(06-26-2017, 06:25 PM)dgiebink Wrote: Reading with interest. Saw my 'sleep therapist' today. She saw that my APAP was set to 5 min - 20 max and said not a good idea. Something about running at 5 for a long time can actually be detrimental because after awhile (i.e., many months ...) your body will begin to develop more apnea events when running a lot at just 5.
This sounds like BS to me. Some people don't need more than 5 or 6 cm to control their apnea. And if for some reason the apnea gets worse over the years, you can always increase the min pressure when its needed.
Quote:So, she set my min-max to 10-15 with a 15-minute ramp from 5 to 15. That way, when not having events, the machine will still put out at 10. She set the upper limit at 15 because my typical high pressure was in the area of 14 or so with just an occasional reading over 15.
And if "running at 5 cm can lead to your body developing more apneas with time" then what's to prevent your body from developing more apneas with time while running at 10cm?
More seriously: I would not trust this sleep therapist any further than I could throw her. Because even if the pressure increase were warranted, her rationale for explaining why it was necessary is a crock.
It's true that a lot of people are not particularly comfortable breathing at 5cm, and that's a good reason for increasing the min pressure from 5cm to something higher, but then you also don't set a 15 minute ramp to go from a starting ramp pressure of 5cm to a min pressure of 10 cm. (By the way, a 5cm increase in 15 minutes might be enough to make it
harder to get to sleep if you are sensitive to pressure increases.)
And it's also true that a min pressure of 5cm is not high enough to properly treat a lot of people's OSA: If your titrated pressure is 10cm and your min pressure is 5cm, then you are spending a lot of time at subtherapeutic pressures, and that can allow too many events to happen NOW (not several years from now). Typically you need that min pressure setting to be within 2 cm of your titrated pressure from a sleep study (if you had one) OR you want that min pressure to be within 2cm of your 90% or 95% pressure setting based on a week or two of autotitration if they didn't do a titration study.
So when would increasing the minimum pressure from 5cm to 10cm make sense? Under any of these circumstances:
1) Data shows lots of events occurring when the pressure is at or near 5 cm with frequent pressure spikes above 10cm.
2) 90% or 95% pressure level is at least 10cm
3) Patient reports that breathing is uncomfortable at 5cm because not enough air is coming into the mask.
But if your data looks good at 5-15, you're sleeping well in terms of getting to sleep and staying asleep, and you are feeling better in the daytime, there's no good reason for increasing the minimum pressure if you don't want to.
