Self selection of CPAP pressure

[mayfam]

I am quite sure I have sleep apnea from my symptoms of waking gasping, and finding myself short of oxygen for a while, not to mention snoring.

I bought a CPAP machine (REMstar Lite), and am wondering if I can set my own pressure as foillows (I have already found out how to do the adjustment). Start at 4 cmH2O, and sleep at that pressure until it's clear that the symptoms are still there. Then go to 5 cmH2O, and so on. When the symptoms aren't there anymore, add 2 cmH2O to be sure, and stay at that pressure.

The goal is to save time by avoiding a sleep study, costs, etc., etc.

Now I can well anticipate the arguments against doing this. But do you think it will work?

[Wulfman]

I am quite sure I have sleep apnea from my symptoms of waking gasping, and finding myself short of oxygen for a while, not to mention snoring.

I bought a CPAP machine (REMstar Lite), and am wondering if I can set my own pressure as foillows (I have already found out how to do the adjustment). Start at 4 cmH2O, and sleep at that pressure until it's clear that the symptoms are still there. Then go to 5 cmH2O, and so on. When the symptoms aren't there anymore, add 2 cmH2O to be sure, and stay at that pressure.

The goal is to save time by avoiding a sleep study, costs, etc., etc.

Now I can well anticipate the arguments against doing this. But do you think it will work?

You're on the WRONG forum if you think we're going to chastise you for trying to help yourself.

It would be easier to do with a data-capable machine (like a REMstar Pro 2 or M Series Pro), but you can probably achieve your objectives.

I've been told that years ago, they handed out most of the CPAPs with a setting of 10 cm. That was where I started out after I suspected that my sleep study was flawed.....I ultimately increased it to 12 cm., but I did have a Pro 2 and the Encore Pro software.

Hopefully, you only have simple Obstructive Sleep Apnea and just need to breathe a little better at night.

You'll have to go by "how you feel".

Good luck and hang out here to keep us up-to-date.

Den

[mayfam]

Den, thanks for your reassuring input. I found it particularly interesting that 10 cmH2O was once a universal setting. I am wondering if there is any setting on a machine that is too-high for safety. I somehow doubt it, or we would have heard of the negatives.

In another post, a contributor reports that her supplier is adjusting her higher (at her request) at 0.1 cmH2O increments. Instinctively, this sounds ridiculous. A person's optimum pressure will differ according to sleep position, how relaxed they are, type of mask, current weight, and probably a dozen other variables. Even the weather affects ambient pressure. And a modest 2000 ft shift in altitude is equivalent to a full 5 cmH2O.

So I would guess that the optimum pressure deduced from a single night's sleep study is actually + or - at least 2 cmH2O of the "correct" setting.

But of course I'm an engineer and not a doctor.

[Wulfman]

If a person has simple OSA, then there wouldn't necessarily be a pressure that would be "too high"......except for comfort's sake.
The problems arise if a person is subject to Central Apneas and/or Mixed (Obstructive and Centrals). Typically, pressures over the 10 cm. mark could trigger Centrals IF the person is prone to them.

The "ideal" pressure is usually the lowest possible pressure that achieves the lowest AHI.....and with which one can sleep the best.
We haven't heard of anybody giving out "prizes" for having the HIGHEST PRESSURES.


Den

[rested gal]

If I were going to throw a dart and guess at a pressure to use, I'd put it at 10 cm H2O.

[ScottyT]

I'd start low if I were you. I sleep tested with a very high AHI -- 91.3. I'm on 5cm for a two-week trial, and it's dropped me to less than 10 events per hour. So I'll likely move up from 5 once this trial is over, but it's enough to make one heck of a difference for me. I think starting low also gives you a better chance of keeping at it. I've felt 10. I don't think I could sleep with 10 now, but if I ease up week after week, I'd likely be able to do it. But odds are I won't have to go that high.

[mayfam]

Thank you all. I appreciate the input - lots.

[rested gal]

I've felt 10. I don't think I could sleep with 10 now, but if I ease up week after week, I'd likely be able to do it.

Good point, Scotty. It's ok to work one's way up gradually. Definitely better to do that than not be able to use CPAP at all.

