Can less pressure be better???

Malibu · Post by **Malibu** » Fri Apr 21, 2006 4:28 pm

Hello all,

I just finished my follow up titration a few nights ago and the results were they started at 7cm and ended with 7cm.

No apneas or hypopneas the lady said.

I have a Remstar Auto/w c-flex and the software (1.5i) to go along with it.

I have had a months worth of data and it points to a definite drop at the 8cm point with an AHI of .4 to .6. At 7cm it showed an AHI of 1.8 to 2.2. Beyond 8cm showed a pretty level graph with no real improvements.

I tried it at 6.5cm at home (Auto 6.5cm to 11cm) and had many hypopneas and one apnea and my wife said I was very restless compared to 8cm (Auto 8cm to 11cm). I guess I should have duplicated it at 7cm but wanted to see how my progress was by going lower and letting the machine do its thing.

The question is was it just a fluke that 7cm produced no apneas or hypopeas on their sophosticated test equipment yet at home it seems I should have no less than 8cm? Of course when I have it set Auto 8cm to 11cm that every night is kind of different pressure wise and I expect that.

I was just wondering if peoples experience that sometimes more can create more problems etc than less and maybe the software is reporting things that may or may not be correct. It was just kind of a surprise that 7cm was the end result during my test and I felt pretty good the following day. I realize that software etc can drive you crazy and if you feel good you must be pretty close on the numbers.

Maybe I should just set it to CPAP of 7cm and see what happens? Opinions?

Thanks,

Malibu....(Marc)

Guest · Post by **Guest** » Fri Apr 21, 2006 4:48 pm

Marc,

Part of the problem in doing such tests is the differences in reporting between different brands and types of AUTO titrating device.

You have a good machine. The best you can do is to experiment with it but don't compare it to other AUTOs.

It may tell you that all is well at one CMS setting vs the sleep lab machine giving a different CMS reading for the same results.

As always with AUTO therapy, it is how you feel that becomes the most important measure.

Also it is fair to say that over time, your adaptation to CPAP in general will change. The hope with the AUTO type devices is that they track the changes and by referring to the reports, you can adjust your hi/low range.

One issue with AUTOs is to try to keep the hi/low settings close to what your titration needs are for a given fixed pressure.

Cheers

DSM

roztom · Post by **roztom** » Fri Apr 21, 2006 5:15 pm

One thing with my Auto that I have not figured out : Kind of a CHicken or egg situation.

I get more OSA as pressure increases. MY Resmed pressure increases are triggered tby Snores. I snore - also did so during my titration. The machine responds to Snores and raises the pressure - I "suspect" that the pressure increase is actually triggering the OSA events.

I have a AHI trough at 9 cm , where I happen to be titrated. My APAP is set 5 - 11 cm. My AHI is lowest at 9, on the button - it is a sharp trough. From 9 upward my OSA climbs quickly but my Hypopneas drop. Catch-22 it seems. MY combined AHI is best at 9, on the button. - around 1.5

I suppose that means I should just set it for a straight CPAP of 9cm and deal with the constant pressure.

Tom

Malibu · Post by **Malibu** » Fri Apr 21, 2006 9:19 pm

Interesting thought about the snores triggering pressure increases...hummm

I will have to check to see if there is any corelation to that on my graphs.

I set it to 9cm CPAP and out of 8 nights, 4 were zero, and the other 4 varied from .5 to 2.0. So I guess there is an advantage to each mode, APAP or CPAP and trying to figure out which one will work the best on any given night is like looking for a needle in a hay stack. The sleep doctor I am dealing with seems to like the idea of the auto unit but making sure the number span at the most is a couple of numbers higher and lower than the actual CPAP titrated number rather than trying a catch all 5 to 15 for example. The problem is if your to low it seems you have the event that gets you up and then the machine tries to fix it. Being close to the right number might prevent some of those events.

Thanks,

Malibu (Marc)

ozij · Post by **ozij** » Fri Apr 21, 2006 10:34 pm

Marc,
In addition to the points mentioned by others, you migh consider your machine's calibration.
Who's to say that your machines 8 is an objective 8, truly 1 cm/h2o higher that the sleep center's?

The center's result can be a fluke, they can be the result of a non-calibrated machine (yours or theirs) or it can be the best pressure to use on you own machine.

The only way of settling the question is for you to try - for about a week - with special attention to how you feel.

O.

Goofproof · Post by **Goofproof** » Sat Apr 22, 2006 10:26 am

Use Auto 8 CM to 11 CM, that should give you the best and leave room for a bad night, all nights are not created equal. Jim

roztom · Post by **roztom** » Sat Apr 22, 2006 12:18 pm

I've actually got my first appt with my Sleep Doc since I started xPAP in Feb.

I'm a 2 month veteran, LOL. I'm doing very well though I wish my AHI was lower. AVG AHI 1.9 on APAP 5 - 11 but on MY Encore AHI vs Pressure I'm 1.4 at 9 cm, that seems to be my sweet spot.

Is a 0.5 difference in AHI worth chasing?

Now is that difference worth the higher constant pressure ?

Will the higher leak and higher constant pressure and maybe more disturbed sleep be off-set by a 0.5 reduction in AHI?

Is that difference something you can feel or is that small increment just a number?

I'm going to see my Doc next week and I'm going to show him the data and see what he thinks.

ANy of you have any thoughts?

Thanks,

Tom

Bellcrest · Post by **Bellcrest** » Sat Apr 22, 2006 12:41 pm

My sleep Doc was impressed with the printouts I took him, but........his final comments were, it really doesn't matter about number, How do you FEEL?

