How much should I bump my pressure?

[LinkC]

Yeah! What he said...

Bravo, chickenman! You have eloquently stated my outlook on the subject, as well.

[carbonman]

I will not recommend a forum to "typical patients" that routinely supports self-titration without good tools ("the software").

Flame on! I'm right behind you.

[boston]

of course it would be best if everyone had data capabilities and software, unfortunately he doesnt.
so in this instance, it is probably best if he try a small change and see if it helps.
should he just sit by if hes not feeling better?
if he goes to the doctor, the doc has no data to go on, he would probably say, lets try upping your pressure a bit.

im not arguing the use of data and software, but if you dont have it, what are you supposed to do.

seems to me he has 3 choices :

1. stick with the pressure hes been using, which isnt working (edit: or wants to try and achieve the best therapy possible) or he wouldnt be thinking about changing in the first place.
-or-
2. end up frustrated because its not working and eventually quit therapy all together.
-or-
3. try a SMALL change and see if it helps.

[El Pap]

of course it would be best if everyone had data capabilities and software, unfortunately he doesnt.
so in this instance, it is probably best if he try a small change and see if it helps.
should he just sit by if hes not feeling better?
if he goes to the doctor, the doc has no data to go on, he would probably say, lets try upping your pressure a bit.

im not arguing the use of data and software, but if you dont have it, what are you supposed to do.

seems to me he has 3 choices :

1. stick with the pressure hes been using, which isnt working or he wouldnt be thinking about changing in the first place.
-or-
2. end up frustrated because its not working and eventually quit therapy all together.
-or-
3. try a SMALL change and see if it helps.

Didn't you read his earlier comments in the thread, Boston? He said, and I quote: "I have a machine that is non-data capable but is working for me. I'm not in a position to purchase new machine, having had my current one for only about 6 months. By and large my CPAP titrated at 8cm has resulted in a vast improvement in my health. There is no question about that."

Your assertion that Jason's therapy isn't working or that he's in jeopardy of quitting doesn't jibe with his own comments. Which makes your three choices nothing but a straw man argument.

The question is whether he should attempt to further improve his successful treatment by experimenting with higher pressures. There seems to be legitimate disagreement amongst forum members on this point.

[roster]

........
The question is whether he should attempt to further improve his successful treatment by experimenting with higher pressures. .........

El Pap,

That is not the question I have an interest in at this point.

Instead, I am interested in the question, "Should the forum be advising patients who do not monitor their therapy with software to tweak their pressure settings?".

It has been rare to see forum members doing this and it could be disastrous to the forum to take this as a general direction.

Regards,

[Jeeper]

Jason S.,

Four years ago I was in the same position as you are today. My machine was not data capable, I was still as tired as I was after two years of cpap at a pressure of 7. I searched for all possible solutions without receiving much support from my doctor, DME, or insurance. My insurance will only replace a cpap after five years and then only after another full study. According to my wife the snoring had stopped but the sleep button in my butt was still there. (I could sit in a chair for a few minutes and fall asleep.)

I started increasing my pressure .5cm. at a time every two weeks. I did keep detailed notes regarding how I felt. With each increase I felt a little better. It took several months to go from a 7 to a 10 but I did it. After reaching 10 I couldn't tell much difference and maybe some deterioration in sleep. I went from 9.5 to 10 a few times and finally decided for the cpap I was using 10 was better. I tried going up further but that didn't show improvement in sleep. I did tell my DME and received the form letter response, on the phone, about how dangerous it was to tweak pressures. I also told my doctor who said he was comfortable with it up to a pressure of 10. After a few more months I bought a RemStar APAP "tank" and used the lcd readout for input. I have since bought a M series APAP with AFLEX along with reader and software. After going between cpap and apap along with cflex and aflex settings, I prefer APAP 9.5 - 12 with aflex turned off. My AHI is consistently below 1.0. AHI goes up when I try it as a CPAP at 10.

Good luck!

Jeeper

[DoriC]

Jason asked a question about increasing pressure, he's been on cpap for several months now with some success, he knows we're not professionals, and he knows that any advice taken has to be his own decision. And certainly the advice given was quite conservative and from "pros" we respect. I am so thankful that I found this forum in time to insist on an exchange for the M Plus first pushed on us. If we hadn't known about data-capable machines before that 30-day deadline, we would not have been in a position to purchase one at our own expense either. Of course, having data capability was a must for us. I had to know the AHI and Leak numbers so we could make educated adjustments. Keep us updated, Jason.

[LinkC]

Four years ago I was in the same position as you are today. My machine was not data capable, I was still as tired as I was after two years of cpap at a pressure of 7.

Same position??? Did you miss the post about his titrated pressure making a "vast improvement in my health"? Or how about "and it's working for me"?

