CPAPtalk.com

boston wrote:Give the guy a break, he does not have a data capable machine.
If he wants to improve his therapy, either because he isnt feeling great now or he just wants to try for the best therapy possible, this is the only way he can do it.
The only measure he will have is if he feels better or not.
He has been a member here for some time, hes well informed, hes not going to kill himself for raising his pressure a bit.
He knows how he feels now, he knows how he has been feeling up to this point, he knows how he felt before cpap.
After a week of bumping the pressure up 0.5 he should know if hes feeling better, the same, or worse.
I say go for it, 0.5 increments for at least 5-7 nights. That said, I raised my pressure once by 0.5 and had the worst night ever, so the next night I went back down.
Youve got support here, just take it slow on the pressure and make intelligent decisions, youll be fine.

I guess I now have to withdraw this part of my earlier post in this thread:

rooster wrote: ........
But please be aware that you did not receive advice from the members of cpaptalk.com to change pressure without monitoring data before and after. .............

If the forum begins to take the stance of "change your pressure and see if you feel better", then it is going in a direction that I believe is very detrimental to the forum.

rooster wrote:

boston wrote:Give the guy a break, he does not have a data capable machine.
If he wants to improve his therapy, either because he isnt feeling great now or he just wants to try for the best therapy possible, this is the only way he can do it.
The only measure he will have is if he feels better or not.
He has been a member here for some time, hes well informed, hes not going to kill himself for raising his pressure a bit.
He knows how he feels now, he knows how he has been feeling up to this point, he knows how he felt before cpap.
After a week of bumping the pressure up 0.5 he should know if hes feeling better, the same, or worse.
I say go for it, 0.5 increments for at least 5-7 nights. That said, I raised my pressure once by 0.5 and had the worst night ever, so the next night I went back down.
Youve got support here, just take it slow on the pressure and make intelligent decisions, youll be fine.

I guess I now have to withdraw this part of my earlier post in this thread:

rooster wrote: ........
But please be aware that you did not receive advice from the members of cpaptalk.com to change pressure without monitoring data before and after. .............

If the forum begins to take the stance of "change your pressure and see if you feel better", then it is going in a direction that I believe is very detrimental to the forum.

On infrequent occassions I must agree with my dear rooster friend ... this is one of those occassions.

If Jason cannot afford to get a data capable machine, Jason then needs to consider getting another lab titration ... I know, makes no sense.

If Jason is certain that he is not sensitive to central or mixed apneas, then trial and error without data may not be all that harmful but getting to the ideal pressure will be nearly impossible without extensive and detailed records of a qualitative sense of well being ... and that would also assume that there are no other underlying health or external environmental issues factoring into the sense of well being ... an almost impossible task to say the least ... like affording another lab titration when you can't afford a data capable machine.

The suggestion for a proxy measure with a data capable finger pulse oximeter is a good alternative though not ideal.

rooster wrote:If the forum begins to take the stance of "change your pressure and see if you feel better", then it is going in a direction that I believe is very detrimental to the forum.

Oh, I don't know if it's all thaaaat bad for someone with plain vanilla OSA to be encouraged to try some pressure adjustments without data feedback. After all, that's what the people in this study were doing:

Link to a study that concluded, "yes."
"Can Patients with Obstructive Sleep Apnea Titrate Their Own Continuous Positive Airway Pressure?"
http://ajrccm.atsjournals.org/cgi/reprint/167/5/716

They had no software, nor any data (that I know of) from the window of their machines. All they had was how they felt, and some presumably had feedback from their sleeping partner -- "You were still snoring." or "You weren't snoring."

Sure, it's better/easier/faster to have the type of machine and tools to see what went on during treatment. Especially if massive leaks could compromise the therapy. But lacking those things, I have no problem whatsoever with people choosing to try a few cm's more pressure to see if that makes them feel better in the morning.

From what I've read repeatedly on this and other message boards, it's not at all unusual for sleep doctors to raise the pressure another couple of cm's -- without looking at machine data, and without another sleep study -- when a patient who has been feeling good on CPAP complains of beginning to feel tired again. One or two cm's more than what was originally prescribed are not that big a deal, imho...not for "most" people.

