Prescribed range 5-12. Why a range?

Hi

After abandoning my cpap a year ago I’d like to restart but have forgotten my initial education by my provider.

why is there a prescribed range 5-12 when 11 is my goal pressure?

Should I use auto ramp if the range starts low and builds up?

Thanks

Using a range allows the user to stay at a lower pressure unless more pressure is needed. Pressure needs can change throughout the night, based on sleep stage and position. If a person finds it takes too long for the machine to reach an effective pressure, the lower end of the range can be raised to enable the machine to meets needs quicker. Allowing extra pressure in the range beyond what is expected to be needed (in your case 11) is a safety measure, just in case. If it's not needed, the machine won't go there.

As to the ramp, if you feel you need to use the ramp feature (it's a matter of preference) a couple tips are to not start it so low as to be uncomfortable and starved for air. Even if your ramp will go to a therapeutic pressure if there's a need, the less your machine has to chase impending trouble the more effective it will be at preventing events. And the more comfortable you are with the air being sufficient, the easier you can relax and lean into the treatment and sleep. If you are one who falls asleep real quick, shorten your ramp time accordingly. If you are not bothered by the air and don't need to adjust gradually you could skip the ramp altogether.

If 11 cm H2O is your "goal pressure", then 5 cm H2O sounds kind of low. You can look at your sleep data and see what's happening, but if you've been titrated at 11, then my experience would put your lower bound at maybe 8, subject to your comfort and looking at your sleep data.

The idea of a range is as what's been said. Not everyone is comfortable with having pressure changes, but if you are one then your "resting" pressure can be lower most of the time, and the machine can bring the pressure up when it needs to. Then it can drop it back when between events. If your lower pressure is too much lower than the pressure that's needed to take care of your apneas, it may take your machine too long to get from the "resting" pressure to 11 (or whatever pressure is needed), and you will still experience apneas since you machine can't treat them as well; i.e the machine can't keep up with the events.

Personally, I used the ramp for a few days back when I started with cpap, but it was set to start at 4, and I didn't feel like I was getting enough air. My prescription was 8-10, so I just turned off the ramp off and that was fine. The machine would quickly go up to 8, and start there. No problem. But the ramp is there for comfort...one should keep it short, though, since your machine is not as able to deal with apneas while the ramp is running up. If you need it, you'll find out. For figuring out where you should be at home (as opposed to at the sleep lab *smile*), you'll need to look at your sleep data and see what's happening.

A lot to learn to get the best results from your therapy, but there's lots of help here. Good luck!

Ramp on the AirSense machines...there's 2 choices for ramp.
Auto Ramp....it works differently than normal ramp.
Normal ramp uses a lower starting pressure (the default is 4 cm but can be started higher) for a set period of time where it gradually increases the pressure upwards until the minimum pressure is reached then ramp disengages until you turn the machine off for whatever reason.
Auto Ramp...it uses a 30 minute time frame OR when it senses you are asleep (supposedly by the rhythm of the air flow) to get to that minimum pressure.
If you go to sleep 10 minutes after you start the machine it isn't going to take another 20 minutes to get up to the minimum pressure...it goes to that minimum pressure in just a minute or so. It does this so that the pressure can pretty much immediately be optimized for any events that might happen early in the night.
If using regular ramp...those events wouldn't be treated and might slip past the defenses.

See the manual for explanation.
https://sleep.tnet.com/home/files/resme ... -guide.pdf

Now your starting minimum pressure is 5 cm...to be honest that's not much different from the 4 cm minimum default that ramp will start with. You probably can't even tell much difference and most people wouldn't even need to use ramp with that starting minimum pressure of 5. Now if your starting minimum was say 10...that ramp might be more useful and more comfortable for some people.
To be honest..with a minimum pressure of 5 it doesn't really matter much which ramp might be better if someone wanted to use ramp.

I don't know why there is a mention of target 11 unless that is the target pressure they might want to use if in cpap fixed pressure mode and that is often a worst case scenario pressure. Covers pressure needs if on your back or REM but maybe you don't need 11 if not on your back and if not in REM.
If that was the case I would have to use 18 cm all night because that's what I need sometimes during REM and me tell you it wouldn't be much fun. I use APAP mode...let's me get by with 9 or 10 for the 80% of the time I am not in REM and only goes to 15 to 18 when I am in REM and need more.. It's a whole lot more comfortable to do it that way.

I don't know if the 5 cm is too low of a minimum or not. It might be just fine for you if that 11 cm is something you rarely need to go to. My minimum...is 7 and I use EPR of 3 and my machine gets to 18 when it needs to and my AHI is usually below 1.0.
We need to see the detailed reports to really get an idea what is going on and to see if the current settings are doing a good job.
viewtopic/t158560/How-to-post-images-for-review.html

I would suggest staying with 5-20 for a week or so. Then I would change the min to somewhere near your 90% or 95% pressure (average for that week).

You can leave the max at 20, unless the higher pressure is bothersome and/or you're experiencing "clear airway" events.

I don't like using the 90/95% numbers as the guideline for the minimum unless they are relatively close to the median pressure numbers.
Especially short term...anything less than a month is short term to me.

90/95% numbers are too easily skewed higher by relatively short periods of time at the higher pressures.

Remember the definition.....at OR BELOW and the below part could be significantly below.

I have seen 90/95% numbers of 15 or higher but actually only used higher pressures for maybe 30 minutes out of the entire night.
Rest of the time it was around 10 cm...

Long term average for my 90/95 % numbers...I once did the work to average 6 months of 90/95% numbers and long term they were at 11 cm. Short term for a week...there were at 14 and 15 and 16 for some weeks.

Now if the median pressure is close to the 90/95% pressure consistently and there's not much difference..then yeah maybe but otherwise I prefer to use the median pressure as more of a guideline for that minimum pressure starting point.

Chandleresque wrote: ↑

Tue Apr 10, 2018 12:42 am

After abandoning my cpap a year ago I’d like to restart but have forgotten my initial education by my provider.
why is there a prescribed range 5-12 when 11 is my goal pressure?
Should I use auto ramp if the range starts low and builds up?

I would suggest you download SleepyHead so you can monitor your results. With an auto machine the normal practice is to start with a wide range and then narrow it down after that. If you think your typical pressure is going to be in the 11 cm range, I would suggest the following as a beginning set up:

Minimum: 7 cm
Maximum: 20 cm
EPR: 3
Ramp: Auto
Ramp Start: 5 cm

Then when you see what your results are in SleepyHead you can refine those settings. Likely maximum pressure can be reduced because the machine doesn't want to go there anyway. Minimum may have to be increased. If you feel you are short of air before you go to sleep bump up the Ramp Start by say 1 cm at first. Bump up the minimum by 1 cm as well.

Hope that helps you get started. Here is a short guide on how to get into the clinical menu to change settings:

A10 Clinical Menu - Short Guide

Chandleresque wrote: ↑

Tue Apr 10, 2018 12:42 am

why is there a prescribed range 5-12 when 11 is my goal pressure?

Because a lot of doctors are stupid about auto machines.

If you feel that 11 is your probable target, set the machine for a minimum of 10, if it ends up sitting at 10 all the time, lower it a cm and see if it sits at that pressure all the time too...

Better than setting it too low to start and having more events as a result.

Chandleresque wrote: ↑

Tue Apr 10, 2018 12:42 am

Should I use auto ramp if the range starts low and builds up?

If you need to, that's mainly for your comfort to get to sleep, some people like it, some don't.