The only position you two share is lying down when you sleep!

In your case 4 yrs ago, (where it's NOT working) I'd suggest consulting with your Dr.
In Jason's case (where it is obviously is working) I'd say "Don't mess with success". And don't experiment when you don't have an empirical method to measure the result.

It aIn't rocket surgery!

[Jason S.]

Thanks to all those who responded. To clarify:

My therapy has been generally very effective right from the get go (7 months ago), but I thought recently I might be getting a bit sleepier in the afternoons. Just yawning, not sleeping. A month ago, I had a back-sleeping apnea that was not prevented by the CPAP machine. This concerns me although I generally sleep on my side, but not always. I knew from the sleep study my back sleeping apnea was much worse than my side sleeping but I'm not sure how (if at all) that situation is approached by the proscribed titration. Do they go for a "90 percent solution", i.e. set the pressure at the minimum level which prevents apneas in the predominant sleeping position? I would like to know the answer to this question.

Secondly, one poster mentioned he got a letter from his insurance company saying it was very dangerous to change the pressure settings. Why is it dangerous, and isn't it also dangerous to NOT TREAT apneas that are occurring while back sleeping when the titration is set for a predominantly side-sleeper? I understand that A-PAP would handle the above scenario but then why wasn't I prescribed for A-PAP given my sleep study revealed an clear difference in apnea severity for side and back sleeping positions?

Finally, for Rooster, why does it disturb you when you feel the forum is going in a certain direction? It is a forum of opinions, and unless you have certain agenda to promote, then the direction the forum is headed shouldn't disturb you. It will go the way it wants to go. Do you have an agenda to promote? Another poster stated the obvious, but its worth restating. There are many knowledgeable people here, yourself included, who offer opinions on various aspects of CPAP. Each person reads the opinions, weighs them carefully against his own personal situation, and makes his own decision. We are not sheep.

[LinkC]

As I understand it, a pressure setting too high can trigger centrals.

You gotta find the "sweet spot". And judging that based on how you feel is not likely.

[Jason S.]

As I understand it, a pressure setting too high can trigger centrals.

You gotta find the "sweet spot". And judging that based on how you feel is not likely.

Thanks, so you are saying a trade-off is made to keep pressure as low as possible even knowing it doesn't treat the back-sleeping apneas because that is less dangerous than triggering centrals?

[roster]

...........Finally, for Rooster, why does it disturb you when you feel the forum is going in a certain direction? It is a forum of opinions, and unless you have certain agenda to promote, then the direction the forum is headed shouldn't disturb you. It will go the way it wants to go. Do you have an agenda to promote? ..........

Jason,

Absolutely I am promoting an agenda on this website and have stated it many times!

There are many planks in my agenda and one of them calls for everyone to fully understand that there are data-capable machines and software available that might make a huge difference in their therapy and health.

Speaking of software, your most recent comments about your positional sleep apnea tell me that your case might benefit significantly from analysis of data from such software.

The final plank in my agenda states, "Suit yourself." Ultimately it is the individual's right to decide what to do with his treatment.

How was NYC?

Regards,

[Jason S.]

Speaking of software, your most recent comments about your positional sleep apnea tell me that your case might benefit significantly from analysis of data from such software.

My comments were recent, but the symptoms are not new. They were well-documented in my sleep study. Additionally, the sleep therapist commented that she got "good numbers" during my full-night titration study. So I must conclude that the prescribed therapy was negligent is overlooking my back-sleeping numbers, or else they are OK with the back-sleeping apneas. For them to knowingly prescribe a machine that wouldn't treat me sufficiently as determined by two full-nights of testing for the sake of dispensing a cheaper machine would be criminal negligence, would it not?

NYC was great, we were lucky on Sat & Sun with mild sunny weather for mid-July. The rates are DOWN.

[roster]

........ So I must conclude that the prescribed therapy was negligent is overlooking my back-sleeping numbers, or else they are OK with the back-sleeping apneas. For them to knowingly prescribe a machine that wouldn't treat me sufficiently as determined by two full-nights of testing for the sake of dispensing a cheaper machine would be criminal negligence, would it not?

.....

Three nights in two certified sleep labs and no one ever mentioned to me that my positional component was extreme. Sleep science is still in its infancy and doctors "practice".

[DoriC]

Jason, that's how we were able to determine my husband's best pressure setting, by using an auto on various settings and having the software to analyze events, leaks, snores,etc. (I must say we had a lot of help with that from the pros). He was titrated at a pressure at 13cm so we started with an 11-15cm range, making adjustments for several months until we determined that the changing auto pressures disturbed his sleep and the daily reports showed that cpap at 12cm gave him his best AHI. In our case, we were lucky that the titration was pretty accurate, but as I've learned here, many sleep studies are way off the mark and don't show the whole picture.