Newbie needs help! AHI is still high. Optimal pressures, leaks?

[Fevered Ego]

Hello everyone,

I started CPAP therapy August 16th. My sleep doctor basically just handed me my Dreamstation and more or less said "let the machine figure itself out for you". He started me out at auto pressure setting of 5-20. The first couple of nights, I felt like I was suffocating, so he changed my setting to 10-20. This allowed me to actually breathe, but it still took a while to get used to the machine. I was using the AirFit nasal pillows for the first couple of weeks, but I could not get used to using a chin strap, so I requested the AirTouch Full Face Mask. This is so much more comfortable for me, but I'm not seeing too much of an improvement in my sleep or my AHI. I had my followup a couple weeks ago and he changed the pressure again to 11-14. A few days ago, I contacted my doctor about raising my pressure, as I wasn't noticing an improvement, so he changed it again to 11-18 (seemed odd that he would only raise the maximum pressure instead of the minimum, but then again, "he's the professional", right?)

I'm at the point where I've gotten almost 100% comfortable with using the machine and I love my FFM as opposed to the Nasal pillows, but I'm still not getting the quality of sleep that I want. Can anyone tell from these charts if I'm leaking too much? Does my pressure range look sufficient? Can I ditch my sleep doctor if insurance is paying for my machine?

These charts are in order Sunday night, Monday night, and Tuesday night....





Also, in last night's data, there's a long period of time in the middle of the night where there appears to be a lot of events, but my pressure stays stuck on the minimum of 11. Does this seem right?

Any help is appreciated, and honestly, I trust you guys more than my sleep doctor.

P.S. - at-home sleep test, AHI=16. No in-lab study done.


Thanks in advance!!

Fevered Ego

[Wulfman...]

Try increasing your minimum pressure one centimeter for a week and see if that helps. If it does, do another increase and keep monitoring. If things get better, you know you're going in the right direction.

Regarding your question about pressure not increasing.........
The primary events that increase pressure are Flow Limitations and Snores. If you don't have many/any of them, your pressure can't get to where it needs to be soon enough (if at all) and the apneas and hypopneas take place.


Den

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[Fevered Ego]

Try increasing your minimum pressure one centimeter for a week and see if that helps. If it does, do another increase and keep monitoring. If things get better, you know you're going in the right direction.

Thank you Den! I'm going to try this and see how it goes

[longwood]

it seems that more pressure needed to overcome the OSA. I would like to try this first : min 12, max 15-16

[Fevered Ego]

I increased my minimum to 12 about a week ago and everything was going fine and I was actually starting to see an improvement until this morning when my DME called to inform me that my doctor had put in an order to change my minimum pressure back down to 11. Am I obligated to stay with this doctor and DME if my insurance is renting my machine from the DME for the first year, until they purchase it for me? Why would my doctor change my pressure back? He didn't even call or email me about, just had the DME change it remotely. So confused.

[ChicagoGranny]

I increased my minimum to 12 about a week ago and everything was going fine and I was actually starting to see an improvement until this morning when my DME called to inform me that my doctor had put in an order to change my minimum pressure back down to 11. Am I obligated to stay with this doctor and DME if my insurance is renting my machine from the DME for the first year, until they purchase it for me? Why would my doctor change my pressure back? He didn't even call or email me about, just had the DME change it remotely. So confused.

Don't say a word to anyone. Just change it back to 12.

Screw 'em. It's your health and your CPAP therapy.

[Fevered Ego]

Don't say a word to anyone. Just change it back to 12.

Screw 'em. It's your health and your CPAP therapy.

Thanks! That’s what I thought too! I have a follow up with the doctor later this month. Do I just go into it expecting to be questioned about “tampering” with my machine and just play dumb? Or can I cancel altogether? How do I disconnect my doctor from the DME so that he can’t push any changes through? Or could this possibly just end up being an unending back and forth between myself and the doctor changing pressures?

[ChicagoGranny]

Or can I cancel altogether?

In my case, I have to see the doc once per year to get her to renew my prescription for supplies and confirm I am still using CPAP. This is needed so my insurance (Medicare Advantage) will pay for masks, etc.

My doc has been told in no uncertain terms that no one is to touch my machine or my machine's settings except me. She was close to "firing" me when that first came up. Our relationship improved after a couple of years.

Think about why you need to see your doc and how often. If he brings up you changing the settings, tell him you do better with the higher minimum. If he objects, go along with him. But, keep using the settings you want.

Or, you can go to war with him. Just figure out what sleep doc you will see if this one fires you.

[palerider]

Do I just go into it expecting to be questioned about “tampering” with my machine and just play dumb?

"You stupid patient, you changed something! RAWR RAWR RAWR"

"Doc, have you forgotten... YOU WORK FOR ME... Either you *HELP* me, and we work together or I find another doctor".

*GOOD* doctors are thrilled that their patients are learning how to maximize the effectiveness of their treatment.

[Wulfman...]

Don't say a word to anyone. Just change it back to 12.

Screw 'em. It's your health and your CPAP therapy.

Thanks! That’s what I thought too! I have a follow up with the doctor later this month. Do I just go into it expecting to be questioned about “tampering” with my machine and just play dumb? Or can I cancel altogether? How do I disconnect my doctor from the DME so that he can’t push any changes through? Or could this possibly just end up being an unending back and forth between myself and the doctor changing pressures?

As palerider noted, the doctors work for YOU. You and your insurance are paying for their services.

It works the same with prescription medications. They can prescribe a dosage for you, but you don't have to take any or all of what they're prescribing.
First question........ Is the pressure of 12 showing better results than 11 did? If so, print out your reports, take them along with you and if push comes to shove, you can pull them out to prove your point.
Along with that, (if necessary) you can tell the doc that you don't want anybody else changing your machine......remotely or otherwise.
There's nothing "magic" about one centimeter here or there (unless one setting works better than the other).
People using auto CPAPs typically get their pressures adjusted more than that every night.

If your doctor doesn't want to work for you, get another one or do without like many of the forum members who came to that conclusion. I kicked mine to the curb about a month after I started my therapy. He prescribed me a pressure of 18 cm. and I changed mine almost immediately to 10 cm. and had very good results. I had a fully data-capable machine and the software to monitor my therapy. Just "garden variety" OSA with no particular problems, so I came to the conclusion that I was quite capable of taking charge of my own therapy.


Den

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[djams]

I increased my minimum to 12 about a week ago and everything was going fine and I was actually starting to see an improvement until this morning when my DME called to inform me that my doctor had put in an order to change my minimum pressure back down to 11.

Trying to find a silver lining here. The thing that shocks me the most here is that your doctor is monitoring your therapy! This is a positive.

I know for sure that this didn't/doesn't happen at the sleep factory I go to (I'm just over 6 months in). Considering this, maybe give your doc the benefit of the doubt and at least call and ask to have a discussion about your min pressure - and any other settings you'd like to change. And who knows who really issued the order?

My personal experience on this topic at my recent 6 month follow up was positive. I explained why I'm doing what I'm doing, and showed the PA SleepyHead on my laptop. They are OK with me making changes - even enthused.

YMMV.