CPAP pressures less than 4?

I am using a Dream Station CPAP. My initial setting was 12 for pressure, with my AHI (apnea hypoxia index) around 2 consistently.

I did a trial of only sleeping on side, NO backlying, and has been able to reduce pressure down to 4 with AHIs staying roughly about 1 -2. No increase in problems at all. The Dreams Station reportedly cannot be set to a lower pressure than 4 cm H2O.

I would like to try reducing pressure and possibly discontinue CPAP if the apneas can be controlled by sleep position, though I want to be monitored so I know whether there are apneas or hypoxic events. How can I continue to titrate down the pressure in a monitored situation, or do a test of sidelying without going for another expensive sleep study?

Thank you for input..

You can't do what you want to do with your cpap machine.
To know for sure you need a real sleep study.
There is therapy value even at 4 cm pressure. I think there is maybe 1 machine that might allow a 3 cm minimum but that's it and to know for sure you have to have no therapy pressure at all and the only way to do that is a real sleep study.

If you had a real diagnostic sleep study it should have told you how much your AHI was when on your side vs when on your back.
Or did you have one but they kept you on your back the entire time?

Thanks, you pointed me in a good direction.

My sleep study only reported the figures for when I was lying on my back / supine.

When I questioned them about SIDELYING data from my sleep study, turns out my values ere GREAT and NORMAL as long as I stay off my back. I will invest in some good sidelying pillows and then be able to at least leave cpap home when traveling, and if my trial goes well, maybe skip the cpap altogether as long as I am certain I stay off my back and symptoms of sleepiness are gone.

I am working with sleep specialists on this, and appreciate their advice, though as you can see, sometimes questions can yield new possibilities for treatment which are less costly and inconvenient than cpap machine.

IF U R CONSIDERING A SLEEP STUDY, I suggest you intentionally sleep on your side for part of the night and obtain data for sidelying to compare to supine /back lying.

Thank you for posting.

Some people are lucky enough that if they stay on their side their sleep apnea events are so minimal that they aren't a problem.
The main issue is that it isn't always so easy to stay on one's side the entire night for any number of reasons but if someone can get it done and not have to use cpap....more power to them.

I prefer side sleeping because I have increased back pain when I sleep on my back but if I sleep on my side very much then I have shoulder pain so I end up on my back because the shoulders hurt so bad.

Some people only have enough apnea events to be a problem when in REM stage sleep. We can't do much to limit REM though and we don't really want to limit REM as the body needs all the normal sleep cycles for the restorative powers of sleep to work their magic.
It's a bummer to have to use cpap for just 20% of the night but that's what we have to do sometimes.

And yes....while I know that sleep studies are usually going to concentrate on supine sleeping situations to get a worst case scenario picture of things we should also include some side sleeping in those sleep studies because for some people they might be able to get by without cpap if they stay on their side. I had an in lab sleep study and I slept both on my side and on my back. For me there was no real difference in how severe I was in one position over another. Not everyone will have a marked difference in severity of their OSA with position. Also sometimes there is a marked difference in pressure needs for those that side sleeping doesn't reduce the events enough to do without cpap. I know one person who needs 18 cm pressure when sleeping on their back but only 9 cm when on their side.
9 cm is a lot easier to get comfortable with than 18 cm...and for that reason they do everything they can to stay on their side.

You are wecome to try, but eventually you may need to use cpap anyway.
Due to arthritis, I have on occasion had to sleep in different positions because . . . pain.
I am glad I was able to just roll over, already comfortable with cpap.
Fighting two discomforts at a time ---not my kind of fun.

Just to let you know, the reason for a minimum possible pressure setting is that below a certain pressure, the exhaled CO2 will not be cleared out of the mask and thus be re-inhaled.

Some very old machines went as low as 3, but that was discontinued.

D.H. wrote: ↑

Wed Mar 18, 2020 4:47 pm

Some very old machines went as low as 3, but that was discontinued.

Not necessarily old machines.
DeVilbiss currently makes cpap/apap machines with a minimum pressure of 3 being available even now with current models.
It is the only brand that I know of that today offers a machine that will do a 3 cm pressure.
Also there are a couple of bilevel machines that offer a 3 cm EPAP in certain modes only.
Example...my current ResMed AirCurve 10 VAuto offers 3 cm EPAP in S mode only.

Pugsy wrote: ↑

Wed Mar 18, 2020 4:58 pm

D.H. wrote: ↑

Wed Mar 18, 2020 4:47 pm

Some very old machines went as low as 3, but that was discontinued.

Not necessarily old machines.
DeVilbiss currently makes cpap/apap machines with a minimum pressure of 3 being available even now with current models.
It is the only brand that I know of that today offers a machine that will do a 3 cm pressure.
Also there are a couple of bilevel machines that offer a 3 cm EPAP in certain modes only.
Example...my current ResMed AirCurve 10 VAuto offers 3 cm EPAP in S mode only.

In any case, no machine ever made will go below 3, as far as I know.