[Pressure] Pressure Range Assistance

[Sleeprider]

I think this is actually encouraging. It is still short of the goal, but here we have a result that is pointing to obstructive apnea rather than the complex pattern we saw earlier. It really helps in moving forward because you're on the right track, and could start slowly titrating upward at 0.5 cm increments until you reach the minimum level of obstructive apnea and flow limitation, or CA or PB begins to appear. Once things are stable, you can reintroduce Flex and see if that changes things or not, and make other minor changes for comfort.

We are trying to get AHI below 5, and lower if possible. Keep in mind that the number of events usually improves in time as you adapt and realize the benefits of PAP. Hopefully, you start feeling better too. AHI is really a surrogate for how you feel and can get about a normal routine without fatigue.

[Autarch]

I feel better using the cpap just getting between 8-12 AHI. I was not having issues nodding off but I had no not realized how much it was affecting me until starting. I originally went in due to snoring issues and reports from my wife about seeming to stop breathing. Since using it she is no longer hearing my snoring at all. 

Do you suggest sitting at the current 10 settings for about 5 days before moving it up or down? My only goal is to get 5 or under just to get out of the statistical range of body stress / increased likelihood of heart issues. 

[Sleeprider]

So far I think 10 fixed has been the best result. A few more days to get a baseline would not hurt. I don't recall seeing results for APAP at 8-12. That is certainly right in the range, and I have no problems with you trying it. Mostly I was looking to see if the fixed pressure would remove the central component, and it seems to have done that. If it returns upon trying variable pressure that would kind of confirm it.

It's all a bit of trial and error guided by some basic principles of how most of us respond to different variables. We learn something from each experiment.

[Autarch]

No 8-12 yet but I may try it in a couple days to see what happens.

[Autarch]

I added days since last update and updated the 'changes to pressure settings' graph from Sleepy Head. So far the lowest I have had was 5.92 using 5-10 back on the 22nd. 28th may not have been the best results as I was out drinking that evening.

Flex is still off.

[Sleeprider]

I added days since last update and updated the 'changes to pressure settings' graph from Sleepy Head. So far the lowest I have had was 5.92 using 5-10 back on the 22nd. 28th may not have been the best results as I was out drinking that evening.

Flex is still off.

I just lost a long post summarizing all your data...crap. 

Looking through everything, your best overall results were the 2 nights you used a fixed pressure of 10 and no flex.  Even your best night with a variable pressure of 5-10, your pressure was pegged at 10 all night.  The fixed pressure of 10 also saw your lowest flow limitation and RERA.  Considering your prescription was for 7.0 CPAP, I'm tempted to say, stick with the fixed pressure of 10, and you can experiment with different flex settings to see if it makes any difference.  Ultimately, this may not result in consistent AHI less than 5. In general, you seem to respond better to single pressure, than variable.  If you want to try higher pressures, stick with fixed pressure.  Your results are unusual in that you do not have a linear response of improved OA at higher pressures, at least using variable pressure.   At your follow-up with the doctor, you will have a lot of information to show, and I think you need to discuss whether a bilevel strategy may be better. 

By staying at a fixed 10 pressure, you're showing compliance with the original prescription, and you have plenty of experimentation showing a wide variety of pressure does not work well. It would be interesting to see you on a BiPAP to see what happens.

[Autarch]

Thanks for your ongoing input. I've added 9-10 in addition to the 10-11, so as you say even having a variable overlap with a pressure which is good when constant does seem to be worse. I may scoot it to 10.5 and see how what that does as there was an improvement from the 7 to the 10. 

How does bipap work, on exhale and inhale the pressure completely changes rather than minor adjustments? If so, would setting a constant pressure of 10 then turning up flex simulate it in a way?

[Sleeprider]

Flex is a very poor substitute for bilevel. The Resmed EPR is much more like a 3-cm bilevel. The pressure relief of AFlex and CFlex just provides momentary relief at the beginning of exhale, and in the case of AFlex inhale. I used machines with flex for years, and still don't know how to fully explain it. My though is that you have no centrals to speak of, and as long as your airway can be patent in exhale with EPAP pressure, a boost of pressure support in IPAP or inhale might knock out the hypopnea.

[Autarch]

Sleeprider, I created a new thread as well, but GP is giving me a referral after looking over the data. Do you have any Sleep Specialist recommendations / know who I should avoid for the Columbus Ohio area?

[Beej]

I've seen providers at both OSU Sleep Medicine and Ohio Sleep Medicine Institute.
Either will be acceptable if you are an active participant in your treatment.