Titration study says I need 5 cm H2O pressure

My CPAP titration study that I got two days ago says I need 5 cm H2O pressure. In my sleep study in August my overall AHI was 6, 10 on my back, with only 5 minutes of REM sleep.

I’ve mostly been using straight CPAP of 8 as prescribed as a trial before my titration study. I did a few days of auto on a pressure of 10 to 14. No matter what, I don’t feel any different using CPAP. It doesn’t seem to do anything for me.

Is there any point in using CPAP if all I need is a pressure of 5?

Past threads with sleepyhead charts:
1 - viewtopic/t173921/Self-adjusted-to-high ... tired.html

2 - viewtopic/t173815/What-is-this-breathin ... cored.html

3 - viewtopic/t172375/AHI-57-positional-sle ... -CPAP.html

4 - viewtopic/t171380/First-sleep-test-AHI- ... I-lt2.html

Why don't you set your machine to fixed 5 and see what the data looks like. Have you considered that some of your problem could be related to something other than Sleep Apnea?

The healthiest sleep is uninterrupted sleep at whatever pressure makes that possible. Good health to you!

"I don’t feel any different "
For many people, "feeling different" can take awhile.
The brain and internal organs benefit nonetheless.
The rest sneaks up on you.
At around four months, I discovered that I could RUN two blocks without getting winded,
when previously, I could barely walk one block without getting pooped.
I still feel younger than I did ten years ago.
(Up until I look in the mirror.)

chunkyfrog wrote: ↑

Wed Dec 26, 2018 1:39 pm

For many people, "feeling different" can take awhile.

I felt different pretty much from birth.

ilatruman wrote: ↑

Wed Dec 26, 2018 12:52 pm

My CPAP titration study that I got two days ago says I need 5 cm H2O pressure. In my sleep study in August my overall AHI was 6, 10 on my back, with only 5 minutes of REM sleep.

I’ve mostly been using straight CPAP of 8 as prescribed as a trial before my titration study. I did a few days of auto on a pressure of 10 to 14. No matter what, I don’t feel any different using CPAP. It doesn’t seem to do anything for me.

Is there any point in using CPAP if all I need is a pressure of 5?

It doesn't sound like the sleep study got a full test. For example, your REM was only 5 minutes. So, your sleep was possibly way too short of a full night and/or your sleep is shattered that you can't get much REM sleep. Either way is not good, and it also doesn't fully test your sleep apnea and the pressures needed since many people are worse during REM sleep.

Without cpap, you have at least 6 events per night. Since you didn't have a normal night of sleep with normal amounts of REM, you may have more events than that. But even 6 means your sleep is being disturbed several times an hour.

Sleep apnea tends to get worse over time. You may be mild now, but you could be moderate in a few years, and then severe. Do you want to wait until you are severe to start treating the sleep apnea? Keep in mind that this makes your heart work harder and deprives your organs of oxygen. This causes cumulative damage and leads to high blood pressure which leads to strokes and heart attacks. Better to treat now before it gets bad. I sure wish that *I* had started much earlier.

Did your sleep study say how long your events were or how low your oxygen goes? Sometimes, the events are longer and cause more damage, but the summary does not take that into consideration. Only the number of events per hour.

A pressure of 5-15 is almost wide open, and not much of a prescription based on knowledge. It sounds like a guess as they didn't know what to prescribe. Many doctors also assume the machine will just figure it out and go where it needs to. But they don't realize that when you are breathing fine, it will go back down, let events happen, and then crawl back up. It is far better to have the minimum set so that most events are prevented. The range is to to allow it to go up for short times when you need more pressure, such as sleeping on your back and/or REM sleep.

A pressure setting of 5-15 (even if correct) does NOT mean that all you need is 5.



Feeling better - often takes time to as you realize that you don't feel bad. It is not an instant jolt of energy.

Over time, I realized:

I wasn't having nightmares
I was falling asleep faster
I was waking up fewer times per night
fewer bathroom breaks
no more morning headaches
no more gasping, choking fits
I was less grumpy
I wasn't saying "tired" every time I was asked how I was
not snoring of course, easier to share a hotel room with friend

Most of these took awhile to realize that things had improved.

jnk... wrote: ↑

Wed Dec 26, 2018 2:03 pm

chunkyfrog wrote: ↑

Wed Dec 26, 2018 1:39 pm

For many people, "feeling different" can take awhile.

I felt different pretty much from birth.

You too?
I knew you were special.

Did your sleep study say how long your events were or how low your oxygen goes? Sometimes, the events are longer and cause more damage, but the summary does not take that into consideration. Only the number of events per hour.

A pressure of 5-15 is almost wide open, and not much of a prescription based on knowledge. It sounds like a guess as they didn't know what to prescribe. Many doctors also assume the machine will just figure it out and go where it needs to. But they don't realize that when you are breathing fine, it will go back down, let events happen, and then crawl back up. It is far better to have the minimum set so that most events are prevented. The range is to to allow it to go up for short times when you need more pressure, such as sleeping on your back and/or REM sleep.

