Blowing hot 'n' cold on APAP

[Uncle_Bob]

I'm having good nights and very bad nights on my new APAP machine
I did manage to get nights of zero AI's but recently numbers have started to go up again. My Monday night was AHI 15.9 and AI 2.0 very bad with about 17 event bars on the graph ranging from 10-15 seconds each.

It was a real kick in the teeth after starting out on APAP so well. So I printed out my detailed report for that night and another previous bad nights report and faxed it to my doctor late Tuesday afternoon. This morning the PA called and told me the doctor thinks the APAP is raising the pressure too high and as a result I am getting centrals. So he recommended a pressure change from 7-13 to 5-10. Does this sound right? what if the 10 is not high enough to take care of some obstructive events? I was titrated at 7cm.

I'd be interested in what people think about this

[Sleeprider]

My thought (since you asked), would be to lower the upper range to 10 without changing the lower range, and observing the changes for a week. IMO 5 is not enough pressure, and I would feel suffocated by it. If central apneas from high pressure are the issue, this approach should let you evaluate therapy at a lower upper pressure. I personally played with a wider range of pressures and have narrowed it down to 9-13, but my pressure is nearly steady all night at 9-10. I never hit the upper bounds any more. Earlier, with a wider range my pressures would bounce around a lot more and reach the upper limit setting of 14. Finding that minimum effective pressure, and allowing a small variation to clear obstructive apneas seems to be key. My APAP is practically operating in CPAP mode these days.

[spacetoast]

I was titrated at 9cm and I have set my machine with the upper limit at my titrated pressure and the lower limit at 7cm. I did that because my sleep report noted centrals at higher pressures. I am averaging an AHI of around 2-2.5 for the last few weeks.

Of course I switched masks last night to the FullLife and so I'm not going to worry about my AHI for a week or so until I get used to the mask. My leak rate was insane and jumping all over the place, but my AHI was about 2.5. I recall waking up many times last night, fidgeting with the mask.

Sorry, didn't mean to hijack. But yeah, higher pressures above my titrated pressure seemed to cause centrals. Why don't you try something like 6-8, splitting the difference?

When I started with my apap, I left it in the 4-20 mode and quickly switched to 8-20. The pressure would sometimes go up to 11 and one time 12, but I noticed a bunch of centrals too (I have a Sandman HC Auto which detects them). So I changed my pressures to what I have now.

[ozij]

Dropping to 10 sounds right to me too -- . Are you using EPR?

O.

[Uncle_Bob]

I'm thinking dropping to 10 but not going down to 5. I've tried 6 and woke up with suffocation panic. I've tried 6.4 and been OK and noticed the machine likes to use 6.4 for most of the nights.

I have EPR, settling and ramp all OFF

[ozij]

So he recommended a pressure change from 7-13 to 5-10.

and noticed the machine likes to use 6.4 for most of the nights

Now I'm confused. How can teh machine like to use 6.4 if the minimum is 7?

O.

[Uncle_Bob]

So he recommended a pressure change from 7-13 to 5-10.

and noticed the machine likes to use 6.4 for most of the nights

Now I'm confused. How can teh machine like to use 6.4 if the minimum is 7?

O.

Sorry I forgot to mention i tried 6.4 as a minimum for a couple of nights too.

[ozij]

If you tried 6.4 as a minimum, and the machine hung about there, then your doc's suggetion to go below 7 it is not unreasonable. I can understand better now why he suggested you go below 7.

I would try it by the way -- go below 7 -- but I'd base how low on how I felt.

What made you move from min = 6.4 to min = 7 ?

O.

[Uncle_Bob]

What made you move from min = 6.4 to min = 7 ?

O.

I just noticed how much time without an event the machine spent at 7cm during the night and just thought well how low can i go?

Also looking at my pressure chart the pressure nevers get above 9cm. All of my events occur between 8 & 9cm. It looks like the pressure is rising during most of the events so to me the machine is doing what its suppose to do but not quick enough to stop an event occurring.

[ozij]

Got it.

[Uncle_Bob]

Things are not looking much better. pressure 6.4 - 10

[Uncle_Bob]

I changed pressure to 5 - 10 and EPR from OFF to level 2. A bit of a difference

Note the day time nap with one event but that was before i changed the pressure for nightime

[ozij]

You've got one good doctor!

O.

[Uncle_Bob]

AHI of 3.0 last night with pressure 6-10 and EPR of 2. I'm sticking with these settings for the time being