If I were Jason, I'd do my pressure raising experiment in whole cm's, not half cm's. I would give each change at least 4 or 5 days as others have suggested. But if I were going to raise the pressure at all, I'd not drag it out with half cm changes.

I'm with Rested Gal!

I see no harm in JasonS doing this. Like her, I would suggest 1 cm increases for 4 or 5 days.

Sleep doctors do this all the time. I had a retitration study last April. The Specialist wrote this order to the Provider - Change pressure setting to 9 cm ( I already, thanks to this forum knew how to do that AND again, because of this forum, I knew that 9 cm was not enough for me). He ADDED to the order (+ or - 2 cms)!!!!

I actually took my pressure down and benefitted. Higher pressure was causing Central Apneas.... Lower pressure eliminated that and improved my sleep quality. Moral is: dont necessarily assume that moving up is always the right thing to do.

rooster wrote:Without data how will you know if the pressure changes you make are improving your therapy or making it worse? "How you feel the next day" is a subjective measure influenced by dozens of factors besides CPAP therapy. I rarely recommend pressure changes without the capability to monitor data.

Regards,

Well, I suppose I would rarely take your recommendations, so we're on the same page here.

BTW, what subjective measure did I have which alerted me to my OSA in the first place? And by what subjective measure have I determined that CPAP has been an effective treatment for me? The answer to #1 is I felt bad. The answer to #2 is I felt good. It isn't that complicated. I don't know about others (hypochondriacs, IMO) but I don't have a myriad of other issues that affect how I feel on a daily basis. It ain't rocket science.

I have a machine that is non-data capable but is working for me. I'm not in a position to purchase new machine, having had my current one for only about 6 months. By and large my CPAP titrated at 8cm has resulted in a vast improvement in my health. There is no question about that.

If you want to cast me to the leper colony of non data-capable users, so be it. Somehow, I will find a way to endure.

LinkC temp wrote:Can I have your mask when (not if!) you die??

Absolutely, you can have it. You'll probably already have been rotting 6 feet under for 30 years in your double-wide casket, but I'll leave it in my will for my heirs to drop it on your grave site.

I find that changing in halves is better as I lose my weight. Whole numbers are just too much of a change. I've tried both and halves are the answer. My AHI runs 0.02 down from the beginning 11.0 with the year ago pressure of 14cm (now 9.5cm). I've lost 37 pounds in the year. I'm still dropping the weight and I think I'll eventually be at a 6.5cm to maybe a 7. Oximeter is running 95 at rest, pulse 67 (I have some asthma) to 98 at night with a 2 litre oxygen bleed. The oxygen REALLY makes a difference...I'm a mile up here in Prescott AZ. I also feel GREAT!! Maybe being retired since I was 43 (I'm 62 now) "might" have some influence too. Ya wanna talk sleep? I probably hold the record...also for watching TV.

boston wrote:Give the guy a break, he does not have a data capable machine.
If he wants to improve his therapy, either because he isnt feeling great now or he just wants to try for the best therapy possible, this is the only way he can do it.
The only measure he will have is if he feels better or not.
He has been a member here for some time, hes well informed, hes not going to kill himself for raising his pressure a bit.
He knows how he feels now, he knows how he has been feeling up to this point, he knows how he felt before cpap.
After a week of bumping the pressure up 0.5 he should know if hes feeling better, the same, or worse.
I say go for it, 0.5 increments for at least 5-7 nights. That said, I raised my pressure once by 0.5 and had the worst night ever, so the next night I went back down.
Youve got support here, just take it slow on the pressure and make intelligent decisions, youll be fine.

Thank you.

ConnieM wrote:Jason, Can you tell me how to bump up my pressure please? I have the same machine. Thx!

Unplug the machine from the power jack (not the wall outlet). Make sure you unplug the CPAP machine and not the humidifier. I made that mistake. Then hold down the two arrow buttons while plugging back in the machine. You can then adjust the pressure to the desired level. After a short time it locks in. If you want to readjust you need to unplug it again.

rested gal wrote:
If I were Jason, I'd do my pressure raising experiment in whole cm's, not half cm's. I would give each change at least 4 or 5 days as others have suggested. But if I were going to raise the pressure at all, I'd not drag it out with half cm changes.

