(11-09-2023, 05:48 PM)CPAPfriend Wrote: 1) Because increasing pressure support is what addresses snoring, as per the ResMed clinician guidelines. Snoring is nothing more or less than residual obstruction. But yes, that is the balancing act. If CAs went up, then it could do more harm than good. One possible consideration is letting the CAs be slightly elevated and wait to see if they subside. In addition, increment PS up as slowly as possible.
Thanks. I'll raise PS another 0.2. When I started this thread I had it at 4.4. Raised it to 4.6 a few days ago, now I'll set it to 4.8. No increase in CA index so far and I think a decrease in snoring.
Quote:2) It's patients like you that I think PAP patients can get a lot of encouragement from, if it took as many steps / tweaking as you imply. I used to think differently, but I now think that the vast majority of patients give up on PAP too soon, never exploring some subset of variables that could have been their goldilocks zone. At the same time, I'm not saying it's the patient's fault if PAP doesn't work. Noncompliance can be for a variety of reasons.
Another factor is adaptation. Many people expect to be able to just start using their CPAP machine, and some can, but most people require time to adapt. It can take a few nights, weeks, or even months to fully adapt. And you do need to take charge of your own settings, unless you happen to be one of the very few who has a provider who can do it. Most people expect that their care providers will monitor and adjust their settings, but they rarely go beyond looking at compliance and AHI.
So it comes down to patient expectations. The expectation that no adaptation period will be necessary and that care providers are knowledgeable about machine adjustments. The former is their fault, but the latter is a severe weakness in our health care system.
I did a lot of tweaking the first couple of years. At first I kept going to my care providers to get adjustments for aerophagia and then a high CA index. Their solution was to treat aerophagia by switching to a BiPAP machine, which raised my CA index, and their solution to that was to lower the pressure and the PS. At that point I took over and found out that the aerophagia was indeed due to high pressure, which was helped by the bi-level therapy, but the solution to the elevated CA index was lowering the PS. For quite a while I had to do a balancing act where too high of a pressure caused aerophagia and elevated my CA index, too high of a PS elevated my CA index but lowered my aerophagia, and too low of a pressure lowered my aerophagia but raised my OA index. Couldn't have learned any of that stuff without the help of ApneaBoard. It took me a long time to adapt but I knew I had to do it. Otherwise I was going to suffer from the effects of OSA.
