Caveats for PAPressure being too high

[Sparchitect]

Been on CPAP treatment with grand compliance for a couple years now and will gladly expand if more info is needed when I check in again tomorrow morning.

When I had my polysomnograph done a few years back I was 296 lbs (for a 6'2, 18 y/o male that's bad but not hopeless). Since then I've brought myself down to the 260 lbs. range, and yet the moderate help I've been getting from the CPAP seems just to be getting worse.

I've been diagnosed as having mild OSA and have been on a steadfast 8 cm water-column setting since the beginning. My concern at the moment: if my optimal needs have changed (theoretically, gone down from the 8 cm when I was more overweight) could my still being at this pressure be causing as much hinderance as it is averting?

Feel free to direct me to alternate url's and please let me know if I step on any newbie-taboos or such. See you all in the morning.

[rested gal]

My concern at the moment: if my optimal needs have changed (theoretically, gone down from the 8 cm when I was more overweight) could my still being at this pressure be causing as much hinderance as it is averting?

I'm not a doctor or anything in the health care field, so this is just my opinion... No, using 8 cms even if you don't need that much pressure wouldn't hurt a thing. If you're sleeping well and are not bothered unduly by mask/machine/pressure then continuing with the pressure of 8 isn't causing a problem, imho.

Congrats on the weight loss! Sounds like you would be a candidate for a trial on an autopap if your doctor will prescribe that. Let the auto-titrating cpap machine (autopap) arrive at the best pressure for you now. You may very well still be an " 8 ".

If I were going to do a trial with an autopap, I'd want it to be the Respironics REMstar M Series Auto with A-flex. Might as well have as much comfort as possible while you're at it. And I'd want the range of pressure set at 6 - 16.
A-flex and C-flex both turned on. And a heated humidifier.

I liked your signature line about "wit and perseverance" being part of your treatment equipment. Those are the best features to have when using these glorified leaf blowers.

[Guest]

Thanks for the info, RG. Being that 8 cm is a relatively low setting it seems logical to assume its safety at this point.

In general, however, are large drops in weight associated with a necessary reduction in pressure (for those whose optimal pressures are in the higher end of the spectrum) or would reducing pressure post weight-loss only be to make the sleeping experience more comfortable? At this point I'm simply grasping for straws, and anyone's experience or knowledge would help confirm which of my worries are plausible and which are highly unlikely. For instance [though I hate to keep rambling] if anyone has come across such phenomena as sudden changes in pressure requirements that seem to have no physical explanation (no weight gain, smoke exposure, etc), then it would at least confirm for me that what I'm dealing with here may be of similar nature and not need the physical link I'm so sordidly rooting in the black of slumber for.

Auto-titrating PAP devices and other such concepts will likely be a good choice in my near future, but assuming that 8 cm is a safe pressure no matter how low my optimal pressure becomes, I am left still with the question of how to explain and remedy the lackluster nature of what I'm experiencing.

A friend in need just phoned in urgency, thanks again for any light you all may shed - gotta' fly!

[socknitster]

How are you feeling on 8 cm? Good? If so, no worries.

If not, I'd either get an apap or another titration. If it has been a few years, you are probably due. Your apnea may get worse with age regardless of your weight.

A pressure of 8 if what you really need is a 6 shouldn't hurt. But sometimes there is a "sweet spot" in there for an individual.

I'm like a train wreck above pressures of 18. Just fine around 10-16 on my bipap. But those are much higher pressures than you are using.

Jen

[Sparchitect]

Ah, thank you Jen.

Physically I've not found any discomfort or problem with the pressure setting, but it seems that over the past two years (been on CPAP for 2.5 years) my quality of rest has gone down the tubes on a slow but steady decline. It's good to know that I'm not crazy, anyway and that all of this may come down to a simple adjustment in pressure.

[Bookbear]

People differ widely. I can give you two examples of people I know on cpap. One was nearly 300 lbs. last year. He now weighs 180. He was titrated at 20. He is now titrated at 12. Another I know lost almost 100 lbs. Doc insisted on a new sleep study ("You shouldn't need cpap now"). Old titration was 14, new titration was.... 15. So, two people with similar weight loss, but very different results cpap-wise.

