CPAP Plateau

[Uncle_Bob]

I'm starting to like CPAP so much now i don't like to talk about being stuck because that might suggest that i could stay stuck

No, I'm on a CPAP plateau and i'm looking for ideas on how to get off it ....

Basically I've got my leak down to an average of 0.2 over the last four nights. I have also been on an increased pressure of 10cm which is my titrated pressure BUT i'm still getting high HI's. My AI is always 0 - 0.5 but then AHI always ends up being 10 - 20.
I have noticed on the couple of occasions I wake a 3am and then take a peek a the numbers that the leak is 0 the AI is 0 and the AHI is low at around 2-3. So it seems that in the 2nd half of my sleep my numbers go crazy.

So if anyone has any suggestions I would appreciate it

Is it possible that I may need a pressure higher than my titrated pressure ?

P.S Doc will not let me change to APAP machine as i have changed machines once already. He will change my script to APAP if i want to buy my own machine. He discourages APAP because he sees so many patients that have trouble with them and apparently they are not a good substitute for his skills. Apparently HMOs and governments like APAPs and that should scare the hell out of me

[OutaSync]

Yes, it's very possible that you may need a higher pressure than your titration indicated. Remember that your titration night is only ONE night and most of us vary quite a bit from night to night. If I were you, I would bump up that pressure by .5 and see if that improves your HI. It can't hurt and it might help.

Bev

[track]

My experience is the same as yours regarding low to zero AHI for the first hour or two and then jumps up the last 2-4 hours. I don't know what the answer is for HI. I get about the same HI at a pressure of 12 as I do at 8 so raising the pressure does not seem to effect my HI significantly. I have been pretty stuck on an HI of 4-6 for 2 years now and I have varied the pressure from 6-16.
You really don't need apap to determine the best pressure...a cpap over several weeks will accomplish the same thing as you adjust pressure and dial in what works best for you.

[Linus]

What is your titrated pressure?
APAP in my opinion is the way to avoid extra doctor's visits over time. The machine will adjust as your conditions change.

Maybe the machine is set up incorrectly for a sleep study? You say that half of the night is good. It makes me thing that it goes into ramp or something like that for the second half of the night. Someone chime in here on that. I have seen reports of this issue before. I may have it wrong, but I thought I would mention it.

How long have you used CPAP?

[alnhwrd]

Bev's suggestion is a good one. I was titrated at 9 and am currently at 12 with good results. If you are using EPR, you could try reducing or eliminating that. And I always like to suggest that people try taping their mouth for a few nights to see if that makes a difference for them. It doesn't cost much and can rule out that you are losing air.

[Pineapple]

Apparently HMOs and governments like APAPs and that should scare the hell out of me

Hun? Where'd he get that one? IMO HMO's don't know the difference between an APAP and a CPAP or they would be insistening everyone was given an APAP as it is a more flexible machine. APAP can also be run as a straight CPAP. Your doctor's arrogance scares the hell out of me

Your titrated pressure was based on a one night sample under less than optimal circumstances (you were in a strange room, strange bed, with a bunch of wires hooked up to you with someone watching you all night) It's quite possible it's not right. I agree with Bev, pop it .5 cm and see what happens. Remember to let it sit for at least a week before you make other changes. I should point out that the first couple nights my numbers are way out of line, then my body seems to acclimate to the change and the numbers level off, so don't be freaked out and put it back the first night (unless you have a really nasty reaction to the change)

[Uncle_Bob]

Thanks for the suggestions folks.

My titrated pressure is 10 and that's what I'm at (for the last 4 nights).
I could potentially increase the pressure to 9.6 (increments are 0.2). But don't i risk getting central apnea's ?
I have tried mouth taping and lanolin for 2 nights and didn't seem to do anything.

Prior to the last 4 nights I was leaking average of 0.25. Now my leak is much lower and I attribute that to using new nasal pillows, so it looks like the first set of pillows lasted me just 3 weeks. I'm not sure if that is normal, i know some people get longer out of them.

