Questions: still tired, recent pressure chg, try an APAP?

[2girlsmom]

I will give everyone a quick rundown... am wondering if an APAP trial might be a good idea?

Oct 07, titrated at 10cm, most of my problems were in REM--33.5 events an hour in REM vs an overall AHI of 12.1 or so. I was given an M Series Plus so no real helpful data but used machine faithfully, felt better w/in a few months until maybe 3 months ago when tiredness came back--dozing off often, not feeling rested, etc.

Went for another titration, this time through a sleep doc at another sleep center. They said I was still snoring at 10cm and tried 12 and 14. Apparently the snoring resolved completely at 14 so my Rx was written for 14cm. *I think it's worth mentioning that they claimed they "got a good half hour's sleep at 14 for me" which I feel is NOT enough to know if that pressure caused me problems... anyway Was Rx'd a Resmed Elite II so I can now monitor things but before that came I changed my M Series to 12 in the meantime as 14 was hard to deal with. I noticed I felt better but planned on doing 14 once the Elite came. I felt better the days doing 12cm but thought I should just do what was prescribed. I haven't gotten my full study report yet--need to call again on that.

My AHI is normally under 5 events in an hour but my concern is since at my titration a year ago my events were controlled even better and with me feeling so tired now I am concerned that 14 is too high and possibly causing centrals. I have the software on the way--my thought is my events are happening mostly in REM as some nights I barely dream if at all so overall avg is ok, but my REM sleep is probably really bad apneawise. My highest AHI lately has been 7, lowest 3. I know that doesn't seem to bad, but like I said, my concern is that my REM time is spent having apneas thus I am not feeling rested even though my AHI is decent.

I hope this makes some sense... I just want to feel better darnit!

[echo]

Hi 2girlsmom -- here's my completely non-medical opinion--
You're completely right about the possibility of getting central's. Even a 0.5cm difference is enough to make them start appearing a lot.
An AHI of 5.0 ain't bad, but as you know we all strive for something around 1.0. Many can tell the difference between a 1.0 night and a 3.0 night.

You should definitely look to getting the full sleep study report , also from the titration at 14 - did they notice any central's there?

You have two options to do an at-home titration:
1) get an APAP
2) use the CPAP, start at a lower pressure, e.g. 10 or 11. Increase by 0.5 pressure once a week and monitor for that week. Make a plot of your AHI vs. pressure and see which pressure has the lowest AHI. I would start below 12 just to make sure you're not getting overshooting the central's mark, if that is indeed an issue. It's just as easy to overtitrate and undertitrate.

I had a very similar experience when I first started. I was prescribed a CPAP at a range between 7 and 10. They say that 10 was a bit too high because I ws getting centrals, but 7 wasn't stopping all the events. So it was a balance. I started with 7 - felt great for a few weeks then the exhaustion returned. Went to 8, 8.5, 9, 10, tried it in CPAP mode, APAP mode,.... none of it worked for very long. After a few weeks I'd go back to being tired again. By then a year had already passed, and I still wasn't 100%, so I decided to try 10.5. That seemed to work. I went to 11, and wham! Central's all over the place. (I can see central's on my P&B 420E). So now I'm using 10.5, even though my "official" titration is max 10. I suspect that the night I had the titration, it was my first time ever with CPAP, and it was only a one night snapshot, so I'm not too surprised now, in retrospect, that they missed the mark a bit.
I stll get a few central's now and then on 10.5, but maybe 2 or 3 a night, and that doesn't affect me as much as the high amount of 'flow limitations' I get when I am at 10.0 or lower.

So yes! Keep at it, take charge of your own therapy, listen to your body, and make changes if you have to!!
(but always make only ONE change at a time and stick to that change for ONE week before making any conclusions).

Edit: note that some people do better on CPAP than on APAP. I tried an APAP range of 8-12, and 10-12, and those worked no where near as well as straight CPAP at 10.5, plus the pressure changes kept waking me up. Since you don't have an APAP at the moment anyway, my 2 cents worth would be to do option #2 above. That's not such a bad option And in the meantime you can push for the APAP - it's good to have the flexibility to run in either mode.