Balancing act

So I read here that a high pressure can induce clear airway events. Ever since discovering how to set the pressure myself I've been experimenting with trying to find the "right" pressure for me. Titrations are a bunch of baloney IMO since they don't even remotely resemble a normal sleeping environment.

Normally I'm on 20cm but at that pressure about 55-60% of my events are clear airway. I also get pretty bad aerophagia, sometimes to the point of forcing me to get up in the middle of the night and go for a fart-walk. At 20 however I tend to sit around a 3 AHI and generally speaking get no RERA, PB or Vsnore and low leak numbers. At 15-17 my AHI goes up to around 7 and I start getting RERA's, PB's and Vsnore but my CA's go down by about half. 18-19 seems to be a tipping point for where I get the worst of both worlds.

So my question is, what the hell should I be prioritising? AHI? Lower CA's? Lower RERA/VB/PB? Higher methane output?

I would concentrate on getting rid of the CA's before anything else, then work on the others one at a time so you can check variables and know what's what as you go.

Just thinking if your sleep apnea happens to be significantly positional, maybe you can stay on your side, and maybe even experiment and elevate the head of your bed a bit. If either or both of these enables you to get by on a bit lower pressure, maybe you can have the best of both worlds - lower AHI and lower centrals. Worth a try.

IMHO, you should be prioritizing:

Overall AHI AND comfort FIRST. It doesn't really matter all that much what the AHI is made up of, if the total AHI is consistently less than 5, there are no nasty clusters of huge numbers of events, the events that do get through are not too long, and you're feeling decent enough.

So in my opinion, you're in a balancing act between reducing the pressure just enough to ease the problems with aerophagia (and hence increase your sleep continuity) and reducing the pressure too much so that the AHI > 5 and the FL, the RERAs, and the snoring problems all start as well. The AHI, the FL, the RERAs, and the snoring all affect sleep quality/continuity as well as your health (in the case of the AHI > 5)

What happens if you have the machine set to 18 cm?

ddk,

I don't remember which machine you got, and the profile link isn't showing on your signature. Is it at least a "Pro" (model 450)? Does it have AutoIQ? If you can switch your machine to auto mode temporarily you'd have the option of trying a range of pressures and the high pressure (and air-in-belly discomfort) might be activated only when needed.

You'd also talked about having your mouth open in a past posting. Are such leaks still a problem? I'm guessing it is hard for a CPAP to compensate for leaks when it is at the top of its range, which could mean your airway isn't being stented as well, which means the appearance of Snore, FL, RERA and Hypopnea's at what would otherwise be an effective pressure.

--SleepyCPAP

This worries me a bit... feel we're getting dangerously close to playing doctor. If your (OP)'s doctor isn't helping you, find another one who's really sleep oriented, but I'm not sure we should be playing around with these problems, esp. where CA's are involved at high pressure and esp. as they are related to serious problems and be very difficult to get rid of.

At 20 cm the AHI is 3???? 50 % or so are centrals/clear airway? That means CA index 1.5 per hour approx?? That's not a scarey number at all.
It's doubtful that those are related to pressure..if they were the problematic kind at that pressure we would expect to see many, many more. There's a good chance that some of them are likely "normal" anyway..as in an occasional sleep onset central and some of them may be a turning over in bed central and maybe an occasional awake/semi awake breathing irregularity getting flagged by mistake.
Especially if aerophagia in the middle of the night is so bad a person as to get up and do a fart walk. Wonder if the CAs are popping up around awake times.??

If the aerophagia is THAT bad...that's not acceptable. No one should have to accept their sleep being disturbed like that.

Has anyone ever discussed a bilevel pressure machine?? Not the fancy ASV kind...just the kind that Robysue and I use???

I obviously misunderstood the ratio and will let you smart people follow up - not a techie here by a mile!

Julie, can I join your club? That 50% CA number scared me too!! Glad Pugsy cleared that up!

DoriC wrote:That 50% CA number scared me too!! Glad Pugsy cleared that up!

We have to remember what original number we are taken 50% of. In this case a meager 3.0.
Sort of how we have to ask what the original number was when someone tells me that so and so increased by 300% which sounds horrible but in reality the deal was the AHI of 0.3 had gone up to 0.9... I would take that any day of the week and go on my merry way.

Pugsy,

Thanks for pointing out the 50% of WHAT factor here. Percentages are fractions and in order to interpret them you've got to know the denominator.

Also thanks for pointing out that someone (as in his sleep doc) should have mentioned BiPAP (as in the ordinary kind) to ddk before. Aerophagia at 20 cm is just beggin' for being switched to a plain old bi-level machine

SleepyCPAP wrote:I don't remember which machine you got, and the profile link isn't showing on your signature. Is it at least a "Pro" (model 450)? Does it have AutoIQ? If you can switch your machine to auto mode temporarily you'd have the option of trying a range of pressures and the high pressure (and air-in-belly discomfort) might be activated only when needed.

451P. The site here doesn't show that option in my sig for some reason even though I have it selected and I've told the mods here about it several times. It's just plain CPAP.

kteague wrote:Just thinking if your sleep apnea happens to be significantly positional, maybe you can stay on your side, and maybe even experiment and elevate the head of your bed a bit. If either or both of these enables you to get by on a bit lower pressure, maybe you can have the best of both worlds - lower AHI and lower centrals. Worth a try.

I've tried a lot of different things. Currently I have a latex pillow and mattress which are super comfy. Nothing has helped much although I have managed to reduce leaks significantly. I sleep on my side and pretty much hardly move during the night at all. Dead to the world so to speak.

SleepyCPAP wrote:You'd also talked about having your mouth open in a past posting. Are such leaks still a problem? I'm guessing it is hard for a CPAP to compensate for leaks when it is at the top of its range, which could mean your airway isn't being stented as well, which means the appearance of Snore, FL, RERA and Hypopnea's at what would otherwise be an effective pressure.

I'm actually getting good leak numbers now, usually quite low (65, 95%).

Julie wrote:This worries me a bit... feel we're getting dangerously close to playing doctor. If your (OP)'s doctor isn't helping you, find another one who's really sleep oriented, but I'm not sure we should be playing around with these problems, esp. where CA's are involved at high pressure and esp. as they are related to serious problems and be very difficult to get rid of.

The doctor I'm seeing is actually a private consultant through a public clinic and is considered to be quite good. I've heard, from several GP's in several different clinics, without even asking about him, that they all regard him highly. I don't think he's the problem as much as the system is. I can only see him once every 4 months as that's what's covered under Medicare (Aussie version). And that's mostly just a check-up. He knows about these issues and can't give me an APAP or BPAP until further tests are done. It's basically a long process.

Pugsy wrote:If the aerophagia is THAT bad...that's not acceptable.

It's only occasionally that bad. Most mornings it's just a half hour of... venting, before I get up and for the next couple of hours after that. Annoying and embarrassing but not particularly disturbing (of my sleep anyway).

The link to your machine choice in the equipment menu is broken..it's because that machine has been discontinued and it looks like discontinued equipment leaks are all broken. I had one the other day with my mask.

Just add it to your comments section.
PR System One Pro CPAP with CFLex model 451