Reducing hypoapnea's: Increase or decrease pressure?
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Reducing hypoapnea's: Increase or decrease pressure?
Reviewing today's data had 17 hypoapneas. The minimum auto setting on my system One is set to 6.0. Most of the hypo's occurred at a pressure of 6.0. Maybe a third happened at 7.0. I've only been on cpap for a few weeks and might be too early to make changes, but wondered if increasing the pressure or decreasing the pressure .5 would have any significant effect lowering the hypo's. It's my understanding keeping the pressure .5 or just below the pressure when a hypoapnea occurred is ideal. Any recommendations?
PR System One & Humidifier
Re: Reducing hypoapnea's: Increase or decrease pressure?
Hi Tech Guy,
A Hypopnea is a partial obstruction. If one were experiencing these and/or full obstruction events it's reasonable to consider an upwards pressure change unless you're also suffering from a lot of (real) central apneas. Our systems can't tell if we have CA's ... they report Clear Airway events, which has the same abbreviation but that doesn't mean it is the same. A central apnea occurs when the brain fails to command a breath when it should. It is thought that most/all of us have some CAs during sleep, so their presence is not necessarily a sign of a problem. If I saw a lot of Clear Airway events while I knew I was asleep I would want my doctor to help me be sure they were not centrals. When you raise pressure on some patients (fairly rare) it can lead to more CAs.
Here's a better question: How are you feeling? 17 events over a full night isn't an awful problem in and of itself.
A Hypopnea is a partial obstruction. If one were experiencing these and/or full obstruction events it's reasonable to consider an upwards pressure change unless you're also suffering from a lot of (real) central apneas. Our systems can't tell if we have CA's ... they report Clear Airway events, which has the same abbreviation but that doesn't mean it is the same. A central apnea occurs when the brain fails to command a breath when it should. It is thought that most/all of us have some CAs during sleep, so their presence is not necessarily a sign of a problem. If I saw a lot of Clear Airway events while I knew I was asleep I would want my doctor to help me be sure they were not centrals. When you raise pressure on some patients (fairly rare) it can lead to more CAs.
Here's a better question: How are you feeling? 17 events over a full night isn't an awful problem in and of itself.
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Re: Reducing hypoapnea's: Increase or decrease pressure?
Hi khauser, Been on cpap a few weeks. Still paying back the sleep debt and it might be a while. Get days where I still want to take a nap in the middle of the afternoon and generally tired in the middle of the day. At least I'm not waking up totally exhausted anymore lol. Clear airway was 10 events and OA 2. Still dealing with memory loss and cognitive impairment remembering things etc. Reasonably comfortable with the mask and falling asleep. Was thinking about kicking up the pressure .5 and see if there is any reduction in the hypos while keeping an eye on the rest of the data. Curious to see if it makes things better or worse.
Last edited by Tech Guy on Fri Oct 11, 2013 10:16 am, edited 1 time in total.
PR System One & Humidifier
Re: Reducing hypoapnea's: Increase or decrease pressure?
Tech Guy wrote:Reviewing today's data had 17 hypoapneas. The minimum auto setting on my system One is set to 6.0. Most of the hypo's occurred at a pressure of 6.0. Maybe a third happened at 7.0. I've only been on cpap for a few weeks and might be too early to make changes, but wondered if increasing the pressure or decreasing the pressure .5 would have any significant effect lowering the hypo's. It's my understanding keeping the pressure .5 or just below the pressure when a hypoapnea occurred is ideal. Any recommendations?
Unless this is happening on a regular basis, I would leave the pressure alone. What is your average AHI?
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Re: Reducing hypoapnea's: Increase or decrease pressure?
AHI last night 4.02. Think it's an average taken over the duration of the last few weeks? The hypo's have been averaging 10 to 30 a night.
PR System One & Humidifier
-
Wulfman...
Re: Reducing hypoapnea's: Increase or decrease pressure?
You need to increase your minimum pressure.Tech Guy wrote:AHI last night 4.02. Think it's an average taken over the duration of the last few weeks? The hypo's have been averaging 10 to 30 a night.
Den
.
Re: Reducing hypoapnea's: Increase or decrease pressure?
