Self selection of CPAP pressure

[Snoredog]

studies show that more than 70% of SDB events are eliminated at 8.0 cm pressure (study sponsored by Resmed).

In the olden days (when slink started) they didn't have PSG's, they just gave you a machine set for 10 cm and sent you on your way.

If you did have OSA, that pressure will restore or prevent your oxygen levels from dropping to dangerous levels, you will certainly be better off even if under treated at that pressure than without any.

To bad you didn't find a Pro machine or an auto, they would give you basic AHI info and you can gauge how you are doing.

But if you feel better that is all that counts.

[mayfam]

Thank you, Snoredog. Could you please indicate what model machines might provide the feedback info to help me more? Having just also found and bought a second machine in a garage sale for $5, I'm encouraged to think I can find them for almost nothing. BUT I've found that the sellers often have no idea what the machines do, so I need to know myself.

[Pinhead]

Once you hit 8 I would keep it at that presure for a week before changing again. I find that best to try something a few nights to make sure you like the change.

I switched it Aflex from C flex and did great the first night after a week my AHI was higher then it was on C Flex so I changed back.

I have an auto and now set from 9 to 15 and my 7 day average runs from 11-13 I have yet to figuare out what causing the changes.

Jack

[hades161]

I started out with a Remstar plus no data machine and humidifier I bought used from my girlfriends co-worker about 2 years ago. I had a PSG to work with but never was titrated till this last winter. My info: The apnea index is 67.5, the apnea/hypopnea index is 116.4, and desaturations occur to 57%. The mean saturation during the night is only 85%. Cut and pasted from my PSG report.

I started this whole thing by feel. I knew my pressure was going to be high because I talked with people here and showed them my PSG results and they gave me a general ball park to tune in on.

I put the unit on a pressure of 8. First thing I did was put on the mask, turn on the machine and get use to breathing with the mask on and the pressure, I think I sat at my computer playing a game for like 30 minutes or so till I didn't think about what I had on or how I was breathing. Then I tried to lay down on my back, I normally could NOT lay on my back without feeling like I wasn't getting enough air so I figured if I could at least get it so I could lay on my back and breath and feel like I wasn't suffocating that it would be a good indicator I was getting close. I ended up trying 10 and then 12 before I could lay on my back without feeling that I had to turn over to breath. I tried 12 cmH2O for about a week, I noticed I was still having headaches and was sleepy during the day and knocking off in the middle of movies or shows. I then bumped it up to 14 for the next week and found that the night time bathroom trips stopped and that I had more energy but still had the darn headaches and sleepiness. I bumped it up to 16 and found that the headaches went away and that the sleepiness got better and I slowly was getting more energy. I stayed at 16 cmH20 for 3 months or so till I was able to borrow the money for a data capable unit that I bought at cpap.com for 600$.

Once I had the Data Capable unit, the one listed here on my profile, I was able to tune in my leaks and other things but in the end my pressure was still about 16. I had a PSG about 6 months ago after finally getting all my medicare / medical assistance stuff in line at the instistence of my Pulmo doc and guess what we found was my pressure?? Even though I had about a years worth of data from my Apap saying 16-18 that I am sure he never looked at. Yup you guessed it 16. Now if only finding the right mask was that easy =P

So yes you can do it by feel BUT till you get a data capable unit or can rent / borrow one or get tested you will still be taking a shot in the dark. Do what you need to to get by, as something is still better then nothing if your careful, but in the end it's still best to get it confirmed. There are so many other things that can effect your treatment besides just pressure, the only real way to limit the variables is to get data.

[turbosnore]

At least keep the pressure high enough to push the used air out.
Also, beware the pressures over 10, because higher pressures can turn your
possible obstructive apnea events to central apnea events in which case you
may become worse.

[rested gal]

I wouldn't be particularly concerned about the possibility of pressures over 10 causing "central" apneas. Yes, that can happen for a few people, but not the majority of people. Anyway, (and this is just my opinion...I'm not a doctor) even if it does happen for a few people, centrals are not something to be more afraid of than obstructives... nor are they "worse" for you than obstructives:

viewtopic.php?t=14225
On page 2:

The phenomena of pressure-induced central apneas is tossed around far too freely. The vast majority of people do not get centrals because of ultra-therapeutic CPAP levels. BiLevel, Pressure Support (PSV) and Proportional Assist (PAV) Ventilation are another matter. You need some mechanism to drive the pCO2 below the sleeping apneic threshold, and plain old CPAP rarely is able to do that. OK, if you wanna argue that CPAP increases base lung volume (Functional Residual Capacity)(FRC), and since that increases gas exchange, some people can generate centrals that way, fine. But it's not as many as you might think.
SAG


Links to Central Apnea discussions
viewtopic.php?p=22702

SAG (StillAnotherGuest) is and RPSGT, RRT, and the manager of an accredited sleep lab.

