My Auto-titration experiment-a surprising result

[chazz]

I have been using APAP for about 18 months (Resmed S8 Auto Vantage, Aura-Headrest nasal pillows). My initial sleep study showed AHI=39 and a recommended titration pressure of 11 cm. My APAP consistently showed a pressure of 12 cm. The results were acceptable, but not great: leakage of 0.3-0.5 l/s (18-30 l/min), AHI's ranging from 5-8/hr, and HI's from 3-5/hr. I also had significant mouth leakage problems every few days.

I was curious about whether my sleep apnea had changed since the initial sleep study, and thought I could do a rough study "on the cheap" using my Vantage in straight CPAP mode, no EPR, with pressure at the lowest setting (4 cm). I figured that in my case 4 cm would not be that different to 0 cm.

Surprise! I found the results at low pressures were excellent, and eventually titrated to optimal pressures of 6-7 cm which gave great results: leakage rates between 0-0.02, AHI's of 2, and HI's of 0.0 to 0.2. Most importantly-no more mouth leakage.

I would be interested in getting your impressions of this result.
Chazz

[rested gal]

Sounds like the better control of leaks down at the lower pressures might be the key to your better results.

In the sleep study, were you sleeping on your back most of the time?

Do you sleep on your side most of the time at home? That could account for some of the discrepancy between sleep study results and your "at home" results.

Another thing -- this sounds minor, but using even as little as 4 cm pressure is still using pressure. Since 6 or 7 seems to be working for you, that's not a whole lot more than 4....so.... 4 cm could have been keeping your throat open somewhat well, thus giving you such a different result than the sleep study did.

My guess is that a different sleeping position at home, and not needing a humongous amount of pressure when in that position made the home experiment so dissimilar to the sleep lab results.

If you say you sleep on your back all the time, I take all this "back!"



Nonetheless, it's good to hear you've worked it out yourself and found comfortable, effective treatment! WTG, chazz!

[chazz]

Dear Rested Gal,
As always, your analysis is very astute. I agree with you that a major factor here is the lower leak rate at lower pressures. In answer to your questions:

1.In my sleep study the time was divided about two thirds on my side, one third on my back.

2.At home I try to sleep on my side, but I do lapse to sleeping on my back. I don't know if it is close to one third of the time.

What puzzles me is why the APAP mode would not have settled to a lower pressure. Isn't that the whole point of APAP? I had, at times set APAP range from 5 to 16. I never read a daily pressure of less than 11.5.

I know people who tell me that when they did not get good results their physician upped the pressure (as high as 19), changed to APAP or BiPAP, added EPR or A-flex, etc.

Maybe, there are situations in OSA where less is more. Do you think others on the forum could benefit from this?

Thanks,

Chazz

[RosemaryB]

2.At home I try to sleep on my side, but I do lapse to sleeping on my back. I don't know if it is close to one third of the time.

If you want to try sleeping exclusively on your side, you can use the backpack stuffed with a pillow trick. That's what I do. I wear a small comfortable backpack at night. I've stuffed ti with a pillow so that it's pretty full. It prevents me from rolling on to my back.

Sounds uncomfortable, but it's way more comfortable than any of the other things I do to make this work, like wearing a mask. As long as there are no leaks, my AHI is dependably under 1.0 with this.

Tennis balls sewed to my pj's didn't work in the slightest. I can sleep on one or two of them with no problem at all. Guess I'm not like the princess and the pea .

I thought the backpack idea was unique, but then I read about it in a book I got on sleep apnea. Nothing new under the sun, as they say.

[track]

My apap reads around 13..give ot take 1, 95% pressure every morning. If I sleep on my back my AI is between 1.2-2.5 and if I limit myself to my side by sticking a soccer ball under my Tshirt, the AI is less than 1. The big difference though is in duration of the event. On my back the apnea events are typically 2 to 3 times longer in duration.

[jqp]

I did a similar thing when I got my card reader. My Rx is 13

I worked my way from 10 to 15cm in 0.5 increments. It turns out 12 is my magic number. Somewhere between 12 and 13cm, leaks start to happen. At 12, no leaks, and I sleep the whole night with very few apneas.

Good luck with it.

JQP

[Goofproof]

Less is more in many ways, Less pressure means less leaks. Leaks are the biggest problem we face with getting the treatment to work. Leaks cause the APAP to think we need more pressure, while it really causes more leaks and, reduced mean treatment pressure. Leaks also make data collection unreliable, and that leads us into false thinking, about the changes we need to make on treatment.

APAPS are good, but as in most things, taking personal control can lead to better options. Odd's are over a night your pressure needs aren't going to change more than 3 or 4 cm, no matter what position you sleep in, it makes sense to limit your pressure range to the lowest, that will take care of your needs. Jim