No events with at-home titration.Why does pressure increase?

[Terry]

I've tinkered with pressure settings by raising up from 8 to 9, but Flow Limitations are still high, but with lower AHI. If I move pressure back to start at 8, I end up with higher AHI. I guess it's a balancing act that I've haven't quite figured out yet!

Raising the pressure should lower your AHI as well as reduce the flow limitations, assuming the flow limitations are caused by your airway starting to collapse.

The only balancing act I'm aware of is that as the pressure goes up, it's possible to cause Central Apneas, so you would need to keep an eye on the CA numbers.

If 9 was better and didn't bother you, but you still had flow limitations, you could certainly try 10 and see how it goes.

[jdip]

I have similar issue with pressure rising. When looking at data, all I can see is that is rises when there are flow limitations and snoring flagged, although my husband doesn't hear me snore since on CPAP.

I also notice there are no apnea events during the time the pressure rises. But there's no way of knowing if it took care of an apnea before it happened.

I've tinkered with pressure settings by raising up from 8 to 9, but Flow Limitations are still high, but with lower AHI. If I move pressure back to start at 8, I end up with higher AHI. I guess it's a balancing act that I've haven't quite figured out yet!

I hope you can figure out the right balance soon with the help of the great people here.

What counts as high for flow limitations? Mine had frequent spikes to 0.10 and 0.25, and once to 0.40.

[PaytonA]

Based on what I saw on my data last night, I would guess that somewhere around flow limitation=0.50 the machine starts to respond by raising the pressure.

[OpalRose]

Terry,
Thanks for responding. I am watching the pressure at 9 for awhile, so far still have flow limitations and RERA's. I'm not sure if the higher pressure causes more RERA's or that RERA's occur because of flow limitations. Either way, I have been waking up every couple hours.

jdip,
Your flow limitation numbers seem quite low and should be nothing to worry about.
My numbers are usually closer to 1.0 or more, and I think that is too high.

PaytonA,
Yes, I see on my data that the machine will raise pressure according to flow limitation and snores
(I don't think I snore, but the machine must think so!)
When I look at my FL chart, it looks as if a battle is going on all night.

[OpalRose]

jdip,
Didn't mean to hijack your thread. My apologies.
Please let us know the outcome of your doctors visit.

[jdip]

jdip,
Didn't mean to hijack your thread. My apologies.
Please let us know the outcome of your doctors visit.

No worries, OpalRose!

Will do, but it will only be in a month. Waiting while feeling completely exhausted and brain-dead is the worst part.

[OpalRose]

jdip,
Didn't mean to hijack your thread. My apologies.
Please let us know the outcome of your doctors visit.

No worries, OpalRose!

Will do, but it will only be in a month. Waiting while feeling completely exhausted and brain-dead is the worst part.

jdip,
Just be sure that while you are waiting, to sleep on your side (stay off your back if possible), and try to sleep elevated.

[jdip]

jdip,
Just be sure that while you are waiting, to sleep on your side (stay off your back if possible), and try to sleep elevated.

I read about those things helping. I've always slept on my side so that won't be a problem. I'm still trying to figure out how to elevate the top half of my body though... I might find some planks of wood to put under the mattress.

[TyroneShoes]

It's great that you were able to get your AHI down like that! Do you think you can get it even lower with higher pressure? I understand that at higher pressures leaks and aerophagia become an issue.

That is my understanding as well. Also, it can raise your centrals. I have had a bit more leak issues at 10-14 than I did at 8.

But I subscribe to the theory that there is a point to stop tinkering. Anything >5 is considered not to be a medical issue, not to be defined as SA, "cured", and normal. If you have an AHI of >5, either with or without a xPAP treating you, you are considered not to be a sufferer.

So once you get >5, I think that you should do only things that are completely without risk of raising your AHI (and for me, at ~3, this included a few steps that were obviously safe and carrying potential of getting the numbers even lower). For me, 1.5 is possibly as low as it will go. Sure, I like the "zeroes" when they occur, and I would be happy if things go even lower, but there is a point of diminishing returns with tinkering, and my best guess would be that I am probably at that point.

If things start to ramp higher, obviously it is time to deal with that, but if things stay where they are or go lower, it would take a lot of convincing that some "new finding" in treatment of SA would be something to inform more tinkering. Staying >1.5 or going lower would just be that much more to be thankful for.

So a tinkering phase is smart, but so is re-evaluating your progress. When Bush 41 wanted to push on into Baghdad in 1991, his advisors said "let's think about that first, and maybe not do it", and he listened, re-evaluated his goals, and probably made the right choice. Of course he could not predict that this would open the door for his son, Bush 43, to not re-evaluate his particular goals in 2003, but was still arguably the correct move for Bush 41.

Correct or not, the important thing is he stepped back and re-evaluated occasionally rather than continue chasing an original goal which may have become moot after conditions on the ground changed. I consider that a good object lesson.

[eseedhouse]

But I subscribe to the theory that there is a point to stop tinkering. Anything >5 is considered not to be a medical issue, not to be defined as SA, "cured", and normal. If you have an AHI of >5, either with or without a xPAP treating you, you are considered not to be a sufferer.

I think you mean "<5", not ">5". You seem to have mixed up your "greater than (>)" with your "less than (<)".