Doctor told me "some people just don't tolerate CPAP"

[palerider]

Initially my doctor had my range set at 6-18. I assumed my high AHI was caused by the wide range

This idea that "a wide range" has any meaning, or detriment, needs to die!

Problems are caused by *too low a minimum pressure*, not by the "range".

Your higher AHI was because the minimum pressure was too low, and the machine spent too much time getting up to the pressure needed, then trying to get back to the minimum that was set, causing more events.

so I asked him to narrow it and he said my data showed that the pressure almost always set itself around 8.9. He narrowed it to 8-12 but then it began to set itself to 11. This is when I started seeing the clear airway events so I lowered it to 8-9 myself.

That wasn't a good idea.

How can it be that an identical pressure treated me one night but causes so many clear airway events just a few weeks later?
Have I developed complex sleep apnea? The only other changed variable is I stopped wearing my chinstrap because I believe I no longer need it to sleep with my mouth closed, which, to my understanding, is supported by the low leak rate from last night.

Because the squidgy meatbag on the end of the hose is *full of variables*.

Any advice would be much appreciated.

Edit: I just noticed that the pressure during the longest period of uninterrupted sleep on the successful night was between 6 and 7! Is it possible all of my problems are caused by the pressure still being too high? Why would the machine adjust to 8, 9, 11, when 6/7 seems to work fine? Also, I thought "95%" referred to the pressure that the machine spent 95% of its time set at, if I was between 6 and 7 for several hours why would the 95% be 8.9?

No. Sleep varies from night to night, and indeed, hour to hour, your needs vary as you change position, or sleep stage.

As to the 95% number: http://adventures-in-hosehead-land.blog ... de-to.html

Set your pressures to a min 6, max 20, and turn EPR *OFF*

[palerider]

One other detail I should mention- I just remembered the for the second half of the successful night, during that long period of uninterrupted sleep, I switched over to a pillow mask. Is this why the pressure is so much lower? How drastic are the pressure differences of various masks? I'm not sure if I should set my nasal mask range to 6-7 or just try to switch to pillows with a wider range.

full face masks will pull the lower jaw back and narrow the airway with some people, requiring higher pressures to overcome narrowed airway.

[snarch]

Initially my doctor had my range set at 6-18. I assumed my high AHI was caused by the wide range

This idea that "a wide range" has any meaning, or detriment, needs to die!

Problems are caused by *too low a minimum pressure*, not by the "range".

Your higher AHI was because the minimum pressure was too low, and the machine spent too much time getting up to the pressure needed, then trying to get back to the minimum that was set, causing more events.

so I asked him to narrow it and he said my data showed that the pressure almost always set itself around 8.9. He narrowed it to 8-12 but then it began to set itself to 11. This is when I started seeing the clear airway events so I lowered it to 8-9 myself.

That wasn't a good idea.

How can it be that an identical pressure treated me one night but causes so many clear airway events just a few weeks later?
Have I developed complex sleep apnea? The only other changed variable is I stopped wearing my chinstrap because I believe I no longer need it to sleep with my mouth closed, which, to my understanding, is supported by the low leak rate from last night.

Because the squidgy meatbag on the end of the hose is *full of variables*.

Any advice would be much appreciated.

Edit: I just noticed that the pressure during the longest period of uninterrupted sleep on the successful night was between 6 and 7! Is it possible all of my problems are caused by the pressure still being too high? Why would the machine adjust to 8, 9, 11, when 6/7 seems to work fine? Also, I thought "95%" referred to the pressure that the machine spent 95% of its time set at, if I was between 6 and 7 for several hours why would the 95% be 8.9?

No. Sleep varies from night to night, and indeed, hour to hour, your needs vary as you change position, or sleep stage.

