New to CPAP, need help choosing right pressure.

General Discussion on any topic relating to CPAP and/or Sleep Apnea.
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Pugsy
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Re: New to CPAP, need help choosing right pressure.

Post by Pugsy » Mon Jul 11, 2022 10:29 am

kidchameleon wrote:
Mon Jul 11, 2022 10:10 am
I feel like I'm pretty close to a 0 AHI and I don't want to continue screwing up.
If the 0.0 thing is your ultimate goal....get rid of that idea right now. Even if you get it that doesn't mean you will feel it.
If nothing else a false positive awake flagged event will mess up "perfection".

Your goal should be good solid sleep and not some arbitrary number. Did you know that AHI 0.0 doesn't mean you slept great and will feel like a million bucks. It's just a number. But it doesn't guarantee anything except maybe a chance to pat yourself on the back. You can get an AHI of 0.0 and still sleep like crap and feel like crap.

You are going to have nights like last night and nights like the night before...accept it.
You only worry about nights like last night when you start seeing them happen consistently night after night and THEN the first thing you should do is decide if those flagged events happened when you were asleep or not...THEN start wondering if something needs to be changed because the flagged events seem to be asleep events.

You can have false positive/awake/arousal flagged events in any category. It's not limited to centrals.
I know this to be a fact because I have had them myself.
Sounds to me like you need to do more education on flow rate evaluation.
Watch the videos here
http://freecpapadvice.com/sleepyhead-free-software
I am 100% certain that some of your flagged events got flagged when you weren't fully asleep. How many I don't know but I know some of them you weren't asleep. If you weren't asleep they don't count in terms of therapy effectiveness and you can't fix awake flagged events with pressure changes anyway. You have to fix the cause of the awakening and it isn't always related to the airway collapsing.

Here is an example I like to use
the ASLEEP breathing is circled in red....the other stuff after it is related to not being asleep and they just don't count
Image

and a more zoomed out image of the same time frame. All that mess flagged after the circled area simply doesn't count in terms of cpap therapy effectiveness. Changing anything won't fix that poor sleep/awake breathing stuff. I have to fix the cause of the poor sleep in the first place and it wasn't related to the airway itself.
You can't fix bad sleep with cpap tweaks if the bad sleep is from anything other than airway issues. You just can't.
Image

Make sure the problem you are trying to fix with cpap setting tweaks is fixable with a tweak.
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kidchameleon
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Re: New to CPAP, need help choosing right pressure.

Post by kidchameleon » Mon Jul 11, 2022 11:19 am

Oh, I know 0.0 isn't a realistic thing to shoot for. I should have specified that I meant somewhere in the 0 range. But I don't know if some people feel better with zeroes or ones or anything above those, so I'm still not sure what number would fit me. I know I've seen some people say that they don't feel good unless they're less than 1 and I've never been that close so it's something I wanted to try and get. Regardless of all that, I know it's how I feel that really matters, I just thought maybe getting close to any number near 0 would help. Maybe even having consistent 1s will be good enough, I just need to stay on that for awhile. I haven't slept well in so long I can't even remember, I'm sure it'll take some time to feel something.

Yeah, I'm pretty sure I slept badly last night because of how unprepared I was in going to sleep. And I'll be sure to look into those videos. One big problem I have is that I wake up a few times at night. I still don't know why exactly. I just open my eyes and go back to sleep, even these past few days where I had 1s.

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Pugsy
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Re: New to CPAP, need help choosing right pressure.

Post by Pugsy » Mon Jul 11, 2022 11:40 am

kidchameleon wrote:
Mon Jul 11, 2022 11:19 am
One big problem I have is that I wake up a few times at night. I still don't know why exactly.
Did you know that to wake up a few times during the night is entirely normal and to be expected?
Could be no known reason or could be the normal end of REM stage sleep awakening.
Google "sleep stages" and look at the normal hypnograms. Every single one of them will show a normal brief awakening at the end of the REM cycle. Since the number of REM cycles can vary during the night we would expect for the number of the post REM awakenings to also vary.
Most of the time we aren't awake long enough to form a memory of the awakening but for some people, for some reason who sleep maybe not as soundly, they are awake long enough to form a memory.

I briefly looked at my machine's LCD display this morning when I got up. AHI was 2.15...don't remember exactly but that is "high" for me but I feel wonderful this morning. I haven't really looked into the detailed data but I already know why I feel better....number of hours of sleep exceeded 8 by a little bit. Number of hours of sleep is my BIG crystal ball on how I feel. I don't even have to look at the AHI. Always, always my AHI is about 75% false positive flagging anyway.

