Self titrate? Guessing game?

So last night I changed the EPR setting from 3 to 2. I was surprised at how much easier it was to breathe. Somewhere I thought I had read that the EPR set to 3 was for comfort. In any event, I woke up this morning with a headache, tired, and per my machine my AHI was 13.9 for last night. I seem to be moving in the wrong direction. Now what?

Make your changes slowly, single and incrementally. Give your body time to adjust to one change and then assess.
We can all have a flukey night, even when things have been going consistently great. Don't make changes based on one night.

In response to your original question, yes... to a point.

As has been pointed out, no one here is going to give medical advice, but the one piece of advice I can definitely give is to read the clinical manual for the S9 Auto and understnad what tweaks you can make. There is so much good information on this site that you can't help but get a better understanding of your situation.

You need to look at your detail data. That is where you will find some answers. The one advantage you have is with an auto you can set a range and see what is happening. I have heard that a 2 under and 2 over is a good place to start, but you need to spend the time going over posts and make that decision.

Good luck with your surgery and hopefully you can do a lot o reading and get up to speed during your recovery.

John

apneawho wrote:Make your changes slowly, single and incrementally. Give your body time to adjust to one change and then assess.
We can all have a flukey night, even when things have been going consistently great. Don't make changes based on one night.

Jo reggelt Madmagyar (I'm Hungarian too, so Good Morning!). What apneawho and some of the others are saying is key. I'm really guilty of NOT following this advice and I have been driving myself nuts. So one change, give it a week or two and then reassess.

Also, what 70's just said about the data. Make it a habit each day to review it and see what is happening during and leading up to your events. Look at all the relations between the different items it tracks. They all tell a story, and it up to you to figure out what they are saying. It's difficult at the start, but we all here can help.

- John

A reduction in EPR from 3 to 2 is a 1 cm change. We really wouldn't expect to see much of a change with a 1 cm change in pressure for 50% of the night. We can hope but realistically not expect much. Also it is quite possible to have AHI variations from 1 to 4 per night without any changes at all. So we can't put much stock in last night's numbers all by themselves. You could very easily just have had a bad night no matter what pressure.

I do think that most likely you will need more of a reduction in EPR than just 1 to maybe see a change in AHI at the numbers you have been seeing. Probably turning EPR off would give you the best chance and it might not be enough of a change in overall average pressure but it hurts nothing to go down on the EPR slowly.

I really expect you will need an increase in pressure to attain any significant changes but stranger things have happened and you never know till you try just the EPR changes before going down the other road of changing pressures.

avi123 wrote:In my opinion the idea that you can titrate yourself with your home CPAP is wrong. To titrate properly you need a few more medical equipment such as EEG, ECG, RIP, etc., costing thousands of $ each. But first check the article mentioned in my signature line about the AHI value being useless for any indication of Sleep Disorders. As to your MD not trusting your home CPAP data makes a lot of sense to me. My MD who is a pulmonologist MD and an Internal Medicine MD, also does not give a damn about my CPAP data output, saying that since it relies on air flow only it's for the birds. Only a full PSG could try to pin down an effective pressure if there is one. Most of the active posters on this board who are just lay people but assume as being mavins insisting on to telling their doctors how to treat them. And if a doctor does not comply with their expertise then they would look for another doc. And another one and ........... So watch out for posters who actually crave attention by posting inssently and rendering medical advice.

From the article you mention in your signature:

Dr. Sullivan wrote:Probably the best indicator of SDB, however, is simply the response to continuous positive airway pressure (CPAP) treatment. “It really is a no-brainer,” Dr. Sullivan remarked, pointing out that CPAP administration is especially easy with the newer devices that automatically set the appropriate amount of positive pressure.

It's funny how he says that AHI isn't well defined, then says the response to CPAP is what matters as though "response" is some objective measure.

I will say that I agree that AHI isn't all that matters. But does my AHI as recorded in my machine of less than one indicated that I'm better than the AHI of >50 recorded during my sleep study. I'd say YES, and this is a no brainer. However, does it mean that my AHI being less than 1, 5 or 20 means there isn't anything more that can be done? I don't think so. However, it becomes very subjective at this point. I think I should be able to sleep better than I currently am.

As a layman, I feel that O2 and CO2 levels in the blood would be a better measure of effectiveness. After all, isn't that the function of breathing? However, if these values are okay, yet your sleep is interrupted because of your poor breathing, then a measure of sleep interruptions would also matter.

I respect the training and knowledge that doctors possess, but sometimes they tend to miss the problems due to a lack of or a concentration on a specialization. You know the saying, "If your only tool is a hammer, every problem looks like a nail."

For about a decade, I had episodes of premature ventricular contractions. I'd have days where every fifth heartbeat or so had a skip. I went to my family doctor, who sent me to a cardiologist. The cardiologist tagged me with a recording device to wear for 24 hours. When I went back, he put me on a treadmill and ran me until my heartrate double while wearing an AKG harness. His take was lower my coffee intake and stop smoking. I did and the problem went on. I had more tests and was pronounce well, but with a tendency toward PVCs that no one knew how to fix. I was running a mile to 2 miles a day during that time and bench pressing 225# on my highest set.

Eventually I started waking up in the middle of the night with palpitations. I'd get up and sit at the kitchen table for an hour sometimes, until it went away. One day, I read in a forum where someone else had PVCs and it turned out that they were diagnosed with SA. After Cpap, their problem was solved. So, I scheduled a study and Voila! My problems were fixed.

The moral is that sometimes we have to be very active in the search for a solution to our problems. Unless you happen to run across a doctor who has experienced patients with the problems SA can present and discovered that CPAP makes a difference, they can run you through some expensive testing with no causes found.