Remove the Clear Airway index from the AHI when evaluating possible pressure changes/needs unless the CAs are present in a huge number (over 5 per hour and you are sure you were asleep when they occurred) because CAs won't be expected to be reduced with a slight increase in pressure. Also remember that there is a small percentage of people who will actually have centrals possibly increase with increased pressure. Statistically the number is maybe 15% of the people will have centrals increase in response to cpap pressure...so there's not a huge risk but do keep an eye on them.
Let's use a nice easy example...AHI 4.0.... and that is composed of CA index of 1....OA index of 1 and hyponea index of 2. Over 6 hours of sleep that would be average 6 CA events...6 OAs and 12 Hyponeas. Remove the CA index and the obstructive component (which is the only component that we increase the pressures for) is 3 per hour average. As it stands it is within acceptable limits and unless sleep is highly fragmented because of those events there is no critical need to reduce the numbers.
AHI numbers will vary from night to night. Heck, even now I might have AHI 0.6 one night and the very next night have AHI 4.2 and not change a thing and I don't go changing things when I see a not so pretty report. I have even had an AHI get reported over 7.0 on occasion and not change anything and have it be 90% obstructive.
The need to nap during the day or general fatigue isn't 100% always tied to the AHI. There are people who consistently have AHIs less than 1.0 and they still feel like crap. There's just more to feeling rested than a little AHI number.
For me I found out that how I might feel the next day was related more to hours of good sleep than the AHI. If I get more than 7 1/2 hours of good sleep I won't have any strong need for a nap during the day but when I get less than 7 1/2 hours of sleep then I will almost always get really sleepy around 4 PM. No matter what the AHI is.
Your doctor has you on APAP mode with a minimum and maximum range. I forget why APAP but was it because there was no official titration study done? The minimum pressure is the most critical pressure and the idea behind it is have the minimum pressure set so that it does a good job holding the airway open to prevent the majority of the collapses of the airway and yet be able to increase to where it might need to go quickly enough to get the job done to prevent airway tissues collapses that happen to need a little more pressure for some reason or other (usually supine sleeping or REM related events or both). The machine can't go from 5 cm to 10 cm in 30 seconds to prevent a collapse that needs 10 cm to keep the airway open. This is why setting apap with a more or less wise open range 4 to 20 isn't a good thing to do. It might work great if you only need 7 or 8 cm to get those stubborn events but it won't be effective if you need 10 or 12 or more to keep the airway open. The machine simply can't get there quickly enough and the event comes and goes before the machine can get to where it needs to be.
I don't know if you reduce the number of hyponeas if you will feel better or not. It is possible that they will reduce in time with no change in pressure. There is some truth to the give it time thing. I personally saw my AHI reduce by 50% when I changed to bilevel over about 2 months with no change in anything once I got things dialed in close so that I had AHI around 4.0 but on a rare occasion saw less than 1.0 AHI...so I knew it could work...over the 2 months that rare less than 1.0 number became for of a regular face and the higher AHI became the rare face and I changed nothing.
A small change in the minimum from 6.0 to 6.5 when using APAP mode is a tiny change and unlikely to cause any problems.
Will it help resolve your issues? That's really an unknown because we don't know for sure what the cause for your issues are.
Also remember that some people find that the pressure changes in APAP mode actually disturb sleep and anything that disturbs sleep at any level can affect how a person feels. So sometimes cpap mode or apap mode with a tight range might be an option to consider.
If those hyponeas are disturbing your sleep then reducing their numbers might help but just remember that there's more to feeling better than just a number.
Hours of sleep. If consistently less than 7 hours of sleep...most people aren't going to feel optimal...less than 6 hours there's no way we can expect to feel like we want to feel with that extra energy. I am continually amazed by the people that tell me they get 5 hours of sleep with the machine and complain when they don't feel like running that marathon. Heck, even on my best days I don't feel like running a marathon but at least I don't feel like I just ran one and got run over by the bus at the end of it.
Is the sleep fragmented with lots of wake ups for any reason. Wake ups for any reason mess with the normal sleep architecture that we need so that we get the right % combination of each sleep stage as it is supposed to cycle through
Meds. Research any meds (even OTC) to see if there are any potential side effects that might be in the general energy, fatigue, insomnia..whatever that might affect sleep quality and/or how we might feel during the day.
Pain.
General discomfort.
Mask issues.
and a long list of other stuff.
