When should I stop lowering my pressure.

[fidelfs]

Hi,

I have posted before about my titration study performed in Dec/2009. The technician told me because the mouth leaks and masks leaks she was forced to increased the pressure up to 20 during the night. The result was the Doctor told me my pressure should be 16 but If I wanted I could lowered to 15. I took 15. In other words the sleep study was not a successful one.

After a few weeks I noticed my ahi was low 0.5~1.0 at 15 pressure, but my sinus congestion was up to the roof and it was hard to maintained a decent seal and lower leak (full face masks). I started lowering my pressure to 12 and my AHI increased to 1.4~1.8 so not too bad right? Sinus problems went away.

I had always a curiosity how low can I go, so last night I lower my pressure again to 11, and my AHI increased again to 2.8, but the difference was I felt rested like never before, easy to breath in and out. It was an incredible night. (Opus 360 mask).
Another thing is the graph was almost clean compared to other nights at higher pressure.

My AHI increases because I had an episode between 5 5:30 AM with multiple Obstructed Apneas. I have cold and because my sinus condition my mucous is very thick, and sometimes doesn't let breath in or out. It is like an OA happening but it is caused by the mucous. So those episodes could have caused by that. That also happen during day time when I am awake. Besides those episodes my graph was very clean compared to other nights.

As far I know AHI <= 5 is ok so I am still on target, so should keep this pressure for a week and see how I feel, and if everything is ok, try to lower it again?
Lower pressure = less episodes, but higher AHI? What is worst, Having episodes all night or having them all an once in one hour and either case have same AHI?

[AirBreather]

I am not legally qualified to tell you what to do, but I can tell you what I would do. I would watch the results at the current pressure setting a few more days and calculate a several-day AHI average. Then I would drop the pressure slightly, watch again for several days, and calculate a new AHI average for those days. I would keep repeating that until the several-day-average AHI increases. Then I would set the pressure at the "sweet point" where the average AHI was lowest.

What is worst, Having episodes all night or having them all an once in one hour and either case have same AHI?

I think clustered apneas are worse than scattered apneas, but I also think the fact that your apneas were clustered may have been due merely to chance or were related to your cold. I would collect data over more days at the lower pressure setting and base changes on several-day averages rather than assume that short-term results are typical.

[BlackSpinner]

Same as above but I would experiment again when my cold was over. Because while you have a cold everything is abnormal in your whole breathing system.

[AirBreather]

Same as above but I would experiment again when my cold was over. Because while you have a cold everything is abnormal in your whole breathing system.

I agree with that and even more so if you are taking cold medication that might also affect sleeping and/or apneas.

[fidelfs]

No, I don't like to take cold medicine. It makes me super hyper, and anyways most of cold medicine mess with my hypothyroid.

That is an excellent idea to wait until I recover from my cold.

Just one more question Would you go down to a lower pressure even if that means higher AHI?, but keeping the AHI always under 5?

Do I gain something lowering my pressure?

[Gerald]

I agree with what the others have said.

However, based on my experiments, I've found that an AHI of 5.0 is not OK. My honey and I have found that we need to keep the AHI below 2.5 or we aren't able to keep the O2 saturation levels at 93% or above. Therefore, I urge you to shoot for a consistant level below AHI 2.5.

The key to good therapy is "no leaks"....and i suggest taping your mouth. I've been using 2" Blue #2080 3M Painter's Tape for over a year....and I love it. I hardly have any leaks....my leak line is almost always "straight"......and my AHI stays below 1.0. Using tape is sorta like using a full face mask...but without the discomfort and poor seal that the full face mask delivers.

You might want to try the Aeiomed Aura Headrest mask and Lasenoh Lanolin for nursing moms. The lanolin will improve the seal between your nares and the pillows....plus increase the comfort level.

[AirBreather]

Just one more question Would you go down to a lower pressure even if that means higher AHI?, but keeping the AHI always under 5?

Do I gain something lowering my pressure?

I wouldn't lower the pressure if it results in a higher AHI averaged over several days, especially considering that your current pressure is not abnormally high.

[dwsupt]

I'd try to repeat the experiment while taking Musinex before bed. It should thin things out and cause fewer problems.?

[Julie]

What many people find is that their pressure "needs" to be increased when they look at AHI numbers, and can't understand why they get worse, but in fact, when pressure is lowered, AHI improves. Why? Because when first starting Cpap, they may begin to mouth breathe as a result of all the air being 'forced' in, but they don't realize it's happening and think their therapy's not working, while in fact they're losing lots of good air that way. If they try a full face mask instead of raising pressure (which makes things worse) they find their numbers improve because air is not 'lost', so I might think about trying a new mask to see if it helps.

[cpapernewbie]

Julie
you raised an excellent point. Reducing pressure reduce my AHI and using Auto helps in controlling leaks. More pressure, more leaks - AHI will be unrealiable.

This make me wonder why fidelfs's doctor dramatically increase pressure to 20, when 11 is sufficient to address the apneas. is this the state of the art of Sleep Apnea? Increasing pressure almost 2x the need of the patient is irresponsible since it will have side-effects, leaks and difficulty in sleeping

[fidelfs]

Looking at one of the reports after 2 weeks of treatment it has not changed much!.

I am really confused.

It looks similar to the one at 11. I guess they screwed my titration test big time. I honestly don't know what my pressure should be.

[cpapernewbie]

In my opinion: if the result is about the same, the lower pressure is the better option. High pressure may create centrals and stomach bloating as side effects

I have tried for about 1 year using straight CPAP at 10. I have problems with mouth leaks and very dry mouth at least 2-3 times a week. Taping my mouth was not effective. Due to the large leaks, my humidifier frequently are empty in 1-2 days. AHI around 3-4

Then 2 months ago i started using the CPAP on auto mode 7 to 11, the result is better, AHI 2-3 and taping my mouth is not necessary - and the water in humidifier can last 3-4 days before filling in. Overall much more comfortable - no dry mouth at all, no taping, no need for lasinoh and Ayr Gel etc etc

While we are all different, the universal rule is " the less pressure the better " as long as AHI is <5

[fidelfs]

I think I found the sweet point. I feel a lot better than before. The graph is looking better and my cold is gone.

[fidelfs]

This is funny. My AHI is for last night is 1.0.

The trend is that every time I reduce my pressure, AHI goes up and then comes down between 0.5 - 1.0. I started at 15 and I am now at 11.

Does that mean I should keep going down?

It looks like my body adjust to the lower pressure every time?

I know many here won't agree but I firm believe that my sleep apnea is compounded with my hypothyroid. The worst time I had was Oct-Nov 2009 and went for a test. It was the time when Armour Thyroid my medicine experienced nation wide shortage and I had to take something different.
I am importing it from Canada their version of Armour and I am feeling great.

I have my thyroid under control and my sleep apnea I guess is going down from severe to moderate.

Any one know where can I rent one of those CPAP equipment for self test at home. I am really curious about what is happening.