able to get a direct comparison of AHI values by pressure settings change.

[richart]

In your place, I’d want to keep my AHI under 2-ish. This may all be moot pretty soon, though, because I think you’ll find you don’t like having your pressure at less than 7. Many people feel starved for air when the IPAP is less than that.

Congratulations on the weight loss, by the way! Any tips on how you did it?

Exactly the type of information I was looking for. I was wondering if I might feel starved for air at some point.

To answer your question, strict adherence to the WeightWatchers mobile app and riding a bicycle for 5 to 10 hours a week.

[TropicalDiver]

Given the choice of a pressure of 13 with an AHI of 1.5, or a pressure of say 8 with an AHI of 4.5, your strategy seems to favour the latter.

Why would you think being woken up once every 13 minutes is preferable to once every 40 minutes?

I would add one other consideration: What benefits are you seeing from lower pressures and how does that compare with the negatives? In other words, at a certain point if dropping pressure adds sleep interruptions, why would you want to do that? What benefit are you getting from the pressure drop (mask leaks, air in stomach, fall asleep easier, etc.)?

[richart]

Exactly because of how the number 5 is considered by the medical community. If AHI increased from 2 to 3, I don't know that I would consider it an issue that requires treatment.

Disclaimer: I am not a clinician. First, congrats on the weight loss and being able to reduce the pressure a fair bit. Second, I think the best way to determine whether you no longer need treatment is a sleep study. Like others, I think I would keep going down (maybe now in increments of 1 rather than 2 until I saw my AHI start to creep up OR I felt less rested.

I would determine how well the therapy is going using at least three (and ideally four) measures.
1) Subjective view of quality/quantity of sleep. Also, do feel well rested? Any daytime sleepiness?
2) AHI. Please note that many posters tend to report feeling better with an AHI well below 5 -- it seems like many report feeling best somewhere under 2.5 (but that does vary a fair bit -- for me anything 2 and up I subjectively notice).
3) Subjective tolerance of xpap. Just like super high pressures can be difficult to adjust to, so can super low pressures. Again, subjectively, some posters have felt "air hungry" at lower pressures (for some, this is around 7 or less)
4) Ideally -- O2 sats.

Great information. Thank you. Curiously, I have never had daytime sleepiness at any point, even before the sleep apnea was diagnosed. My sleep quality did get worse when I lost weight and was still using the higher pressures and has improved greatly with the lower pressure. Good idea on the O2. I do have a fingertip pulse oximeter that I can use to check that.

[NoOnesPerfect]

In answer to your original questions - yes, there are people that use those low pressures and see satisfactory results, And there really is no such thing as “generally effective” - it is very much dependent on the individual’s airway structure, jaw structure, etc.

[NoOnesPerfect]

Regarding the pulse oximeter - I am guessing the other poster was referring to O2 saturation or desaturation during sleep, so you would need a recording oximeter. The typical fingertip models that don’t include a separate wrist or handheld portion, or at least a cable to connect to your laptop while in use, wouldn’t show those. Don’t know what you have on hand of course - just trying to clarify.