So I get my CPAP and perhaps a year or so later I found that my weight had gone up, I felt bad, and the doctor looked at my data and bumped my pressure. A couple of years later and again I weighed a bit more, felt bad, and the doctor bumped my pressure.

Then I learned to do EERS[1] during my stressful times of year, moved to a safer city with more sun and great training hills, all while working with a dietitian and personal trainer. As time progressed I reduced my body weight by about fifteen percent. But as the hot weather of summer approached I was having considerable problems apparently with ventilatory gain, my sleep was being fractured by respiratory effort related arousals, and I felt bad.

They wanted to do an in lab titration.

But by this time several things were apparent to me:

  1. It takes time to get used to a new pressure (say a week to weeks).
  2. I sleep different every night so a very expensive one night shot seemed unlikely to fill the everyday bill.
  3. The “in lab” environment would be stressful and much different to me which would change how I was as compared to how I would normally be at home.

So the standard way of doing things looked unlikely to yield usable good results.

So I found out how to set my own pressures and modes and started to find what worked!

My current pressure was 15cm/H2O which seemed a bit high so I set the machine into “Auto” mode and tried a 13cm/H2O to 15cm/H2O setting. Snoring quickly moved the setting to 15cm/H2O and so “Auto” mode was thus eliminated as unusable.

Next I tried about a ten day trial at 13cm/H2O with improved results. How low can we go?

Next a seven day trial at 12cm/H2O with even better results. I kept going lower every seven to ten days until I got to 7cm/H2O where I saw some obstructive events once in a while over a three day period and decided to go back up to 8cm/H2O.

Each setting had some time for my body to adjust. And with the whole process taking some 65 days I really did believe that the lowest usable setting had been found (AHI running under two per hour).

As I continued to look at my data a few months later I saw and responded to the need to raise pressure as fall came. In winter I add EERS[1] to help with the ventilatory gain issues added by stress. Right now I am doing a trial without EERS as we are somewhat removed from the anniversary of the traumatic event which causes the winter stress and spring approaches.

If you start CPAP and they somehow get the pressure into a usable mode to start with that will be great for then. But then your body will start to heal – and – change!!! And so todays pressure will not apply so well a few months down the road. And all bets are off if there is a major life event in there somewhere (or perhaps even a large change in altitude).

Titration needs to be considered a constant ongoing process.

[1]: Gilmartin G, McGeehan B, Vigneault K, Daly RW, Manento M, Weiss JW, Thomas RJ.

Treatment of positive airway pressure treatment-associated respiratory instability with enhanced expiratory rebreathing space (EERS).

Source: J Clin Sleep Med. 2010 Dec 15;6(6):529-38. Division of Pulmonary, Critical Care and Sleep Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA.