What Pressure to Use

Okay. This will be my last question, hopefully, for awhile. Then it will be back to reading the threads to see if I can help anyone with my "wealth" of knowledge ( ).

Here's the question:
I have been experimenting with my pressure settings on my APAP and have found something interesting, which WillSucceed has already addressed in response to something I wrote the other day. But now that I've had a chance to do this for a few days and see my results, I am wondering what path is the right one to choose.

I was titrated at 10 cms. That does wonderfully by me and gives me extremely low AHI's. I don't use CFlex anymore, either, because for some unexplained reason, I get better results without it and I really have no problem exhaling anyway. Recently, as a test to see what would happen, I lowered my bottom number on APAP to 4 (as low as my Remstar will allow), which is probably the lowest I could handle without feeling like there is no air at all coming through the nasal pillows, and left my top number at the 10. My results are showing that the pressure rarely goes over 5, sometimes for a very short period to 6. Mostly, it remains at 4, though. My AHI's are a bit higher than with the 10 cms. straight, but the lower pressure is not bad and it's a lot quieter through my Swift at night. My snore index, though, has returned to 1-2 the past two nights with the 4-10.

Should I set my machine back to the highest number, 10, and just go with the good results or is it better to get used to lower pressure, even though the AHI is a bit higher (this mornng's reading had only one apnea the whole night and a few hypops) and the snore index has appeared again. I have been a bit congested, it seems, on lower pressure, too. Is that telling me something?

Sometimes it seems easier to see the solutions to other people's problems, probably because you're on the outside looking in. When it come to giving myself advice, I second-guess everything I'm thinking. So I'm coming to the pros and I ask you all, what would you do in my situation?

Thank you all for taking the time to read my usual overly-wordy posts. I have a problem in that I write like I talk (on and on and on). Been told I am a bit of a chatterbox at times, as is reflected in my posts. And being I type extremely quickly (part of my profession), it's very easy for me to leave long posts as it takes me no time at all to type them. Thanks for taking the time, though, to read it all. I guess if you made it to that last line, you actually did read it all .

Wow, that is a mystery! What is the actual difference in your AHI with it at 5 as opposed to 10? How long ago were you titrated at 10? And lastly, do you really need CPAP or are you just doing this for the tremendous pleasure of it all????

Oh, Neversleeps, I wish I were just doing it for pleasure (yeah, right).

I was titrated in the end of May. My AHI on straight CPAP at 10 cms is between 0.1-0.5. However, the APAP with 4-10 gives me an AHI of between 0.8-1.2, although the past few nights with that setting, I slept a lot fewer hours so it would raise the AHI anyway. Still not enormous, but the snore index is back (zero with 10 cms) and I still don't know how my oxygen desats are doing. When I was studied, that was described as "moderate," whereas my OSA was described as mild. I only had 4.something hypops (no apnea the first study-never saw the 2nd) and 14.something PLMDs with moderate oxygen desats.

So as I've been told lately, even though I've lost a lot of the weight I had to lose (14 of the 25 lbs. in 7 weeks) and my AHI is very low, I still could be having oxygen desats of a moderate degree AND we don't know if it's the therapy that is causing things to be so much better or if the weight has helped my breathing at night. Which came first, the love or the love song (a Butterfly Boucher song)? I think you know what I mean.

I just don't know what to stick with, lower and quieter pressure that gives me slightly higher AHI's, even though last night was only one apnea, or go back to the 10 cms and get 0.1-0.5 AHI's. Oh, the mystery of it all...

Boy, you sure can get the hackles up for those of us who can't seem to get our AHI below 10 consistenly. Your talking about tenths of 1 Ahi's. wowser. Go with what you feel most comfortable breathing with and step away from the computer and over analyzing!! just joking. Kinda

loonlvr,

It's just ignorance talking on my part. I don't know yet what is something to dwell on and what isn't in some cases. Hey, I've only been on CPAP now since the beginning of June. I know I have a lot ot learn and that's why I'm here. I know I tend to ask a lot of questions, but that's just my nature and how I will find out just what I need to dwell on and what I don't.

