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My results so far
#11
OP has to solve his leak problems, despite what he says about his love for the mask.

He also should have started at a pressure of 13.3 cm, the recommended pressure.

If can not tolerate it, change mask. If still can not tolerate it, go Auto -2 to +2 over recommended pressure, e.g. 11.3-15.3.

The recommended pressure if done in a titration IS USUALLY OPTIMAL PRESSURE!

PLEASE LOOK AT THE CLINICAL GUIDELINES (pp.157 bottom right-158):

CLINICAL GUIDELINES

Why would one want to start at Auto 6-15, whatever.
IMHO, COMPLIANCE may be easier to satisfy, that is the only justification for such a low starting pressure.

So, anything below that optimal pressure of 13.3cm, while SUPINE, basically is SUB-optimal.

I am beginning to be CONVINCED that sleep lab's optimal pressure of 12cm for me, straight CPAP, is THE WAY TO GO, after extensive CPAP data and oximetry studies conducted by ME. IMO, DO NOT GIVE lab titrations the brush-off! You will be given a GREAT starting pressure which you can later fine-tune according to your needs.

I've been going AUTO for 95% of the time. It was helpful with compliance but now way past that....

I NOW FEEL like I just got out of the lab titration. I FEEL THE BEST at straight pressure AND my numbers last night so indicate, despite being sick with cold and bronchitis the past week- YMMV, but do not outright dismiss straight CPAP or at least learn to approach your optimal pressure, whether CPAP or APAP. You want your APAP average pressure within 2 or 3cm of your optimal pressure at a minimum, IMO.

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#12
(06-07-2015, 12:29 PM)tedburnsIII Wrote: OP has to solve his leak problems, despite what he says about his love for the mask.

He also should have started at a pressure of 13.3 cm, the recommended pressure.

If can not tolerate it, change mask. If still can not tolerate it, go Auto -2 to +2 over recommended pressure, e.g. 11.3-15.3.

The recommended pressure if done in a titration IS USUALLY OPTIMAL PRESSURE!

PLEASE LOOK AT THE CLINICAL GUIDELINES (pp.157 bottom right-158):

CLINICAL GUIDELINES

Why would one want to start at Auto 6-15, whatever.
IMHO, COMPLIANCE may be easier to satisfy, that is the only justification for such a low starting pressure.

So, anything below that optimal pressure of 13.3cm, while SUPINE, basically is SUB-optimal.

I am beginning to be CONVINCED that sleep lab's optimal pressure of 12cm for me, straight CPAP, is THE WAY TO GO, after extensive CPAP data and oximetry studies conducted by ME. IMO, DO NOT GIVE lab titrations the brush-off! You will be given a GREAT starting pressure which you can later fine-tune according to your needs.

I've been going AUTO for 95% of the time. It was helpful with compliance but now way past that....

I NOW FEEL like I just got out of the lab titration. I FEEL THE BEST at straight pressure AND my numbers last night so indicate, despite being sick with cold and bronchitis the past week- YMMV, but do not outright dismiss straight CPAP or at least learn to approach your optimal pressure, whether CPAP or APAP. You want your APAP average pressure within 2 or 3cm of your optimal pressure at a minimum, IMO.

Thanks for your post

I did try constant pressure of 13.3 for 2 weeks and my results did not improve at all, I only woke up feeling WORSE. Therefor I reverted back to Auto pressure and over 5 months I have found my current settings of Minimum 9 Maximum 15 to give the best results. The high leaks are probably causing my required pressures to be different to the 13.3 specified, but like I said I have had best results where they are at now. I am going to try a chin strap and If that doesn't solve my problems I will try a new nasal mask.

When you talk about compliance do you mean a minimum use per night? I have seen it mentioned a lot on here. There is no compliance requirement for me, I assume its to do with health insurance benefits? I don't use health insurance. I can easily average 7+ hours per night on constant pressure 13+ though.
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#13
(06-07-2015, 12:29 PM)tedburnsIII Wrote: The recommended pressure if done in a titration IS USUALLY OPTIMAL PRESSURE!
One would think so, but its not in most cases

I don't think, there is such thing as "optimal pressure" for all occasions

For example, my lower pressure set at 9 which feel most comfortable for me, but as I fall asleep, my pressure needs begins to change based on degree of airways obstruction and especially sleeping on my back or in REM sleep.
By doing that, the AutoSet reduce the chances of apneas developing





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#14
(06-08-2015, 01:52 AM)zonk Wrote:
(06-07-2015, 12:29 PM)tedburnsIII Wrote: The recommended pressure if done in a titration IS USUALLY OPTIMAL PRESSURE!
One would think so, but its not in most cases

I don't think, there is such thing as "optimal pressure" for all occasions

For example, my lower pressure set at 9 which feel most comfortable for me, but as I fall asleep, my pressure needs begins to change based on degree of airways obstruction and especially sleeping on my back or in REM sleep.
By doing that, the AutoSet reduce the chances of apneas developing


When I refer to OPTIMAL pressure I am referring to the medical term for it as clearly defined in the Clinical Guidelines.