As to the 95% number: http://adventures-in-hosehead-land.blog ... de-to.html

Set your pressures to a min 6, max 20, and turn EPR *OFF*

Thank you for your response. I understand that one might require different pressures throughout the night, but I am still inclined to use the 6-7 range for the next few nights simply because that is the only pressure that has successfully treated me so far. Are you in agreement with the other posters that my CAs are being caused by EPR or "sleep/wake junk" and that they are unrelated to the higher pressures? If so I will try your recommended settings.

[prodigyplace]

You could continue to use your narrow range but you may be crippling your machine if it determines a higher pressure is needed for a short time. That is why people generally have the high pressure setting further away from the minimum setting. If the machine does not need the higher pressure, it will not use it but the option is there if needed.

[Pugsy]

Take a crash course in distinguishing real apnea events that are flagged when for sure you were asleep from SWJ sleep/wake/junk events or post arousal events.
Watch all the videos here
http://freecpapadvice.com/sleepyhead-free-software

If you aren't asleep then the flagged events don't count in the evaluation process.
I doubt that your centrals are related to pressure or even EPR.

[kteague]

There are some people who just don't tolerate CPAP. Unfortunately that is too often a premature determination. Some take longer and much more effort and guidance that isn't always available from the sleep doc or DME. My first 5 months were awful, to the point I had decided to quit, until I found myself here. I had a friend who was diagnosed with OSA and went in for a titration study on CPAP. He had an initial panic at the rushing air when they tried to put the mask on, stopped the study and went home, and proceeded to have surgery, which did not resolve his OSA. I guess he fit the description of not tolerating CPAP. Each person has to decide what defines a personal best effort. This forum helped me stay motivated by reading how others once struggled but did at some point master the whole process.

[palerider]

Thank you for your response. I understand that one might require different pressures throughout the night, but I am still inclined to use the 6-7 range for the next few nights simply because that is the only pressure that has successfully treated me so far.

Then, why ask? Your desired settings are preventing the machine from doing any work to help keep you from having breathing events.

Are you in agreement with the other posters that my CAs are being caused by EPR or "sleep/wake junk" and that they are unrelated to the higher pressures? If so I will try your recommended settings.

First, your centrals, even on your "bad" night above, are nothing to be concerned about. You simply don't have enough to matter.

Second, *IF* they are caused by the extra ventilation of EPR, then it's easy to find out, just turn it off. If it doens't make any difference, then turn it back on.

[djams]

I understand that one might require different pressures throughout the night, but I am still inclined to use the 6-7 range for the next few nights simply because that is the only pressure that has successfully treated me so far.

Not only throughout the night, but night to night, pressure requirements change. I just happen to have a visual handy from this week. These are back to back nights. Same pressure settings, same mask. On 09/11 I had much higher pressure needs than I did on 09/12. If I had my pressures set to a tight range, I would have prevented the machine from providing the pressure that I needed to prevent more events.

You can also see on the 09/11 chart that my upper pressure needs to be raised (probably to 20)- I'm riding it for significant length of time. I'm not there because I had a night of aerophagia when I tried it previously. Pretty soon I'll man up and try it again.

[jnk...]

Hi all. I've been trying to use CPAP unsuccessfully for over a month. I either rip the mask off in my sleep, or my AHI with CPAP is above 5, or both. . . .

It took me longer than a month to get used to CPAP.

I used to take my mask off in my sleep often. Now it happens very rarely.

An AHI over 5 may be fine when starting out. That should come down if you stick with it and solve issues one at a time.

As for "tolerating CPAP," it gets easier over time as you start to get more benefits from being used to it and have pressures optimized and the right mask adjusted properly.

I know some people who gave up on CPAP after one night and said they couldn't tolerate it. I know others who claimed they couldn't tolerate it after zero nights.

Most forms of tolerance require a choice followed by education and perseverance. Same with tolerating CPAP.

Some with low AHI and few obstructive events find it difficult to do CPAP. They may be trying it just to feel better and then don't. For them, CPAP may be a mere option, and there may be other options that may work better for their getting the best sleep. On the other hand, those with more classic moderate-to-severe OSA should always be encouraged to give the CPAP approach the full shot, because the benefits to health and quality of life FAR outweigh the effort required to get it right and use it all night every night.

