To increase pressure or not, with detailed data Part II

AHI 4.1 (ob 2.5 central 0.3 sleep onset and 1.2 hypop) 13.4cm CPAP EPR 2.

I have had better days at the same pressure but I do feel pretty good with charts like these as well, I am wondering if its body position. Maybe I rolled over on my back? I need to find a pillow to keep me on my side and a cpap pillow.

Anyone have any ideas? I have had nights at the same pressure/leak stats well under 1 for AHI. I can live with this kind of a night but if I can do better that's my mission.

What pressure are you at now? Is that your prescribed pressure?
First I would consider how important the EPR is to you.
Turning it off made a big difference for me. I wish I had done that before trying higher pressures.

Liz, I noticed that from EPR 3 to 2 so I did plan on weaning myself off of it. I will try EPR 1 here shortly. My pressure is 13.4. I am my own doctor as I have no insurance. Originally I was set by a doctor at 9cm, then 10cm, then 16-20cm. I don't think they really know and without another study its just trial and error which is what I am doing here.

The EPR is an individual thing. At higher pressures, it is probably a more noticeable advantage.
Have you had any problems with areophagia?
How did you do in the auto mode?
I wouldn't settle for the results you have posted. I don't worry about a few 10-12 second apneas, but you're up to 37 seconds. Since you are on CPAP, it isn't a response to pressure changes, except possibly those caused by the EPR. EPR made me feel like I had to breathe at the machines pace, so it was waiting for me and I was waiting for it.

Yes, I have some problems with swallowing air the higher my pressure is set. With the same settings I had an AHI of 0.1 the other day with only one short event. I have been tightening my mask more and doing better with leaks and I am thinking its pushing my lower jaw back and possibly causing problems, that or its sleeping position. I am on less and less sleeping meds every night and sleeping longer.

High pressures are hard for me to control leaks and sometimes the lower pressures do the trick. I am only a few weeks into this so my course of action is as follows:

1) Cpap pillow and large pillow so I can side sleep easier and maybe a large pillow behind me will prevent me from back sleeping (if I am).
2) Wean myself off of EPR, as you said thats not as easy once I get around 13cm or so but I think I can get use to it. I want to try this before increasing pressure.
3) Continue to wean myself off of all sleeping meds, I am not taking much now, all my heavy hitters were flushed down the toilet.
4) Continue the quest for the perfect mask and seal. I REALLY liked the Swift FX but at high pressures I blew the tape right off my mouth, maybe I will try the ultimate chin strap.
5) Once my one year is up insurance is suppose to start covering this so I want to see a specialist to see if surgery can help, maybe I can use lower pressures after. I feel pain in the back of my throat without cpap so I am wondering about my tonsils.
6) I did quit smoking, eat super healthy (normal BMI now) and have worked on sleep hygiene but will now also start on more exercise.

I do have an incredibly dry mouth when I wake up and since I do swallow air my five year old is quite entertained as I "rid myself of it" in the morning, but so far no pain. When falling asleep I can feel the air go in and burp it out but when I am asleep who knows whats going on.

As far as APAP I know I have an old post here where I compared the two back when insurance was going to cover this, they later decided not to and took all my gear and told me I had to suffer it out for a year. Took me a while to save up the metric ton of cash needed to buy everything myself. My problem with APAP and EPR for that matter is mask comfort and seal. With APAP having a range I have to fit the mask for max pressure so when I start the mask is too tight, if I make it more comfortable when it starts I have leaks when it ramps up. I went as high as 18cm on APAP and the machine wanted MORE room yet some nights at 13cm I have no events. EPR is the same problem, rocking the mask as I breath. I would like to try 13-15cm CPAP without EPR and leaks under control sleeping on my side and give that a go for a while. Not sure why I am having more events now than before.

We don't always sleep the same very night and thus AHI can vary. Can you post an image of the report you had the less than 1 AHI? If these happen to be REM stage events..REM varies from night to night also. Would you say you had more nights like this one or the less than 1 AHI?

Pugsy, always sharp! I do not really have enough data to really say I have more of one than the other. I have a few of each at this point. As you may remember I can not trust my earlier runs as the leaks were so out of control reporting was compromised.

However, on the ones that look near perfect I noticed the few events taking place seem like they may be REM related. First one would usually be at 90 minutes and so on. So I am thinking 13cm does the trick except when REM hits, then I must relax even more thus collapsing my airway. In a way these new events may be a result of things getting better as before I had serious REM avoidance. Maybe now I am seeing my brain trying more often to enter a deeper state of sleep and/or REM. I really cant explain it but I think I am good to go besides REM. I am trying to limit the pressure needed to keep my airway open as swallowing air starts for me around 12cm-13cm. In fact leaks and eating air really start becoming problems at 14cm.

