Frustrated

[Perrybucsdad]

I don't get it. The first night I used my APAP I had an AHI of 5.5, I have titrated the pressure from 4cm to 11cm and now my AHI is rising and was 9.8 last night. Granted, I still have a cold, but why would the numbers be going up like this and not getting any better? Does coughing and stuff really throw the numbers off that much?

- John

[sonogo]

I can't be authoritative, but I've found over the years when I'm frustrated, I'll assume more pressure is the solution. Sometimes it is, but other times it can backfire and cause more problems. I'm not saying don't experiment with different settings--most of us need to. I might suggest gradual changes (change the settings by just 1) and give it a week or two to gauge the results. I've found that I've never had the same sleep pattern 2 nights in a row, so it takes a few days to see what the average sleep pattern is for you at the new settings.

This "go gradual" approach is frustrating in itself, but I think it's the only way after having tried more substantial changes in the past that didn't work. Another consideration is that your body needs to adjust to the whole situation of air being injected into your throat while sleeping--we're not naturally built for that! Big changes just make adjustment harder.

You didn't mention leaks. Maybe you aren't having any, but if you have a way of checking your leaks, jump on that info. I used a CPAP for about 6 months and was frustrated with the lack of results and the dry mouth I'd wake up with every morning. My doctor said I had the machine, her work was done. It was only on this forum that I learned how to 1) keep my mouth shut at night and 2) find ways to keep my mask from leaking.

Good luck, and we all understand your frustration. This forum is an excellent place for answers (better than mine), so stay tuned.

[Sheriff Buford]

I agree... it takes time. You'll have good days and bad. Some days my AHI goes up and I look back at what the possible cause was... and it may be a 50-50 chance of figuring out what I did. Doing so builds a "sensitivity" to your body and your health.

It's a long drawn-out battle... stay the course... and losing is not possible and not an option.

Sheriff

[Perrybucsdad]

I know my leaks have been all over the place, but they are all (except for one or two outliers) under the red line. I did get a Padacheek liner and I'm just wondering if that in hindering the CPAP?? Sounds crazy, but I would think placing a liner between the face and mask has to generate some leak.

Maybe tonight I will go back to the 4-14cm setting and see what happens. Just very frustrating. I want to think that the cold is what is causing the numbers to be all over the place, but it doesn't make sense.

I'll try and upload last night's data when I have a chance.

[robysue]

Perrybucdad,

Are you are running in Auto range with the min pressure = 4 and max pressure =11 (or 14)?

Or are you running in straight CPAP mode and ramping up from 4?

If you are running in Auto, what's that 90 or 95% pressure level been running? If it's significantly greater than 4cm, you may simply have the min pressure set too low and the machine is thus "chasing" events and taking too long to get up to a therapeutic pressure for you.

[Perrybucsdad]

Here are my stats and the waves.

Robysue... I'm in APAP mode with the min at 11cm and max at 14cm. No ramp. I have increased the min to avoid the chasing. I have been incrementing it 1cm each night, although I jumped from the first night to the second by a few. I have EPR on 3.

[Jay Aitchsee]

John, I'm deleting this post. I think you're getting better advice below
Jay

[Lizistired]

I don't get it. The first night I used my APAP I had an AHI of 5.5, I have titrated the pressure from 4cm to 11cm and now my AHI is rising and was 9.8 last night. Granted, I still have a cold, but why would the numbers be going up like this and not getting any better? Does coughing and stuff really throw the numbers off that much?

- John

What was your starting, titrated pressure from your lab titration?
If you post screen shots at the 8 or 10 hour window, the data will display better than the report format.

[ozij]

Here's one possible explanation of why you events increase when your pressure increases:

Higher pressure make it more difficult to control leakage, and it looks like you've got more events when you have more leaks.

Colds and coughing can definitely mess up your results.

And Liz asked what I wanted to ask also: what was the pressure you started at?

[Perrybucsdad]

Gang... the doctor didn't do a titration study with me, just had me start at 4cm - 14cm.

As far as the report, I'd do a different resolution, but I don't have the data with me right now and will have to do that later when I go home (unless someone knows how to make ResScan "think"" I have the SD card attached as I do have all the data from the card, just not on the card [backed up to a flash drive]).

So should am I seeing suggestions that 1) I turn EPR off (or could I just reduce it to say 1), 2) should I also drop my pressure back down near 4 (here is a LINK to my first night with the machine and no cold)...say maybe 6 or 7cm and then just run it that way for about a week and see what happens? Or keep it at 11 and up to 15? 3) Also thinking of removing the Padacheek liner tonight as that I think is causing me some issues with leaks too.

I guess I'm falling into that "more is better" mindset and that may not particularly be working for me right now.

[Jay Aitchsee]

John, after deleting my previous - I still think you should consider eliminating the epr.
I think 4 was way to low to start and you were right to increase the lower level. Maybe going to 11 as a min was too much. Maybe 8 or 9. I think most people use something like a 4 or 5 spread between low and high fairly successfully. I really agree that increasing the pressure (max) too much, to fast, is counter productive. It causes leaks, and your body seems to resist it. The other thing is to slow down. Pick a spread, let it run for a few days, adjust your mask, get your leaks under control, and then adjust slowly. If you start with your minimum below optimum it will become apparent what it should be. Then, you can adjust the max.
I'll let others suggest pressures.
Jay

[BlackSpinner]

You have a cold. Your breathing passages are inflamed therefore smaller. Of course it will make a difference. There is no point in chasing a goal that will change as soon as you are better. Relax and enjoy the scenery until you are over it.

[Pugsy]

I agree with Jay. Min 4 was obviously too low but I don't know how you got to 11 so quick.

I don't advise making any changes based on data when a person is ill. Also don't make changes on data variations from one single night to the next. I have been at this for well over 2 years and I still see night's where I might have a 0.4 AHI and the very next night have a 4.2 AHI and not see leaks or anything to blame it on. It is normal to have a AHI that varies somewhat. Especially when first starting out and still have leak issues. Until you have a relatively stable leak line don't be going where that 95% pressure might be showing you. At this point it can be misleading because of the leak. As far as the cold symptoms go....it's an upper respiratory infection. It messes with the upper airway..
You cannot rely on any data. We have no way to know just how much of those scored events relate to your cold or not.
Not all but I would bet some are. We just can't tell.

Reduce the minimum and use it without changing things till you have no cold symptoms for close to a week.
Play with EPR if you will but at lower pressures you shouldn't even need much EPR.

[HoseCrusher]

Lower your EPR to 2 and monitor that for a few days. By that time you should be over your illness and will be in a better position to figure out what will work best for you.

[Lizistired]

I don't back up my card anymore. I backup my patient file. I had to rebuild from card backups once and I don't want to have to do that again.

I think we make too many changes too fast. Give yourself some time to adjust to the machine.
Using the humidifier caused congestion for me so I run in passover mode. Others have the opposite experience.
Turning off the EPR cut my AHI from 5-6 to <1.
Are your leaks causing pressure increases, or are pressure increases causing leaks? Or arrousals, and you are resisting the pressure. Who knows?
If I was going to do anything with your pressure, It would be to narrow the range. Maybe 8-10. Any therapy is better than no therapy. You could also try CPAP right in the middle.
Give yourself time to adjust. I wasted almost 2 months before I finally turned off the EPR.