Tweaking pressure - side effects

[MJKelleher]

I started on CPAP on March 2, with a fixed pressure of 12cm. Over those first few weeks I tweaked the ramp (now off), humidity, position, the easy stuff, and watched the data. The last two weeks at those settings, my AHI was 4.97, split pretty evenly between OA, CA and H. I decided to see if I could do better.

Starting June 1, I switched to APAP, min 11, max 15. Most nights I'm bumping up against the max pressure, AHI is 4.4, all the components have dropped but the CA dropped most.

Now for the weird part.

Even before I started this, I slept on my side. Usually on my left, sometimes on the right, depending on which side of my nose was most blocked. (Darned sinuses...) When I started CPAP, I woke up stiff and a bit sore, but from talking to the tech at my titration study, attributed it to actually not moving when I slept. After a few days I got used to that, and it went away.

Ever since I started with APAP, I've been falling asleep on my side and waking up on my back, with it aching - a lot. If I wake up during the night (usually 1-2 times), I'm on my back and it hurts. If I remember to take something, like ibuprofen, before going to bed it helps some, but doesn't eliminate the ache, and I'm still on my back when I wake up.

Any ideas on why this is happening, is there something I can and should be doing differently?

Many thanks for all the great info on this board!

MJ

[Pugsy]

Only thing I can think of is maybe the pressure variations in the APAP mode are slightly disruptive to your sleep and maybe causing some tossing and turning that you aren't aware of....or maybe you sleep so well on it on your side that you need to move on to your back for relief but you don't wake up till the worse pain from supine sleeping happens...
I guess it could go either way.

I have increased pain if I end up on my back so I am going to do some experiments to see if I can stay on my side more.
Unrelated to AHI and therapy which is pretty much equal and I happen to do better with my events in auto adjusting mode because most of the night I only need 10 or 12 cm pressure but usually at least once a night I end up getting to 16 cm or a little more and if I were to use straight cpap mode I would need to use that higher 16 cm all the time and I don't want to do that.

[LSAT]

If you are 'bumping up against max pressure' as you say....the pressure needs to be set higher. 15 may not be high enough to stop an event at times.

[MJKelleher]

Thanks, Pugsy, those are good ideas. I wouldn't mind waking up on my back if it didn't also hurt!

LSAT, this is an experiment for now, and for the short time I've been at these pressures there's a small improvement over the 12cm I was at before. I'm going to let it alone for now and see how the numbers trend. Some nights I don't hit 15, want to see if those nights happen more often.

[jweeks]

If you are 'bumping up against max pressure' as you say....the pressure needs to be set higher. 15 may not be high enough to stop an event at times.

Hi,

That was my first thought, too. Then I realized that putting an upper limit on the pressure was probably the reason that the central events were way down. I wonder if MJ is in a situation with complex apnea? If so, a BiPAP might be a possible answer...a higher pressure on inhale to knock down the A events, and a lower pressure on exhale to keep the CA events at bay.

-john-