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Lowering pressure, but no change in AHI
#1
Question 
I've been experimenting with lowering my pressure. I started with a pressure of 9.2. I found it worked well, but I did get some mask leakage sometimes. I've reduced it by 0.2 every few days until now I'm at 8.2. I still feel fine and there is no appreciable change in my AHI (always under 5 and usually under 2).

Does lowering the pressure like I'm doing result in an immediate change in AHI or is there some latency time for the AHI to change in response to the pressure change?

If not, I'm just thinking I'll keep lowering it until the AHI starts to increase and then bump it back up by 0.2. I'll have fewer sleep disruptions caused by mask leaks.

Personal experiences welcome.
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#2
There is no "latency time". Your AHI will vary from night to night because the state of your airway varies from night to night. It could be that on some nights you will need the higher pressure.

Your leaks are a result of either a poor-fitting mask or a mouth leak. I would recommend trying a different size nasal mask, a different nasal mask, a chin strap, or a full face mask.
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#3
(05-01-2016, 10:12 PM)Jim Bronson Wrote: I've been experimenting with lowering my pressure. I started with a pressure of 9.2. I found it worked well, but I did get some mask leakage sometimes. I've reduced it by 0.2 every few days until now I'm at 8.2. I still feel fine and there is no appreciable change in my AHI (always under 5 and usually under 2).
It could be that you were slightly over titrated. That happens.

Or it could be that some OSA-related inflammation has died down and you need just a bit less pressure.

Or it could be seasonal.


Quote:If not, I'm just thinking I'll keep lowering it until the AHI starts to increase and then bump it back up by 0.2. I'll have fewer sleep disruptions caused by mask leaks.
This is not an unreasonable plan.

I will add this, however: You may reach a point where you wish more air were coming in through the mask for comfort reasons. At that point, stop lowering the pressure.



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#4
It would be wise to check pulse-ox along with your pressure reductions to ensure that you are not causing a different problem.

Best Regards,

PaytonA
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#5
At a pressure of 8.2, I was having daytime headaches, so I bumped it back to 8.6. I just looked at the SH data, and the numbers are much better. My AHI is now always below 2, and there are very few centrals. I can identify the few leaks as times when I pull the mask away to scratch my nose. I'm confident that I have no significant mouth leaks since I started using the technique of pressing my tongue against the roof of my mouth. I may have found my pressure sweet spot. Stay tuned .....
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#6
(05-03-2016, 04:10 PM)Jim Bronson Wrote: At a pressure of 8.2, I was having daytime headaches, so I bumped it back to 8.6. I just looked at the SH data, and the numbers are much better. My AHI is now always below 2, and there are very few centrals. I can identify the few leaks as times when I pull the mask away to scratch my nose. I'm confident that I have no significant mouth leaks since I started using the technique of pressing my tongue against the roof of my mouth. I may have found my pressure sweet spot. Stay tuned .....

Yay!! I turned down my top pressure from 12.6 to 11 some time ago, with no appreciable change in AHI (still below 1). The pressure over 12 seemed to be waking me up. For a LONG time, my pressure would bang flat at 11, but with the change of season and the turning off of the furnace, I'm spending a lot more time below 11 than before. I mention this because your needs can change over time. Also, be aware that you can have the same symptoms (headaches), but a cause unrelated to apnea.
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#7
AHI isn't the only thing that most matter, for me, leak under control and reasonable hours of sleep, 7+ hours is a good number
Not all apneas are born equal, 50 second apnea is not the same as 10 second apnea (more like 5) but count the same, 1 apnea

I use an AutoSet, the lower pressure take care of most events and the gap between the lower and higher pressure settings take care of most flow limitation (FL). FL is not classified an apnea but nevertheless can be troublesome

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Sleep-well






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#8
(05-03-2016, 11:20 AM)PaytonA Wrote: It would be wise to check pulse-ox along with your pressure reductions to ensure that you are not causing a different problem.

Best Regards,

PaytonA

+1

A lot of people are titrated above the pressure that takes care of AHI, because it is one way to raise oxygen levels (with basic Cpap).

The better way to do it is with bilevel.

So to make sure your spo2 is not dipping, a pulse ox is a good idea.

Another thing you need to watch out for (and if your machine can measure it), is if lowering pressure increases RERAs. Your body could be increasing your RERAs to bump oxygenation at the cost of messing with your sleep architecture.

Both these effects (increase in RERAs, decrease in spo2) can cause headaches during the day.
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