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Sleep Disorders

Sleep Pattern Change (Sleep apnea user)

05/06/2008

Question:

I have had obstructive sleep apnea for 67 years. I have used a CPAP since 1985, with a pressure setting of 12.5. A month ago I revisited the sleep lab and the CPAP pressure was reduced to 6.0. Since the adjustment, I have awakened (bathroom) a number of nights and cannot return to sleep in bed. I then move, with the CPAP, into a recliner, where my head is elevated, and I can then fall asleep again.

There have been no changes other than the reduction of the CPAP setting from 12.5 to 6.0.

Any suggestions?

Answer:

Obstructive sleep apnea severity may change over time as may the pressure needed to treat it. These changes relate to a variety of factors: age, weight change, nasal patency (seasonal congestion), sleep position, sleep stages, state of sleep deprivation, medications, alcohol intake and cigarette smoking. There may be other factors that influence sleep study findings. I say this because even when sleep studies are done close in time, and when the above factors have not changed, the severity of sleep apnea can still vary in as many as half of those with mild disease.

There is also a suggestion that CPAP treatment in itself may change the severity of sleep apnea. This may result from the decrease in vibratory irritation to the back of the throat that usually occurs due to snoring. Using CPAP stops this irritation, therefore improves sleep apnea while using it.

Based on the information you provided, a decrease in pressure need from 12.5 to 6 cm seems a bit unusual. The frequent awakenings during the night and improved sleep on a recliner both indicate the pressure may be inadequate or set too low.

Your CPAP treatment needs further evaluation. You should discuss these issues with your Sleep Specialist. Sometimes a repeat CPAP titration study is indicated. At other times, an empiric increase in the pressure with close monitoring is done. There is also the possibility of utilizing an auto-titrating CPAP machine for a week or two. This “smart” machine changes the pressure during sleep according to individual needs. The machine also records information that can be then used to determine a stable CPAP pressure need.

If you would like additional information regarding sleep and sleep disorders, you can obtain it on the American Academy of Sleep Medicine website. This website also contains a list of Sleep Centers across the country so you can locate one near you if need it.

Good luck, and sleep well.

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Response by:

Ziad  Shaman, MD Ziad Shaman, MD
Assistant Professor of Medicine
School of Medicine
Case Western Reserve University