Help with Pressure Optimization

A few people who are aware (one way or another) that their heads fall forward when sleeping, cutting off airway flow, have tried soft (and some not so soft) cervical collars that keep your head up, airway more open and jaw closed (if not lips) that helps with leakage as well. A forum search will bring up lots of info.

If this were my report and I still wasn't feeling the good numbers...besides talking to my doctor about medication possible side effects...I would be trying more minimum pressure in an effort to reduce the flow limitations just to see if a reduction in FLs made any difference in how I felt during the day.

I would plan for well documented experiments and leave the settings alone for at least a week before changing anything unless something drastically bad happened (like a painful belly full of air from the higher pressures).
For FLs....more pressure and with the apap machine in auto mode that means more minimum pressure.
You are going up to around 12 anyway and just staying in that area at least and often with even more.
When you used 14 minimum for the one night...the FLs did reduce.

I tend to be slow and cautious with my experiments. Make only one change at a time and document in a log how I feel the next day both in terms of sleep quality and how I feel in general. Write it down...I guarantee you won't remember it in 2 days and you need to be able to look back and review the settings along with your notes on how you slept and felt.

So I think I would start with minimum of 12 and open the max up to 20. The machine won't go higher than it thinks it needs to go anyway.
Do that for a week....keep your log....then try 13 minimum for a week....then 14 minimum for a week...then try 15 minimum for a week.
See if you can spot any trends or patterns or differences in how you feel.
Don't rely on the AHI...it's going to be low anyway....you are going to be looking at the FL graph for changes and also going by the subjective feelings of how you sleep and feel. Subjective feelings are hard to do...stuff messes with it. Like a short night for some reason...have to sort of disregard those. Not enough hours of sleep is a guarantee for feeling like crap no matter how pretty the reports are.

I did this same experiment some years ago only I did 0.5 cm increases. Went up to 13 over 6 weeks. Back then we didn't have Flow Limitation graphs to evaluate or the flow rate for that matter but we still had how we felt.
Over that 6 week experiment....nothing ever changed that I could tell. Sleep quality was the same...how I felt during the day didn't change...AHI didn't change...nothing changed so I eventually went back down to my 10 cm minimum that seemed to give me the best consistent results.
I did learn something though....that not all our problems involve more pressure to solve them...and at least I tried.
More pressure isn't always the solution but you don't know for sure until you try it.

Given that FLs can disturb sleep and thus mess with how we feel during the day...and more pressure is how we deal with FLs...then it makes sense to at least try more pressure.
Your FLs may not be bothering your sleep quality at all and may have nothing to do with your unwanted symptoms but it's worth at least experimenting to see what (if anything) changes with more pressure.

Should you develop bad air in the gut issues with the consistently higher pressures then we back up and regroup and decide just how important the experiment is. It makes no sense to trade one problem for another problem.

And of course don't forget that talk to your doctor about the potential for medication side effects and especially talk about a reduction in dosage due to how you ended up on 8 mg anyway...maybe all you need is the 4 mg.

If you like EPR...leave it alone. You may find it handy at those pressure in the teens all night long anyway.

yougotatoyo wrote: ↑

Thu May 30, 2019 5:11 pm

Pugsy & Palerider -

Thank you for the explanation on flow limitations.

Based on my chart, what would you recommend as the course of action to reduce these flow limitations?

I am open to suggestions.
Thanks

The normal response to flow limitaitons is, more pressure, which is why the auto machines raise pressure when you've got FL's.

Miss Emerita -
Thank you for the video link

Julie -
I will try and monitor myself to see if I am chin tucking at night. I have a recordable camera that I set up to test this. Thanks.

Pugsy -
Thanks for the tips.
I will definitely try this experiment with higher min pressures and start a logbook and at least try them for a week. I never tried these really high min pressures before because I read an article somewhere that said that if you set your pressures too high, this could be very dangerous to those little tiny branches of veins or arteries in your lungs. I can't remember where I saw that, but that scared the living crap out of me, so I never did it.

I really appreciate you sharing your experiences with me. It gives me a plan of attack and direction to tackle one aspect at a time. I was constantly aiming for a hail mary, and I never hit it. I just have to figure out what works for me and what feels the best. I've always found that EPR 3 has always been good for me, no matter the min or max, always easier to exhale and fall asleep easier.

Palerider -
I watched the SDB video, makes sense.
Thanks