Too much pressure has diminishing returns?

[coldfeet7]

I came across this article while researching the use of AI on sleep data.

https://novaresp.ai/high-pressure-from-cpap-therapy-may-increase-harm-can-low-pressure-pap-therapy-be-effective-without-compromising-ahi/

It mentions studies that discuss diminishing returns on some health outcomes if pressure is too high. In other words, it might be better to find a balance on AHI versus pressure than trying to get to minimal AHI regardless of the required pressure. 

I researched the mentioned articles (admittedly use Preplexity.ai to find and summarize the articles) and it has me wondering if I should be lowering the max pressure and sacrificing some of my <1 AHI. The idea of trying to titrate all of this again is daunting, especially since my min inspiration is still much higher than the levels in the study.

The claims of SleepRes for their KPAP therapy greatly reducing inspiratory pressure and now the Novaresp cMAP reduced pressures are very intriguing. Could this be a new dawn for the PAP landscape and I should just wait for these innovations?

https://www.prnewswire.com/news-releases/novel-technology-for-sleep-apnea-therapy-to-be-introduced-in-record-breaking-webinar-302157504.html

Thoughts?

[coldfeet7]

This article is very approachable and has me thinking I need to get a replacement Wellue ring (mine broke a year ago) and use it to wake me if a very long OSA leaves my SpO2 really dropping, otherwise, just let a few shorter ones happen on lower pressure.

https://www.cuimc.columbia.edu/news/why-doesnt-cpap-reduce-heart-disease

[Nightynite]

Yes, I think I kind of came to that conclusion by accident when I was trying to tame leaks. I now use a lower pressure and don’t worry if I have a few events. I’m actually sleeping better also. Sometimes we get to involved in trying to get a better Oscar score and we just need to realize that is probably not the best approach. Fighting with pressure can also keep you awake

[car54]

I also keep my pressure low. The benefits of fewer events is not worth the large leaks that wake me up.

[coldfeet7]

Since switching to the Bleep Eclipse Halos and taping my mouth shut (and wearing a chinstrap) I have no leaks. A beard and mustache make the no-mask solution perfect to stop leaks. Just a little witch-hazel at night to clean off skin oil so the tape and halo ports don't come loose. 

I stay on my side to avoid the to ramp to 12.8 when on my back. Aerophagia has kept me from ramping the pressure higher than 12.8, so my belly pain was a blessing?  ;-)

Of course, now that I've got a no leak solution and <1 AHI most nights, I learn that these pressures could be increasing risk of inflammation that is not good for the old ticker. At least I learned about it though...

Would love to have participated in the Novaresp (cMAP) or KairosPAP (KPAP) studies.

[Brigabart]

Cool. I will have to go to the studies cited and look at those - I'm curious as to what their ranges for lower pressure are. 
I've only just started with a machine, but I have years of experience with inflammation and my degree was in immunology, so thanks for sharing this. I'm having trouble after one week on my ResMed 11 with ear inflammation issues, so I've had to stop for a couple days. So interesting to read about possible inflammatory reactions with higher pressure.

[G. Szabo]

This subject has already been partially discussed here:
https://www.apneaboard.com/forums/Thread...#pid504625

So, we want to avoid high CPAP pressure and reduce the death rate from cardiovascular diseases. However, the issue is more complicated, as many medical experts working on supplements, lifestyle, diet, and large-scale trials have pointed out. 

It is meaningless to pick one health marker, however important it seems, and optimize it with some therapy because the very treatment that optimizes the selected marker moves some other health marker out of its optimum range, causing increased mortality. Several studies have proved this. What we should always be doing when it comes to these long-term intervention therapies is measuring their efficiency by their effect on life expectancy. 

Example: You can have an additive which reduces the risk of heart attack significantly, so you take it for years, but it eventually undermines your liver function. Hence, you die prematurely with liver failure but with a heart in perfect condition.

Applying these thoughts to our cases: We do not have studies on the effect of not-thoroughly-treated sleep apnea on overall health or on the precise relationship between pressure and inflammation markers, and we do not know which effect can dominate our overall health and life expectancy. 

So, do we want to intentionally decrease the efficiency of apnea treatment and save ourselves from bad health outcomes? But how much do you want to reduce it, and what (health) cost will we be willing to pay for it? Consider, among other things, disturbed sleep cycles and lengths. 

We have no clue. So forget about it.

[coldfeet7]

People will make up their own minds, obviously....

For me, I am changing my mindset and going to try to strike a balance and no longer optimize for lowest possible AHI. People slept without PAP for 99.9999999999999999% of our history so if I have a few more OAs to reduce pressure I think I'll live. ;-)

[Nightynite]

People will make up their own minds, obviously....

For me, I am changing my mindset and going to try to strike a balance and no longer optimize for lowest possible AHI. People slept without PAP for 99.9999999999999999% of our history so if I have a few more OAs to reduce pressure I think I'll live. ;-)

That’s the beauty of being in control of your machine. I chose the same path, I just backed down .02 every 3 days and bingo. My events are 2 or lower. My eyes feel not so funny anymore in the morning.

The one thing I noticed it’s easy to get baited into using the med. pressure to set your starting pressure.   If you do that and then the very next night the med. pressure will be a little higher and then you take the bait and adjust again.   Pretty soon you’re adjusted to the increase but you don’t really need it.

I also noticed the amount of water I use has dropped a little, most likely cause the hurricane is no longer a class 5. It’s a 3 now.

[quiescence at last]

Some of the 99.99999% just died early.
As is said “When I die, I want to go peacefully in my sleep like my grandfather. Not screaming in terror, like the passengers in his car.”

QAL