[Pressure] Last year, AHI <1. This year, AHI >5. WTF?

[srwilsn3]

All you have with CPAP machines are pressure, pressure support, and responsiveness (TImin/TIMax, trigger, cycle, soft, standard, etc). We are looking for the balance between those three to control apnoeic events. At least as best they can. 

Outside that, we have pillows, cervical collars, mouth tape, etc. Again, striving for a balance.

From what I can tell from the charts, most of your events are positional. You have a collar, but is it the proper size with the correct firmness? I do not know. But worth considering.

It really does seem that way. I thought it was due to back sleeping, but with my backpack trick I've entirely stopped back sleeping and my AHI and FLs are unaffected. I confirmed that I sleep on my side(s) all night long with a night cam the past two nights.

I hope to have a new collar at my door today when I get home. Fingers crossed. In your experience, what has "proper size and correct fitness" for you? I have read the board's collar guide, to be sure.

I'm on my side, with a flat pillow, and a collar. I don't know how much more dialed in I can get.

There are many reasons to use a fixed pressure. The main one for me is I react to pressure swings so having a fixed pressure is much more comfortable. I do not worry about my flow limitations as it makes no difference to the machine as it will not increase pressure. Fixing your pressure at 12 is based on what appears to be the median from the charts you have supplied. If it gives you a good nights sleep, but shows flow limitations, there is a choice to be made.

I am going to try this tonight.

The purpose of using increased pressure is not only to control the apnoea’s, but to figure out how much pressure is needed to keep the airway open. As we can see from your charts, the apnoeic events are triggered by, or are triggering, flow limitations. Control one, likely control the other.

Here's hoping.

BTW, a pressure of 15 is not much pressure at all. Many use pressure in the 20’s with no issues, it is a matter of acclimating to it.

Oh, good to know. I just managed >1 AHI for almost a year straight with a median pressure of 6, so I'm just so bemused that I might need >15 pressure now. I'm basically the same weight to the tenth of a pound.

There is a good possibility you need more pressure support than your machine can provide. I believe you can make the case for your insurance company to get a bilevel as you are running out of options with your current machine. 

I think it'll be bilevel for me.

As long as I am in this James Joyceian free thought mode, one other thing to ponder is whether your mask has lost its efficacy due to use. A new cushion, new headgear, and Bob’s your Uncle. I’ve spent far too much time chasing ghosts when it was simply my mask needing a refresh.

My mask is less than a month old, but I have several back ups. I'll swap one tonight to be sure, either way.

Cheerio!

If I could buy you a beer, I would. You've been such an immense help.

[PeaceLoveAndPizza]

I agree you will likely end up needing a bilevel, but let's rule out the things possible with your existing machine. You have been a trooper through this process. I appreciate your willingness to try things out.

Doubtful the mask is the issue, but one never knows. Mr. Holmes' advice remains worth considering.

Oooo, look at you all bemused. What's next? Atwitter? Tickled pink? Chuffed? (Sorry, retired English professor so words make me laugh)

First beer is on you mate. You are a pleasure to try and help. It is a process and you are doing well with a cracking good attitude.

[srwilsn3]

I bit the bullet and bought a used bipap (Resmed VAuto).

Do you recommend any resources for setting it up? I'm thinking of starting with my current pressure with an EPR of 4.

[paulag1955]

I would suggest giving it a few nights before deciding that [X] combination of settings isn't working for you. Like maybe five nights. I'm sure it's different for everyone, but at least some of use need to let our bodies adjust to changes before we can really see how they are working.

[srwilsn3]

I would suggest giving it a few nights before deciding that [X] combination of settings isn't working for you. Like maybe five nights. I'm sure it's different for everyone, but at least some of use need to let our bodies adjust to changes before we can really see how they are working.

Hi Paula! I tried the fixed pressure setting of 12 (my minimum) with an EPR of 3 that PeaceLoveAndPizza suggested (though he was not confident it'd work).

AHI went from an average 5 AHI this week to 14 AHI last night. A new record for apnea events for me! I honestly don't know if I can handle five nights, haha. I do understand your recommendation though, and fully agree with it: there is a lot of night-to-night variation and it's important to let a new change regress to the mean, as it were.

12 is obviously too low as my fixed pressure. Although I had a ton of apneas, I actually stirred less at night. I think, at least, I've supported suspicion that pressure swings arouse me at night.

My bipap arrives on Tuesday. Given a current prescription of 16/20 for my APAP with an EPR of 3, I'm thinking I'll set my inhale pressure at my 95th percentile and my exhale at 4 cm below that. Is that the right start?