Brand new - looking for any input/tips

[zonker]

Here's my graph from Saturday. It seems aerophagia is going to be an ongoing issue. I lowered it down to 7 last night which seemed to be a little better and will post that graph next. Hopefully I can get some feedback.

aerophagia is a bear to have to deal with. it's been the thorn in my side for many years.

as pugsy says, leave the pressure alone until we can see just what more pressure can or will do.

when the time comes to raise your minimum pressure, you may want to raise just a very little each time. your machine is capable of increases of .2 and if you're like me, that's what you'll do. i raised mine SLOWLY and i do mean SLOWLY from my starting pressure of 7 all the way up until what i'm using today, which is 15.4. took me months to get there.

it's good to have low ahi numbers but they don't mean diddly if you can't get a good stretch of sleep. patience will win out in the end.

good luck!

[mike291068]

So what were the results of the home sleep study in terms of AHI and what your oxygen levels did?

Funny(not so) thing is I never heard back from Doc regarding results. I was told by his assistant I had minor obstructive sleep apnea. I did manage to get my CPAP equipment supplier to send me results. I will try to post on here -not sure how legible it is.

[mike291068]

So what were the results of the home sleep study in terms of AHI and what your oxygen levels did?

[mike291068]

not sure if this even useful?

[Pugsy]

Ahhh....a home study that didn't measure actual sleep. I hate those.
Yes, they can under estimate events but they can also over estimate events sometimes too.
Don't blame you for wondering about doing an in lab sleep study but they aren't perfect either....been there and done that myself.
It's not always so easy to sleep in that foreign environment even with sleep aids.

I think if it were me I would back up and go slower with the pressure increases since they do cause aerophagia issues.
Maybe work up more slowly and at the same time work on improving sleep quality to lessen the chance of arousal breathing messing with the results.

[mike291068]

Exactly! I have a hard enough time sleeping in my bed never mind a hospital! I will back it up I guess. Aside from the aerophagia, is there anything else I should be overly concerned with when raising pressure? Thank again

[Pugsy]

No...the only real negatives to more pressure are the more common aerophagia issues...sometimes some leak issues and on really rare occasions central apnea development (which I don't see happening in your situation).

Back up and worry about improving sleep quality first. Do whatever you need to do to give yourself a better chance of having minimal wake ups.

Gotta get the sleep first before any of this matters.

Work on learning how to figure out awake vs asleep breathing. I have a few posts with some quick clear examples but I wasn't smart enough to save them or combine them for easy reference. If I have time and feel like it later I will see if I can find them to help you learn. I am having vertigo issues tonight so makes reading and computer work a bit of a challenge.
It really isn't all that hard once you learn what asleep breathing looks like because irregular breathing is easy to spot.

[mike291068]

Back up and worry about improving sleep quality first. Do whatever you need to do to give yourself a better chance of having minimal wake ups.

Gotta get the sleep first before any of this matters.

Apparently I am a dummy! I thought the whole point of CPAP was to solve this problem! Am I crazy to think that the wakeups are due to the sleep apnea itself?? So confused

This is all very strange to me as I do feel better which makes little sense as I think I am waking up more now but I thought it was due to not having the correct settings worked out yet.

Thanks again - I will look at those videos again.

[Pugsy]

There are respiratory related arousals and there are what are called spontaneous arousals which means no known cause but definitely not related to the airway or any airway issues.

We can wake up from a mile long list of problems but cpap only fixes problems related to any airway issues.

CPAP can only fix bad sleep when the bad sleep is from airway/apnea issues. Doesn't do a damn thing for other causes of bad sleep no matter how much we might want to put all our sleep problems in the sleep apnea basket.

Your wake ups may or may not be related to airway issues and unfortunately you had a sleep study done that couldn't even tell if you were asleep or not. There are home studies that do measure sleep status and sleep stages but the one you have didn't do that.