Obviously, from what you said, I should shut up (you said it more eloquently) before I alienate myself from people who are struggling to get their AHI's down under 10 and stop worrying about 1.2 or 0.5 and go with what feels best. I truly didn't know if that degree would make a difference in the long run as far as the effectiveness of treatment and the ability to heal whatever can be healed, like they say the soft palate stiffens up in time, if that was your cause for snoring, with CPAP therapy.

I really don't mean to sound ungrateful when I speak of my dilemma of which pressure to use when one brings me 1.0-1.2 AHI's and the other 0.1-0.5. It's, as I said, my ignorance not to know it really doesn't make a difference. Didn't mean to ruffle anyone's feathers. You guys are all too wonderful to do that too. And no pun intended regarding "feathers," loonlvr...

Darn, my humble apologies. I didn't mean to sound harsh. Maybe its just my frustration with my own therapy. I was just trying to be a little funny. Keep on posting, plz.

Oh, I didn't mean to make you feel bad. I just guess sometimes I can be insensitive to other's feelings when I post. I think of my situation and don't realize that what I write may cause others to feel...I won't say angry or upset, but less than happy with their own plight.

I really hope they can figure out how to get your numbers below 10 for you. How long have you been on therapy and at least has the 10 been an improvement? Are you feeling better since therapy? Like you said, that really is the most important thing when it comes down to it. And if you're feeling good and getting rest at night, then 10 is not such a bad thing.

Please don't feel bad about what you wrote. It was the last word of your reply, "kinda." that made me feel you had been bothered by my post. And I really didn't mean to do that to you or anyone else.

In general you want to minimize your AHI even at the expense of snores. Ideally you want to minimize both.

A snore can indicate your palate relaxing which can lead to hypopnea or an apneic event. This is why an APAP will take preventive action (raise the pressure) for snores (or "accoustic vibrations") to pro-actively eliminate the possibility of things getting worse. At least, this is what I've read somewhere (not this forum) recently.

If you can get your AHI down but you have a few more snores, don't sweat it. If you can get them both down, even better. But it is your AHI you should concentrate on.

So far I've found that anytime my pressure hits 6 or lower I get snores. And then I get apneas soon after. But if I don't let the pressure get down to 6 -- even 6.5 is good -- then I avoid snores and have fewer apneas.

But that's just me. YMMV.

WAF,

Seems to be what is happening with me, too. On APAP with a low of 4 and a high of my titrated 10, I get snores and somewhat more hypops especially. The apnea is low regardless. But on 10 straight CPAP or 10-10 APAP, my AHI is ALWAYS under 1 and there are zero snores.

So I guess the key would be to keep it at 10 and eliminate the snore index all together, which is what happens, and keep the lowest of all possible AHI's. 10 doesn't bother me in the least on inhalation or exhalation, so I guess I might as well stick with what works. I was just really curious to see what would happen if I lowered my pressure as low as my machine would let it go. It's not awful, but it does slightly increase both the AHI and definitely the SI.

Lori, if I were you I'd use APAP and raise the lower number to find my ideal. Actually, that's what I'm in the process of doing.

But that's me and you have to do what works for you.

Plus, you may find that what works for you is a straight CPAP setting of 10.

Don't use a single nights results to make any decision. I dont' have enought data yet to be sure, but it looks like there may be a fairly typical bell-curve distribution of results for a particular setting: some nights will be terrible, some amazing, and most just very good. If the majority of the nights were in the "very good" category I'd ignore the outlyers (those "amazing" and "terrible') and use the middle of the bell curve to make decisions on.

I agree with WAflowers. The consensus seems to be to have a narrow range when on the Auto mode. So try something like 6-9 and adjust from there .And definitely try each setting for awhile to get a general idea if it works.