[palerider]

Hi all. I've been trying to use CPAP unsuccessfully for over a month. I either rip the mask off in my sleep, or my AHI with CPAP is above 5, or both. . . .

It took me longer than a month to get used to CPAP.

I used to take my mask off in my sleep often. Now it happens very rarely.

An AHI over 5 may be fine when starting out. That should come down if you stick with it and solve issues one at a time.

As for "tolerating CPAP," it gets easier over time as you start to get more benefits from being used to it and have pressures optimized and the right mask adjusted properly.

I know some people who gave up on CPAP after one night and said they couldn't tolerate it. I know others who claimed they couldn't tolerate it after zero nights.

Incompetent doctors, with bad advice, and bad machine settings don't help people along the road to success either.

[snarch]

Thank you for your response. I understand that one might require different pressures throughout the night, but I am still inclined to use the 6-7 range for the next few nights simply because that is the only pressure that has successfully treated me so far.

Then, why ask? Your desired settings are preventing the machine from doing any work to help keep you from having breathing events.

Are you in agreement with the other posters that my CAs are being caused by EPR or "sleep/wake junk" and that they are unrelated to the higher pressures? If so I will try your recommended settings.

First, your centrals, even on your "bad" night above, are nothing to be concerned about. You simply don't have enough to matter.

Second, *IF* they are caused by the extra ventilation of EPR, then it's easy to find out, just turn it off. If it doens't make any difference, then turn it back on.

I didn't mean to seem arrogant, I know very little about CPAP and I need all the advice I can get. I agree that eliminating EPR while keeping everything else constant is a good idea. My doctor mentioned once that some people have better luck with a constant pressure and that combined with noticing the long periods without apneas at a low pressure is why I'm being stubborn. Thanks for all of your advice.

[greatunclebill]

Doctor told me "some people just don't tolerate CPAP"

is it true that CPAP just doesn't work for some people?

Those are two very different statements. Some people can't tolerate dusting the furniture. But, that doesn't mean the feather duster doesn't work.

A wise granny.

[palerider]

My doctor mentioned once

So, here's the thing... if your doctor is so good at this... why are you here?

If you want to be stubborn, then there's not much we can do to help you... If you want to throw away your pre-conceived notions, and get better... well, that's up to you.

[snarch]

My doctor mentioned once

So, here's the thing... if your doctor is so good at this... why are you here?

If you want to be stubborn, then there's not much we can do to help you... If you want to throw away your pre-conceived notions, and get better... well, that's up to you.

Man, there's really no need for the hostility. My doctor is a world famous sleep apnea expert, but he specializes in surgical solutions and is not a CPAP expert. I trust his opinion but I also know that he has a limited perspective when it comes to CPAP. I'm trying to balance what I've been told by him as well as the information I've learned from this forum.

I appreciate your help and I will experiment with all of the advice dispensed in this thread.

[palerider]

My doctor mentioned once

So, here's the thing... if your doctor is so good at this... why are you here?

If you want to be stubborn, then there's not much we can do to help you... If you want to throw away your pre-conceived notions, and get better... well, that's up to you.

Man, there's really no need for the hostility.

There's no hostility. I'm just pointing out the fact that if you want to be stubborn, and go with 'my doctor said', then *we can't help you*, and it's a waste of my time, and other peoples time to offer suggestions.

If you want to consider that "hostile", that's all on you.

My doctor is a world famous sleep apnea expert, but he specializes in surgical solutions and is not a CPAP expert. I trust his opinion but I also know that he has a limited perspective when it comes to CPAP. I'm trying to balance what I've been told by him as well as the information I've learned from this forum.

I appreciate your help and I will experiment with all of the advice dispensed in this thread.

"not a cpap expert". Wouldn't it be better to trust the opinions of a cpap expert?