I am not sure how much bipap would help with a full face mask as differences in pressure seem to "rock my mask" causing leaks and is not comfortable.

Same settings from 9-8-11:

I am worse in REM.... I see variations in pressure needs all the time. I am lucky that my mask seals as well at 18 cm as it does at 10 so I can use a wide range without a problem.

If I was using a mask where it is hard to seal with variable pressures then I would limit the maximum the best I could and compromise with the fact that sometimes I would just have a few events sneak past the defenses.

You might try a real tight APAP range and hopefully if those events needed a bit more pressure maybe you will be lucky and they only need 1 or 2 cm more. Might try your 13.2 with a 15 maximum and see what happens.

Obviously an AHI of less than one at the same settings that you have a 4 AHI just means it works great sometimes..just not all the time. Choices are to keep it the same and accept an occasional 4 AHI night...try a wee bit more straight cpap press or try APAP maybe with tight range.

I use APAP.. 10 min and 20 max... Most of the time my AHI is between 1 and 2...Sometimes I hit 3 to 4 AHI. I don't worry about those nights. I tested my APAP minimums a while back.. I got up to 13 cm minimum.. I never had a remarkable decrease in AHI between the 10 min and the 13... So I just went back to 10 cm and realize that some nights I might have a bit higher AHI than I might want. They are rare...I never know when they are going to occur and it isn't like the AHI goes to 10... There comes a point where given our limitations...leak, aerophagia, REM vs non REM that we can't cover all possible scenarios so we sometimes we compromise.

You are using nasal pillows and I can see handling more of a swing with those, I got a great seal when I used them. If I was not a mouth breather I would just crank up the pressure 14-22cm and see what happens. It's early yet, I'll figure it out. I can't wait until I can see a surgeon, maybe that would at least get me to the point of not needing such high pressures to push through REM.

Some here mentioned, and my doctor has mentioned that you have to be on cpap for a few months to let the swelling and damage in the airway go down. Maybe things will get better in time. My insurance should kick in October 15th so I will experiment until then and print everything out for the sleep doc and hopefully get a recommend for a surgeon just to have a look-see.

Cuda wrote:I have been tightening my mask more and doing better with leaks and I am thinking its pushing my lower jaw back and possibly causing problems...

I thought with your mask that you have listed below, you were not to overtighten it as it has the Air do-hicky and it should be applied a bit on the loose side. Could this be causing all the issues?

Cuda wrote:You are using nasal pillows and I can see handling more of a swing with those, I got a great seal when I used them. If I was not a mouth breather I would just crank up the pressure 14-22cm and see what happens. It's early yet, I'll figure it out.

Yeah, I know you had the open mouth syndrome with the nasal pillows. The other masks just simply have more surface area to have to mess with and thus makes much more work.

I wouldn't be in a real rush to increase pressure given your situation. Yes..this report with AHI of 4 something might not be ideal but it is not like you never have a good report. Work on getting the mask just right and worry about an occasional less than ideal AHI later.

I would track things a bit more to see if I had more low AHI nights or more above 4 AHI nights....given you are new and still fighting with masks and such. One night doesn't make a trend either way. Then consider your options.

Cuda, click on my mask and see if it might work for you, it's a combo pillows and oral cushion so you might get the good seal again. Quite a few of us wear it, some with high pressure. I think tvnation runs a mask trial program, so you could try it to see if it works for you.

I have the Hybrid so I can try that at anytime. I also have the Swift FX, Quattro, Quattro FX and a Zest nasal mask. Only the nasal mask totally ruled out at this point, the Hybrid has not been tried. Yes, I agree on keeping pressure low until I find the right mask and get some reliable results. That first chart is not perfect but I still feel much better than without cpap. The FX is a floater and is great with pressures under 12-13cm or so. Once I get to 14cm and above it seems to need more force to prevent leaks. I still wonder if its the extra pressure on the jaw or sleeping position. I am not going to change anything tonight, just lower the EPR from 2 to 1. Will post results tomorrow as always Thanks for all the input.

I do not understand this, I am getting worse. I have also developed a sore so will have to discontinue the mask possibly but I have other options as far as masks go. It seems in REM the airway is really collapsing now and the events are getting longer and longer. Wish I knew what was going on.

REM events can just be weird I guess. Some nights I need max18 cm and some nights it barely reaches max 12. Leaks are minimal so I can't blame leaks. I just call those night with REM events on steroids. Big, mean and hard to kill.