It would follow that according to the medical experts that is the starting pressure. Any great deviation or discrepancy should be thoroughly investigated.

One's empirical data may beg to differ, or subjective feelings of wellness may beg to differ, but I'll go with medicine and not because the patient 'feels good' at a given pressure. There's a REASON why a pressure is not only recommended by the sleep technologist and raw data further reviewed by another supervisory PSGer, and thereafter reviewed and recommended by a board-certified SLEEP DOCTOR.

My personal impression over the past four or so months on CPAP and on this forum and the other one (where people are nowhere as 'nice' as here) is that sleep lab recommended pressure seems to be taken with a 'grain of salt'- and that should NOT be the case.

That OPTIMAL pressure is supposed to cover all bases/variables. It may be more than is needed for a given sleep position, or other variable, but it's supposedly 'all-inclusive'.

OP, I tried but had some difficulty interpreting your posted charts. I am not disputing the use of Auto mode, but curious what your AVERAGE PRESSURE amounted to for June 2 and the other date posted. I did not see that information.
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#15
Not everyone can use a straight pressure and get good results.

My "so called optiminal pressure" was 9. Most days I can see my 90% pressure hovering around 10.5 to 11.

One thing to keep in mind is that those "optimal pressures" are based on a one night study, and not under optimal sleep conditions! It's a good start, but doesn't tell the whole story. At least on Auto CPAP, you can set a range and watch your numbers and adjust accordingly.

There are a lot of people who do well on a straight pressure, but I am not one of them, and I believe feeling well does matter.


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#16
(06-08-2015, 06:24 AM)OpalRose Wrote: Not everyone can use a straight pressure and get good results.

My "so called optiminal pressure" was 9. Most days I can see my 90% pressure hovering around 10.5 to 11.

One thing to keep in mind is that those "optimal pressures" are based on a one night study, and not under optimal sleep conditions! It's a good start, but doesn't tell the whole story. At least on Auto CPAP, you can set a range and watch your numbers and adjust accordingly.

There are a lot of people who do well on a straight pressure, but I am not one of them, and I believe feeling well does matter.

What is 90% pressure?

With my machine, P95 means that 95% of the time my pressure is AT OR BELOW the pressure listed.

Do note there is really nothing I disagree with that you have posted above.

And I am not saying that CPAP is better than APAP. That is more a subjective call/personal preference.

The sleep titration has to come up with a fixed pressure- they can't do otherwise. There is no APAP recommendation for obvious reasons. That is left to the prescribing physician to determine.

But through my own necessary education the sleep lab, sleep doctor, etc. recommended 12cm for me.

In spite of the foregoing, whether guessing or not, referring cardiologist prescribed Auto 6-15cm.

For the most part, I actually felt pretty good at that setting, until I realized that pressures consistently averaged only 7cm and my oxygen minimum sats would have been, according to the titration (where I sedated myself- I was NOT going to have a bad night), around 83%, nor did REM appear until 9cm that one night.

Do note that my lab titration at 7cm resulted in an RDI of only 3.3 but look at the Sa02 minimum %! Alarming!

SLEEP LAB TITRATION- 12cm was my OPTIMAL pressure:

[Image: 8932ffad-1373-4835-8e9e-005ab489b133_zpscula7hy8.jpg]

So, basically I was feeling pretty good at even that low setting of 6-15cm yet my brain and body were starved of oxygen and I may have had little, if any REM. I did have shortness of breath walking the dog one morning and had to use my emergency inhaler.

This prompted a visit to my Urgent Care, and I was referred to a pulmonolgist, who I saw within a few days. He was good and noticed that REM did not occur until 9cm and upped my prescription to 9-15cm, however he never mentioned my oxygen sats/desats as inadequate at 9cm. That is when I became my own advocate and had to undergo self-education, including running my own overnight oximetry studies for more than a month.

Do note that I have felt good, very good, or even great at times at pressures of 6-15, 9-15, 9.5-14, 10-14, 10-12, 9.5-12, straight 10, 10.5, 11.0. 11.5. I just couldn't tolerate the straight CPAP at higher pressures until recently. And at least I can not go by how I feel when I felt good at so many variable pressures- AHI's were well below 5 at all those pressures- but oxygen satuarations/desaturations?!? That's another matter.
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#17
(06-08-2015, 12:21 AM)Veilsd Wrote:
(06-07-2015, 12:29 PM)tedburnsIII Wrote: OP has to solve his leak problems, despite what he says about his love for the mask.

