Pressure Of 12 - Is Ramping Advised?

[Snooks]

My Sleep Dr was annoyed that I got an Auto Machine but I did so knowing that it can also be used as a fixed machine if desired.

I must admit to being not overly happy nor satisfied with him, but for a while I will do what he says and give him a chance to prove that he knows his game and can help me. Whether I like him or not doesn't really matter, but I must have (gain) confidence in him if our relationship is going to continue.

He wants me to use a fixed pressure of 12 and start with a 15 minute ramp which I would probably do starting around 8.6. I have only done 3 very fragmented evenings on CPAP so far and although not overly comfy, I am coping. I have seen lots of people say that it is better to just start the pressure rather than ramp up. Is ramping the way to go or do you think that I could possibly handle 12 from the start? I find the 8.6 has been ok and 12 is not that much more? Or it doesn't sound much more (lol).

Just after some opinions, we are aiming to negate some possibly treatment enduced CA's.

Thanks

[Snooks]

I forgot to post two Oscar Charts. (They are out of order)

[khauser]

Ramping is not going to positively impact your treatment unless it makes you able to be treated when otherwise you wouldn't. Some people feel like they can't breathe properly at a higher pressure, but don't get adequate treatment at a lower pressure. That's when ramping can help.

I know Pugsy would be telling you to look at the flow rate information to see if you have 'real' centrals, or the machine being confused because you weren't really asleep.

When you say negate treatment induced CAs, is that only based on what we are seeing here?

Did you have a sleep study?

[Snooks]

Hi Khauser,

I had a sleep study indicating 75 events per hr. I then had a Titration study, The breakdown of events on the report only indicated 3-4 CA's the whole evening. Rest were OSA and a few listed as Hyponeas.

The CA's only seem to happen when i am trying to get to sleep. The Sleep Dr believes they are treatment induced and will go away in time, but they are uncomfy because i notice them happening. He wants me to have fixed pressure of 12 and suggested using the ramp to start off. He believes that having no change in the air flow should result in them going away in due course. He may have explained it more technically but that was the gist of it.

[Julie]

I would lower your min. for now to 7, raise the max to 15, and not use the ramp at all (getting to 7 over 15 mins - from the default machine's low of 4 seems a waste of time to me) so I'd try without it. Unfortunately many doctors don't really understand enough about the machines as such and sometimes prescribe numbers that don't make much sense, but certainly trying new ones that, if anything, are lower than you started at is very unlikely to cause trouble for a few nights.

[Snooks]

The only concern i have is that the Sleep Dr wants to try and reduce the ups and downs of pressure, he said something about he believes that this is the cause of the issue. Something about the Co2 being caused to be cleaned and washed away.

Thanks for your suggestion, i will check it out

[Julie]

Your doctor does not understand how the machines work and is not helping you.

You need to find a new doctor, pref. a pulmonologist or at least a neurologist with sleep disorder training.

Experts on this forum - really - can help you to do and feel better.

[Snooks]

Hi Julie,

I tend to agree and thats why i come here, having lurked for a month I have no doubt that many people in here have some great knowledge.

The problem is that as I said in the first post, I don't feel comfy with him, I have toyed around at changing, but given he is a Lung Respitory Specialist, specialiszing in Sleep Therapy, i'm finding it hard to just dump him. Even moreso, after having made many calls and seeking an appointment elsewhere, the earliest i can get in around here is 16th March next year. That is too far off. So i am stuck at making a decision on the little knowledge that i have and with gut feelings to guide me.

This guy also looks after my Lungs and not only the sleep aspect so it is very concerning.

I appreciate your comments and I guess that I have a lot of thinking to do Can i ask why you think sitting on a flat 12 would worsen the condition? You also said that the default ramp rate is 4??? Cant i start at at 8 or 9 and ramp from there?

[Julie]

What I think is that you should download (free) Oscar (see top of forum) so we can see what's going on... you'll post results in this thread according to directions, then we'll advise what might come next - the software's the best there is and gives lots of info (was designed by a member orig. as 'Sleepyhead' but has now morphed to Oscar). You'll need any old SD card to use in your machine and which then goes into your computer the next day (but do go with instructions - and if there's a problem somewhere, please ask). Arbitrarily using a fixed settting of 12 (on a machine that does Apap! is dumb except in a few instances where it's been shown to help, but I would not assume you otherwise need it until further notice).

[Pugsy]

Cant i start at at 8 or 9 and ramp from there?

You can indeed increase the ramp starting pressure to up around 8 or 9 if you wish. It's easily adjustable from the default from the factory ramp starting point of 4 cm.

Why not give the doctor's idea at least a try?
It likely will have zero impact on those centrals and then you can say "I told you so".
It might actually make them worse and you would have a bigger "I told you so".

12 cm fixed is probably more pressure all night than you really need to keep the airway open but some docs are stuck in the dark ages about fixed pressures and central apneas and they just won't move out of the past.

I do think you might want to figure out if those centrals are real asleep centrals or not though. If they are arousal related they don't count.
http://freecpapadvice.com/sleepyhead-free-software

[greatunclebill]

if you are having trouble with straight 12, forget the ramp and start at a pressure you can use all night. then go can slowly start raising the straight pressure in increments up to 12. in no time you will be up to 12 and all will be well in sleepyville with your doc.

[Snooks]

@ Julie I have posted a few Oscar Screenshots at the beginning of the thread. It appears that you missed them.

@ Pugsy I agree that 12 is probably higher than i need, but i have to not only determine the guy is right, i have to feel like i can trust him and i obviously don't and if i don't get things right pretty fast or really annoy him, my driving license can be revoked because he will not sign off on it. I have started at 9.2 and can go up by say .4 and get there in a week and also see if things are improving or getting worse. As long as i cannot hurt myself in the meanwhile. Also assuming it will lead to a result of yes it is better or no it is worse, something difinitive that I can prove and take to him for further discussion. I think 12 straight up would be too hard, though, i have had that pressure when having events and havent been overly concerned despite being awake at the time.

@ Greatunclebill issue sort of covered in my reply to Pugsy above

Thank you everyone, I appreciate the comments and please do not think I am being argumentive for any other reason other than I a really arguing with myself or trying to convince myself what course of action to take in a subject that i know little about whilst being forced (at this stage) to listen to a person that i have no faith in. I truly do appreciate everyones comments. (Besides being worried to the max.)

[Snooks]

I have posted below what was my 2nd night on CPAP. I had a similar result on the first night, this was the second night and as such I ceased using the machine until I saw the Specialist a week or so later, as an appointment had been made 6 weeks prior. The CA's concerned me for obvious reasons but they are almost always when i am trying to go to sleep. It was only a short attempt because i was scared being the second night, I am gradually getting better and staying on it a bit longer. It's a battle (I may have had the EPR on, I cannot remember)

[khauser]

Yes, epr was on. You can see that in the difference between the pressure and the epap. Looks like epr of 1.

Don't let the CAs scare you. You'll wake up if you have to, just like happens with OAs.

You're not even hitting 11 and 0 OAs.i don't see why you would go higher.

[Snooks]

@ Khauser, so perhaps tonight i should try capping it FIXED at 11. That probably would not bee too uncomfy for me and we can see how it goes from there and if it has any impacts on the CA. Be they better or worse.

The CAs waking me up is the issue, it makes it so hard to get to sleep. But using a self hypnosis recording is helping

I'm only one below and if need be, can then adjust it up by .2 each night until at 12 and at least then we should have an indication.

Fingers crossed 11 is not too hard to handle. If need be i could just turn it down to say 9.6 and go to 11 via Auto over a few days.

Thanks guys, will update when anything significant is obvious