Thanks, I'll bump it to 9 cm. Going away for a long weekend in NYC so my sleep pattern will be different, but will give it another week after I return.

rested gal wrote:

rooster wrote:If the forum begins to take the stance of "change your pressure and see if you feel better", then it is going in a direction that I believe is very detrimental to the forum.

Oh, I don't know if it's all thaaaat bad for someone with plain vanilla OSA to be encouraged to try some pressure adjustments without data feedback. After all, that's what the people in this study were doing:

Link to a study that concluded, "yes."
"Can Patients with Obstructive Sleep Apnea Titrate Their Own Continuous Positive Airway Pressure?"
http://ajrccm.atsjournals.org/cgi/reprint/167/5/716

They had no software, nor any data (that I know of) from the window of their machines. All they had was how they felt, and some presumably had feedback from their sleeping partner -- "You were still snoring." or "You weren't snoring."

Sure, it's better/easier/faster to have the type of machine and tools to see what went on during treatment. Especially if massive leaks could compromise the therapy. But lacking those things, I have no problem whatsoever with people choosing to try a few cm's more pressure to see if that makes them feel better in the morning.

From what I've read repeatedly on this and other message boards, it's not at all unusual for sleep doctors to raise the pressure another couple of cm's -- without looking at machine data, and without another sleep study -- when a patient who has been feeling good on CPAP complains of beginning to feel tired again. One or two cm's more than what was originally prescribed are not that big a deal, imho...not for "most" people.

If I were Jason, I'd do my pressure raising experiment in whole cm's, not half cm's. I would give each change at least 4 or 5 days as others have suggested. But if I were going to raise the pressure at all, I'd not drag it out with half cm changes.

Absolutely. And I suppose Jason does have plain vanilla OSA and a sleeping partner to record his snores and leaky mask issues ... though I must admit I have no knowledge of these facts.

What I spend on even a short weekend in NYC would easily pay for a new machine/card reader/software.

But one thing I really like about living in this time and place is individual choice.

Suit yourself.

If all he has is a machine without data capability, what other choice does he have?

Yes, the ideal situation would be for everyone to have data capabilities, but unfortunately thats not reality.
So it seems to me that hes trying to do the best he can with what he has.

At least hes trying to improve his therapy and not giving up all together.

So instead of bitching, why dont you try to give the guy some support, isnt that what were all here for anyway.

boston wrote: .......
So instead of bitching, why dont you try to give the guy some support, isnt that what were all here for anyway.

There are a number of things that I "am here for". One of them is to promote self-monitoring and self-titration. This forum has been a great resource for that. I am recommending it for this purpose (and others) in my local community and in my virtual community.

I am speaking to doctors and other medical professionals frequently about the benefits of self-monitoring/titrating (diabetes model). I have been glad and confident to recommend cpaptalk dot com to the medical profession.

There has been mixed response, but I am encouraged that some of the response from the medical profession has been enthusiastic about cpaptalk dot com. Part of my "pitch" (call it "bitch" if you choose) is that patients can learn from the site how to monitor their therapy with good tools ("the software") and make simple adjustments followed by continuous monitoring to assure effectiveness.

You can have your own opinion, but I will not recommend a forum to medical professionals that routinely supports self-titration without good tools ("the software"). Fortunately, I don't think the cpaptalk dot com community is going in this direction either.

I talk to many patients in my communities (local and web) about their sleep apnea and therapy. You can rest assured that within this conglomerate of patients, Jason S. is in the stratospheric grade of a scale of their knowledge, experience and judgment. For this reason I have little concern about what Jason S. may do (but he should get data capability - he would enjoy it and probably benefit from it ). There is a concern however about the legions of other patients. The patients who don't know their machine model or manufacturer, who don't know the name of their mask, etc. These people are the typical patients. cpaptalk dot com regular members are very much atypical. I will not recommend a forum to "typical patients" that routinely supports self-titration without good tools ("the software").