WAF and loonlvr,

I have tried bringing up the low number a few weeks ago. Originally, my DME set it at 5-15. That was too large a range and Rested Gal suggested I move the low number up closer to my titrated number, which is 10. I was using 8-15, but it seemed that when I had 15 as a high number, I would get events in the 11 and 12 range. Then I tried straight CPAP at 10 and got incredible results. After awhile, then I tried, as an experiment, doing 10-10 in APAP mode and the results were almost exactly, very similar.

So, in the interests of getting the best numbers I can and a zero snore index, I will either try 9-10 tonight or go back to 10-10 and leave it at that. I have done these experiments over the course of at least 3-5 days at a time. I know better than to do something one night and then change it as one night is always somewhat different from the next.

The only other consideration that enters into the equation now is, my mouth patching has been working incredibly now and I wonder if that has anything to do with my snore index being higher. I guess I will have to see when I go back to 10 or 10-10. I also just realized that my mouth puffs seemed to have vanished when I kept the pressure lower, so that answers why I was getting those. I guess I will have to contend with those again. Hope the Tegaderm patches can take it the way I'm rigging them up lately.

I just sent back my mold to Dr. Sue, so hopefully I did it correctly and will have my mouthpiece in a week.

Do you realize I never write a one-liner, or it happens very infrequently? People are going to start seeing my name and just skip over the post since I am so verbose all the time. But when you talk a lot by nature and type just as quickly, it leads to long posts. Sorry...

Personally I think 8-15 could be too wide a range for a titrated pressure of 10. I know some would disagree and a lot depends on the individual.

I know when I go much over my titrated pressure of 8 I start getting a lot of central events (apnea with cardiac oscillations reported by SL3). And if I go too low I get snores (acoustic vibrations).

So I keep myself in a fairly tight range of 6.5-9.

You might want to try leaving your upper range capped at your titration value (10) or maybe just a bit higher (11) and try finding how low you can have the lower range without having your AHI climb.

OTOH, if straight 10 works for you and you can breathe well, maybe you shouldn't argue with success.

OTOH, if straight 10 works for you and you can breathe well, maybe you shouldn't argue with success.

It does very well, except for the mouth puffs. I will see what happens with the secure patch job I have been doing to seal my mouth lately. I haven't tried it at 10, but tonight I will see what happens. I am praying it doesn't pop the seal on the patch, which I am doubling up at the edges with an extra cut-up Tegaderm patch. So far, it's been perfect but I haven't tried it at a 10 cm. pressure. I'll let you know tomorrow if it holds. If not, maybe I'll have to wait for the Nose Breathe device to come.

The beauty of having an autopap and software is to be able to look at the data and tweak one's own treatment. Just like mask performances and mask preferences depend on the individual, some people's "best range" pressure needs differ from another person's.

Bill finds that if he sets the high on his auto above his titrated pressure, he sees centrals popping in on his data. For him (so far) the big benefit of having an autopap is that he can set his low pressure comfortably down below his titrated pressure.

On the other hand, back during my early experiments with autopap when a machine was giving me pressure runaways spending a lot of time up at 18 and 19, I luckily had only a very few random "centrals" show up on the data, night after night, until I got the machine tamed down. For me, even those sporadic centrals did not appear at all until a pressure of 17.

I've been able to use any "high" setting, even up to 19 or 20, and my autopap doesn't ever touch anywhere close to that. Actually I keep the high set at 15 -- my machine never even touching that. 12 and occasionally 13 is about as high as I ever see it go when I look at the data.

I do have to keep my low pressure "up"...have had the low set at 8 for many months. Recently I upped the low to 9 which does better now that I seem to have acquired the habit of sleeping on my back probably half the night. Had always been a lifelong "side sleeper" 'cause of the lifelong untreated sleep apnea, probably!

With the autopap taking such good care of me, and a mask that lets me sleep easily in any position, AND the Tempur-Pedic bed added to my "sleep" arsenal this spring, I've frequently found myself sleeping on my back quite comfortably. A surprise to me.

I never believed the adage about old dogs and new tricks, anyway.