Often people want to put everything in the OSA basket and assume that once they get great AHI numbers that they should be feeling like they can run a marathon and unfortunately a lot of the time people are expecting the cpap machine to fix things that it simply can't fix.
Let's use a nice easy example...AHI 4.0.... and that is composed of CA index of 1....OA index of 1 and hyponea index of 2. Over 6 hours of sleep that would be average 6 CA events...6 OAs and 12 Hyponeas. Remove the CA index and the obstructive component (which is the only component that we increase the pressures for) is 3 per hour average. As it stands it is within acceptable limits and unless sleep is highly fragmented because of those events there is no critical need to reduce the numbers.
AHI numbers will vary from night to night. Heck, even now I might have AHI 0.6 one night and the very next night have AHI 4.2 and not change a thing and I don't go changing things when I see a not so pretty report. I have even had an AHI get reported over 7.0 on occasion and not change anything and have it be 90% obstructive.
The need to nap during the day or general fatigue isn't 100% always tied to the AHI. There are people who consistently have AHIs less than 1.0 and they still feel like crap. There's just more to feeling rested than a little AHI number.
For me I found out that how I might feel the next day was related more to hours of good sleep than the AHI. If I get more than 7 1/2 hours of good sleep I won't have any strong need for a nap during the day but when I get less than 7 1/2 hours of sleep then I will almost always get really sleepy around 4 PM. No matter what the AHI is.
Your doctor has you on APAP mode with a minimum and maximum range. I forget why APAP but was it because there was no official titration study done? The minimum pressure is the most critical pressure and the idea behind it is have the minimum pressure set so that it does a good job holding the airway open to prevent the majority of the collapses of the airway and yet be able to increase to where it might need to go quickly enough to get the job done to prevent airway tissues collapses that happen to need a little more pressure for some reason or other (usually supine sleeping or REM related events or both). The machine can't go from 5 cm to 10 cm in 30 seconds to prevent a collapse that needs 10 cm to keep the airway open. This is why setting apap with a more or less wise open range 4 to 20 isn't a good thing to do. It might work great if you only need 7 or 8 cm to get those stubborn events but it won't be effective if you need 10 or 12 or more to keep the airway open. The machine simply can't get there quickly enough and the event comes and goes before the machine can get to where it needs to be.
I don't know if you reduce the number of hyponeas if you will feel better or not. It is possible that they will reduce in time with no change in pressure. There is some truth to the give it time thing. I personally saw my AHI reduce by 50% when I changed to bilevel over about 2 months with no change in anything once I got things dialed in close so that I had AHI around 4.0 but on a rare occasion saw less than 1.0 AHI...so I knew it could work...over the 2 months that rare less than 1.0 number became for of a regular face and the higher AHI became the rare face and I changed nothing.
A small change in the minimum from 6.0 to 6.5 when using APAP mode is a tiny change and unlikely to cause any problems.
Will it help resolve your issues? That's really an unknown because we don't know for sure what the cause for your issues are.
Also remember that some people find that the pressure changes in APAP mode actually disturb sleep and anything that disturbs sleep at any level can affect how a person feels. So sometimes cpap mode or apap mode with a tight range might be an option to consider.
If those hyponeas are disturbing your sleep then reducing their numbers might help but just remember that there's more to feeling better than just a number.
Hours of sleep. If consistently less than 7 hours of sleep...most people aren't going to feel optimal...less than 6 hours there's no way we can expect to feel like we want to feel with that extra energy. I am continually amazed by the people that tell me they get 5 hours of sleep with the machine and complain when they don't feel like running that marathon. Heck, even on my best days I don't feel like running a marathon but at least I don't feel like I just ran one and got run over by the bus at the end of it.
Is the sleep fragmented with lots of wake ups for any reason. Wake ups for any reason mess with the normal sleep architecture that we need so that we get the right % combination of each sleep stage as it is supposed to cycle through
Meds. Research any meds (even OTC) to see if there are any potential side effects that might be in the general energy, fatigue, insomnia..whatever that might affect sleep quality and/or how we might feel during the day.
Pain.
General discomfort.
Mask issues.
and a long list of other stuff.
Often people want to put everything in the OSA basket and assume that once they get great AHI numbers that they should be feeling like they can run a marathon and unfortunately a lot of the time people are expecting the cpap machine to fix things that it simply can't fix.
