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A Lost Cause?
#21
RE: A Lost Cause?
Here are the results of the titration incrementing the low pressure from 8 to 11 cm.  AHIs are corrected, removing sleep-wake-junk (SWJ) from the score.  I've also included averages from (highly) corrected scores for 5 cm and 7 cm pressures.  That data was very contaminated with SWJ and the corrected values are suspect.  For the most part I've been able to considerably reduce SWJ in the last weeks by behavioral modifications to prevent back-sleeping:

dates  : min pressure*  :  Corrected AHI 

(1/24-2/11  :  5.0  :  4.08)
(2/13-2/20  :  7.0  :  2.85)
3/3-3/6  :  8.0  :  3.05
3/7  :  8.5  :  2.87 
3/8  :  9.0  :  1.94
3/9  :  9.5  :  0.80
3/10  : 10  :  0.62
3/11  :  10.5  :  1.14
3/12  :  11.0  :  1.15
*max pressure = 15 cm for all.

AHI:  A minimal interpretation of these data would be that increasing pressure between 5 and 9.5 reduces the AHI from 4 to 1 and thereafter it remains constant at 1.  A more imaginative interpretation is that AHI bottoms out at 10 cm then begins to increase again with progression to higher pressures.  While there is some indication of pressure induced CAs at 11.0 cm, more nights at that pressure would be required to establish this alternative conclusively.
           
Feelings:  So far as how I feel at various pressures; I think I'm still too close to sleep that is massively dominated by SWJ and am unable to discern the lighter shades of good sleep.  I have felt pretty good sleep-wise in the past week.  Possible 11 cm is a bit less comfortable.  But I still have junky experiences, and I do have bouts of extreme muscle weakness and fatigue.  One quite positive observation, really since starting with CPAP in late December (12/26/2018), is that I have had fewer leg cramps while sleeping. 

I had hoped the higher pressures would help make my flow look a bit less "tortured" but that does not seem to be the case:
   

Next:  Think I'll set the pressure back to 10.0 for a while.

obob
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#22
RE: A Lost Cause?
You have persistent flow limitation and pressure support, rather than pressure is what you need. I would love to see you on a Resmed Airsense 10 Autoset, or, even better a bilevel machine. That's not what we have.Based on your AHI, you are treated. but every inhale ends in a flat-topped wave form. If I was you and if money is not a big issue, I would self-finance a more appropriate device. Your doctor may or may not have the awareness to recognize the respiratory disturbance that is present in these charts. If you can find and obtain a Resmed Aircurve 10 Vauto or even a Philips Dreamstation or System One 700 series BiPAP Auto, this problem can be addressed. You need bilevel therapy. Can you afford to get it assuming the insurance system will not pay for it?
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#23
RE: A Lost Cause?
Thanks for your advice Sleeprider.  

My thought today is to go ahead and purchase an Airsense 10 Autoset out of pocket.  Do you have any particular advice as to particulars, best vendor, caveats etc.  I recall reading a thread by WakeTired who's sleep problems seemed similar to mine, and that there was some discussion on that thread of the Airsense 10 For Her having additional desirable properties.  Do I remember correctly? (I've tried to find that discussion, but can now only find the first page  of the thread, which doesn't get into the For Her machine.)

I haven't given up on my sleep doctor and conceivably he could be amenable to prescribing  a BiPAP machine for me.  I simply have had so little contact that I have no idea what to expect, and then his (or more correctly) his staff's evaluation seems unduly slow and superficial, which is why I ended up here for a better understanding.  Happy that I did.

obob

PS:  I called vendor #2 re the Aircurve 10 vAuto price you mentioned and they denied it.  Perhaps it was some other vendor?  In any  case there is no way I could buy such a machine at this time as I have no prescription for a BiPAP.  I'll work on getting one but it clearly will take a while.  I'll know better in a month.
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#24
RE: A Lost Cause?
Supplier #33. No questions asked, great prices.
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