He also should have started at a pressure of 13.3 cm, the recommended pressure.

If can not tolerate it, change mask. If still can not tolerate it, go Auto -2 to +2 over recommended pressure, e.g. 11.3-15.3.

The recommended pressure if done in a titration IS USUALLY OPTIMAL PRESSURE!

PLEASE LOOK AT THE CLINICAL GUIDELINES (pp.157 bottom right-158):

CLINICAL GUIDELINES

Why would one want to start at Auto 6-15, whatever.
IMHO, COMPLIANCE may be easier to satisfy, that is the only justification for such a low starting pressure.

So, anything below that optimal pressure of 13.3cm, while SUPINE, basically is SUB-optimal.

I am beginning to be CONVINCED that sleep lab's optimal pressure of 12cm for me, straight CPAP, is THE WAY TO GO, after extensive CPAP data and oximetry studies conducted by ME. IMO, DO NOT GIVE lab titrations the brush-off! You will be given a GREAT starting pressure which you can later fine-tune according to your needs.

I've been going AUTO for 95% of the time. It was helpful with compliance but now way past that....

I NOW FEEL like I just got out of the lab titration. I FEEL THE BEST at straight pressure AND my numbers last night so indicate, despite being sick with cold and bronchitis the past week- YMMV, but do not outright dismiss straight CPAP or at least learn to approach your optimal pressure, whether CPAP or APAP. You want your APAP average pressure within 2 or 3cm of your optimal pressure at a minimum, IMO.

Thanks for your post

...

When you talk about compliance do you mean a minimum use per night? I have seen it mentioned a lot on here. There is no compliance requirement for me, I assume its to do with health insurance benefits? I don't use health insurance. I can easily average 7+ hours per night on constant pressure 13+ though.

Bold, above.

Example- Medicare- within the first 90 days as to usage- minimum 4 hours per night 70% of the time in any 30 day period. So, at least 21 of that arbitrary 30 day block CPAP must be used for at least 4 hours each of those days. At least that is my understanding of it.

DME rode my tail and called me on the 30th day since receiving the machine to get an iCode to see if I had complied. Had I not, I still would've had plenty of time to comply, but I had to go to mandatory CPAP follow-up visit to cardio within a few days anyway. It was no big deal to comply, but pretty sure that had my script been for CPAP at 12cm instead of Auto 6-15cm there might've been a compliance issue at that time. 6-15cm worked for compliance purposes, though it was a bad prescription re my oxygen sats/desat problems.

Hope this post helps someone.

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#18
tedburnsIII,
Thanks for explaining your situation. It's good to keep tabs on your oxygen levels. I occasionally wear an overnight monitor to check mine. During sleep test, mine went as low as 69%. Explains why I was non-functioning. But now, with therapy, it stays up most of the night.

It's good that we all have different opinions on CPAP therapy, this way we can learn from one another.

I agree that self-education is the best thing your can do for yourself.

I hope original OP will respond again and let us know how he is doing.
Wink
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#19
(06-08-2015, 05:49 AM)tedburnsIII Wrote: OP, I tried but had some difficulty interpreting your posted charts. I am not disputing the use of Auto mode, but curious what your AVERAGE PRESSURE amounted to for June 2 and the other date posted. I did not see that information.

2nd June 95th percentile pressure 13.3 (maximum 14.6)
6th June 95th percentile pressure 13.6 (maximum 14.9)

I'm stuffed if I know how they figure out your required pressure after one night of recording through the sleep study. I only slept for about 4-5 hours I think, it was so uncomfortable!
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#20
(06-08-2015, 08:50 AM)Veilsd Wrote:
(06-08-2015, 05:49 AM)tedburnsIII Wrote: OP, I tried but had some difficulty interpreting your posted charts. I am not disputing the use of Auto mode, but curious what your AVERAGE PRESSURE amounted to for June 2 and the other date posted. I did not see that information.

2nd June 95th percentile pressure 13.3 (maximum 14.6)
6th June 95th percentile pressure 13.6 (maximum 14.9)

I'm stuffed if I know how they figure out your required pressure after one night of recording through the sleep study. I only slept for about 4-5 hours I think, it was so uncomfortable!

What do those numbers actually represent with your machine?

I actually requested average pressure.

It takes a while to adjust to CPAP. The fact you may have been uncomfortable for that one night and may be uncomfortable at your recommended pressure for a while is not really relevant. That is one of the reasons why some people use APAP- more comfort, but I believe that a fiction.

But it appears you may be near that recommended pressure anyway.
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