Help with Weight Loss and increased AHI:Update

[milesleroy]

Hi,
Last week I posted about my increasing AHI after losing about 25 lbs. Original post:viewtopic.php?f=1&t=101271

Several people were kind enough to post useful suggestions and insights.
While I am waiting for the appt to see my doctor, I thought I would post and update showing new data after increasing my pressure.

Unfortunately it doesn't seem any better. One night it was below 3, but the other nights it was higher, even up to 6 and over 7.

I'd love to hear from anyone who might have some thoughts about what these data are saying.

I have tried several different min. pressure settings on my auto pap. I've tried 12, 12.5, 14, and 14.5. By 14.5 it was getting pretty uncomfortable.
And, the increased pressure doesn't seem to result in better AHIs. Below are the data screen shots from my last 7 days or so.

[Pugsy]

What sleep position do you normally sleep in?
Any set position or all over the place? Spend much time on your back?

You had some success and some not so success at the same pressure settings...so makes me wonder why the change.
What is it that sometimes wants more pressure and other times doesn't.

Do you by any chance have copies of your old sleep studies to see if maybe supine sleeping or REM stage sleep might have been when your OSA was worse? It's fairly common.

So...if you didn't see these reports...how would you say you slept and felt during the day?

[milesleroy]

Thanks for the reply Pugsy.

Normally I am a back sleeper. However, when I asked my girlfriend, she said lately I have been moving around a lot more and rolling on my side more.

As far as how I've felt, I definitely feel less rested than normal (fell asleep in the waiting room while my oil was being changed the other day).

I do have a copy of my sleep study from 2010. Can you tell me what specifically to look for?

Many Thanks

What sleep position do you normally sleep in?
Any set position or all over the place? Spend much time on your back?

You had some success and some not so success at the same pressure settings...so makes me wonder why the change.
What is it that sometimes wants more pressure and other times doesn't.

Do you by any chance have copies of your old sleep studies to see if maybe supine sleeping or REM stage sleep might have been when your OSA was worse? It's fairly common.

So...if you didn't see these reports...how would you say you slept and felt during the day?

[Julie]

Have you tried not to back sleep (using pillows, etc. behind you)? It's the worst position for provoking apneas, but if the obstructives are being addressed by Cpap, maybe the RERAs are not, and it might be worth trying to side sleep if at all possible at least to see if you feel better. I also wonder if you've had a good check-up in general lately, with labs, maybe respiratory testing etc. because not everything's about OSA and some other business might be going on, if only at a low level.

[milesleroy]

Thanks Julie. I am not sure about the side sleeping. I can try, but its never been comfortable way for me to sleep, and I feel like I'm going to push the mask off when my face is on the pillow. But, I can try it.

I saw my sleep doctor at the end of August, at that time, there were no problems, he said everything looked good. And, had a physical in July.

Do you have any specific questions I might want to ask the pulminologist when I go to my appt next week?

Have you tried not to back sleep (using pillows, etc. behind you)? It's the worst position for provoking apneas, but if the obstructives are being addressed by Cpap, maybe the RERAs are not, and it might be worth trying to side sleep if at all possible at least to see if you feel better. I also wonder if you've had a good check-up in general lately, with labs, maybe respiratory testing etc. because not everything's about OSA and some other business might be going on, if only at a low level.

[Wulfman...]

Thanks Julie. I am not sure about the side sleeping. I can try, but its never been comfortable way for me to sleep, and I feel like I'm going to push the mask off when my face is on the pillow. But, I can try it.

I saw my sleep doctor at the end of August, at that time, there were no problems, he said everything looked good. And, had a physical in July.

Do you have any specific questions I might want to ask the pulminologist when I go to my appt next week?

Have you tried not to back sleep (using pillows, etc. behind you)? It's the worst position for provoking apneas, but if the obstructives are being addressed by Cpap, maybe the RERAs are not, and it might be worth trying to side sleep if at all possible at least to see if you feel better. I also wonder if you've had a good check-up in general lately, with labs, maybe respiratory testing etc. because not everything's about OSA and some other business might be going on, if only at a low level.

Lots of us have found other bed pillows that work better with this therapy. Mine is in my profile, but I was using it long before I started therapy and it worked great for me.

But, I can relate to positional sleeping. I'm a dedicated side-sleeper and CAN'T sleep on my back.....at all.


Den

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[milesleroy]

I ordered the pur-sleep buckwheat hull pillow. curious to see if that helps

[milesleroy]

In response to Julie's questions earlier and also fyi:

I located my original sleep study report from 2010. It noted that I slept supine almost 100% of the time. Also, my original AHI was 36, and they titrated a cpap for the second half of the study to a pressure of 8 cm/h20. The report recommended a pressure of 8. At some point after my first month or two with CPAP, the doctor told me to up pressure 10, which is where it's been for about 4 years now, without any issues and with good AHI.

Is it possible the minimum pressure of 10 is too high for me after losing 20 lbs?

[Wulfman...]

In response to Julie's questions earlier and also fyi:

I located my original sleep study report from 2010. It noted that I slept supine almost 100% of the time. Also, my original AHI was 36, and they titrated a cpap for the second half of the study to a pressure of 8 cm/h20. The report recommended a pressure of 8. At some point after my first month or two with CPAP, the doctor told me to up pressure 10, which is where it's been for about 4 years now, without any issues and with good AHI.

