(03-10-2015 08:05 AM)H2Daddy Wrote: The DME currently has my machine set to CPAP at 11. While all my numbers are looking pretty good with this setup, I have trouble sleeping at this constant level. I was thinking about switching it to APAP mode with a setting of maybe 6-11. Any advice from the group?
There is one other option:
It sort of depends on when you are next going to see your sleep doc. if that is months away, you may want to tinker, and if it is a couple weeks away, you probably don't.
You have SH, so you know what the system is doing. You have the power to closely monitor a dynamic situation, and your doc does not have that power.
Instead of a gross change to 6-11, try 10-11 for a few days, and see if your pressure stays at ~10, or if it climbs. If it does not climb, go to 9-11 for another few. Keep an eye on your AHI, and if it does not climb significantly (a day or two is not a trend, as Paula says), you can keep doing these small adjustments as long as things stay normal. You may even want to raise the top limit to ~13 just to see if the machine feels the need to take you there regularly. Its a form of titration.
Think of it this way: if the DME made an educated guess that 11 is "your pressure", they are either right or they are wrong. Opening up the range will allow the APAP to either validate that guess, or blow it out of the water. The APAP has the power to be the absolute authority regarding how good a guess the DME has made, but only if you let it.
Just look for raises from the baseline pressure of less than ~2, and AHI to stay relatively the same (if not better). If your pressure seems to stay nearer to the top of a new range, you may have gone a bit too far and may want to come back the other direction.
It's a bit of an adventure, and hard to predict, but there is not much you can do by doing this this carefully, that can hurt you. You already have good numbers, and if you can gradually lower the baseline without it causing AHI to go up or pressure to cruise near the top of a new range, you are probably not hurting your therapy while at the same time achieving better comfort.
Your APAP is intelligent, and is designed to know what the best pressure is to give you at any given moment, as long as you carefully titrate and calibrate the range. It is so benign that sleep docs often start a patient with the range fully wide open. But your APAP can't use that intelligence to help you find your optimal range if it is bricked at a fixed pressure.
This approach is a way of dipping your toe, instead of plunging in head-first. You trade the luxury of a quick magic fix for a lower risk, by making these changes slowly and gradually.
EPR might also be something to try. Just watch your numbers carefully.
You state "the DME has my pressure set at 11". Was this a choice by the DME or the sleep doc? You are closer to the numbers, so you probably have better data than either of them.
I do not want to discount professional knowledge or technique, and will never insult sleep docs by not having respect for that knowledge and training. A sleep doc can make a better-informed decision, all else held equal, but there is an argument that you can make a better-informed decision simply because you have more and better and newer data, right in front of you on your SD card. It's 2015, and APAP is a major paradigm shift to the old-school mindset of PSG. It is another valuable tool to complement the initial PSG. The PSG is really valuable for ruling out all other causes of your symptoms, and helping make the diagnosis of SA and what the parameters of your particular SA are, while the APAP is valuable at automatically giving you the best pressure at any given moment, once you are diagnosed with SA. PSG is purely diagnostic; APAP is both diagnostic and therapeutic. Both are important tools. Use both.
There is also a tendency for a sleep doc to have a home-team preference for his limited data done in a foreign environment for 3 hours in an uncomfortable bed over the large aggregate of data that you may have from weeks of sleeping in your own bed. If you are a hammer, everything looks like a nail, and there is a mindset that the limited data of a one-time PSG done for a few hours, weeks ago, is better than the very large data sample done by your APAP just recently. And if a sleep doc doesn't make a slight change now and then, how can he validate his own position? It is human nature to support making a decision, right or wrong. If he doesn't weigh in, whether right or wrong, in his mind, the patient will start to think "what do I even need that guy for?" Making a decision, regardless of what it is, helps insulate him from becoming irrelevant to this partnership. So they think they have to weigh in, even if they don't have an informed decision.
The sleep doc thinks his decision based on a limited PSG must be all-important, because he charges either you or insurance ~$3700 for it, and wants to keep doing that
, and does not want to be usurped by the disrupter to his business model that the modern APAP has become, and is now a threat to that. In his mind, his data just has to be better. It had better be, or his business model is in trouble. So the informed decision a sleep doc makes may often be easily skewed by fear, old-line thinking, and just pure arrogance and desperate need for control. But your decision is pure, based on a large sample of pertinent data that you have, and what is best for you.
You are the patient, and your health, and not his business model, is what is of paramount importance. You are not in his ballpark; he is the visiting team in yours. Take control of the situation, rightfully so.