My CPAP pressure changed

[Mr Sleepy]

I was diagnosed with OSA 2 years ago. The sleep study used at that time indicated I needed to be titrated at 6. I just rented an auto-titrating CPAP for the last week. According to the readouts, I should be titrated at 9.4. That's over a 50% swing in only a two year period. In those two years I have lost 6% of my body weight and gotten in better shape. I am 46 years old and I would have thought my apnea shouldn't have "degraded" that quickly in such a short period. Could the big increase in titration pressures be the sign of another underlying medical issue?

[Pugsy]

Maybe the single night lab titration study caught you an a "good" night when you didn't need much pressure?
We don't sleep the same every night. Even now I have many nights where I might need 10 to 12 cm and the very next night I might need 18 cm. I won't even go into the story about the titration study advising 8 cm when I found 8 cm still gave me double digit AHI numbers. Sleep position a factor? Sleep cycles and REM a factor?

It is always I good idea to have any concerns you might have regarding your body checked out by a physician. No harm in being extra cautious.

[Mr Sleepy]

Thanks Pugsy. I guess since it was hard to sleep during the sleep study, it prevented me from falling into a deep enough sleep to really tax my pressure. I saw daily swings on the auto-titrating machine...but they were subtle.

[Pugsy]

I guess since it was hard to sleep during the sleep study, it prevented me from falling into a deep enough sleep to really tax my pressure.

I think this was the case for me and why my titration prescribed pressure was not ideal.
I am known worse in REM sleep...but I didn't get much REM sleep during the sleep studies. In fact during the titration study I got barely 150 minutes and those minutes were highly fragmented. Common sense told me I didn't get much REM and probably not the REM events that I see on my APAP needing 18 cm to kill. I just have to shrug my shoulders and let the APAP do its job. I don't need the high pressures all night and not every night but I do need them sometimes.

I don't think it is so much our OSA deteriorating more as it just is our sleep is varied and sometimes we just need more pressure. One of those things that I choose not to spend a lot to time and energy pondering over. If I can't change it..not much sense in me worrying about it. It is what it is. But that is me and my way of thinking. I have enough to worry about without tackling things beyond my control.

[archangle]

I was diagnosed with OSA 2 years ago. The sleep study used at that time indicated I needed to be titrated at 6. I just rented an auto-titrating CPAP for the last week. According to the readouts, I should be titrated at 9.4. That's over a 50% swing in only a two year period. In those two years I have lost 6% of my body weight and gotten in better shape. I am 46 years old and I would have thought my apnea shouldn't have "degraded" that quickly in such a short period. Could the big increase in titration pressures be the sign of another underlying medical issue?

"Could the big increase in titration pressures be the sign of another underlying medical issue?"

Yes, that is entirely possible. A change in your medical conditions could cause a change in your pressure needs.

However, the pressure you need for CPAP does not equate to general health. Someone with extreme apnea in terms of stopping breathing without CPAP might only require a low pressure to get complete relief. Someone with mild apnea without CPAP may require a higher pressure.

It's also possible that your pressure needs change without any significant change in your general health or the severity of your apnea.

There's also no magic "apneaometer" that you hook a patient up to and come up with a "correct" CPAP pressure. Looking at the same sleep study results, one sleep specialist will come up with one pressure, and another sleep specialist will come up with another pressure. You might come up with different readings on on two different nights with either a sleep lab or an auto CPAP machine. Auto CPAP machines from two different manufacturers may come up with different pressures.

In other words, that Auto CPAP machine might have told you 9.4 if you had used it two years ago. Another in lab sleep test might have told you 9.4 two years ago.

There's no one "correct" pressure. The important thing is not to have the exact right pressure. It's important to have a pressure setting that works. Both in terms of treatment efficiency and patient comfort.

Why did you rent an auto-cpap machine? Are you having problems with your manual CPAP machine?

What CPAP machine have you been using, and what model was the auto CPAP machine you rented?

