Help with pressure change

[aaronk]

I would like to make a pressure change in an attempt to lower my AHI. I'm looking for advice as to what I should try first. I'm doing ok, but have constant low level headaches in the back of my head. Not sure if they are related to sleep or not. I feel fairly well rested, but I don't have much of a reference.

History: I was diagnosed with mild sleep apnea and I've been on BiPap since January 2009. My first PSG showed only 8 events per hour in REM. I don't have a copy of that initial study, but I got bipap right off with a pressure of 10/5. This didn't yield good results with my Rerspironics Auto M. I had a second titration which concluded I needed more pressure recommending 13/7. This didn't work either. Lots of air gulping. About 9 months in, I finally got a reasonable AHI by switching to Auto Bipap mode with Max Ipap of 13, min Ipap 9, max Epap 9, min Epap 5, with a differential of 4. I have averaged 5 AHI for a few years creeping up to 6 more recently. With this auto mode running, my Avg 90% Ipap has been 10.4 and Avg 90% Epap at 7.6. My OSA and Hypops are about equal parts. I think the studies showed I was getting complex apnea with the higher pressure. My current pressure feels quite comfortable, but I do snore a bit on my back and would like to play with my pressure and see if I can get a lower AHI.

So, should I try raising my epap from 5 to 6, or maybe 7? Does that make any sense?

Aaron

Here is a recent page from Encore

https://www.dropbox.com/sh/z9zkyb9b866ke23/rJSC52Cb5V

[robysue]

So, should I try raising my epap from 5 to 6, or maybe 7? Does that make any sense?

On the night that you post, the 90% EPAP is 9. So yes, it may help to increase the min EPAP some since you say that snoring is also a problem.

in light of the past history with aerophagia, I'd suggest going slowly. Bump the EPAP up from 5 cm to 6 cm and leave it there for a week or two. See what the numbers look like, but just as important, keep track of how the stomach feels. If aerophagia raises its ugly head you may need to go even slower and decrease the MIN EPAP pressure down to 5.5 and see if that's tolerable.

If the AHI numbers don't improve after a week or two and aerophagia is NOT an issue, then you could bump the pressure up by another 0.5 to 1.0 cm and leave it there for a week or two.

[aaronk]

So, should I try raising my epap from 5 to 6, or maybe 7? Does that make any sense?

On the night that you post, the 90% EPAP is 9. So yes, it may help to increase the min EPAP some since you say that snoring is also a problem.

in light of the past history with aerophagia, I'd suggest going slowly. Bump the EPAP up from 5 cm to 6 cm and leave it there for a week or two. See what the numbers look like, but just as important, keep track of how the stomach feels. If aerophagia raises its ugly head you may need to go even slower and decrease the MIN EPAP pressure down to 5.5 and see if that's tolerable.

If the AHI numbers don't improve after a week or two and aerophagia is NOT an issue, then you could bump the pressure up by another 0.5 to 1.0 cm and leave it there for a week or two.

Thanks for the help. Sounds like a plan. A question: Is aerophagia bad for the body? At my current pressure I burb a bit taking a bathroom break once per night. Not too bad though. (I'm 61 and have the enlarged prostate thing)

I'm trying to avoid sleeping on my back, but I start loosing sleep thinking about it all night. My shoulders get crampy so I keep alternating sides which doesn't help either. When I do give up and sleep supine, it's very welcome. I know my numbers go down when I side sleep. I couldn't figure out why my numbers got better during a trip to Europe. I was probably more tired plus the pillows in our hotel were really fat which made it hard to sleep on my back. Live and learn.

... Aaron

[robysue]

A question: Is aerophagia bad for the body? At my current pressure I burb a bit taking a bathroom break once per night. Not too bad though. (I'm 61 and have the enlarged prostate thing)

I don't think aerophagia is necessarily bad for the body---unless it's so bad that it is really interfering with your ability to get to sleep and stay asleep or keeping you in pain for much of the day. In the bad old days, that's how bad mine was.

Yours doesn't seem to be triggering any real problems. You just want to keep it that way as you adjust the pressure upwards.

I'm trying to avoid sleeping on my back, but I start loosing sleep thinking about it all night. My shoulders get crampy so I keep alternating sides which doesn't help either. When I do give up and sleep supine, it's very welcome. I know my numbers go down when I side sleep.

If the numbers are acceptable when you sleep on your back AND if you wake up feeling better---in the sense of feeling like you got better (subjective) quality of sleep and you feel rested and refreshed, then I'd say: Sleep on your back. The whole point of the machine is to keep your airways open regardless of your sleep position. It could be that marginally higher numbers on your back are being caused by being more fully relaxed and more deeply asleep. So just what is the difference in the numbers between supine sleep and non-supine sleep when you are using your machine?

[aaronk]

A question: Is aerophagia bad for the body? At my current pressure I burb a bit taking a bathroom break once per night. Not too bad though. (I'm 61 and have the enlarged prostate thing)

I don't think aerophagia is necessarily bad for the body---unless it's so bad that it is really interfering with your ability to get to sleep and stay asleep or keeping you in pain for much of the day. In the bad old days, that's how bad mine was.

Yours doesn't seem to be triggering any real problems. You just want to keep it that way as you adjust the pressure upwards.

I'm trying to avoid sleeping on my back, but I start loosing sleep thinking about it all night. My shoulders get crampy so I keep alternating sides which doesn't help either. When I do give up and sleep supine, it's very welcome. I know my numbers go down when I side sleep.

If the numbers are acceptable when you sleep on your back AND if you wake up feeling better---in the sense of feeling like you got better (subjective) quality of sleep and you feel rested and refreshed, then I'd say: Sleep on your back. The whole point of the machine is to keep your airways open regardless of your sleep position. It could be that marginally higher numbers on your back are being caused by being more fully relaxed and more deeply asleep. So just what is the difference in the numbers between supine sleep and non-supine sleep when you are using your machine?

I was averaging about 7,8 AHI at home in the USA, went to Europe, suddenly had 4 or 5 AHI which I'd never seen before. Later my doc said you do better on your side. My 2nd titration was at 13/7 NOT auto and said side sleeping was cured but on the back, significant flow limitation, soft and frequent snoring, hypops, and occasional obstructive persisted. Centrals were mostly at transitions.

That 13/7 got me more air gulping than I wanted, and my numbers were still sort of high like 8 and 9. My doc said this isn't working and lowered my pressure and switched to auto bipap. Been there for a few years creeping up to 6 AHI.

Bottom line, the best I can tell is that if I ignore possition, I end up with 6 or 7 AHI over the long haul. If I really get aggressive and try to stay on my sides, I get to 4 or 5 average over a week or so, but I can't really sustain that. There was talk of complex (centrals?) at higher pressures, but not fully resolved by anyone.

Do you think a more modern machine such as the S9 will give me much more data for analysis? My Auto M doesn't have as much data as the new bipaps... the next morning on the LCD or downloads. I'm trying to convince doc to score me an S9 from insurance, but insurance wants me to keep using my 4.5 year old Respironics Auto M as long as parts are available.

... Aaron