Hey All,

I finally got a copy of my titration results, and am confused at how they arrived at 15 for my optimum pressure.  

Here are the stats:

Pressure      Duration Report Time        Duration Sleep Time         AHI            Mean O2        Lowest O2   Hypops  Central   Obstr   Mixed
    4                    0:20:42.0                          0:05:14.0                80.3             96                    91             6           0            1        0
    6                    0:16:13.0                          0:16:13.0                66.6             96                    93             18         0            0        0
    8                    0:19:12.0                          0:08:42.0                34.5             96                    91             1           4            0        0
   10                   0:26:18.0                          0:26:18.0                 0.0              97                    94             0           0            0        0
   11                   2:45:21.0                          2:31:51.0                 9.5              96                    90             20         3            0        1
   13                   1:17:55.0                          1:17:55.0                 6.2              97                    93             8           0            0        0
   15                   0:59:47.0                          0:50:47.0                 9.5              97                    94             4           4            0        0

It seems to me that 10 is my magic number...not 15.  Why would they continue upping the pressure once you hit zero?  Isn't that the ultimate goal?

Hi Barry,

It is excellent that you are knowledgeable enough to note this situation. Very impressive, especially for one who is newly diagnosed!

The goal is the lowest AHI for a specific case. Often it does turn out to be AHI < 5, as that is considered to be 'normal' for adults.

I can think of several reasons, but here are only two:
The severity of the sleep apnea condition can be worse (in some people, not all) by body-position, and/or by sleep stage, during which a higher pressure is needed to treat the condition.

For examples, the condition may be worse on while one is sleeping on their back (supine position).  The condition may be worse during REM-stage sleep.

You may have not been able to acheive and/or maintain REM-stage sleep at 10cm. I do NOT know if that is the case, it's just a possible example. Sometimes a thorough review of the data from both full reports will provide the answers. This may be worthwhile in your case, depending on how well you respond to the first PAP setup that you get. Overall it looks like you responded very well to PAP treatment, since there was as significant decrease in AHI and the average oxygen levels were good at > 95%.

Good luck to you,
Guest MJ

PS. I often try to explain the importance of the titration data to people who are not doing well on PAP, because the reasons why someone is not doing well can be often found in that data. Would it be okay with your if I use your case and posted data as an example?

G-MJ,

Thanks so much for your opinion.  I have looked over the other graphs/data and see that I was in fact IN REM sleep when they bumped from 10 to 11.    Very strange.   Another oddity is that they seemed to ramp to 10 very fast, blow past to 11....then stayed at 11 for over two hours while continuing to have apneas.

I do understand there are probably hundreds of other factors/reasons for doing what they did.  I am not alarmed or concerned, just curious (it's my nature!). I used my new machine for the first time last night at 15 and slept pretty well, but it does make me wonder as mistakes do happen.


...and feel free to use my numbers!

.
Hi Barry,

I feel it’s important to make a few additional comments, before losing track of you in the web-world.

It’s important to note that you did respond well to PAP, and that the treatment significantly improves (AHI of 80 down to below 10) the condition. That’s good news. However, although the AHI was significantly reduced, it did not fully normalize. Therefore it would be good if you could (at some point) use a fully data-capable PAP device to monitor the effectiveness (AHI) of your at-home treatment. Getting one may involve some rigmarole with your sleep doc/insurance/DME. A good sleep doc is key. Ask if you need help with this. If not, then a fully data-capable PAP can be prescribed on a trial period instead at some point in time.

When there is residual AHI, it may be that the more advanced types of PAP devices and/or pressure combinations that can better treat the condition than CPAP. I am on uncertain ground here, as it becomes quite complicated, and must be considered on a case-by-case basis.

The point of this post is not to alarm you, but rather intended to make you aware that there may be more PAP options/adjustments possible in regards to your treatment. Good follow-up care is very important.

Again, good luck to you.
Guest MJ

PS. Thanks for permission to use the numbers!