[Mr Sleepy]

Archangel, thanks for the insight. I could tell my CPAP therapy was ineffective. I was always feeling tired and would wake up with a great deal of persperation around my neck. When the CPAP therapy is ineffective, I always sweat profusely around my neck. I discussed this with my doctor (primary care physician...not a sleep specialist). I asked about another sleep study. He suggested renting the auto-titration machine to look at my pressure setting. I have been using CPAP for 2 years and it's been a continual battle ruling out issues (the correct mask, ineffective chin straps, sinus issues, etc.). I now have a good full face mask (ergo no chin strap problems), use Flonase daily (minimizing previous sinus problems), and have gotten used to sleeping on my back. By process of emlination, I was concerned about the pressure. I slept MUCH BETTER on the few days I had the auto-titrating machine. I have a ResMed Escape S8. I'm not sure the model of auto-titrating machine I rented (probably should have looked), but it was a ResMed.

As for underlying medical issues which may have necessitated a greater pressure, I get physicals annually and don't have any known issues. I was just worried that my primary care physician was not up on what issues might cause pressure requirements to shoot up. After hearing the responses to this question, it sounds more like pressure settings are more of an art rather than a science, and a wild swing from a one night sleep study vs. 5 nights in your home with auto-titration would not be uncommon.

[Pugsy]

By process of emlination, I was concerned about the pressure. I slept MUCH BETTER on the few days I had the auto-titrating machine. I have a ResMed Escape S8.

This is why we tell people to get a full data machine. The Escape offers no useful data. It's a shame you had to suffer for 2 years. With data available one would see up close if the pressure was doing an optimal job. Obviously it wasn't at the titrated pressure. It took me all of one week to get my pressures dialed in once I got the software to see what was going on.

Should you ever be in a position to get another machine...get a full data machine and an auto machine if you can.
Never know when it might come in handy again.

[Mr Sleepy]

Thanks. I will do that.

[GumbyCT]

I now have a good full face mask (ergo no chin strap problems), use Flonase daily (minimizing previous sinus problems), and have gotten used to sleeping on my back.

As for underlying medical issues which may have necessitated a greater pressure ...

Did you know that sleeping on your back requires more pressure? Did you sleep on your back during your study?

Try sleeping on your side tonite to see if it makes a difference for you.

[Mr Sleepy]

Gumby, I had alsways slept on my stomach until my diagnosis. I was told at the sleep study I was not allowed to sleep on my stomach for monitoring reasons. I realize sleeping on my back requires greater pressure, but it has minimized mask leakage issues. Whenever I tried to sleep on my side, I would wake up on my stomach with a leaky mask. I really did sleep poorly at the study, and I suspect that prevented me from falling into a deep sleep for very long, thus minimizing my pressure requirements. From what I've seen on this forum, it appears there are sizeable pressure swings than what I had originally thought. You do raise an excellent point, and thanks for your help!

[Pugsy]

I think it was another forum member, Rooster (Roster) who has reported the most impressive pressure needs variances with regards to sleeping on his back vs his side.
Supine needs 18 or 19 cm...
On his side 9.5 cm
So guess what he worked on doing...yep...staying on his side.
Not everyone will see such a variation. I found it didn't make much difference for me. Either in pressure needs or AHI.
I normally sleep on my side and when doing some experiments to keep me on my side all night..I still had those stubborn REM events so I needed the APAP pressure increases for those anyway. So I quit worrying about supine sleeping and any possible "worse OSA events" and I just let my APAP machine do its job.

All these possible variables and how they might possibly impact therapy comfort or AHI or pressures are just more reasons for having a machine that offers full data. If I had been going on just how I felt those first 2 to 3 weeks...the machine would have ended up in the closet and I would have found another forum to talk on.

[archangle]

I was told at the sleep study I was not allowed to sleep on my stomach for monitoring reasons.

I wonder how many stomach sleepers are unnecessarily on CPAP because a lab made them sleep on their back?

[BlackSpinner]

I was told at the sleep study I was not allowed to sleep on my stomach for monitoring reasons.

I wonder how many stomach sleepers are unnecessarily on CPAP because a lab made them sleep on their back?

Probably not many because there is a reason they are in the sleep lab in the first place.

[archangle]

I was told at the sleep study I was not allowed to sleep on my stomach for monitoring reasons.

I wonder how many stomach sleepers are unnecessarily on CPAP because a lab made them sleep on their back?

Probably not many because there is a reason they are in the sleep lab in the first place.

Lots of people go into sleep labs and find out they don't have apnea. After all, it is primarily a test to see if you have apnea. If a stomach sleeper with some medical problem not caused by apnea goes in and gets a false positive apnea test because they were forced to lie on their back, the the doctor might stop looking for his true medical problem.

Truckers in particular often have to get apnea tests just because of their weight and/or neck size.