pressure/AHI interpretation?

[herefishy]

Finally found a snipping tool on the other computer, so can post my screen shot. Have my tools together now so can ask a question.



My question is - seems like no matter how high or low I set my pressure, my events stay nice and low - I know - tough problem to have. But is there anything else to look at to see if "all is well" at the lower pressure? When I set it higher, it doesn't seem to bother me, but are there other disadvantages to doing that? I checked my O2 last night with the higher pressure and it stayed fine, guess I'll check it at the lower pressure?

[Guest]

Set it low and shut up.

[Cavmdc]

Guest posting shouldn't be allowed.

Sorry, I don't know the answer, but I appoligize for their rudeness.

It's a good question, that I'm sure someone will be able to answer.

Greg

[Pugsy]

How much of a difference are we talking about between the higher pressure and lower pressure?
Generally we like to use the lowest pressure that gives us acceptable results but that's mainly from a comfort level.
If someone "feels" better with the higher pressure for some reason...then use the pressure that offers the best general overall feeling if there is a difference in how you feel.

The only disadvantage I can think of is the remote chance that higher pressures trigger centrals but your AHI is nice and low so that doesn't seem to be happening here.
The higher pressure equals centrals fear is really over rated anyway. Pressure triggered centrals can happen at lower pressures just as easily as higher pressures if someone is going to have that sort of respiratory response to cpap pressure in general.
It's really a relatively small percentage of cpap users who end up with this problem. There's a whole lot more people using higher pressures with no increase in centrals than the other way around.

[herefishy]

Oh, that's right, I cut off some important info, didn't I - low is around 10, high around 13. The only thing that seems funny, I thought when I raised the pressure, eventually I would see where it stabilized, but seems the higher I set the max, the higher it goes, and I don't understand it. If I raise it up to 15 or so, then that's where it goes and blows me away.

[Pugsy]

Back when I first started cpap therapy and around the 6 month mark long after I had things tweaked to get really good looking reports, I decided to try a higher minimum to see what, if anything, would happen.
I had settled on 10 cm minimum and 20 cm maximum in APAP mode as offering me the best AHI and the variations in pressure never bothered me (sometimes I would kiss that 20 cm mark but not for long and not every night). AHI ranged from 0.5 to 2.0 for the most part.
So I decided to check out what would happen if I increase the minimum and I began an experiment increasing minimum 0.5 cm a week till I reached 13.0 minimum. There never was any real obvious change in anything. I still had the same AHI and still saw my pressures kiss 20...slept the same...felt the same. So there comes a point when things don't change a whole lot at least on paper. I saw no added benefit to using the higher minimum but then I also didn't see any negative effects either.
Only difference was when I first put the mask on...10 cm is easier to breath with than 13 cm...so I opted to use the 10 cm minimum. Purely comfort related. Now if I had seen or felt some sort of improvement with the higher minimum then I would of course made the effort to adjust to it but I saw no need.

[herefishy]

Thanks, I'll keep it low unless I see a difference in O2.

[Drowsy Dancer]

How much of a difference are we talking about between the higher pressure and lower pressure?
Generally we like to use the lowest pressure that gives us acceptable results but that's mainly from a comfort level.
If someone "feels" better with the higher pressure for some reason...then use the pressure that offers the best general overall feeling if there is a difference in how you feel.

The only disadvantage I can think of is the remote chance that higher pressures trigger centrals but your AHI is nice and low so that doesn't seem to be happening here.
The higher pressure equals centrals fear is really over rated anyway. Pressure triggered centrals can happen at lower pressures just as easily as higher pressures if someone is going to have that sort of respiratory response to cpap pressure in general.
It's really a relatively small percentage of cpap users who end up with this problem. There's a whole lot more people using higher pressures with no increase in centrals than the other way around.

Pugsy, I've always wondered. Over the very long term, do people's pressure needs gradually increase with time as they age (throat getting saggier, etc.)? If so, it would make sense to use the lowest effective pressure so you have somewhere to go, as it were, over time.

[Pugsy]

do people's pressure needs gradually increase with time as they age (throat getting saggier, etc.)? If so, it would make sense to use the lowest effective pressure so you have somewhere to go, as it were, over time.

I don't know...I haven't seen any changes in pressure needs myself but then they have always been rather random anyway.
Of course I have only been on the machine 4 years this coming May.
I haven't seen any documented studies that point to as time goes by we all are likely to need more pressure due to whatever...but then I haven't looked either.

I don't know that with time everyone can accept that things will change and more pressure is automatically going to be needed.
I am more inclined to work the present and not "what if I need more pressure 10 years from now". It's not a foregone conclusion...it's a maybe I will need more pressure later and if I do I will cross that bridge when I come to it.
And then maybe I only need 1 cm more pressure or maybe 10 cm more .... so many maybes and what ifs.

Me personally...I am for the here and now and make things the best I can for the here and now and I try not to dwell on "what ifs" because the what ifs may never materialize.
I am for doing what makes me feel the best I can right now because we don't know what the future holds at all for any of us.

[jweeks]

Oh, that's right, I cut off some important info, didn't I - low is around 10, high around 13. The only thing that seems funny, I thought when I raised the pressure, eventually I would see where it stabilized, but seems the higher I set the max, the higher it goes, and I don't understand it. If I raise it up to 15 or so, then that's where it goes and blows me away.

Hi,

Are you changing it night to night, or are you letting it run for a week or so before checking the AHI? There is a hang-over effect from pressure, and it takes your body a while to adapt to a change in your machine settings. If you are doing this on a day by day basis, try running for a week on each pressure.

If your O2 levels look good on either pressure, then the deciding factor is how you feel. If you feel great on the lower pressure, then feel free to run that way. The only thing you might miss is a stubborn event, but it might be that 13 isn't high enough to treat a stubborn event, either. In contrast, if you have any central events, the higher pressure might cause more of them to happen. Either way, just make sure you watch your data for a while, and revisit if you start having a few days in a row where you don't feel as sharp as you usually do. You can always run this past your RT or sleep doctor if you want a professional opinion.

-john-

[herefishy]

Thanks for the advice.