CPAP newbie, AHI not going down, adjust pressure?

[satsumass]

Hi,
I'm a CPAP newbie, 32 year old male, been using it for 2 weeks now. Have a System One AFLEX...i'm still learning about this condition and how best to treat it (with my doctor of course) but the next time I can get in with my sleep doctor is 4 more weeks, and so far the machine hasn't helped much at all. My AHI at stanford was 7.5, at my CPAP titration study fell to 1.5 and i woke up feeling noticably different, but now that i've had it at home, it's been around 4.5, and i don't feel much better at all.... I don't THINK it's a mask issue...the mask leak number is zero, so that means the fit is tight, right?

Anyway, my pressure was set to 10-12cm range. After a few days of no change I figured out how to change the pressure and have been messing around. I noticed that my 90% number was close to 12, so started increasing. BUt I don't know how to increase the pressures in response to a 90% number...what is the right "algorithm" for this? How do most people use the 90% number to make changes if at all? Can someone explain to me the problem of "chasing" central apneas?

I've gradually over the past two weeks increased it to a range of 12-15, and last night was surprised to see my highest 90% reading yet of 13.5, but still an AHI of 4.5...making me wonder if i'm just chasing central apneas with this higher pressure....i just can't understand how stanford was able to get me a 1.5 AHI...they must use a different machine for titration or maybe measure it differently? Is there any issue with measurement respironics, and what is the affect of laying in bed along time iwth the mask on NOT asleep on AHI numbers? 12 is comfortable, for me at least once i get used to it the higher pressure feels more "open" but what are the risks of titrating the pressure too high? how do I know i'm too high???

OK i know lots of questions, I have a lot of reading to do on this board...but would really appreciate the help...if anyone has any good recommendations for a good sleep doctor in the bay area please let me know!

[Pugsy]

Where are you getting the AHI numbers? Off the machine LCD screen or software?
If off the machine...those are 7/30 averages shown and 2 weeks isn't enough time to see dramatic changes in those numbers.
The 0 number for leaks off the LCD screen just means that for zero % of the time no large leaks. That is all that means.
Large leak territory is rather high around 80 to 90 L/min so you would have to have a pretty significant leak for substantial length of time for it to show up on the LCD screen on the machine.

You have a PR System One APAP with AFlex....what is the model number on the bottom of the blower unit?
550 or 560?

If you have the software...what is the breakdown on that AHI....how much for each category? This information is available only in the software. If the bulk of the AHI is clear airway then increasing your pressure won't help. We need to know more information before any ideas on pressure changes are offered.

If you don't have the software...if your machine model is 550 look in my signature line for Sleepyhead software...it works with the 550 machine. If you have a 560 machine then send me a private message and I will point you to some software that will work with the 560 machine. Right now SleepyHead is not compatible with the 60 series machines.

[SleepTechTN]

<removed>

[satsumass]

Wow, just want to thank you so much for taking the time to reply, I will definitely heed yoru advice and move the pressure closer to prescribed for now

[jweeks]

Wow, just want to thank you so much for taking the time to reply, I will definitely heed yoru advice and move the pressure closer to prescribed for now

Hi,

A sleep tech cannot ethically give you treatment advice over the internet. As a non medical person, I cannot give medical advice. I can, however, speculate on what I might do if I was in that situation. For example, if my 90% number was near 12, I'd set the lower number within 2 cm of the 90% level, and leave the upper number at the max. In this case, that would be an APAP range of 10 to 20. Run for a week, then check the data. If the 90% number moves, then move that lower number to be right about 2 cm of pressure under the 90% number. It is the lower number that is most critical, and the upper number has to be high enough that you are not capping your treatment by maxing out. If you start seeing centrals, then back off and seek help.

Some folks are OK using themselves as CPAP lab rats. At the same time, there are some conditions that get worse with higher pressures, and some that get worse with lower pressures. There are also any number of relatively tricky conditions that require sleep study type data and a really good medical doctor to nail down. If you kind of know what you are doing and have been left out in the cold by the medical system, then you probably do want to do this on your own. But if you have a good relationship with a doctor and you have a DME or respiratory tech that you can work with, then you might want to work through those channels. Taking control of your treatment can have rewards, but there are also risks involved.

