Range vs Fixed prescription

[ZenaPrincessSnoozer]

I am looking for a bit of education please. My prescription is for a constant pressure of 14. I had a ramp option, which I turned off because I had trouble breathing at the lower levels. This constant pressure works well for me. My husband's prescription is for a range (8-14, I think) so he has an S9Auto (and might need to try an ASV machines because his AHIs/hr still range from about 3 to 12, all over the map) . What are the experts looking at when determining whether to prescribe a fixed, vs a range of pressures. I have mostly OSA, while hubby has CSA. Is that the determining factor?

[big_dave]

Some people are bothered by the auto CPAP's pressure swings, and they do better on fixed-pressure CPAP. OTOH, some people have a varying pressure need caused by positional apnea (more pressure needed when sleeping on your back), nasal congestion, or weight gain or loss, among other issues.

The bottom line: try both and see which works better for you. If you want to try auto CPAP, you would use a range 2 or 3 cmH2O above and below your fixed pressure (such as 12-16 or 11-17). You will want to download your data to see how well the new settings work for you, in case further adjustments are needed. The Elite and the Autoset both have the data you need, but the Elite is not capable of auto CPAP.

[Sheriff Buford]

As big dave stated, its a personal preference. In the autoset mode, the S9 can take up to 14 seconds to treat a suspected apnea. I have found that I prefer the straight cpap mode, and I do feel better during the day. I do though, try the autoset mode about twice a year to see if my body has changed and prefers the autoset mode. Again, most folks prefer the autoset mode over capap mode, and some don't.

Sheriff

[chunkyfrog]

It is best to have a fully data-capable APAP, because it can be run both ways; and like the Sheriff says--
change up once in a while to keep current with what your body needs.

[Wulfman...]

I am looking for a bit of education please. My prescription is for a constant pressure of 14. I had a ramp option, which I turned off because I had trouble breathing at the lower levels. This constant pressure works well for me. My husband's prescription is for a range (8-14, I think) so he has an S9Auto (and might need to try an ASV machines because his AHIs/hr still range from about 3 to 12, all over the map) . What are the experts looking at when determining whether to prescribe a fixed, vs a range of pressures. I have mostly OSA, while hubby has CSA. Is that the determining factor?

In my opinion (and without knowing all the details and the results of his sleep study), for a doctor to prescribe an APAP in a range of pressures to someone with Central Sleep Apnea could be borderline "malpractice".
There are alot of factors involved, but from what little you've told us, it's no wonder that his AHI is all over the place.

Are both of you using software to see the specific nightly data from your machines? If not, I'd strongly recommend that you get it and see what's happening.

Den

.

[archangle]

In my opinion (and without knowing all the details and the results of his sleep study), for a doctor to prescribe an APAP in a range of pressures to someone with Central Sleep Apnea could be borderline "malpractice".

Not necessarily. For instance, 8-14 auto is probably not going to cause any more CA problems than a straight pressure of 14.

Far too many doctors and patients don't realize that an APAP doesn't have to be set to the maximum range of 4-20.

Given the choice, always get the APAP vs. CPAP because you can always set the APAP to a narrow range or even to manual CPAP.

I think all patients should be started on APAP, with a narrow range if necessary, monitored for a while, and then left on a somewhat limited APAP range that works well for the patient. One important thing that's necessary for proper APAP is not not set the minimum pressure too low, because that way, the patient spends part of the night without enough pressure, and the pressure changes may cause leaks and other problems.

[49er]

After trying various pressure combinations, I have settled on a straight cpap pressure of 5 with a neck collar. I felt due to being hypersensitive to stimili, I needed as few disturbances as possible. My AHID is mostly 2 and under.

If after addressing other non cpap issues doesn't work to increase my time slept on the machine (I am at 4 hours right now) then I may try a pressure range to see if that would help. Or I may just slowly increase the straight cpap pressure.

49er

[Tino2You]

Hi Zena,

As Big Dave said, your logical first step is to pull your (and your husbands) data off your SDCards that your machines use. You can download the ResMed or Sleepyhead software (both free) to extract the data and give your graphs of exactly what is going on throughout the night. You said

because his AHIs/hr still range from about 3 to 12, all over the map

he may be having leak issues and his AutoSet may not be reacting quickly enough to keep up. Once you can "see" the data you can make that determination. Otherwise you are shooting from the hip.

-tino