I could already tell by looking at your last night's report that you had a rough night last night and it wasn't the AHI that was the big clue....it was the obvious awakenings that showed up when you turned the machine off and back on again.
I am betting you had even more awakenings where you didn't turn the machine off.
More awake time means more chances of false positive flagging...so any flagging happening around a known awake time I am pretty sure is a false positive.
The flagging at around 04:40 ish...for sure false positives. I would bet my last dollar on it.

And you got 5 hours and 40 minutes on the machine (of which some of it you were awake)....it's to be expected that you don't feel so great this morning. Simply not enough sleep and even if you had 0.0 AHI you would still feel like crap most likely.

Now why you aren't sleeping so great....that's the million dollar question and just means that you have to do a LOT more detective work to try to figure it out.
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zonker
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Re: New to CPAP, need help choosing right pressure.

Post by zonker » Mon Jul 11, 2022 1:12 pm

kidchameleon wrote:
Mon Jul 11, 2022 10:10 am

Unfortunately, I broke my 1 AHI streak today and woke up with an AHI of 3.71.
you know what? it happens. hell, after 7 years on the machine, it still happens to me. what i'm trying to teach myself is the very patience i try to espouse to others. :lol:

but i know (cuz folk here have said it) that we sleep differently each night. not wildly swinging and things DO settle down.

but you and i need to learn to live with it.
why folks don't like it when asked to clarify their statements?
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Pugsy
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Re: New to CPAP, need help choosing right pressure.

Post by Pugsy » Mon Jul 11, 2022 1:29 pm

zonker wrote:
Mon Jul 11, 2022 1:12 pm
it still happens to me. what i'm trying to teach myself is the very patience i try to espouse to others. :lol:
You mean you don't practice what you preach??? :lol: :lol: It's hard to do....I know first hand.
Did your mom ever tell you "don't do as I do...do as I say"....I know my mom was real proud of that one.

One of my hardest experiments some years back was when I set the pressures and made a vow to not change it for 6 weeks no matter what happened. That vow was really hard to keep but keep it I did and you know what I learned.
1...my AHI reduced by 50% on average at the end of the 6 weeks from when it started (from 3 to 5 AHI to 1 to 2 AHI)
2...my overall sleep time increased by 45 minutes on average from when I started.
3...my overall sleep quality was a bit improved as well (this was before the back issue really flared up and created big problems) or maybe I thought the quality was better when it was actually the 45 minutes more that made me think quality was better.
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zonker
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Re: New to CPAP, need help choosing right pressure.

Post by zonker » Mon Jul 11, 2022 3:41 pm

Pugsy wrote:
Mon Jul 11, 2022 1:29 pm
zonker wrote:
Mon Jul 11, 2022 1:12 pm
it still happens to me. what i'm trying to teach myself is the very patience i try to espouse to others. :lol:
You mean you don't practice what you preach??? :lol: :lol: It's hard to do....I know first hand.
Did your mom ever tell you "don't do as I do...do as I say"....I know my mom was real proud of that one.
are you my sister?
:lol: :lol: :lol:

i think your mom got her "handbook" from the same place as mine did.

it just discourages me still when i think i've had a "good numbers" night OR i've been on a roll with numbers being, like, 0.11 then seeing a 1.86 or whatever. eventually, i'm going to have to just plain give up looking at my charts everyday and just stay with my journaling of how i feel in the morning.

anyway, to kidchameleon-just sayin' that patience isn't easy. but you WILL get there eventually and things will seem much brighter.
why folks don't like it when asked to clarify their statements?
We can't take this journey for you, but there is a forum full of people here who will gladly take it with you.-jnk

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kidchameleon
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Re: New to CPAP, need help choosing right pressure.

Post by kidchameleon » Mon Jul 11, 2022 10:32 pm

That's good to know that waking up is normal. I was worried that was going to be a problem. Guess I shouldn't worry too much.
And I'm really glad to know that AHI decreases the more you stay on certain pressures and that even at around 2 you can still feel great. It really makes me excited to see how much improvement I'll be able to see if I stick with a certain pressure for awhile.
Thank you both for all the help, I definitely don't feel as hopeless as I used to.

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Re: New to CPAP, need help choosing right pressure.

