Can pressure be too high?

[Fredricr1]

My RT started me at a pressure level of 8 (Dreamstation), which brought my AHI down from 17 to between 4 and 5. That’s good! I upped it to 8.5 after 3 months to see if I could do better and my AHI dropped to .5-1 range (sometimes a little over 1, but mostly just under) for the next 3 months. To experiment, I upped it to 9 three days ago and my AHI went to 1.2, 2.1, and 2.5. It’s only been 3 days, but I’m curious if too much pressure becomes less effective? Is there a sweet spot?

(Yes, I know that “9” is lower than what many people use; I’m talking relative to one’s specific symptom pattern).

Thanks,

[Pugsy]

Which category of apnea event seems to have increased a bit?
Not all categories of events reduce with more pressure...central apneas might actually increase.
It could also be possible that you are having some awake flagged events due to maybe not sleeping so great while the body adjusts to the new pressures.

And yes...sometimes people do seem to have "sweet spots".

I don't go so much with the AHI as long as it is fairly low. We don't sleep the same each night anyway so I expect the AHI to vary some.
I go more on how I sleep and feel than I go by just AHI alone. AHI of 0.0 doesn't mean much if I slept like crap.

[Fredricr1]

Which category of apnea event seems to have increased a bit?
Not all categories of events reduce with more pressure...central apneas might actually increase.
It could also be possible that you are having some awake flagged events due to maybe not sleeping so great while the body adjusts to the new pressures.

And yes...sometimes people do seem to have "sweet spots".

I don't go so much with the AHI as long as it is fairly low. We don't sleep the same each night anyway so I expect the AHI to vary some.
I go more on how I sleep and feel than I go by just AHI alone. AHI of 0.0 doesn't mean much if I slept like crap.

Using the DreamMapper app, it looks like obstructive apneas were the big jump. I will normally have the occasional 1 or 2 centrals and that was the case after my bump to 9. But my Obstructive events, which range from 0-4 typically jumped to 5 and 7. Again, we have a small n of only 3 days so I don't want to make too big a case for it and yes, it may just be an adjustment period. I'll keep an eye on it and lower back to 8.5 if I don't see any added benefit after a month or so.

[Pugsy]

If OAs and hyponeas increase then I look at what changed that might cause the increase....sleeping on one's back more than other nights is a common cause because OSA can worse when supine and we might need a little more pressure.
Also REM stage sleep..it's common for OSA to worsen and need more pressure during REM.

This is why we say we don't sleep the same each night. We may spend some time on our back or maybe we sleep longer and more soundly and just have more chances of an increase in the amount of REM.

The slight increase you are experiencing....more pressure doesn't cause obstructive stuff. Something else caused them.

Now if you woke up a lot during the night then you have an increased chance of false positive flagged events muddying up the evaluation process. The machine doesn't know if you are awake or asleep because it can only measure air flow. It can flag awake/arousal breathing irregularities as some sort of apnea event (it's not limited to centrals) and if we aren't asleep they don't count.

[Pugsy]

You might want to be using OSCAR software so you can see when those events are being flagged which might give you a clue as to what is causing them.
You can't see the details with DreamMapper.

OSCAR https://www.sleepfiles.com/OSCAR/
http://www.apneaboard.com/wiki/index.ph ... stallation
http://www.apneaboard.com/wiki/index.ph ... rpretation

[Fredricr1]

Thank you for your insights, Pugsy.

I’ve hesitated downloading Oscar. I’m just generally wary of downloading apps off the internet (vs commercial apps). Is this generally judged by the community to be wholly safe?

[Pugsy]

I understand your concerns about downloading...I am the same way.
OSCAR is totally safe if you get it from the links we provide here.
I have it on my laptop. I didn't get any sneaky bugs included with the download. No hidden bad guys.