[BobbiC]

Hi, All: I am a newbie--had diagnostic sleep study and titration study--after a nightmare week with a loaner--and my r.t. putting my own machine together wrong (with another nightmare night) I am on my way. Last night was my 9th night on therapy - but I have a question for your "vets". My R.T. told me the insurance company will take back my machine unless I reach "compliance" which is 4 hours--I know there is something inside my machine that is recording my usuage - (AeioMed --Remstar II) - and I love the machine. But you see I have another medical problem--I have interstitial cystitis which requires me to go to the bathroom 3-5 times per night--and, no problem--I just unhook the hose--and go to the bathroom leaving my mask in place --but I am shutting off the machine--so the question is my machine is recording all these 2/3 hour "compliance" times---I was told that the CPAP therpay might help my nighttime frequency for the bathroom better--but I was wondering about shutting off the machine--or should I just let it run -until I get hooked up again.
What do you all think? Also, the air coming in (I was told I was a "5") tickles my nose--and it is maddening - also, I am using a breathe right strip to make it easier to breathe in and out (I have a slight deviated septum) --I am 60 years young, just diagnosed with this in July-October --am a breast cancer survivor (2 yrs. 4 mos) so I know I can conquer this too --with a little patience and persistence. Also I hate going to bed looking like Darth Vader--why don't they make the darn headgear in colors--like pink!!
Thanks for you help.
Bobbi

[jnk]

BobbiC- Machines that record compliance generally record all usage in a 24 hour period from noon to noon if the clock is set right, so you should be good if the total for each day is over 4 hrs. Try never to sleep without it, and try to get 8 hrs of usage a night, at least for a while.

mayfam- There are reasons to get a sleep study if you can. It can show whether you have issues affecting your sleep beyond OSA, and sleep clinic titrations make sure all your issues are being addressed. If that isn't possible, you may at least want to seriously consider the recomendation given above and sell your machine and then get a data-capable machine. That way you can do what you can to handle events that you may not "feel" the next day.

[Georgio]

Some would say that 4 cmH2O is such a low pressure that it is difficult to breathe. If you were to work your way up, you might be better starting at 7. To make it without a sleep study, a fully data capable machine would be a big asset.

Georgio

[rested gal]

Mayfam, here's an interesting study that was done to see if people with obstructive sleep apnea could adjust a cpap on their own, to come up with an effective treatment pressure. The answer was "yes"...

"Can Patients with Obstructive Sleep Apnea Titrate Their Own Continuous Positive Airway Pressure?"
http://ajrccm.atsjournals.org/cgi/reprint/167/5/716

We all do what we can, and what we can afford. But do keep thinking about how to get a sleep study in the future. jnk is right:

There are reasons to get a sleep study if you can. It can show whether you have issues affecting your sleep beyond OSA, and sleep clinic titrations make sure all your issues are being addressed.

In the meantime, you're doing a good thing to begin treatment for yourself, any way you can do it. A full data machine and software would make self treating easier, but it can be done with a plain cpap giving you no info. If it's plain OSA that you have.

[echo]

I'm all for taking charge of your own therapy so no chastizing from me, just a thought...
Another reason not to change your pressure indiscriminantly and to work with a sleep doc/clinic is if you would have a pulmonary disease.
You might also want to look to purchasing a pulse oximeter. That's the only way you'll know if the therapy is sufficiently stopping oxygen desaturation. (Arousals are another issue, and those you won't know about unless you do a full PSG).

[mayfam]

Thank you all - again. I will read the article with great interest. Last night I went to 6 cmH2O and wore the device for 8 hours. Tonight, I'll go to 8 cm, so you can see I'm getting to levels that you've mentioned are most likely to be helpful. More in due course.

[mayfam]

Here's another study where CPAP therapy was as successful without a sleep study as with one:
http://meeting.chestjournal.org/cgi/con ... 4/4/227S-a

In this case, doctors empirically set the CPAP pressure for the non-sleep-study patients without adverse effects. Their average pressure was 9.5 +/- 1.6 cm H2O. The study population was largely male and averaged 52 years old. There was an impressive improvement in somnolence for both sleep-study and empiric patients.

This reflects the advice given here, to start using CPAP machine at around 10 cm. I am not ruling out a sleep study later, but feel reassured thus far just starting on my own.