[amos]

Uncle Bob,

My experience was similar to yours. I felt about 5% better each week for the first 10 weeks. Then I began to hit plateaus of a week or two. Then, one day, I would notice an improvement. Maybe all you need is to stay with the therapy, and let nature take its course.

amos

[fuzzy96]

lol amos

stay with the therapy, and let nature take its course

are you pushing laxatives

uncle bob- trying .5 cm wont hurt just make sure leaks etc are in check
run for a week or so and keep a journal or some sort of record so you can see if it helped or not

[Wulfman]

Thanks for the suggestions folks.

My titrated pressure is 10 and that's what I'm at (for the last 4 nights).
I could potentially increase the pressure to 9.6 (increments are 0.2). But don't i risk getting central apnea's ?
I have tried mouth taping and lanolin for 2 nights and didn't seem to do anything.

Prior to the last 4 nights I was leaking average of 0.25. Now my leak is much lower and I attribute that to using new nasal pillows, so it looks like the first set of pillows lasted me just 3 weeks. I'm not sure if that is normal, i know some people get longer out of them.

Only if you're susceptible to them. If your titration took your pressure above 10, and they DID occur, they would have been noted.

If you take your pressure up.....and the AHI numbers get lower......you'll know you're going in the right direction.

If you're using EPR, you're effectively lowering your pressure by the EPR setting number. You would either need to raise your pressure setting or decrease the number of the EPR setting.


Den

[bdp522]

it looks like the first set of pillows lasted me just 3 weeks. I'm not sure if that is normal, i know some people get longer out of them.

You should get at least 3 months from nasal pillows, many of us get much longer. Have you cleaned the pillows well? Try a soak of 1:3 vinegar and water. This will remove any oil or soap residues left on the pillows. Be sure to rinse very well.

Brenda

[Uncle_Bob]

it looks like the first set of pillows lasted me just 3 weeks. I'm not sure if that is normal, i know some people get longer out of them.

You should get at least 3 months from nasal pillows, many of us get much longer. Have you cleaned the pillows well? Try a soak of 1:3 vinegar and water. This will remove any oil or soap residues left on the pillows. Be sure to rinse very well.

Brenda

3 months Mine seemed to break down and go extra soft and would not seal just into my 3rd week.
I wonder if my DME gave me a used nasal pillow, i never did receive it in the sealed bag that the replacements came it.

I'm cleaning mine daily or every other day in warm water and a bit of baby shampoo. I might switch to vinegar if that's what everyone else is using.

[Uncle_Bob]

Thanks for the suggestions folks.

My titrated pressure is 10 and that's what I'm at (for the last 4 nights).
I could potentially increase the pressure to 9.6 (increments are 0.2). But don't i risk getting central apnea's ?
I have tried mouth taping and lanolin for 2 nights and didn't seem to do anything.

Prior to the last 4 nights I was leaking average of 0.25. Now my leak is much lower and I attribute that to using new nasal pillows, so it looks like the first set of pillows lasted me just 3 weeks. I'm not sure if that is normal, i know some people get longer out of them.

Only if you're susceptible to them. If your titration took your pressure above 10, and they DID occur, they would have been noted.

If you take your pressure up.....and the AHI numbers get lower......you'll know you're going in the right direction.

If you're using EPR, you're effectively lowering your pressure by the EPR setting number. You would either need to raise your pressure setting or decrease the number of the EPR setting.


Den

Thanks Den and Fuzzy.

Really I had no idea about the EPR altering the pressure. I think i forgot to raise my pressure last night but i noticed my EPR was set to 3 and i left it at 3. I think i will try to decrease that before i increase the pressure, I don't want to do too many things at once. Having said that my quattro mask arrived yesterday so i used it last night for the first time and got an AHI of 9.6 but a leak rate of 0.40. I woke noticing a leak at 3am and saw the leak rate at 0.46 so i made the straps tighter.

I do not like the elbow/valve issue on the Quattro where the air gets shut off if you have the swivel elbow going up over you head. I normally have my hose going up over my headboard, i had to bring it down and have it go to my side.

I might go back to the Swift LT and chinstrap tonight with the EPR set to 2. But its nice to know i've got the quattro that i think i could work with if i get a cold or allergies etc.


Thanks
Bob