Is it possible the minimum pressure of 10 is too high for me after losing 20 lbs?

It's been reported here many times that when people lose weight, their pressure needs can go UP. Yes, it seems logically backwards, but it IS what people have found.

So, the answer is......."not necessarily".

But, if at some point you want to try another pressure......go for it. It's YOUR therapy. Just monitor the results.


Den

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[Julie]

I personally find that no matter what I do if I end up on my back (or even close to it) my mask becomes a joke - tho is ok on a side - and nothing at all I do will prevent the huge leaks and noises, especially if I've lost even 5-10 lbs.

[milesleroy]

In response to Julie's questions earlier and also fyi:

I located my original sleep study report from 2010. It noted that I slept supine almost 100% of the time. Also, my original AHI was 36, and they titrated a cpap for the second half of the study to a pressure of 8 cm/h20. The report recommended a pressure of 8. At some point after my first month or two with CPAP, the doctor told me to up pressure 10, which is where it's been for about 4 years now, without any issues and with good AHI.

Is it possible the minimum pressure of 10 is too high for me after losing 20 lbs?

It's been reported here many times that when people lose weight, their pressure needs can go UP. Yes, it seems logically backwards, but it IS what people have found.

So, the answer is......."not necessarily".

But, if at some point you want to try another pressure......go for it. It's YOUR therapy. Just monitor the results.


Den

.

I have seen the other threads on here indicating that weight loss created increased pressure needs for some people As I look back over the data I posted at the top of this thread, it seems that my 95% pressure on bad nights is up around 16. Is there any reason to think setting the pressure at 16 might improve things? I understand what the 95% of the time pressure means, but I don't understand if that is saying that's a level where I'd get better results or not

[Wulfman...]

In response to Julie's questions earlier and also fyi:

I located my original sleep study report from 2010. It noted that I slept supine almost 100% of the time. Also, my original AHI was 36, and they titrated a cpap for the second half of the study to a pressure of 8 cm/h20. The report recommended a pressure of 8. At some point after my first month or two with CPAP, the doctor told me to up pressure 10, which is where it's been for about 4 years now, without any issues and with good AHI.

Is it possible the minimum pressure of 10 is too high for me after losing 20 lbs?

It's been reported here many times that when people lose weight, their pressure needs can go UP. Yes, it seems logically backwards, but it IS what people have found.

So, the answer is......."not necessarily".

But, if at some point you want to try another pressure......go for it. It's YOUR therapy. Just monitor the results.


Den

.

I have seen the other threads on here indicating that weight loss created increased pressure needs for some people As I look back over the data I posted at the top of this thread, it seems that my 95% pressure on bad nights is up around 16. Is there any reason to think setting the pressure at 16 might improve things? I understand what the 95% of the time pressure means, but I don't understand if that is saying that's a level where I'd get better results or not

Not unless your pressure "experiments" lead you there. My "rule of thumb" is to use a pressure somewhere between the "average" and the "90%" (or 95% depending on the make of the machine). You can always work up to it, but I prefer to try to use as low of a pressure that will prevent almost all of my events.

Relating these events from my own experience......
My sleep study (March 2005) stopped at 16 cm., but there were a few remaining events (mostly snores).

My sleep doctor, in his infinite wisdom (NOT) wrote my prescription for 18 cm.

I got my equipment from CPAP.COM and it was set to that pressure from the prescription.

I TRIED that pressure for about 45 min. to an hour. Couldn't imagine trying to sleep with that much pressure all night.

Reset my machine to 10 cm. (eenie, meenie, minie, moe). But I had learned that 10 cm. was about the "average" pressure used by the vast majority of CPAP users.

I DID have the Encore Pro software from the get-go, so I could monitor the results (and adjust if necessary).

After a few nights, I downloaded my card......and, lo and behold, I was having AHI numbers around 1.0.

So, I left the pressure at 10 cm. for about a year before I finally started experimenting with 11 and 12 cm. (12 seemed to get rid of most of the residual "snoring")

Then, I bought an APAP with not too many hours on it from one of the forum members and experimented with a range of pressures of 10 - 15 cm. for a week. I only hit 15 for a little over a minute on ONE night. So, I knew that my prescription was "bogus". And, reviewing the results, I confirmed that the 12 cm. setting I had been using was about the best option of that pressure range. So, that's what I've been using since late 2006. My AHI was also higher in Auto mode.

I had used a C-Flex setting of "2" since I started.......and after some experiments in 2012 decided to turn it off completely in early 2013......and it reduced my average AHI from about 0.4 to 0.2 - 0.3.

Could I completely eliminate ALL of my events by going up to 15 or 16? Maybe......but I'd prefer to keep that "doomsday" option in reserve, in case I have to use it. I'm not complaining with the numbers I'm seeing and prefer to keep the pressure as low as possible.

Over the years, I've watched my numbers gradually decrease on their own......using (almost) the same settings.
I think the last time I tried a range of pressures was in 2008 for a nap. I actually didn't have hardly any events, but the Respironics Auto had the little pressure "probes" throughout that nap. I had my minimum set at 12 and I think it hit 13 cm. for very a brief period (other than the pressure probes).


Den

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