Post by palerider » Mon Jul 11, 2022 11:18 pm

kidchameleon wrote:
Mon Jul 11, 2022 11:19 am
Oh, I know 0.0 isn't a realistic thing to shoot for.
Anything under 1.5 is great, but you get less and less improvement the closer you get to 0, ie, the difference between 0 and 1 is probably not something you'll ever notice.

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Re: New to CPAP, need help choosing right pressure.

Post by sleepyhead22 » Tue Jul 12, 2022 12:18 am

Hey kidchameleon,

Was just reading through your thread and have a couple of thoughts. I do have some questions for you though before I say anything. I'm new to being a sleep apnea patient, but not new to medicine.

Since starting this post way back in March, do you feel significantly improved? I know you have problems with insurance, but have you seen a doc recently? Sounds like your case is fairly complicated. When was the last time you had a thyroid panel? I'm trying to think outside the box; there may be other causes to your symptoms other than just sleep apnea, though that is clearly a contributor.
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kidchameleon
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Re: New to CPAP, need help choosing right pressure.

Post by kidchameleon » Tue Jul 12, 2022 9:32 am

That's good to know! I don't care if it's 1 or 0 as long as I feel good. My number went down to 2.3 today, hopefully if I keep it up I'll see improvements.

I haven't felt any improvement, honestly. I do have hypothyroidism and I've had a panel done recently, but everything is alright. I also used to take antidepressants, since I thought this fatigue was caused by it but I never felt anything from them. I did find out I have low testosterone a few months ago, but I know bad sleep causes low testosterone production so I think that'll get fixed once I start sleeping better. I'm doing what I can to raise it though, like weight lifting and taking supplements. Really though, I'm sure I haven't felt better because of how much I keep changing things, that's why I'll keep my current settings for a week or two.

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Re: New to CPAP, need help choosing right pressure.

Post by sleepyhead22 » Tue Jul 12, 2022 1:29 pm

I'm glad you're receiving medical care and had a recent thyroid check. As you know, one of the most common symptoms in hypothyroidism is fatigue. I really hope you can work out your insurance and get a sleep study, with cpap titration. It's amazing how much information one night at a good sleep lab can get you.
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kidchameleon
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Re: New to CPAP, need help choosing right pressure.

Post by kidchameleon » Tue Jul 12, 2022 4:45 pm

Thanks, I thought my fatigue and sleepiness came from hypothyroidism for years. Thankfully I now know it's sleep apnea. Unfortunately without insurance I'm still paying off that sleep study. Maybe if things don't work out I'll get a sleep titration. For now I'll just stay on my current pressure and see where that goes.

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Re: New to CPAP, need help choosing right pressure.

Post by sleepyhead22 » Tue Jul 12, 2022 5:30 pm

The fact that you say you haven't felt any improvement since beginning this self-titration journey in March is somewhat discouraging, and again makes me wonder if there are other factors at play. But I wish you luck, sincerely
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kidchameleon
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Re: New to CPAP, need help choosing right pressure.

Post by kidchameleon » Tue Jul 19, 2022 12:25 pm

Alright, after a good while I decided to post what I have. I haven't made any single change, all I do now is press the power button. I still sleep with the backpack, which really helps. I mostly sleep on my right side but occasionally on the left.
I'm very satisfied seeing my numbers on the 1-2 range. I was even surprised to get a zero one time! I feel like I might be closer to my goal now, which is a consistent range of around 0-1. I know it's based on how I feel, but it would be nice being able to go that low.
Should I continue using this pressure or should I raise it? I still feel the same as always but hopefully having more consistent 0s and 1s would help.
https://imgur.com/a/Y4rU39X

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Re: New to CPAP, need help choosing right pressure.

Post by Dog Slobber » Tue Jul 19, 2022 12:38 pm

Great job and great discipline.

You now have a pretty good data point of 14-20 pressures that we can compare to.

Knowing that, I would:
  • Increase minimum pressure to 15. If your comfortable with 15, if not try 14.8, maybe 14.6.
  • Leave it at that value for a time period similar to your 14-20
  • Don't dwell on single nights, you still may have an occasional higher AHI night
  • What we're looking for is:
    • lower AHI
    • less activity in the flow limitations
    • flatter pressure trace, including lower peaks
Keep visiting the Statistics page to compare the AHI of 15-20 to your existing 14-20. Remember the more nights on 15-20 the more statistically significant it will get.