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Pressure Change from 6 to 11. Do I do it in steps?
#1
I had an updated sleep study last week, and the nurse called to say my pressure is now 11. It has been at 6 since my last sleep study 5 years ago. Do I adjust it to 11 right away, or do you think I should step it up each day? I do see the doctor at the end of next week, but when the nurse called, she told me to get my machine adjusted to 11. Is it normal to go up 5 levels in 5 years? My weight is 150 and I am 5' 5". I have only gained 10 pounds in 5 years.
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#2
Since the result is based on a sleep study, it should be fine to go to 11. But I think I'd do it in a couple of steps. Go to 8 for a week or so and see how you feel, then to 11. Since your machine won't really let you know what your ahi experience is, I think this would be the better way to do it and keep from possibly triggering too many CA events.
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#3
I have done my pressure changes in increments of 0.5cm every time. I would raise it by 0.5cm and keep it there for 10 days at least.

You can try raising it by 0.5cm and keeping it there for 5 days and then repeat, till you reach 11.
Or you can try raising it in 1cm increments and keeping it there for 5-10 days and then repeat, till you reach 11.

You have been on 6cm pressure for 5 years, so its not like you need to get to 11 in a hurry, so take your time.

It depends on what you are comfortable with. I did it by 0.5cm at a time because if I tried raising it by 1cm, I felt that the machine was rushing me to breathe. The 0.5cm jump was more tolerable for me.

Another suggestion I have for you is to upgrade your machine to the latest generation and get a full data capable machine. S8 escape II is pretty old technology and who knows if it is even putting out the correct pressure after 5 yrs in service. Since its been 5 years, you would be eligible for an upgrade under most insurance policies. You should check your insurance coverage to see. There is plenty of good advice on this board on what machine to buy and what machine to avoid.

YMMV.
Started APAP 4-20, Closed range to 7.5-14, then straight 8.0 w/ Aflex 3
RDI always below 1. But sleep much much better at straight pressure.
Started on F10, Tried Quattro Air successfully. Finally settled on P10.
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#4
Edited and moved below because I quoted it in a new post and edited it there rather than just editing it. So now I had two near-copies of the same post. So I deleted this one.
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#5
Thanks. I wanted to do the pressure change first on my old machine to get used to the change in pressure, and then I can get a new machine and get used to that. I think trying both changes at the same time would be harder for me. I did have my old machine tested a couple of weeks ago, and it does still blow the correct pressures. I'll see how others weigh in, but last night at 11 was not too bad, but it was sure blowing hard and I think I was making me hold my breath (Central Apneas?). Maybe I'll try 8 tonight. My sleep study was HORRIBLE. I was up most of the night. I tried an apap in the fall, and it said 11.5. I thought it must be broken or something. The apap and also at my sleep study, I got air in my stomach. I do see the doctor next Friday, so I am hoping to have at least a few nights of 11 by then so that I can talk to him about the new pressure.

Yes, I am trying to get a new machine. I tried the Airsense 10, as I wrote in another thread, but everything about it did not work for me. I tried the Elite. It also had problems for me. I am thinking of trying Respironics. I have a list of DME providers because two of them each told me that I need to go to a DME company with more options. My plan is to call them next week and start machine shopping. I hope to have an upgraded machine soon!

I only have apenas during REM, so most of the time, I have zero apneas, but then during REM I have 33. I'll see if this has changed when I get my sleep study results. I would have thought the apap would be great, but it said it was at an average of 11.5. I am looking forward to meeting with the doctor to go over everything.
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#6
I would just go to 11 with no intermediate steps. If you had an auto machine, that's what it would do anyway when it needed to break up an apneic event. If you are already used to using the machine and have good compliance, you probably will be asleep and the only thing you will notice is feeling better in the morning. If you are already using a ramp mode, then you probably will be asleep before you get to 11. If not, and the added pressure bothers you getting to sleep, you may have to ramp if you're not already.

I self titrated my S-8 up from 9.0 to 11.5 cm H2O over the period of 6 years based on how well I felt I was sleeping (no data reporting, no auto); I'd gain weight and after a while started feeling bad so I would bump it half a cm until I felt better. Guess what my 95% pressure is on the S-9 Auto and the Remstart 560 Auto? 11.5 cm H2O. In this case, you've already been evaluated in a formal sleep study and I'm guessing they likely found that your 95% pressure was 11. You still had problems at lower pressures so they they kept increasing your pressure in steps. They took you up to 11, and that's where it needs to be 95% of the time to prevent your apneas from occurring. They took all the guess work out of the equation for you. You probably slept through the study and were OK in a lab setting at 11. I'd go there first and if you have problems, then maybe think about backing down. But for now, from what you told us the best empirical evidence seems to say that 11 is where your body wants to be. Bottom line is that you need your machine set to the level it prevents your apneas.

Another way to look at it - if you were first starting out with CPAP and your sleep study said you needed 15, they would start you at 15. You wouldn't likely go home and adjust your machine to a lower pressure so you could work your way into the pressure you needed. You'd just start at 15. And you would be likely better satisfied with your results than if you started at say 5 with the intention of going up one cm each week for ten weeks.

OMM



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#7
(03-03-2015, 10:44 PM)Clearskiesaustin Wrote: Thanks. Yes, I am trying to get a new machine. I tried the Airsense 10, as I wrote in another thread, but everything about it did not work for me. I tried the Elite. It also had problems for me. I am thinking of trying Respironics. I have a list of DME providers because two of them each told me that I need to go to a DME company with more options. My plan is to call them next week and start machine shopping. I hope to have an upgraded machine soon!

Please, if you can, shoot for an auto titrating machine. Probably set to 6-15 and you will never know it. It would start at the 6 you know and only go up when you actually need it.

In my limited experience with the Respironics (just a couple of weeks now after a few years on the S-9 Auto and several years on an S-8 Elite) I am finding the System One is a smoother and more comfortable machine to use. It might be with your effort to try, especially if you didn't care for the ResMed units.

OMM
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#8
Thanks! I tried the self-titrating at 6-12, but it was horrible for me. I'll look into the System One. I think the problem with the apap is that I wake up every time it changes pressures. That happened every time they changed the pressure at my sleep study, so I only got about 3 hours of sleep. I also don't use the ramp because it keeps waking me up as it ramps, even on 30-45 min. However, on continuous, I fall asleep in 15 min.
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#9
I don't use ramp feature, ever, either.

If I recall correctly, I read the Resmed units made more abrupt pressure changes than does the Respironics System One. Even if you like and need a single pressure machine, you can do that with any of the auto units if you get to the sweet-spot figured out. Also, the Respironics has a mode that will test you on auto and then after a few days, act like a fixed pressure machine at the pressure it figures out you need. Then periodically, it will go back and do a night of auto to make sure nothing has changed. I don't use that mode, but I believe it is available.

OMM
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#10
Whenever my "sleep doc" changed my pressure, he did so in steps of 2cm. So 8 to 10 then 10 to 12. The results for me were increased ingested air for several weeks. Now that I have a data capable machine, I can guarantee each step up also resulted in increased central events, too.

Since you have been using it a long time, you could try it in steps of 1cm. Do it then wait a week. If you feel okay and do not experience ingested air problems (wake up belching, farting, or have stomach pains from the air), then go ahead and increase another 1cm or even 1.5. Rinse, repeat.

PaulaO2
Apnea Board Moderator
www.ApneaBoard.com


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