Goofproof · Post by **Goofproof** » Sat Apr 22, 2006 2:29 pm

[quote="roztom"]I've actually got my first appt with my Sleep Doc since I started xPAP in Feb.

I'm a 2 month veteran, LOL. I'm doing very well though I wish my AHI was lower. AVG AHI 1.9 on APAP 5 - 11 but on MY Encore AHI vs Pressure I'm 1.4 at 9 cm, that seems to be my sweet spot.

Is a 0.5 difference in AHI worth chasing?

Now is that difference worth the higher constant pressure ?

Will the higher leak and higher constant pressure and maybe more disturbed sleep be off-set by a 0.5 reduction in AHI?

Is that difference something you can feel or is that small increment just a number?

I'm going to see my Doc next week and I'm going to show him the data and see what he thinks.

ANy of you have any thoughts?

Thanks,

Tom

Goofproof · Post by **Goofproof** » Sat Apr 22, 2006 2:34 pm

Bellcrest wrote:My sleep Doc was impressed with the printouts I took him, but........his final comments were, it really doesn't matter about number, How do you FEEL?

What he's telling you is he's not on CPAP, so it doesn't matter to him. I think they go hand in hand. As a mechanic I find it hard to correct machines without the correct tools, amd some knowledge helps too, and luck is handy to have too.

Bellcrest · Post by **Bellcrest** » Sat Apr 22, 2006 2:48 pm

Goofproof wrote:
Bellcrest wrote:My sleep Doc was impressed with the printouts I took him, but........his final comments were, it really doesn't matter about number, How do you FEEL?
What he's telling you is he's not on CPAP, so it doesn't matter to him. I think they go hand in hand. As a mechanic I find it hard to correct machines without the correct tools, and some knowledge helps too, and luck is handy to have too.

Oh but he IS on CPAP. He told me it took him about 5 - 6 months and many masks (of course he wouldn't have to buy them) to get on the right track. He knows what I am talking about when I say I am struggling. I was however, able to help him out by telling him about the aussie heated hose. He bought one and loves it. !

He agrees that the software helps, the bottom line to him is How do you feel?

Goofproof · Post by **Goofproof** » Sat Apr 22, 2006 3:02 pm

Bellcrest wrote:
Goofproof wrote:
Bellcrest wrote:My sleep Doc was impressed with the printouts I took him, but........his final comments were, it really doesn't matter about number, How do you FEEL?
What he's telling you is he's not on CPAP, so it doesn't matter to him. I think they go hand in hand. As a mechanic I find it hard to correct machines without the correct tools, and some knowledge helps too, and luck is handy to have too.
Oh but he IS on CPAP. He told me it took him about 5 - 6 months and many masks (of course he wouldn't have to buy them) to get on the right track. He knows what I am talking about when I say I am struggling. I was however, able to help him out by telling him about the aussie heated hose. He bought one and loves it. !

He agrees that the software helps, the bottom line to him is How do you feel?

roztom · Post by **roztom** » Sat Apr 22, 2006 3:17 pm

The issue is AHI 1.9 with most of my time at lower pressure or 9cm at 1.4 AHI.

According to MY Encore & 45 days of data APAP data 5 - 11 cm:

CM AHI
5: 1.6
6: 1.8
7: 2.1
8: 2.5
9: 1.35 ****
10: 2.2
11: 2.7

What do you think?

"Tom

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CPAPopedia Keywords Contained In This Post (Click For Definition): AHI, APAP

Malibu · Post by **Malibu** » Sat Apr 22, 2006 7:46 pm

Tom,

I looked at all my graphs and you were right, 99 percent of the pressure increases came from snores without any indication of hypopneas or apneas however I think snores come first and then the hypopneas, then the apneas. So I guess maybe it is fixing the snore so it doesn't become a hypopnea etc.

My personal experience would be to keep the lowest number very close to where the hypopneas disappear and allow a little upper end to catch things that might happen with changing conditions like colds, normal things etc. To low and things happen that the machine doesn't catch fast enough and you get up. I guess like you say it's a catch 22 thing...lower pressure results in more episodes but the lower pressure may result in more comfortable sleep.

Sometimes I think my disturbances come from the pressure increases but I can't prove that one. I checked my Remstar Auto with a water column manometer and 8 is 8 on the gauge.

Also I found out that for example if I set it to 7cm which is a shade below optimum that the charts say I spend allot of time at that pressure however the end result is my AHI is greater. I think sometimes it's kind of misleading that the lower pressure has the greater time when in reality it was that pressure that caused most of my problems...IE..the chart looks great however a number or so higher would have been the better choice.

Thanks!

Malibu (Marc)

[quote="roztom"]The issue is AHI 1.9 with most of my time at lower pressure or 9cm at 1.4 AHI.

According to MY Encore & 45 days of data APAP data 5 - 11 cm:

CM AHI
5: 1.6
6: 1.8
7: 2.1
8: 2.5
9: 1.35 ****
10: 2.2
11: 2.7

What do you think?

"Tom

roztom · Post by **roztom** » Sat Apr 22, 2006 7:55 pm

When I look at the data it seems anything other than 9cm messes my AHI up. 9 cm is such a narrow pressure - coincidently that is where I was titrated !!

What happens to me is my Hypopneas go down above 9 but my OSA goes up !! The lowest combined AHI is 9 on the button.

It looks like I should be CPAP at 9. When you look at my numbers you can see even a narrow range 8-10 would probably give me a higher AHI.

Tom

Can less pressure be better???

Can less pressure be better???

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