[mayfam]

Thanks for all input - am reading avidly. Am now sleeping with 10 cm CPAP, after pausing at 8 cm as advised. No significant problem wearing the mask.

Last night I woke two hours later than usual to visit the bathroom, a good sign. After that I slept with the mask off, and awoke gasping.

I think I'm getting somewhere! Will stay at 10 cm and see if the above repeats.

[mayfam]

Slept without the machine for one night, and woke gasping.
Slept with the machine first half of night (OK), and then without it for the second half (woke gasping).

Took pressure up to 11 cm, and had a good sleep. I think I'm about "there". Rather too much mask leakage, but that's a small matter to fix.

Thanks very much for all the help on this post!

[echo]

Just wondering why you keep torturing yourself and going without the CPAP for half or a full night? Is it just to see if the gasping continues, or because you are having issues with the mask, hose, humidifer, whatever?

If you really want to verify the OSA at home, just get a pulse-ox and sleep without the CPAP one night. If you have OSA then you should see defininte periods of desaturation. Of course this will in no way resemble a proper sleep study, but at least you'll get an idea of the O2 desaturation. The other feature of sleep apnea is arousals - they wreck your sleep just as much but there's no way you're going to be able to detect them at home short of buying an EKG system and a technician to go with it

Now do yourself a favor and use the durn thing the whole night, every night

[roster]

.............
I am not ruling out a sleep study later, but feel reassured thus far just starting on my own.

IMO, you would do better to forego the sleep study and spend the money on a fully data-capable machine with card reader and software. It is difficult to get the pressure set optimally over one night in a sleep lab setting. Doing it yourself over several days in your own home works better for many.

[mayfam]

Continuing thanks to all.

I sleep with the machine at 11 cmH20 all night. Just a couple of times, when I woke at 1 am or so for a bathroom visit, I left it off to see what happens, and I didn't feel I slept well then.

The machine and I coexist nicely. The mask isn't perfect, and on occasions my eyes "pop" (tearduct flow?), or a leakage position develops. To a large extent I correct the mask position in my sleep now. I am pretty sure my sleep is much improved, and I have more energy during the day. Something I actually like is the feeling, with the machine on, that I'm breathing from the bottom of my lungs as well as the top.

I would say this is it - except that I will look for an opportunity to follow up with a better-feedback machine and/or a sleep study. With the rest of life getting in the way, it may have to wait. I'd guess there's about an 80% probability that added investigation won't add much. But it's still worth doing when I can get to it.

Thanks again - all!

[DoriC]

Have you tried any other FF masks? My husband did not do well with fit or leaks with any of the ComfortFF . I'm too new to make any recommendations, except that my husband uses the Ultra Mirage FF and does well, and he's also testing the Mirage Quattro but not long enough to give an opinion either way. I know you can do pretty well at cpapauction with prices. Maybe some others can help with that. Dori

[rested gal]

I am pretty sure my sleep is much improved, and I have more energy during the day.

Good job, mayfam!!

hades, you did, too...I still think your story is a classic "do it yourself" success.

Could you please indicate what model machines might provide the feedback info to help me more? Having just also found and bought a second machine in a garage sale for $5, I'm encouraged to think I can find them for almost nothing. BUT I've found that the sellers often have no idea what the machines do, so I need to know myself.

Here's a link to names of quite a few machines that record useful data, and names of many that don't:
viewtopic/t35685/viewtopic.php?p=307168#p307168

[mayfam]

Thanks, Doric C, for mask suggestions. I also have a cover-nose mask, and a nose-cushion one, but not at my current address. Will try them later.

Thanks also, Rested Gal, for machine-capability-listing, and much help earlier in my epic. My next project is to find a data-capable machine.

Regards,

Mayfam

[PeakTek78]

All:

I too am a user of the REMstar LITE and am fairly certain that my current pressure setting is inadequate. I have been at the same pressure setting (7) for at least ten years and have unfortunately experienced what one may consider significant weight gain during this time. Lately, I've been very tired and my wife has reported that I "snore" much more frequently. On two trips with my friends in the last six months, they too have reported that I "snore" as much as I did prior to getting my first CPAP machine.

All this said - I have scheduled a new sleep study to get these issues addressed. I am not MD-phobic and want to make sure I get this fixed. The issue is that I am unable to get an appointment with my pulmonary doctor or for a sleep study for at least a month. I have another trip with friends coming up and frankly it is embarrassing to inconvenience them by "snoring" so loudly when we share a room.

Does anyone have instructions on how I may change the pressure of my REMstar LITE until I'm able to see the Doctor and get a sleep study? I understand this is taboo and I apologize if it is inappropriate for these boards. I simply want to increase my pressure to 10 to see how it makes me feel until I'm able to get the correct services.

If you're willing to share your wisdom, my direct email address is: PeakTek78@yahoo.com

Thank you in advance for your time and considerations.