A pressure setting of 5-15 (even if correct) does NOT mean that all you need is 5.

The sleep lab tech said my recommended pressure is 5, not 5-15. Currently my setting is 8 (which was an arbitrary pressure chosen by the Sleep doctor before my titration study).

I don’t have any O2 desaturations (always above 92 or 95 I think). I do believe that I have more events than my original sleep study detected because of my fragmented sleep in the study. I had super fragmented sleep in my titration study too. I snore loudly - I can be heard through a closed door down the hall.

ilatruman wrote: ↑

Fri Dec 28, 2018 5:05 pm

Did your sleep study say how long your events were or how low your oxygen goes? Sometimes, the events are longer and cause more damage, but the summary does not take that into consideration. Only the number of events per hour.

A pressure of 5-15 is almost wide open, and not much of a prescription based on knowledge. It sounds like a guess as they didn't know what to prescribe. Many doctors also assume the machine will just figure it out and go where it needs to. But they don't realize that when you are breathing fine, it will go back down, let events happen, and then crawl back up. It is far better to have the minimum set so that most events are prevented. The range is to to allow it to go up for short times when you need more pressure, such as sleeping on your back and/or REM sleep.

A pressure setting of 5-15 (even if correct) does NOT mean that all you need is 5.

The sleep lab tech said my recommended pressure is 5, not 5-15. Currently my setting is 8 (which was an arbitrary pressure chosen by the Sleep doctor before my titration study).

I don’t have any O2 desaturations (always above 92 or 95 I think). I do believe that I have more events than my original sleep study detected because of my fragmented sleep in the study. I had super fragmented sleep in my titration study too. I snore loudly - I can be heard through a closed door down the hall.

If you're snoring with the cpap, your pressure is too low.

Also, something to think about... Titration studies are very often wrong. (that's why most of us are here).

ilatruman wrote: ↑

Fri Dec 28, 2018 5:05 pm

Also, something to think about... Titration studies are very often wrong. (that's why most of us are here).

Is that true about the titration studies? Is it more accurate then sleepyhead? I’m thinking of getting one

palerider wrote: ↑

Fri Dec 28, 2018 7:32 pm

Titration studies are very often wrong. (that's why most of us are here).

+1

Truer words have never been spoken.

It is in many respects the very reason auto-titrating machines (APAPs) were needed and invented.

Pressure needs often vary throughout the night and night to night. Many sleep docs routinely add on a few cm to the single prescribed pressure in order to address that fact.

Lab titrations still have their place, though. The primary values of the lab titration are (1) documenting overall reaction to pressure to see if other sleep issues are unmasked once OSA is titrated away and (2) collecting data for proving to payers that PAP helps the patient.

An educated patient can dial in the best pressure for himself over time much better than the medical snapshot of a single night in a strange bed.

jnk... wrote: ↑

Fri Dec 28, 2018 10:47 pm

palerider wrote: ↑

Fri Dec 28, 2018 7:32 pm

Titration studies are very often wrong. (that's why most of us are here).

+1

Truer words have never been spoken.

It is in many respects the very reason auto-titrating machines (APAPs) were needed and invented.

Pressure needs often vary throughout the night and night to night. Many sleep docs routinely add on a few cm to the single prescribed pressure in order to address that fact.

Lab titrations still have their place, though. The primary values of the lab titration are (1) documenting overall reaction to pressure to see if other sleep issues are unmasked once OSA is titrated away and (2) collecting data for proving to payers that PAP helps the patient.

An educated patient can dial in the best pressure for himself over time much better than the medical snapshot of a single night in a strange bed.

Often, it's even worse than that, since they're fiddling with the pressure for (sometimes) a good part of the night. You'll see titration reports that say "patient slept well at 8 cm pressure for a whole 45 minutes! Then they stamp DONE! on it and send the poor sap home.... soon to end up here, if they're lucky.

Is there a risk to me putting pressure from CPAP 8 to APAP if say, 8 to 20? I’m scared of the higher pressure but also curious what sleepyhead would show.

ilatruman wrote: ↑

Thu Jan 03, 2019 8:44 pm

Is there a risk to me putting pressure from CPAP 8 to APAP if say, 8 to 20? I’m scared of the higher pressure but also curious what sleepyhead would show.

There's a bigger risk of *not* doing it.

As to your fear of "higher pressure". think about this. 20cm isn't anywhere near enough pressure to inflate a balloon.

Stick a straw 8" into a glass of water, blow on it, you've just blown bubbles at over 20cm of water pressure... cuz that's what it is, the pressure it takes to push water down (or up) 20cm. that's it.. nothing scary at all. It's a tiny fraction of one PSI.

Thanks. I will try it tonight. Stupid nasal pillows are driving me crazy post-cold though - my nose hurts so much. Hopefully I’ll finally be able to keep the mask on the whole night tonight. It’s been a while.