My original question was poorly worded. I knew that the pressure number was based on my sleep study and set my doctor. He is relatively unfamiliar with the treatment of sleep apnea. So, I wanted to go to him as an informed consumer. If the 5+ events an hour are well within normal ranges and/or changing the pressure would have no effect on the number of events, I wasn't even going to bother to ask him.
The standard to describe severity of sleep apnea disorder is that 5 or under events per hour are considered normal. I personally would not be thrilled with my breathing stopping 5 times per hour and nor call this acceptable. I think that if you are paying someone to set the pressure and optimal machine mode based on expertise and they are a bit lacking in that regard, perhaps a different sleep doctor would be in order. The pressure setting is a fairly serious matter and incorrect can either not provide effective therapy or actually be dangerous. Consider a second opinion from another sleep doctor who can review your sleep study and titration study. Sleep study measures if there is sleep apnea and titration is used to dial in pressure/machine mode settings and results in the prescription.
Finding the optimal pressure for you sometimes requires good communication among all members of your medical team, of which you are the primary member. If your doctor is anything like mine, he may encourage you to optimize pressures yourself, as my doc encourages me to do. Although the RT at your DME is not permitted to change pressures without a doctor's permission, your doctor may be very comfortable with his informed, educated patients making small changes to pressure.
To quote one of the leading doctors in the OSA-treatment community, Barry Krakow, as quoted by Dr. Steven Park at his site:
"I believe the vast majority of patients must be trained to adjust their own pressure settings . . . There is no reason why patients could not be instructed in this approach to care . . . This self-care model can also work very well to further enhance the relationships between patients and their DME personnel. . . . I appreciate that some patients cannot learn to approach their care in this manner, but arguably anywhere from 30 to 60% of PAP users could learn this approach, and it’s just common sense that healthcare systems should be implemented to encourage patients to understand how to gather subjective data about themselves to then make informed decisions about changing the objective pressure settings on their machines." -- [http://doctorstevenpark.com/dr-barry-krakows-review-of-totally-cpap-part-5]
To be honest, I know how to change every characteristic of my machine but since my BiPap prescription is 25/21, what would I change to? I have turned off the the BiPap to experiment and run at 25 and not seen any difference in AHI or air leaks, etc. I honestly wish I had spoken to the mysterious doc who did my prescription but he was always too busy and couldn't even get together on the phone. If these beloved doctors feel it is fine for trained therapy patients to monkey with settings, why not see training somewhere on youtube or the internet... not just HOW to change settings but how to effectively change settings to improve therapy? Without this "training" I am convinced that most will not really benefit from changes; best to consult their sleep doc. Heck, while you are talking with the sleep doc, as that doctor how/why making changes on the fly would be of benefit.
You make good points, wiredgeorge. Both doctors that I mentioned have participated in online forums that are focused specifically on patients who prefer to be active participants in their own therapy choices. But neither of them is on record suggesting ever cutting out medical professionals when making medical decisions. Teamwork always trumps an either/or approach.
Adjusting pressures oneself with permission from one's doctor is not rocket science. If your machine gives you trending data, you already have the perfect tool for optimizing therapy and evaluating the effects of small changes over time with comfort features (ramp, EPR, etc) and pressure(s). The objective data (leak rate and event indexes) along with subjective judgements on how you feel is a powerful combination for getting treatment as good as it can be.
I believe that many patients never need to make any adjustments whatsoever to their machines. They are the ones who were easily titrated to a perfect pressure during the one night and who took to therapy like a duck to water. They feel great immediately and the one pressure does it for them now and forever. Perhaps they are the majority.
On the other hand, some patients who have trouble with their therapy find that small adjustments to their comfort features and treatment pressures make a big difference, and so they enjoy taking a more active role for the benefits that come to them. I believe those are the patients Park and Krakow refer to. The information needed for being involved in one's own therapy is easily found online at helpful public forums.
One day OSA treatment may more closely follow the model of, for example, the training received by diabetes patients who are trusted with very serious decisions in their own treatment. Slightly pressurized air is much safer for self-titration than insulin, after all. And if APAPs can be trusted to vary pressures, certainly trained patients can be trusted to do so, when that is necessary for optimal treatment.
I am sorry if your sleep doctor is 'mysterious' or 'hard to reach.' But in my experience, once I had the diagnosis and the prescription, I was able to become educated enough from fellow patients to make responsible decisions in my use of PAP to get my numbers low and the therapy comfortable enough to use at all times so that I never ever sleep without it and feel great.
-jeff
The short answer to you original question, DadisSnoring, is that if the few events you are currently experiencing on CPAP are due to obstruction then increasing the pressure should indeed get rid of them. However, obstructive sleep apnoea is not the only thing that can cause a raised AHI as reported by a CPAP machine. I strongly support the idea that you consult with you doctor, but it should not be hard to have a try at turning you CPAP up a little to see if this reduces your residual AHI without negatively affecting you comfort. To be clear, I am not a fan of the "set your own pressure however you like and who cares what anyone else thinks" line of thinking that is prevalent on many internet OSA fora, but your above posts suggest that this is not what you had in mind anyway. Best of luck.
My numbers last night were Total clear away Apneas 28 Total obstructive Apneas 16 Total Hypopneas 3 I slept for 6:48 with 100 percent mask fit.
Without going to the doctor as of this evening I was wondering if they are bad, indifferent or acceptable? I did not wake up feeling tired nor did I feel tired during the course of the day. I work outside and felt okay today. I know when I've had a bad night by how I feel in the morning. I am still confused by the numbers. Any comments?
I tend to ignore home-machine-reported hypopneas, myself. They aren't on the same level of significance as in-lab PSG true hypopneas, in my opinion.
The obstructive apneas may be helped by pressure adjustments, BUT those clear-airway apneas could be central apneas, which can be made *worse *by pressure adjustments.
So although I am generally, in principle, all for OSA patients who are educated on how to do so making pressure adjustments themselves, I am not so big on anyone with significant central apneas playing around with pressure(s). It isn't because I think it to be dangerous for them. It is just because having one consistent pressure every night over time can actually help the body fix centrals on its own better than when pressures move around at night on a single night, or from night-to-night. Small movements, slowly, over time, for treatment pressures can be fine--but only when AHI trends down in average from doing so and a close eye is kept on it.
I believe it's better when a doc is directly involved in pressure decisions when central apneas may be in play longterm, from my point of view.
The great thing about the ResMed S10 Autoset machine is that a low and high limit can be set for auto titration. My doctor originally set limits at 10 and 12. When my machine kept ending up at the high limit he changed it to 12 to 14. Most recently it has been trending to 13.8. Some nights my Events are as low as 1 and some nights as high as 6. As of late, I was not happy with the nasal mask that I was using because it damaged the bridge of my nose and I would leak through my mouth. I could not find a chin strap that worked for me so I ended up taping my mouth shut. That worked but did not help my nose. When I saw the new ResMed Airfit F20 I knew that I had to try it. Since I was due for a new mask I changed to the Airfit F20 and have been loving it ever since then. No nose damage and no air leaks. Also, the EPR function works very well.
