APAP trial over need sugestions for CPAP setting

Well the DME called me Friday and said they needed my trial APAP machine for someone else to use. No word from my doc, expected to hear from him on one of the last two Fridays since he had all of my downloaded info. He is most likely on vacation around the 4th holiday. So I am on my own as to what to set my CPAP pressure at. I am hoping someone can offer suggestions as to were it would be best to set my CPAP pressure at. I am leaning to a pressure of 18 cm/w. This was the pressure set at my 1st study last august which was subsequently lowered to 10 after getting my oral appliance.

Here are the numbers from my last 6 days on an APAP.

6/28 - 7/2 90% pressure is 14
Obstructive Apnea 2.1
Hypopnea 3.5
AHI 5.6
Flow limitation 1.0
Ave Snore 7.1
Ave 90% leak 49.3
Ave leak 38

During this period I had 1 day were my 90% pressure reading was 12 but the next 2 nights it was 17 but then settled down over the next couple of nights to 12 and 10 respectively. The my AHI numbers for this time were a little higher than the previous 2 weeks.

For this trial I have felt quite a bit better than previously when on CPAP at a lower pressure. I am still taking Provigil but am thinking of discontinuing it soon. At least I have been able to stop drinking 4 to 6 cans of Coke to just stay awake which had been causing my weight to shoot up week by week. I feel significantly more rested after waking up also.

I have no idea what the doctor will recommend but what do you think I should set it? I will leave it there while I wait for the doc to decide to write a letter to my insurance claiming medical necessity for an APAP or tells me my CPAP set at _ _ cm/w is good enough for me.

Thanks for your suggestions.

Dale

What was your pro 2 readings. It does quite well for figuring out your CPAP settings. Your 90% setting + 1 CM would be a good place to start, but you need to secure the leaks a little better. Jim

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Hi Jim
Yes I know the leaks are a bear. Anytime my pressure goes much over 13 I get lots of leaks. I am pretty sure I am not mouth breathing, I used to tape but trained myself to keep my mouth shut It does not matter what I use FF or nasal I still blow things off my face.

My numbers on CPAP at my set pressure of 10 the week before starting APAP trial were as follows:

AHI ave 6
OAI ave 3
HI ave 3

Like I said earlier I felt like crap before the trial so I am sure I need a higher pressure most nights. What was weird, at least to me, was how during my trial my pressure bounced around from night to night. My first night on APAP my 90% pressure was 9 the next couple were 18 and 20. Then I stayed around 11 - 14 most days. I would like to set my pressure at a high enough level to eliminate most apneas but that usually means I can not hold a seal with most masks. I have had better luck with the CL2 but even with that I am losing a seal when I get up around 16 -18. I had a bloody nose a couple of nights ago with the CL2 nasal prongs so I am going back to my Hans Rudolph ff and using Rested Gals panty hose tricks to nail down the leaks. Maybe if I get an APAP from my doc full time then I might have a lower pressure range most nights. Who knows!

I am getting very tired of the pills I take because of the problems with OSA from blood pressure, thyroid, depression and daytime sleepiness. I went in for surgery on my wrists a few weeks back and I had to give the nurse a card with all my medications on it, half of which were for something relating to OSA, because it would be impossible for me to remember them all and their dosages. I am only 48 and I have more medication than most of my relatives in their 70's. If I could get my OSA more under control maybe I could cut out some of the meds. At least I am hoping.

Dale

Your pressure may have "bounced around" during the trial because of leaks. Remember, an auto can bump itself up trying to compensate for leaks.

I would bump up the Pro to about 14. That seems a happy medium between your titrated pressure and 10.

With your pressure being so high, I would definitely try to get a REmstar Auto with cflex. The cflex will help your exhale with the high pressure. Is that the one you had for your trial?

Yes Linda I did have the RemStar Auto. Since I new what I was doing I changed it from APAP to Aflex and set the Cflex to 2, something my DME never did when I was on a pressure of 18. It was a chore to exhale at that pressure, when I found cpaptalk the first thing I did was to get into the setup and check my cflex setting. It was at the lowest setting. What a relief to exhale easier

You think 14 would be high enough? Seems like I spent a lot of time over that but like you said that could have been related to the leaks. I will try my Hans Rudolph with the panty hose over the nose tonight and see how that does stopping the leaks into my eyes. The only problem is I have to figure out how to keep the pantyhose from slipping off where I place it and covering the vent holes, I don't think that would be a good thing.

Thanks for your input.

Dale

Dale92 wrote:

Here are the numbers from my last 6 days on an APAP.

6/28 - 7/2 90% pressure is 14
Obstructive Apnea 2.1
Hypopnea 3.5
AHI 5.6
Flow limitation 1.0
Ave Snore 7.1
Ave 90% leak 49.3
Ave leak 38

14cm is your CPAP pressure. No reason to bump it in either direction. Control your mask leaks better and you should see lower AHI. Look at what your snores did at lower/higher pressure, they should be the lowest at 14cm.

Set your Pro up with 6 or 7cm Ramp to 14cm pressure, use Cflex setting of 2 you should be fine. Throw out and forget about that 18cm found pressure, the person titrating you at the lab didn't have any idea on what they were doing.