Increase Minimum Pressure?

[mtncpapblue]

During the trial part of my starting with CPAP, we found that my AHI numbers were significantly lower with A-flex off. However, I found it hard to take the constant pressure, so we switched to A-flex. My numbers pretty much doubled, but still kept me below the magic 5.0 mostly. We reasoned it is better to stay on the program with A-flex and put up with higher numbers.

Now, after gathering a few weeks' data, I have a better feel for the numbers, and they are pretty much consistent with the A-flex trial above. Some nights however are much higher with respect to my averages.

I am considering the next parameters to vary. Would I start by increasing the minimum pressure? Currently my range is 6.0 to 10.0. I rarely pin it against 10.0, so that looks OK for now.

[Pugsy]

What is the AHI breakdown? How much of it is Clear Airway Index?
On the nights where the AHI is higher than your normal average...how much of it is Clear Airway?
If you are going to increase the minimum in hopes to bring the AHI down a little....best to make sure that what you are trying to reduce is something that we treat with pressure. We don't try to treat Clear Airway events with an increase in pressure because they won't respond.
Obstructive apneas and hyponeas are treated with pressure.
Clear airway events aren't treated at all unless you have a truck load of them and then you get a different type of machine.

[mtncpapblue]

Trial:

Without A-Flex:
AHI average: 4.0
CA average: 0.3
OA average: 0.6
H average: 3.1

With A-Flex:
AHI average: 4.6
CA average: 1.3
OA average: 1.1
H average: 2.2


Now:

With A-Flex:
AHI average: 5.5
CA average: 1.6
OA average: 1.9
H average: 2.0


OAs seems to be increasing. So, I am thinking of increasing the minimum pressure, from 6.0 to say 6.5 for starters.
During the trial, my therapist was intent on getting me back to the OA average of 0.3, but the constant pressure, which she increased up to 8.0 seemed to bother me during the day. Switching to A-Flex increased OAs and CAs.

[LSAT]

In my opinion...these are insignificant differences. The main question is..."how do you feel after a nights sleep"?

[mtncpapblue]

, I knew someone would say that. Yep, small numbers compared to small numbers, probably mean little.

[mtncpapblue]

How do I feel?

Hmm: not sure yet. I think I am better, now that the chest pain is starting to get somewhat better.

This will take time, so something to look forward to: feeling better ...

[Pugsy]

You aren't counting the Hyponeas???
I thought the way you were talking the AHI itself doubled but looks like you are mainly counting OAs? Is that right?
The overall AHI is not all that different.

The differences are insignificant but if you want to try a little more minimum pressure then try it. Using AFlex does lower the pressure a tiny bit. Wouldn't hurt anything to try a little more minimum pressure though. I would probably do the same thing if I were in your shoes. Been there, done that when I went up to 13 just to see if things would change. If you are comfortable experimenting then do what you want to do.

Most important thing is how do you feel? Resting well? Sleeping good? Getting good numbers of hours of sleep?
You can watch the numbers but an AHI of 0.0 doesn't guarantee anything. Just remember the goal is not a perfect math score.
The goal is to sleep better, rest better and feel better.

[Todzo]

, I knew someone would say that. Yep, small numbers compared to small numbers, probably mean little.

Hi mtncpapblue!

I think of pressure as "anti-inflammatory therapy". The pressure moves the fluids out of the tissues and they shrink. So when the pressure is removed for a time - they shrink less - higher AHI.

But pressure tends to cause the use of higher volumes of air which can lead to irritation of the airway passage (swelling - AHI) and unstable breathing (breathing takes off - very bad).

My tendency is to leave the machine where it is if it seems to be working pretty well (AHI under 2 (in my case from experience - under 5 may be a good number) and no signs of unstable breathing (high minute volume numbers, periodic breathing, clear airway events preceded by a higher air volumes in the flow waveforms).

- - - and then - - - use lifestyle to reduce swelling and promote good breathing reflexes - - - - - - >

Lower Stress
Aerobic and Interval Training Exercise
Raise the head of the bed a few inches (concrete blocks from a building supply store for less than five dollars why not?)
Half veggies - - anti-inflammatory foods - - anti-oxidant foods - - Q3s - - good high quality protine
Spend quality time with friends and family

Once in a while I do make pressure changes - - after several weeks of seeing reasons that I should.

Have a great year!

Todzo

[mtncpapblue]

I still agree the numbers are small. The therapist was pretty determined to get the OAs to zero. The numbers don't show it, but some nites the OAs were zero on constant pressure. Compared to about 2 on A-Flex. She kept me on constant until I couldn't breathe any more. The daytime symptoms were tight chest, shortness of breath, wooziness. It was hard to clearly separate cause and effect, panic, recovery etc. However, I was fine before non-A-Flex, and fine after non-A-Flex. I.e. fine on A-Flex.

Even tho it was clear I needed to be on A-Flex (at least until I became more accustomed to CPAP), my therapist still bemoaned the fact that she could not get my OAs down to zero. She knew she could using non-A-Flex.

So, now I am thinking that I should be working toward that, as my OAs are settling to about 2 over time. By increasing the minimum pressure a bit over time, it may be closer to constant pressure and may reduce the OAs. Yet, my therapist made no such suggestions. It was see ya in a year boy. Got my dough, gotta go.

Hence the line of questioning here .....

[Julie]

I think your therapist either has a case of OCD or you've 'misheard' her, but it's most important to have constant therapy, to see your numbers low yes, but not necessarily <1 at the cost of making you uncomfortable, and to just get on with making cpap a part of your life, aflex or not. Maybe you need to stop focusing on fractions of printout numbers and establish a routine that works to get the most out of what you have - you will look back in six months and wonder what all the fuss was about.

Hypopneas are part of the package, whether or not they're less bad. If you adjust your machine up or down by a notch to get a feel for other settings, then leave it alone for a few nights to get a good idea of the picture rather than reading too much into one night.

Good luck, you should be fine.

[mtncpapblue]

Thanks Julie. Exactly how I feel. My DME eventually got onto that, but still kept with the 'too bad you couldn't stand the constant, so we could get your OAs down to zero'. Like she had to give me that shot each time.

The other thing I was discussing with my wife, that I have sorely neglected, is that I should be gathering up my data, summarized well, and sit down with my GP. After all it was he who prescribed this treatment path, and he has the bigger picture re my overall issues, which extend beyond CPAP. My experience so far is that he is very informed on this treatment, and actually was highly opinionated on using A-Flex. (he indicated all of his patients are recommended by him to use an automatic setting - he was passionate on that). When I mentioned this to my DME, she got all uppity. Great. But for me the GP wins.