Weight loss rarely 'cures' apnea, but it often (not always) allows for a lower pressure to be used successfully. If you are feeling good at 8, its a low enough pressure not to be causing any worries if your actual need is lower. You could drop the pressure by 1 and try that for a week at least, then see how you feel. I wouldn't go below 6, though.

Not only do people differ, but your own needs may vary from night to night. The amount of time you spend sleeping in a given position, your general health (cold, aches and pains, emotional state), all can and do alter your pressure needs from night to night. It's also possible that your initial titration was not correct (after all, it's based on one night, or half a night, in a strange room in a strange bed, with many wires glued to your body....)


8 is a fairly low pressure, I wouldn't worry to much about increasing a bit at a time, again giving any change a week at least to assess success. Also, be sure you aren't getting leaks. You don't mention if you have had new masks over the 2.5 years you've been on cpap. If you haven't, it's quite likely that your old mask is no longer sealing correctly and you are getting leaks. Leaks compromise the therapy.

Good luck!
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[Sparchitect]

(cold, aches and pains, emotional state ),

Now you've really got my gears turning. I wouldn't have guessed but am now noticing a distinct pattern...

Anyway, I love this free association as it brings to light all sorts of nifty little things! Thanks everyone, and don't be shy!

I've been using the same mask from the start and have been relatively confindent as to its efficiency, mostly because I've always been under the assumption that the CPAP unit's pressure sensors would adjust and compensate for small leaks incurred throughout the night. My Sparky-senses are tingling, which means I'm about to get a big fat 'NO' when I check in tomorrow morning But the sooner I get my facts straight and distill the misconceptions the sooner I get to say hello to my old self! hehe

[Vonon]

Hummm. I've been wondering about pressure setting changes too. My sleep study said I did "great" at 9 and a pressure of 11 caused centrals. My doctor had the pressure on my machine set at 10. So Ive been thinking that even a slightly too high pressure can cause problems.

[socknitster]

If it has been 2.5 years AND you lost weight, I think you ought to get a full night titration at a good sleep lab so all your questions can be answered and you can feel better asap!

I know everyone has horror stories about their titration, but honestly once the first one is out of the way and you know what to expect, it can't be that bad the second time!

Jen

[roster]

Sparchitect,

Welcome and don't worry about taboos. This is a very open and liberal forum but we do have some nasty family feuds from time to time without any lasting damage.

Of course I can't evaluate your situation, but the first two of my pet things to be checked are, 1) make sure you are not mouth leaking or mouth breathing and 2) consider the possibility of silent GERD causing arousals.

Rooster

[socknitster]

Yes, you GO Rooster! Those two problems are common (and I have them a well). You should definitely eliminate them as contributors to how you are feeling. Do a search, there are lots of posts on both topics. Jen

[Sparchitect]

centrals.

Sorry, come again? Some sort of breathing difficulty, I imagine.


Another titration would be a great idea. I'd actually look forward to it. After twelve rounds of ECT [two of which went horribly wrong ] sleeping with a gazillion electrodes attached to me never really made me nervous.

Lastly, thank you, Rooster. Mouth-leaking issues were what brought me here a couple of weeks ago, and it was a breath of fresh-air to see an entire community of CPAP-ers fully aware of and remedying mouth-breathing issues with tape and coming up with good results [up 'til then mouth-taping was a mad last-ditch effort I'd come up with in attempt to confirm whether or not my mouth was playing a role in my decline]. I regret having not resorted to the internet for answers long ago.

After several years of being a CPAP patient I'm slapped in the face with the realization that I'm still more of a newbie to it than I could have ever imagined1. I'm going to skim the 'collective wisdom' link if ever I get a chance, but for the moment, are their any general links that will distill alot of these technical details that are going over my head such as 'silent GERD', 'central' and such? I'll have to keep on reading here when I get back from my first attemt at going out for an honest jog... cheers everyone!

[roster]

[quote="Sparchitect"]........... are their any general links that will distill alot of these technical details that are going over my head .........

[Sparchitect]

I've gone from being down to the last ideas in my arsenal to being surrounded by possibilities I don't fully understand, and it's actually not that bad a feeling! Excellent. Here we go...