_________________
| Machine: AirCurve™ 10 VAuto BiLevel Machine with HumidAir™ Heated Humidifier |
| Additional Comments: Mask Bleep Eclipse https://bleepsleep.com/the-eclipse/ |
I may have to RISE but I refuse to SHINE.
Re: Reducing hypoapnea's: Increase or decrease pressure?
Appreciate the reply Pugsy. It might be too early to change things but wanted to explore some options. My average pressure is 7.4% with the minimum at 6.0 and max 15. Think it spiked twice last night to 9. Seem to be hovering around the minimum most of the time. The A-flex is set to 3 (on a scale of 1 to 3) unsure what these values mean. Certainly don't feel like a million dollars lol. Haven't noticed any real difference using the cpap other than not waking up totally wiped out anymore. There are no pills or meds taken but did have an experience years ago where my chemistry got messed up from medicine the hospital gave me and never recovered. I'm also at high altitude for a short period of time. Going from sea level to 7,000 feet complicated the O2 deprivation even more. Have had fragmented sleep for a long time and never got sufficient REM to feel rested. Some nights are better than others but do toss and turn a few times during the night. Should I change the A-flex setting or consider standard cpap mode with a constant pressure? Just not feeling that rested with 7 to 8 hours of sleep a night. Know it's early and time will tell. Didn't have any official titration study other than the one night home sleep study. My original test results indicated for the home sleep study showed 157 events (47 Obstructive, 0 Centrals and 110 Hypoapneas) (17.3 hr). AHI of 24.8 an hour. Supine AHI was 11.9 an hour.
PR System One & Humidifier
Re: Reducing hypoapnea's: Increase or decrease pressure?
AFlex setting is strictly what feels good to you. Whatever gives you a natural or as close to natural and comfortable breathing rhythm.
You have a PR System One machine. If you think you might want to give cpap mode a try I would still use APAP mode but I would set the minimum to equal maximum or a 1 or 2 cm difference between minimum and maximum because in APAP mode the PR S1 flags Flow limitations and in cpap mode it doesn't bother to flag them and flow limitations are something the machine will use to decide if it needs to increase the pressure. Since in cpap mode there can't be any change in pressure Respironics has elected to simply turn off that recording function so it shows 0.0 all the time for Flow Limitations and can give the appearance that there are no FLs when in reality there could be a lot of the little buggers. In my way of thinking if they are important enough for the machine to increase the pressure then they are important enough to know if they are present even if the machine won't do anything.
You have a PR System One machine. If you think you might want to give cpap mode a try I would still use APAP mode but I would set the minimum to equal maximum or a 1 or 2 cm difference between minimum and maximum because in APAP mode the PR S1 flags Flow limitations and in cpap mode it doesn't bother to flag them and flow limitations are something the machine will use to decide if it needs to increase the pressure. Since in cpap mode there can't be any change in pressure Respironics has elected to simply turn off that recording function so it shows 0.0 all the time for Flow Limitations and can give the appearance that there are no FLs when in reality there could be a lot of the little buggers. In my way of thinking if they are important enough for the machine to increase the pressure then they are important enough to know if they are present even if the machine won't do anything.
_________________
| Machine: AirCurve™ 10 VAuto BiLevel Machine with HumidAir™ Heated Humidifier |
| Additional Comments: Mask Bleep Eclipse https://bleepsleep.com/the-eclipse/ |
I may have to RISE but I refuse to SHINE.
Re: Reducing hypoapnea's: Increase or decrease pressure?
I have consulted with the cardinals on this matter and we are in agreement. You must discontinue cpap for 7 days. Fast on the 8th day and begin anew on the 9th day.
Re: Reducing hypoapnea's: Increase or decrease pressure?
LOL, all that's going to do is delay the inevitable. It would be a 'cardinal sin' to stop treatment at this juncture .Ptastic wrote:I have consulted with the cardinals on this matter and we are in agreement. You must discontinue cpap for 7 days. Fast on the 8th day and begin anew on the 9th day.
PR System One & Humidifier
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Perez Turner
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- Joined: Thu Oct 10, 2013 10:52 pm
Re: Reducing hypoapnea's: Increase or decrease pressure?
This is good news and worthy comments by the participants. I am happy to find an informative topic to manage pressure. Thanks for sharing this.
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