Frustrated

Randy, I was thinking the same thing. I'm not patient enough to do the fractional drops so I'm just going to try 17cm. 16cm I was comfortable with when I was in APAP and that was my minimum. 18 was a little hard last night. Had to use the ramp and almost was tempted to turn EPR on, but didn't.

The thing that bothers me though is the Centrals are really not all that bad (1.9 Index last night) but the darn obstructives. Why isn't the high pressure keeping the airway open.

I did confer with my wife and she did say she rolled me over about 5:30am which was when they all ended. I NEED to find a way to stay on my stomach, and the crazy thing is I hate sleeping on my back.

I don't think those centrals where hugely related to the massive increase in pressure. Not like we would expect to see anyway. I would have expected to see a truck load of centrals like that last hour of OAs if pressure was going to cause a bunch of centrals.

Have I told you about Rooster and his experiment with his pressures and sleep position? Forgive me if I have but since it is pretty dramatic I will mention it again for newbies if nothing else. He was titrated needing 18 or 19 cm straight cpap supine. A true hurricane to exhale against. With some time and experiments he determined if he slept solely on his side he only need 9 cm pressure. It is unknown to me if REM events impacted his pressure needs. Anyway..he learned to stay off his back by using his APAP to see what and when the pressures needed to respond to.

Now not everyone has such a dramatic pressure need variable. And not everyone who is markedly worse supine sleeping can learn to stay off their back. I have a friend that is also markedly worse as far as events and pressure needs are when she is on her back. Sometimes 16.5 cm straight cpap just doesn't do the trick. She also doesn't like sleeping on her back but can't seem to stay off her back once she goes to sleep. She even tried the backpack full of tennis balls thing. Started out on her side..slept through the night and woke up on her back laying on the backpack full of tennis balls and from her reports looked like she had been there a good 2 hours. The discomfort of the tennis balls never woke her up. At this point we decided to heck with it and just try to figure out a pressure that would work for the bulk of the time and not worry about keeping her off her back because apparently it was a lost cause.
She also has won the Bifacta...sleep study confirms more events on her back and in REM also,,though in her case supine was much worse than REM but REM still a major factor. We then started seriously looking for a BiPap for her.

She didn't do well with APAP. The pressure variations made it too difficult to get and keep a good seal at the higher pressures the APAP was going to. We are still tweaking the BiPap Pro. Making gradual progress. AHIs for the most part well under 4 except for a few oddball nights. EPAP 14.5 and IPAP 18.5 now... more importantly she reports that these pressures are hugely easier and more comfortable to sleep with. Husband reports she doesn't move around as much. No miracles on how she feels during the day but she doesn't get enough hours of sleep due to external forces but she is working on it.

My personal Bipap experiment now a little over 2 weeks into it. Huge success. Wish I had thought to try it 2 years ago.

In REM AND on/or your back (or both)...you must really have some super duper events on steroids needing really high pressures. They sure aren't easily managed.

Let us know what the slight decrease in pressure shows.