pressure setting from Auto to CPAP

When changing modes from APAP to CPAP, what should CPAP setting be? Maybe 2 or 3 above the usual APAP 95th centile or maximim reading (not range maximum)?

I would set it AT the 95th centile

Thank you LSAT - but can I ask why, please.... what will happen for the other 5% of the time - will CPAP mode eliminate the need for the higher pressure above the 95th?
Sorry for my ignorance.

There's a long (and trust me a long) explanation of the 95% mode, but in the auto-pap mode, your machine never gets higher than the 95% mode to treat the apnea events you had. Place your pressure at the 95% mode. See what your ahi and events are. You made need to "tweak" the number, but go several nights before you make any moves. By all means see how you feel on the cpap mode. If you feel better in the auto-pap mode, go back to the auto-pap mode. Some folks will notice a preferable difference in how they feel.

Sheriff

Are you verifying something or setting it your self?

There are risks with increase pressure. For most people the risks start at 24 mmH2O which is why most machines only go to 20 but for some people lower is a real risk.

Find what your Auto machine was doing for a max and use that as a max for the CPAP and I expect you will be uncomfortable.

If your going from an Auto to a fixed because the other machine failed and you can't reach your DME, I would pick 2 under the the 95% as a starting.

Otherwise ask. If your AHI is .7 with an auto max of 8, I would pick 6 or 7. If your AHI on the auto is 33 with a 95% of 17 on an auto, 16 or 17 might be best.
At your sleep study they started at 5 and ramped it up until your AHI went way down. That or a value within 2 is most likely what is on your prescription.

You need to provide more info for anyone to give you advice. Non one here wants to dive you medical advice over the net.

I am a newbie, so at this point just getting a feel for things, but was a bit surprised by how differently going from CPAP to AUTO was. Seems like I had many more event and my snoring increased dramatically. Here is some SleepyHead info, some of which I am still trying to comprehend:

CPAP Statistics as of Saturday, February 04, 2012
2 days of CPAP Data, between 2/3/2012 and 2/4/2012
Details Most Recent Last 7 Days Last 30 Days Last 6 months Last Year
AHI 4.45 3.22 3.22 3.22 3.22
Hours per Night 10:07 08:59 08:59 08:59 08:59
Average Pressure 7.25 7.58 7.58 7.58 7.58
95% Pressure 8.00 8.00 8.00 8.00 8.00
Average Leaks 3.82 2.50 2.50 2.50 2.50
95% Leaks 12.00 12.00 12.00 12.00 12.00

Changes to Prescription Settings
First Last Days AHI Machine Mode Pr. Rel. Min Pres. Max Pres.
2/4/2012 2/4/2012 1 4.45 ResMed Auto EPR x3 4.00 8.00
2/3/2012 2/3/2012 1 1.65 ResMed CPAP None 8.00

Corkster52 wrote: was a bit surprised by how differently going from CPAP to AUTO was. Seems like I had many more event and my snoring increased dramatically.

Your AHI?....what is the breakdown to each event category? Central Index? Hyponea Index and the Obstructive Index? Mainly how much of your AHI is Central?

APAP range 4 min and 8 maximum with EPR of 3 probably keeps the pressure overall just a bit lower than you might need. EPR of 3..brings the pressure down 3 cm with each exhale...so if you are reaching the max of 8 cm...during half the time you are using 5 cm.

You may or may not need a bit more minimum pressure/maximum pressure to offset the EPR reduction.
It depends on the central component of your AHI. If 50% of your AHI is centrals...then you may not need more pressure. You might need a little more pressure to deal with the snores, if they are excessive, in that case probably just a bit more minimum pressure.

Is this what you mean?


AHIApnea / Hypopnea Index 4.45
HypopneaHypopnea 1.48
ApneaUnspecified Apnea 0.10
ObstructiveObstructive Apnea 2.47
Clear AirwayClear Airway Apnea 0.40

I am wondering if I am getting leakage due to the long ramp time and low pressure that I have. The ramp is 45 minutes and pressure starts at 4 and maxes at 8. Could I be getting leakage at 8 after I am asleep and in effect lowering the pressure to stop the apnea and the snoring? Should I stop the ramp and just go to 8 and check for leaks right away?

Using the ramp is a comfort feature. It is designed to start you off at a lower pressure that is more comfortable while you are falling asleep, then the machine can ramp up the pressure to what you need. An extended ramp time can get you off to a rocky start.

A good ramp time is 5 - 10 minutes. This is roughly based upon how long it takes you to fall asleep, but there are no hard and fast rules about this. With that said I think that ramping over a period of 45 minutes is excessive. The same goes for the starting pressure. Many of those that use the ramp feature set their lower pressure to somewhere in the range of 70 - 80% of the normal pressure. This gives you a little relief from the blast of full pressure, and a little time to ramp up to full pressure.

Since your max pressure is 8, I would suggest setting your minimum pressure to 6 and adjusting the ramp time to 10 minutes. See if that seems more comfortable.

Many people don't want to fiddle with the ramp at all and just have the machine come on at the pressure they expect to use.

Part of my problem is that I take sleep meds to go to sleep (Lunesta), and trying to figure out my new "normal" routine. The Lunesta takes right at an hour to make me drowsy, so I want to figure out when to take it, when to put on the mask....and so on.

Corkster52 wrote:The ramp is 45 minutes and pressure starts at 4 and maxes at 8

45 minutes is a long time to ramp to 8 cm. Starting out at 4 cm it is going to be low for quite a while. Without seeing the timeline of events being scored we don't know if any are occurring while the pressure is low and are showing up during ramp time. You have predominately obstructive events in your AHI and not much in the way of centrals. If you are going to use EPR of 3...why not just try a very short ramp time so you get your pressure up a little faster? In fact using EPR you might find you are comfortable enough without using ramp at all. Either that or increase the starting ramp pressure to 6 cm as HoseCrusher said with a short ramp time.