-john-

[lazer]

..A sleep tech cannot ethically give you treatment advice over the internet.

Wow! And I see that remark likely chased off someone whom I thought was a very respectful and decent resource.

I swear that I read SleepTechTN's post last night and thought it was very well written and even he pointed out that he's not a doctor and only posting his thoughts from his experience.

Did I miss something that went on in here today OR is there just something in the water again...

[49er]

..A sleep tech cannot ethically give you treatment advice over the internet.

Wow! And I see that remark likely chased off someone whom I thought was a very respectful and decent resource.

I swear that I read SleepTechTN's post last night and thought it was very well written and even he pointed out that he's not a doctor and only posting his thoughts from his experience.

Did I miss something that went on in here today OR is there just something in the water again...

Unfortunately, I am posting after the fact but I totally agree with you about sleep tech tn being totally responsible in his posts. I dealt with him by PM and he was very careful not to overstep his boundaries.

JWeeks, this person was a treasure as far as providing assistance and now I fear he has left permanently, which I can't blame him for.

As one who feels I have been left hung out to dry by the sleep medicine industry (2nd doctor is probably ok but I am still leery), I am really getting tired of people who don't want me to be able access online advice by telling me to check with my doctor. People are responsible enough to know what advice to take and not take.

And if they are not and do something they don't understand, they are totally responsible for their own actions. It is just plain old common sense which doesn't need oversight by people like you who have appointed themselves as board posting czars.

By the way, if I had checked with my doctor regarding tapering off of psych meds, I would still be on them because the advice was to taper too fast. It was one of those "evil" internet boards that got me safely off of them.

49er

[Pugsy]

I am posting after the fact but I totally agree with you about sleep tech tn being totally responsible in his posts

I totally agree with you. I thought that his thoughts were offered in a totally responsible manner and it was obvious that seeking professional advice was number one on his recommendations and that is totally correct. Mostly he just explained things and said for people to be patient...I just don't see how that sort of conservative response would possible be construed as problematic.

Here we finally get a sleep tech with some common sense that doesn't spend all the time berating us for thinking for ourselves and instead all he does is offer to help us think clearly....and we again chase off someone who only wanted to help.
I, for one, welcomed him with open arms. It is always helpful to have another pair of eyes to look at things.
He is right...damned if you do and damned if you don't and we chase off someone who could really help and wanted to help and that is really sad. We bitch about the techs that preach to us and we finally get one that doesn't and what do we do...bitch because he treats us like we have a brain in our heads and actually doesn't preach to us.

We all know that this forum is just a discussion place for ideas to help us optimize this treatment. It is not supposed to be a replacement for proper medical advice but a lot of people don't have access to (for whatever reasons) proper medical advice or care so we do the best we can with what we have available here.

I hope he reconsiders but I did get a note from him telling me that he wouldn't be posting again.
Perhaps you all that do want him to stay and participate could convey to him how much we value his ideas and get him to change his mind. We have doctors on this forum...they offer their ideas and thoughts...we don't bash them.

[49er]

I am posting after the fact but I totally agree with you about sleep tech tn being totally responsible in his posts

Perhaps you all that do want him to stay and participate could convey to him how much we value his ideas and get him to change his mind. We have doctors on this forum...they offer their ideas and thoughts...we don't bash them.

Just sent him a PM.

49er

[Suzjohnson]

I am posting after the fact but I totally agree with you about sleep tech tn being totally responsible in his posts

Perhaps you all that do want him to stay and participate could convey to him how much we value his ideas and get him to change his mind. We have doctors on this forum...they offer their ideas and thoughts...we don't bash them.

Just sent him a PM.

49er

I did too. Suz

[jweeks]

..A sleep tech cannot ethically give you treatment advice over the internet.

Wow! And I see that remark likely chased off someone whom I thought was a very respectful and decent resource.

Hi,

My intent wasn't to chase anyone away. Rather, the question that the original poster had was whether or not to adjust pressure. I simply doubt that any medical professional would tell someone over the internet to change their pressure without having had an office visit, doing some basics like blood pressure, checking their data download (if available).

I swear that I read SleepTechTN's post last night and thought it was very well written and even he pointed out that he's not a doctor and only posting his thoughts from his experience.

Yes, I thought the same thing.

-john-