Need help with titration etc

[maskracer]

I tried APAP for the first time and after 4 weeks I can say something isn't right. I feel like I'm never getting enough pressure coming in and wake up a lot at 3a or 4a. It sucks. When I go back to CPAP I feel it's an improvement but the pressure seems a little intense. Here is possibly the issue. I am about 15 lbs lighter than when my pressure was set (at 9cm). My ENT says try manually setting the machine at 8cm, which I will do tonight. I will go for a sleep study if this remains unresolved but I'd love to hear some advice. While I'm at it, one mask question. After trying ten or so masks, the mirage activa nasal mask seems to be right for me. I love the loose straps and the "floating" interface. Is there anything even better along these lines? I tried the quattro ff and hated it. Thanks!

[robysue]

First question I have is what's the Auto range you are using? If your min pressure is a lot lower than your prescribed 9cm, that might be the issue with why you feel like you can't get enough pressure on the APAP. If you really want to try to make the APAP work, you might try bumping that min pressure setting up to something like 7cm.

Second, some people do indeed sleep better with straight CPAP than they do with APAP. And maybe you are one of them. So the ENT's idea of using CPAP at 8cm seems like a reasonable idea. You might want to try sleeping with it at that setting for several days before deciding whether 8cm works for you.

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[archangle]

Try staying on APAP and raising the lower pressure limit if you aren't getting enough pressure. Or lowering the maximum if you're getting too much. Many people say to set the minimum pressure to your 95% pressure.

[moresleep]

Having used several different APAPs, I can say I have come to the conclusion their main benefit is that they generally record more data and have software you can get that allows you to see what is happening on your own PC. If used to titrate, they should generally be set within narrow ranges, though, and not allowed to roam all the way from the bottom to the top--they are both too slow in adjusting up to the pressure that is needed (if the range is too wide) and also have a tendency to sometimes "run wild"--that is, roam higher than is needed.

Your ENT's suggestion to set the pressure to a manual 8 cm is probably good. There's at least one study that shows that patients do supprisingly well finding the right manual setting just through trial and error. You might also consider trying an auto range of something like 8-11. If you can download the data, you should be able to see what is going on. Make sure there are no bad mask leaks--those can throw everything off. Then, you can nudge the settings in the direction that seems to make the most sense. If you generaly graphs to post, there are people here who can help you try to interpret them.