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[Treatment] Self Titration
#1
I am CPAP naive and have been self managing my OSA due to necessity.

A recent home based sleep study found my AHI to be 2 (normal) but the report itself indicated it could be a false negative due to a whole range of issues and malfunctions. My wife who is a RN (reg. nurse) said that I did not need a second test, as she has observed enough episodes of snoring, gasps and obstructive breathing to say I needed intervention.

Two weeks on with APAP therapy (ResMed S9 AutoSet) my current results are:
AHI: 4.0
Pmean = 7.0
P95 = 11.5
Pmax = 11.9

Amongst my research, an American Academy of Sleep Medicine Review: Auto-Titrating CPAP (Dr Berry et al) concludes P95 is an adequate choice for fixed CPAP.

I wish to continue with APAP, not with a fixed pressure setting, so my question is what range should I set my S9. Is my current setting of 4-12cmH20 adequate?. Should I reduce my upper range in small increments and if so to what level?.
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#2
G'day Jeff

When you look at the pressure plot in ResScan, is it spending a lot of time near the maximum, or even flatlining against the upper limit? If so you should increase the maximum pressure. An APAP will go as high as it needs to, and no higher, so don't be scared about increasing it a couple of points.
DeepBreathing
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#3
(02-17-2014, 11:05 PM)DeepBreathing Wrote: G'day Jeff

When you look at the pressure plot in ResScan, it it spending a lot of time near the maximum, or even flatlining against the upper limit? If so you should increase the maximum pressure. An APAP will go as high as it needs to, and no higher, so don't be scared about increasing it a couple of points.

I get what you are saying DeepBreathing, As a matter of fact the graph plot is flattening a little at the P12 line. I'll lift the bar a notch at a time.
Thanks
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#4
Well, do you feel like your sleep has improved? How are your leaks? <5 AHI is considered "successful" but as we know here it can sometimes take a little extra work to get to the point where you feel like you're getting good sleep, night in and night out.
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#5
I would do it from 8 to 14 minimum and if you can handle 14 without any issues, maybe even go to 15 or 16 for a few weeks to see if you ever need that much pressure. If you don't, then lower it back down. Don't change your pressure setting sooner than a week or two so you can see how things go before changing anything. JMHO
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#6
Hi TassieJeff,
When you make changes, waite a week or 2 between changes so you can check your data over time, as you are looking for trends; and don't make too many changes at once.
Good luck with your self-titration.
trish6hundred
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#7
(02-17-2014, 11:30 PM)eviltim Wrote: Well, do you feel like your sleep has improved? How are your leaks? <5 AHI is considered "successful" but as we know here it can sometimes take a little extra work to get to the point where you feel like you're getting good sleep, night in and night out.

Hi Eviltim
Leaks are all smiley faces. The graph shows a different story; when I simply disconnected the hose on a few nights to go to the bathroom (thought it would be OK for the auto-stop to take care of things). I soon realised it blew the graph to the stratosphere each time. I now hit the off button and it's all good.

I never had a sleep problem before (my wife did Big Grin) but APAP therapy, and fiddling with mask, is taking a bit to get used to. I'm happy to keep working on it though.
(02-17-2014, 11:37 PM)trish6hundred Wrote: Hi TassieJeff,
When you make changes, waite a week or 2 between changes so you can check your data over time, as you are looking for trends; and don't make too many changes at once.
Good luck with your self-titration.

Thanks a lot Trish600. Good advice...I'll go with it.
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#8
I see no point whatsoever in limiting the high end at all, as the machine won't use it unless it is needed. If you need a pressure of (say) 18, why would you want it limited to 15? Set the high limit to max, and set the low limit to 6 or 7 for a week or so, and see how often it hits the low limit if it does, then lower it by ONE wait a week, and check again.
*I* am not a DOCTOR or any type of Health Care Professional. My thoughts/suggestions/ideas are strictly only my opinions.

"Only two defining forces have ever offered to die for you. Jesus Christ and the American Soldier. One died for your Soul, the other for your Freedom."
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#9
Moving the Max pressure on a CPAP is not the same as changing other things -- within reason, upping the Max gives "headroom" for the MACHINE to do it's thing.

Then you can watch the mean and 95% and max values for a week or so and decide where to make your next move.

I moved my max directly to 16, worked my Min up to 12 and at that point dropped my max back just above the highest values I have seen recently, at 14.

For now, I am on 12-14 and with very few events. 7-Day Avg AHI 0.5

(It's really less since at least some of the events are machine artifacts.)
Sweet Dreams,

HerbM
Sleep study AHI: 49 RDI: 60 -- APAP 10-11 w/AHI: 1.5 avg for 7-days (up due likely to hip replacement recovery)

"We can all breathe together or we will all suffocate alone."
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#10
The goal is for the machine to give you what you need, rather than trying to wean the pressure lower (doesn't work).
*I* am not a DOCTOR or any type of Health Care Professional. My thoughts/suggestions/ideas are strictly only my opinions.

"Only two defining forces have ever offered to die for you. Jesus Christ and the American Soldier. One died for your Soul, the other for your Freedom."
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