CorruptAlligator - CPAP Problems

[CorruptAlligator]

@Gideon, please look at additional data and recommend me the higher limit.  As you can see it varies depending on the night.  I have night when pressure of 12 is the max reach.

Please pay close attention to the pressure settings. First 3 images are pressure from 7-15, and the last image is 7 -12.

As far as how I feel, I don't feel much better, about the same as any other nights with higher AHI. As far as numbers, it seems like I have best luck with 7 -12 pressure as you can see.

[CorruptAlligator]

Here's the last attachement that has setting of 7-12.

[CorruptAlligator]

@Geer, so my VA recommended a upper endoscopy and they didn't find anything cancerous or ulcers. What they found however, was H-pylori bacteria, and treating that now so that we can rule that out for my symptoms. It seems the general populous has H-pylori in their body, like 50% if I'm not mistaken. But, it is known to cause ulcers and eventually cancer. This could be it or some sort of allergy like you.

[SarcasticDave94]

Something of note, Ramp is still showing at 45 minutes at 6 cmH2O. This cancelled most therapy benefits for that 45 minutes at pressure of 6 every time you're starting the PAP. The most recent chart has 3 startups, Ramp time for these 3 together is 135 minutes, full usage was at 432 minutes, but 432 minus 135 Ramp equals 297 therapy minutes. I suggest either reducing that Ramp time or turning it off altogether.

[CorruptAlligator]

@SarcasticDave, I have it on 6 and ramp for the purpose of falling asleep. I have issues starting at pressure of 7 for falling asleep, so I have to start my ramp at 5 or 6. But, it's on auto, so once I fall asleep it detects it, and it's out of auto ramp. It doesn't last 45min is what I'm saying. It's anticipating for me to fall asleep so it can go on auto mode.

[Geer1]

Max pressure primarily depends on you specifically not the data. Does higher pressure become obviously uncomfortable for you or affect your sleep quality? If not then increase it to 15 cm or even higher and the extra pressure may fight off these restrictions on the odd night you need higher pressures. If it does make it uncomfortable or you objectively are sleeping worse with a higher pressure setting then you can limit it to what you feel is comfortable.

The only time that data drives a reduction in max pressure is in rare situations where higher pressure worsens flow limitations or apnea. That doesn't seem to be an issue for you though so the decision on where to set max pressure is an objective choice based on how you feel at the different settings.

[CorruptAlligator]

@Geer, I really don't know since I'm asleep when it comes to my max pressure. What I do notice is that my AHI is generally lower with my pressure in the range of 7-12, despite what the data shows on certain days.

I mean, I rarely have AHI as low as .5, and my pressure setting was 7-12.

What should really determine if pressure is not enough is when there is increase in apnea due to insufficient pressure shown in the data. But, with such low AHI of .5, there's hardly any apnea despite the pressure looking like it's trying to reach up. Question is, is that really an indictor or not.

If I've reached .5 with 7-12 pressure setting, is further tweaking valid?

[Geer1]

If the higher pressure was an issue you would know about it. You need to look at averages and for example one of the other nights using 7-12 you had 2.92 AHI and one of the 5-15 nights pressure didn't exceed 12 (so effectively a 5-12 range) and AHI was 3.09. AHI is one number to look at, 95% flow limitations is another one. If increasing pressure doesn't help decrease either of these then sticking with a lower pressure can be a valid choice (higher pressure is only helpful if it helps).

A lot of your apnea are perhaps questionable as to whether they are real or not. By real I mean an actual breathing issue during sleep. A fair number of "apnea" flagged by these machines occur when you are awake (commonly called sleep wake junk), transitioning to sleep or if holding your breath (common when changing position).

Many of your apnea are also central apnea occurring in small groups which is common in some people during transitions back to sleep and earlier on in PAP treatment. Again this makes me think they aren't real per say and this type of apnea may improve with time. Sometimes higher pressure can cause these central apneas although a lot of the examples posted are occurring when pressure is below 12 cm.

Overall I wouldn't worry about AHI too much. Try focusing on how you feel. Sometimes this is easiest done by changing settings and letting it run for a week or two without looking at the data. Objectively ask yourself if you think the settings have helped and then review the data and see if there is any correlation. It is easy to get caught up on numbers and chase 0 and telling yourself your sleep must be better because ahi is lower. That isn't necessarily true as ahi is only one small indicator of sleep quality.

The on thing you could consider trying is reducing EPR to 2. Reducing EPR slightly might help with central apneas but it will make flow limitations worse. One reason I wonder about trying this is your claims that you can't fall asleep at a pressure of 7 cm so you use ramp set at 6 cm. The pressure difference from 6-7 cm is negligible and I highly doubt it is affecting your ability to fall asleep. What may be significant is that EPAP only drops to a minimum of 4 cm so when at 6 cm pressure you are only effectively getting 2 cm EPR and this then increases to 3 when pressure increases to 7 cm. You may be more comfortable breathing at EPR of 2 (EPR is mostly a comfort setting although it has some effects on flow as well).

[CorruptAlligator]

Today my AHI is .8 with CA of .27 and I feel very good. I think the low numbers lately is mounting to me feeling much better, and I hope to feel even better over days and months with my numbers staying low with the cervical collar.

I have been on certain antibacterial meds for 2 weeks to kill the bacteria, so that could be causing some side-effects, but I do notice improvement in how well I feel now. I will keep my current settings. Thank all!

[SarcasticDave94]

Good to hear it. Keep at it.