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[CPAP] Getting the right pressure
#1
Getting the right pressure
Hi all. First time poster here. 

I got my OSA diagnosis a few months ago: home study recorded an AHI of 5.9

I picked up my machine last week. I've been getting pretty bad scores so far (SIGNIFICANTLY worse than my diagnosed AHI). 

I was getting a lot of centrals for the first few nights - those mostly went away when I turned off Flex. I also suspect my mask was a problem - I started off with a Phillips Dreamwear full face mask, which obstructed my nostrils a bit - I've since spent 2 nights with a ResMed F-20 FFM, which has been much more comfortable. 

I've had 2 nights with the new mask. I've been steadily increasing minimum pressure every night (since getting the machine) to cut down on apneas/hypopneas (up to 8.5cm from a prescription of 5cm), but I'm still getting a whole lot of them, and my pressure seems to be getting pretty high... 

Wisdom tells me I should probably wait until I have a few more nights of data to post here, but I'm too eager to get some feedback. I'm only including one night... because of the two nights I've had the new mask, I sabotaged one by getting wine drunk before bed. For what it's worth, the night I'm including is the lowest AHI night so far (8.66, compared to a range of 9.55 - 22 -- though I am suspicious of the accuracy of some of those scores). 

My recollection of the night was pretty solid sleep from around 12:00AM-2:00AM, then again from 2:30AM-7:15AM. I'm honestly just kind of shocked by how high the pressure is getting. (for what it's worth, I'm 25 and thin). Any thoughts? Should I just continue bumping up the pressure? 

Thanks a lot for your help and let me know if there's anything I'm missing.


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#2
RE: Getting the right pressure
Hopefully time will smooth things out for you.
To me it looks like setting the min to 10 will help avoid some of your OSA events. Give it a few days.
Leak rate is low which is good.
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#3
RE: Getting the right pressure
Here's last night's data. Bumped the pressure minimum to 10.5

I probably didn't actually get to 'sleep' until around midnight. Clearly, using ramp leaves me with a lot of untreated hypopneas in the beginning. 

The second screenshot is the same night, but focused on the period after 1AM, where things appear to have smoothed out quite a bit. I'm still getting some centrals - but most of them are coming shortly after obstructive apneas. 

I may bump the pressure up one more cm...


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#4
RE: Getting the right pressure
Rcol, I'm not one of the many folks who can provide analysis and sound recommendations (I'm trying out for Class Clown), yet I can offer this strong suggestion: when you make a change, unless it causes some really bad results, give it a few days to see the effect.  Our bodies are like ocean liners: they often take a very l-o-n-g time to change course.
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#5
RE: Getting the right pressure
wow! I'm new to this thread, but my first instinct was to limit your maximum pressure to 9.0.  Let's try minimum 6.0, maximum 9.0 and leave the Flex out of it.  Seriously, look at this chart and tell me a max pressure of 9.0 is bad, and high pressure is good.

[Image: attachment.php?aid=6902]
Sleeprider
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#6
RE: Getting the right pressure
(06-21-2018, 05:55 PM)Sleeprider Wrote: wow! I'm new to this thread, but my first instinct was to limit your maximum pressure to 9.0.  Let's try minimum 6.0, maximum 9.0 and leave the Flex out of it.  Seriously, look at this chart and tell me a max pressure of 9.0 is bad, and high pressure is good.

I get what you're saying, but that cluster of events is mostly obstructive apneas, and the pressure is climbing higher and higher to treat them, right? I know higher pressures can cause centrals, but don't the obstructive apneas just mean that I was probably unusually obstructed for some reason?
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#7
RE: Getting the right pressure
There are two possibilities, the most likely is the obstructive apnea is positional, and no pressure will resolve it, but a soft cervical collar will. The other is that higher pressure actually creates a flow limitation that ends in obstructive apnea. I'm inclined to agree with you, but when I see this much OA, i don't think pressure is going to resolve it without some help.
Sleeprider
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www.ApneaBoard.com

____________________________________________
Download OSCAR Software
Soft Cervical Collar
Optimizing Therapy
Organize your OSCAR Charts
Attaching Files
Mask Primer
How To Deal With Equipment Supplier


INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED AS MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEB SITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
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#8
RE: Getting the right pressure
(06-21-2018, 09:22 PM)Sleeprider Wrote: There are two possibilities, the most likely is the obstructive apnea is positional, and no pressure will resolve it, but a soft cervical collar will.  The other is that higher pressure actually creates a flow limitation that ends in obstructive apnea.  I'm inclined to agree with you, but when I see this much OA, i don't think pressure is going to resolve it without some help.

Here's last night. The first is the whole night, the second is a zoom in to 2AM-8:15AM

I'm thinking you might be right about flow limitation. Like, for whatever reason, I'm getting some apneas/hypopneas, the machine is overreacting to them, and the higher pressure (above some threshold, maybe 13 or 14) causes more events, creating a viscous cycle until the crazy, 20cm pressure wakes me up. Does that sound reasonable. 

I'm thinking I might either try straight pressure at 10.5 or 11, or just keep the minimum at 10.5 or 11 and cut the maximum down to 13 or so.


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#9
RE: Getting the right pressure
I wonder how much of your obstructive apnea is positional? Do you sleep on your back or side? (You might not actually know this as you're asleep but your bed partner might give you some ideas). I suspect you might roll over onto your side part way through the night when things improve.

Does your pillow tilt your head forward? You really need a pillow which provides support under the neck so that the head is tilted very slightly backwards, ensuring the airway is open. Many members have found that using a soft cervical collar to support the neck causes this positional apnea to clear up almost completely.
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#10
RE: Getting the right pressure
(06-22-2018, 10:17 AM)DeepBreathing Wrote: I wonder how much of your obstructive apnea is positional? Do you sleep on your back or side? (You might not actually know this as you're asleep but your bed partner might give you some ideas). I suspect you might roll over onto your side part way through the night when things improve.

Does your pillow tilt your head forward? You really need a pillow which provides support under the neck so that the head is tilted very slightly backwards, ensuring the airway is open. Many members have found that using a soft cervical collar to support the neck causes this positional apnea to clear up almost completely.

I ocassionally lie on my side when I'm trying to get to sleep, but I believe most of my sleeping time is spent flat on my back. My home test actually recorded something like 95% supine.

Anecdotally, I woke up at 6 or 7 last night with my left arm completely dead from being stretched out above my head while I lay flat on my back. 

My pillow is pretty flat. I wouldn't say my head is tilted back, but it shouldn't be raised forward much either.
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