Pressure Increasing from 11 to 14 cm

[sleepyhead100]

Hi, I’ve been treating my sleep apnea with CPAP for 7 years (I’ve complied with the treatment pretty well, even though it hasn’t been easy). In 2006 I chose to have the UPPP surgery knowing full well there was a risk that the surgery was not a sure thing (it was a very tough experience and you need support!). Based on my titration studies over the last 7 years, my CPAP pressure has gone from 6 to 8 to 10 to 11 and just recently to 14. Over the past year and a half, my weight increased from about 152 lbs to 163 lbs. For me, 10 lbs does make a difference. So far, I’ve been able to reduce my weight back down to 155 lbs with about 5 more to go.

Questions:

Has anyone else had a rapid increase in pressure like this?

I’m 44 years old. If my pressure continues to increase at this pace, I’ll eventually max out on my ability to tolerate the CPAP machine, as well as its ability to treat the condition. Has anyone else experienced this? If so, what did you do to continue treatment?

Is it possible that, as my doc shifts my pressure upward, my body just “adjusts” to the pressure, essentially creating an upward spiral? Or, is my sleep apnea getting that much worse, this quickly?

My doctor mentioned possibly trying an oral appliance, or a combo of an oral appliance + CPAP, if we get to that point. I’ve heard that the oral appliances have negative side effects. How concerned should I be?

I really appreciate any input or support. Thanks so much!

[cosmo]

Have you tried the 14cm pressure?

[sleepyhead100]

Yes, I've been on the 14 cm pressure now for about 3 weeks. I've been able to sleep with it, somewhat still getting accustomed.

[Pugsy]

Sometimes the airway tissues just want to sag a bit more as we get older.
Maybe sleeping position affects things a little more now than it did a while back.
I have been on cpap now for 4 years...pretty much the same pressures now as back then.
I don't think it is something that we just automatically need more pressure to do the same job as in developing some sort of tolerance if that is what you were thinking.

We have other forum members who have been on the machine longer than you have and their pressure needs really haven't changed.

What are you using to evaluate your pressure needs? Software? What machine?

[cobra4x4]

Sometimes pressure changes will be required depending on the root cause of your sleep apnea. It could be obstruction of the airway due to enlarged tongue or your facial features being too small, Muscles and tissue surrounding the airway becoming weaker or growing larger, airway way more oval than round (this is my case, my airway flattens out when relaxed thus potentially choking off air flow) etc etc

There are many variables and everyone is unique therefore pressure requirements will vary accordingly between individuals.

[Kitatonic]

Since wearing this cervical collar, my pressure has decreased significantly. Now I attributed this to less leakage since my mouth is remaining closed. But another thought is tht the collar is supporting the airway from collapsing or that aging sagging neck. My pressure last night was only 5.6(95%), about one cm lower than before the collar.

Have you changed your mask? The pillows seem to require less pressure, lowering mine another cm compared to the nasal mask.

[TangledHose]

I've been on CPAP/APAP for eight years with same 12cmH2O pressure the entire time - - when I recently switched to APAP I set it for a range from 8cm up to 12.5cm to give me a little cushion on the high side, but my data over the last 60 days indicates the my 90th percentile is only around 9.5 and I have only hit the max 12.5 for 1% of the entire 60 day time frame with 8 hours per night of usage. So to answer your question, at least in my experience, your body doesn't get used to pressure and require more as time goes by like taking some certain drugs as an example. I acctually think my pressure requirements have really gone down to a slight degree even though I don't have the data to prove it - - basically same body weight over that length of time.

[sleepyhead100]

Sometimes the airway tissues just want to sag a bit more as we get older.
Maybe sleeping position affects things a little more now than it did a while back.
I have been on cpap now for 4 years...pretty much the same pressures now as back then.
I don't think it is something that we just automatically need more pressure to do the same job as in developing some sort of tolerance if that is what you were thinking.

We have other forum members who have been on the machine longer than you have and their pressure needs really haven't changed.

What are you using to evaluate your pressure needs? Software? What machine?

Hi, Pugsy! My pressure needs are being determined through titration studies, approximately every 1 to 2 years. My machine is a ResMed S8 Escape II. I was told that the software was not available to me. I guess part of my concern is that my pressure is being determined by a single study held on one specific night with circumstances that are nothing like my normal sleeping experience at home. Thanks for your response!

