Question: How many folk have had their cms lowered by Dr

dsm · Post by **dsm** » Mon Sep 19, 2005 9:04 pm

I was in a conversation with one of our members from Seattle who has said that her very xPAP aware doctor believes she may benefit from having her cms lowered.

This is an interesting proposition as it seems to fly in the face of what I suspect most of us might think.

I have (for whatever reason) always assumed that for anyone titrated at xx cms that to go up in cms doesn't do any harm (if the patient can tolerate it) but that going down invites more SA & OSA events.

The person in question commented to the Dr that they were feeling more tired than normal. This was when Dr said lets look at going to lower cms.

So the questions are (this is users of straight cpap)

1) Has anyone had their cms lowered & benefited

2) What would you expect by having your cms lowered

DSM

snork1 · Post by **snork1** » Mon Sep 19, 2005 10:39 pm

I had my pressure lowered and it did indeed help, but its a bit more complicated than that.

I had major nose/sinus surgery which really opened me up and made CPAP work better. But I was running at my same 10-14cm pressure and not REALLY feeling better.

I got retitrated and lowered to 5-10cm and it seemed be less disturbing to my sleep and my results FEEL better now.

Interesting thing is my doc talked about checking the lower pressure during the study in HIS LAB, but the sleep technician had NO plans to even try anything below 10cm, until I requested that.

It all worked out but was a bit odd. It reiterates how closely you must monitor your own situation and interactions with the "professionals".

TXKajun · Post by **TXKajun** » Tue Sep 20, 2005 10:04 am

One of the advantages of having an APAP and software is that I can monitor my therapy and make informed decisions based on what I've read and learned, especially from this board and online. There is a wealth of information on the web about OSA (unfortunately, it seems like quite a bit of this information is either out-dated or just downright wrong!).

I posted a while back a list of a whole ton of OSA references. A few of them actually said something to the effect that "after being on CPAP therapy for a while, the soft palate recuperates and strengthens" due to not snoring up a storm every night. IMHO (I'm not a doctor or medical or respiritory professional, so this is only my opinion and NOT medical advice, so take it with a large grain of salt!) when we start successful XPAP therapy, our throats/palates recover to some extent and, with this regained strength, is not near so apt to close off and cause apneas. This being the case (again, IMHO), the patient's need for the initial pressure from initial sleep titrations SHOULD become lower for each person after several months.

That said, I've been monitoring my APAP therapy with a PB 420E and using the Silverlining software. Since starting back in January of this year and being prescribed a pressure of 16 cm, I've noticed that my 90% pressure has steadily dropped over the months. Also, I started with an UltraMirage FF mask and have recently acquired a DreamFit mask and started using that one. Again, with the new mask, my 90% pressure dropped even further! To make a long story short, last night I lowered my APAP settings for my 420E to a low of 7 cm to a high of 11 cm with no ramp time, and running in APAP mode, IFL1 off. Today I did another check using the software and my 90% pressure is only 7 cm (software recommends a setting of 8 cm)!! Quite a bit of difference from my titrated pressure of 16, no?

I have done all this on my own, no bothering the good Sleep Dr. (who is darn near impossible to get hold of and resides in Albuquerque which is about 5 hours away) who only interpreted my results and sent that interpretation to my local GP Doc. I do know that I am sleeping better, longer and deeper than in the last 7 or 8 years and that I have energy to do just about anything I want, including playing with my 9 year old son and sitting at my desk at work and not fall asleep.

Was making the changes without doctor permission wise? Probably not. Was it cost-efficient and time-efficient? Definitely. Do I feel better? YES!!!! So I'm going to keep doing my self-diagnosis and making the changes (I consider it merely "tweaking" my APAP) until I can optimize them. The software is absolutely invaluable! The only 2 things I'm lacking are an oxygen saturation meter to check blood oxygen levels and an EEG to check sleep stages. But I figure I can do with out those until I can get another sleep study authorized by my GP Doc and paid for by insurance. Until then....

This therapy works!!!

dsm · Post by **dsm** » Tue Sep 20, 2005 4:56 pm

TXKajun wrote: <snip>
A few of them actually said something to the effect that "after being on CPAP therapy for a while, the soft palate recuperates and strengthens" due to not snoring up a storm every night. IMHO (I'm not a doctor or medical or respiritory professional, so this is only my opinion and NOT medical advice, so take it with a large grain of salt!) when we start successful XPAP therapy, our throats/palates recover to some extent and, with this regained strength, is not near so apt to close off and cause apneas. This being the case (again, IMHO), the patient's need for the initial pressure from initial sleep titrations SHOULD become lower for each person after several months.

TXKajun,

Thanks for this - very interesting - opens up a very good line of thinking.

Cheers

DSM