I have crappy sleep quality. Lots of wake ups but it's from pain or something else. Not related to airway issues at all.
CPAP can't fix my bad sleep from pain....I wish it could but it can't.
90% of any AHI that I have will be from arousal false positive flagging. I have my OSA well treated and at least I don't have desats down to 70% and I don't wake up with massive killer headaches and I don't wake up to pee every hour on the hour.....but I still wake up often from pain. It is what it is.

Your situation is further complicated by the fact that if (big IF) your wake ups are from the airway issues that you may need a pressure that comes with its own set of problems...the aerophagia stuff.
So you can't just jump in and see if more pressure fixes the problem or not. Heck, we don't even know for sure that it's fixable with more pressure at this point. It's an easy experiment though unless someone has a problem with more pressure....and you do.
So you have to back up and proceed more slowly.

[mike291068]

Ok - it's coming together, thanks for the detailed explanation. Makes sense now. I backed pressure off to 6 last night, Still had 2-3 wakeups but other than that slept relatively well. Will post graph shortly.

[Pugsy]

Oh.....Some wake ups are a normal part of the sleep cycle. It's quite normal to wake up after a REM cycle. Normally we don't remember waking up because the time awake is so brief but sometimes we do remember a very brief awakening.
As long as not prolonged and not an awful lot of them we don't worry about 2 or 3 wake ups.

[mike291068]

That makes sense - it seems I am waking after my REM cycles, oftentimes prolonged, last night was moderate for me. I wrote down my awake times and will be going through data later. Is there any benefit to lowering the max pressure at this point. People seem to have conflicting opinions on this. Thanks!

[Pugsy]

The maximum setting has no bearing on response time for anything unless you happen to be up high and the machine decides it no longer needs high and takes its own sweet time going back down.
None of the changes (up or down) are done in the blink of an eye anyway.
If the machine could go to 100 and it never went above 10....it makes no difference if you set the max to 100 or 10 in terms of how the machine goes about doing its job.

Some people prefer to keep a tight range. Others prefer to let the machine sort it out.
The machine won't go up without what it thinks is a good reason to go up. Now sometimes that reason isn't as important as what happens when the machine goes up. Example....some snores or flow limitations cause the pressure to go up but then a person develops aerophagia issuses or sometimes centrals because of the higher pressures. So those issues end up being more of a problem than a few snores or flow limitations might be. Sometimes we have to make compromises when problems arise. Pick the lessor of 2 evils kind of thing.

I don't have a problem with centrals nor do I have any real aerophagia issues so I keep the max wide open and let the machine sort it out.

If your machine never ever goes to whatever max you have it set at....moot point. Doesn't really matter. Won't change the response algorithm one way or the other. It does give some people peace of mind though to limit it and others peace of mind to know that with it wide open should something weird happen and they need more pressure then the machine could go there.
Peace of mind is priceless.

[palerider]

Is there any benefit to lowering the max pressure at this point. People seem to have conflicting opinions on this. Thanks!

Unfortunately, there are a lot of ignorant, and indeed stupid opinions out there.

Your max pressure could be a million,and it wouldn't make *any* difference at all to you.

Typically, the only legitimate reasons to lower the max pressure are if you're having aerophagia, (rare) or if you have significant pressure emergent central apnea (very rare).

So, no there is zero benefit to lowering the max pressure. There is a potential detriment though, if you've lowered the max, and have a bad night, you may prevent the machine from being able to do anything to make your sleep better.

If you weigh 200 pounds, is there a benefit to getting on a scale with a Max of 250lbs vs one with a Max of 500lbs? No. No benefit at all.

There is, however, a benefit in raising the min pressure, that being fewer breathing events, fewer arousals, better sleep, and more effective EPR since when your pressure is 6, it can only give you two cm of exhale relief.

[mike291068]

This all makes sense to me. I believe someone on another thread/site was claiming that having a narrower range somehow affects the algorithm in one way or another. The way you both explain it makes complete sense to me. It seems people are shocked, even dismayed when I post my range but I assume it is more because of the minimum than the range necessarily.