[Pressure] Help with Pressure Setting

[Vesimir]

Sorry for long post.  I am seeking advice on what pressure settings to use.

I started on APAP 4 days ago before receiving a prescription from my doctor (was taking months to get a prescription and I decided to start therapy).  Summary of data those 4 days has been:

7/15/17 - AHI 1.60 (Min 8 Max 20 w/ EPR of 3)
7/16/17 - AHI 2.24 (Min 8 Max 20 w/ EPR of 3)
7/17/17 - AHI 3.19 (Min 8 Max 20 w/ EPR of 3)
7/18/17 - AHI 4.37 (Min 7 Max 20 w/ EPR of 2)

Sleepyhead charts are below in reverse chronological order.  I seem to have few obstructive apneas and an increasing number of "clear airway" events though I did not have any central apneas at either of two recent in-center sleep studies.

I just received a prescription from my doctor today recommending "a trial of autoCPAP ranging from 10 to 20 cm H2O as a clear final required pressure was not elucidated from [my second in-center sleep study]."  I have seemingly been having good results at pressure below 10 over the past four days and am hesitant to increase to the higher pressure being prescribed.

As shown in the charts below, my "95% pressure" has been 10 or under every day.  My max pressure has never gone above 11.  Here are the charts:









Should I raise pressure?  In case it matters, some additional background on why the doctor arrived at the "10 to 20" number and copies of in-center reports:  

1. My First in-center sleep study in June.  I didn't sleep enough.  Pressure was raised from 5 through 15 and I continued to have OAs.  No centrals.  Was asked to come back for another study to continue.


2. Second in-center sleep study in July..  Pressure was raised from 10 to 15.  Report says OAs and snoring resolved at 14.  No centrals.
Report says it is unclear why a lower pressure on this second study was sufficient as compared to first study, but was probably related to poor sleep efficiency.


Last report also recommends office evaluation to review potential causes for the poor sleep beyond the obstructive sleep apnea.  I do not have problems sleeping at home as I did in the sleep center.  I've felt really good for the past 4 mornings after using the machine and am not falling asleep during the day.

Thanks in advance for any advice.

[ajack]

the 8cm is working for you for oa/h, you can bring the max back to 15.
I don't know why the CA have shown up, unless you are on opiates or other ca inducing meds? They are probably just pressure induced and will settle down in time.
With the CA you are getting, I would turn the epr to 1 or zero. It should help. You can also leave it on 3 if you want to there aren't that many to be a concern.
I would increase the ramp to 6, so you don't get a stuffy feeling and in time turn down the time and eventually off.

Your pressure, tidal volume, minute ventilation, insp/exp time and breath rate are fine. I see no indicator for bipap, as was suggested.

[Vesimir]

Thanks ajack.  I'm not on any meds other than a pill for high blood pressure.  At your suggestion, I tried pressure of 8-15, EPR of 1, and increased ramp to 6 last night.  AHI was 1.3.  I'll check out the charts this evening, but seems pretty good!

[ajack]

New users getting some CA is very common and normally settle down. It's the body balancing the o2 and co2 levels. with excess o2, it doesn't trigger to breathe until the co2 levels rise. It's just that it didn't show up in your titration is the curious thing. It may well be how they count them. There wouldn't be an o2 desaturation with pressure induced CA. So wouldn't be flagged as a real event.

There are some very good chart readers here, so I'm sure you will get some more opinions on them. Your apnea is fixed at <5, so it's fine tuning from here on.

[Gideon]

the important question now is, How do you feel?

[Vesimir]

I feel great.  It's been a huge positive difference since starting last week -- way more energy and I'm not falling asleep in the car and at work.

Just reviewed last night's chart below.  This is the first time I had any significant leaks.  Nothing else stands out to me since I'm still learning to read these.

[ajack]

Week one and everything is good. I wouldn't change anything for now. A few leaks, all under 25, so isn't a big deal. bonjour has the very good mask fit link in his signature.

[DavePaulson]

Make sure to clean the sealing surface of the mask daily to remove oil, that can cause your mask to leak.

Dave