Pressure INCREASE after weight loss?

[paul9123]

Hello all,

I've been on CPAP since August 2009 and in that time have lost around 40 pounds.

I went in just after Thanksgiving for a follow up sleep study, mask half on, half off. I was very curious to see what my no-mask AHI would be after losing the weight. Met with the doctor earlier this week (obvious he hadn't even looked at my file until I walked in the room). My AHI without a mask is down to 60 from 120. He recommended that my pressure be increased from 12 to 14 and asked if I had gained weight (like I said, hadn't read the file). When I questioned the increase he said during titration that's the point at which the tech said I stopped snoring.

Has anyone ever seen their pressure go UP after losing weight? I figured I would either stay the same or go down to 10. Granted, after a year, 12 does not really feel like "pressure", it feels natural, but when I tried 14 I felt like my eyes were going to pop out of my head and my lungs filled like balloons. I couldn't exhale through my nose but instead had to exhale through my mouth. I suppose 12 probably felt that way when I started out but boy it was unpleasant.

What would the ramifications be if I called the doctor back and said I'd be sticking with 12 (or showed up next year with a card that read 12 all year?) I don't care if the doctor is annoyed with me since it is patently clear that neither the sleep lab nor the DME have any interest in anything other than my wallet, but I would not like to be called noncompliant and end up in trouble with the insurance company. I'm happy with where I am. I'm losing weight, I feel great, I sleep great, I'm alert all day, my memory's back, and I'm never cranky.

Best I can figure is maybe my pressure should have been 14 from the start but they knocked it down a couple because I had a bad time with the mask at the original titration.

Thanks, Paul

[crispin2006]

Curious! All I heard is, when you're losing weight, the pressure will be decrease.
In the last 4 weeks (beginners-weeks), I slimmed 5 kg with ongoing tendency (in spite of pre-Xmas time), but my follow-up study will be in January, so I can't give any idea on your problem.
My pressure is at 14 hPa, and it was very hard in the beginning. But my sleepdoc gave my a soft-start machine, which increases the pressure from 6 to 14 within 20 minutes. That's ok for falling asleep and when I sleep, the pressure doesn't bother me.
Was it easier for you to lose weight AFTER the cpap therapy than before? I feel like that.

[Janknitz]

It's not unheard of for pressure needs to INCREASE with weight loss. That's why people are urged to have another study before assuming they can decrease the pressure (or stop CPAP altogether) just because they've lost weight. It belies the myth that OSA is caused strictly by being overweight--other factors are at work here, too.

You have a data capable machine, so what does your data say now and how do you feel? You could try slowly increasing the pressure and watch your data and how you feel to determine if the pressure increase works for you or not.

[tattooyu]

What would actually cause the need for an increase in pressure after a weight loss? Seems counterintuitive but I know it obviously happens. Could it be that after losing weight, tissues are more flabby and stretched out? I know as I've lost weight--I'm 203 lbs. down from my high of 248 lbs.--that I have some loose skin I'm not happy about. Maybe something similar is going on in the throat?

So far, my pressure has remained the same. I plan on doing another big push to lose another 30-40 lbs., so we'll see what happens then. I'll probably request another sleep study.

[sleeplessinaz]

Hi there--I just had a sleep study --for titration since I lost 25 pounds and they increased my pressure from a "7" to an "8". I don't know why losing weight makes our pressure needs go up but that is what my sleep technician told me too.