[sleepyhead100]

Since wearing this cervical collar, my pressure has decreased significantly. Now I attributed this to less leakage since my mouth is remaining closed. But another thought is tht the collar is supporting the airway from collapsing or that aging sagging neck. My pressure last night was only 5.6(95%), about one cm lower than before the collar.

Have you changed your mask? The pillows seem to require less pressure, lowering mine another cm compared to the nasal mask.

Hi, Kitatonic! When the pressure increased from 11 to 14, I switched from a size "M" FF Mirage Quattro to a "L" after meeting with a specialist at the DME. Seems like the leakage has improved with the change. I think my main concern is why my pressure keeps increasing so rapidly. Interesting that you found you needed a lower presser using the pillows. I've been using the FF mask due to the mouth breathing. Thanks so much for your response!

[Pugsy]

My pressure needs are being determined through titration studies, approximately every 1 to 2 years. My machine is a ResMed S8 Escape II. I was told that the software was not available to me.

Well there is software that we could get you but your machine doesn't gather any data beyond hours of use.
So no sense in getting it but it's out there if you know where to look.

That's how come they are doing the titration studies because they don't have any data from the machine that would offer what pressure is needed.
Instead of giving you a machine that would offer that needed data that gave you a machine that gathers no useful data.
And you get to spend the big bucks on titration studies and doctor gets to make the big bucks interpreting the sleep study and all this could have been avoided if you had been give a machine that collected useful data and probably cost the DME maybe $50 more. They gave you the cheapest machine that they could so they could make the most amount of money.

When/if you can get a new machine you might want to learn about full data machines and get one that you can use the software with. The new S9 models that offer full data (avoid any mention of Escape) we can use SleepyHead software...see my signature for links...The User guide gives you examples.

[Drowsy Dancer]

My pressure needs are being determined through titration studies, approximately every 1 to 2 years. My machine is a ResMed S8 Escape II. I was told that the software was not available to me.

It's worse than that. I believe that your machine does not even collect full efficacy data. The software is available, it's your data that's not "available," because your machine isn't collecting it.

It would make more sense to me to have you get a data-capable APAP, rather than retitrating you every year or two. But then I'm not the one making money off your sleep studies.

Perhaps it isn't so much that your pressure needs have increased dramatically as that the lab has never really gotten your pressure right. But why in the name of all that is holy not have you use a machine that collects efficacy data?

[sleepyhead100]

My pressure needs are being determined through titration studies, approximately every 1 to 2 years. My machine is a ResMed S8 Escape II. I was told that the software was not available to me.

Well there is software that we could get you but your machine doesn't gather any data beyond hours of use.
So no sense in getting it but it's out there if you know where to look.

That's how come they are doing the titration studies because they don't have any data from the machine that would offer what pressure is needed.
Instead of giving you a machine that would offer that needed data that gave you a machine that gathers no useful data.
And you get to spend the big bucks on titration studies and doctor gets to make the big bucks interpreting the sleep study and all this could have been avoided if you had been give a machine that collected useful data and probably cost the DME maybe $50 more. They gave you the cheapest machine that they could so they could make the most amount of money.

When/if you can get a new machine you might want to learn about full data machines and get one that you can use the software with. The new S9 models that offer full data (avoid any mention of Escape) we can use SleepyHead software...see my signature for links...The User guide gives you examples.

Thanks, Pugsy! Very interesting and helpful. Would be nice to be able to have the data and not have to go for titration studies to have some idea of what's happening. Would also be nice to have my pressure based on a broader range of information instead of just a one-night sleep study in a lab where I may or may not sleep. I'll look into a data-capable machine. I really appreciate your help.

[sleepyhead100]

It's worse than that. I believe that your machine does not even collect full efficacy data. The software is available, it's your data that's not "available," because your machine isn't collecting it.

It would make more sense to me to have you get a data-capable APAP, rather than retitrating you every year or two. But then I'm not the one making money off your sleep studies.

Perhaps it isn't so much that your pressure needs have increased dramatically as that the lab has never really gotten your pressure right. But why in the name of all that is holy not have you use a machine that collects efficacy data?

Great question, Drowsy Dancer. You and Pugsy are on the same page with regard to my need for a data-capable machine. I'll do my research. I appreciate your response. Good information that isn't always shared by docs and DME's!