How To Choose Pressure Range?

[rockncountry101]

I was recently diagnosed with OSA. I got a prescription for a CPAP. I couldn't get anyone to sell me an auto machine without a specific prescription for an apap. That is until I found the wonderful folks at cpap.com. On my prescription it calls for a single pressure of 9. I have noticed that my AHI is increasing I assume because I am finally achieving REM sleep (something that I didn't do during either sleep studies.) Having the Airsense 10 I can set my pressure range for whatever I want but I'm not sure what I should set it to. Any suggestions?

[palerider]

I was recently diagnosed with OSA. I got a prescription for a CPAP. I couldn't get anyone to sell me an auto machine without a specific prescription for an apap. That is until I found the wonderful folks at cpap.com. On my prescription it calls for a single pressure of 9. I have noticed that my AHI is increasing I assume because I am finally achieving REM sleep (something that I didn't do during either sleep studies.) Having the Airsense 10 I can set my pressure range for whatever I want but I'm not sure what I should set it to. Any suggestions?

it would be best, from now on, if you quit posting new topics for every question you have, and keep an ongoing thread, so that people who are trying to help you can review the history you have, and thus help you better.

I'd set it for min 9, max 20, then check your data with sleepyhead.

[Pugsy]

So you are using cpap at 9 cm now and the AHI is increasing?
Just how much increase are we talking about?
And what is the event category breakdown of those AHI stats?

[Wulfman...]

I was recently diagnosed with OSA. I got a prescription for a CPAP. I couldn't get anyone to sell me an auto machine without a specific prescription for an apap. That is until I found the wonderful folks at cpap.com. On my prescription it calls for a single pressure of 9. I have noticed that my AHI is increasing I assume because I am finally achieving REM sleep (something that I didn't do during either sleep studies.) Having the Airsense 10 I can set my pressure range for whatever I want but I'm not sure what I should set it to. Any suggestions?

What makes you think that a "range" is going to help?
You've given us practically no information in this post to go on.
How much is it increasing? From what to what? How are your leak numbers?
If you start using ranges, you may get bumped out of the various needed sleep stages (deep and REM) and into lighter ones.
Many things with using APAPs in ranges involve the characteristics of one's breathing. Some things trigger pressure increases (like snores and flow limitations) but outright apneas won't trigger pressure increases and they will occur anyway.
Are your apneas immediately preceded by flow limitations and/or snores? Or, do they just occur without preceding events?
Using ranges can also exacerbate leaks, too. You would need to adjust the mask to the highest pressure it may hit.

Maybe you just need to bump your fixed pressure up a centimeter or so at a time and see what that does. If the numbers get better, you know you're going in the right direction.


Den

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[palerider]

What makes you think that a "range" is going to help?

well, a "range" could find more optimal pressures a lot faster.

[Wulfman...]

What makes you think that a "range" is going to help?

well, a "range" could find more optimal pressures a lot faster.

NOT NECESSARILY!!!

You still need time with either method to see what works and what doesn't.
One or two nights don't indicate a trend. Nobody sleeps the same night after night.

Night before last, I had a 0.9 AHI and last night I had a 0.0. That's about the range of AHIs I see in my reports. From a statistical standpoint, I don't need to use a range of pressures because there's virtually nothing to "fix".


Den

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[palerider]

What makes you think that a "range" is going to help?

well, a "range" could find more optimal pressures a lot faster.

NOT NECESSARILY!!!

You still need time with either method to see what works and what doesn't.

that's an excellent condemnation of the typical lab titration process... and I agree. getting things right does take time, however, if, for example, he needs 15cm of pressure, then one night on auto would get a pretty good indication of that, whereas raising pressure a cm every few days would get you to the same place.... in a month.

it's a tool, and used properly, can be very useful.

[Wulfman...]

What makes you think that a "range" is going to help?

well, a "range" could find more optimal pressures a lot faster.

NOT NECESSARILY!!!

You still need time with either method to see what works and what doesn't.

that's an excellent condemnation of the typical lab titration process... and I agree. getting things right does take time, however, if, for example, he needs 15cm of pressure, then one night on auto would get a pretty good indication of that, whereas raising pressure a cm every few days would get you to the same place.... in a month.

it's a tool, and used properly, can be very useful.

I've never said that one way is better than the other.
BOTH methods work IF the person knows what they're trying to fix and the degree of "fixing" that needs to be done.
It also depends on the users breathing characteristics. AND, their sleep quality.
If the user is seeing events (AHI) in the 1 - 3 range and only needs a little extra pressure, then a slight increase over a few nights may show that a pressure increase is warranted. If we're talking about events in the 3 - 5 range, then maybe the APAP pressure range method might be better.
It often takes more than "dial wingin'" to get the optimal settings. It takes some understanding on how these machines work and evaluating their breathing characteristics and events during sleep. Masks can make a difference, sleep positions, bed pillows, other medical issues, medications, humidity and a whole long list of what we've seen the users try to deal with here on the forum.
A person needs to use some introspection of their own situations to figure it out for themselves. It's almost impossible for us to know everything about them to give the best recommendations. Lots of times we get "lucky". But, it takes time and the user needs the experience and education to obtain their own best results.

It's "baby steps".


Den

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[Wulfman...]

that's an excellent condemnation of the typical lab titration process... and I agree. getting things right does take time, however, if, for example, he needs 15cm of pressure, then one night on auto would get a pretty good indication of that, whereas raising pressure a cm every few days would get you to the same place.... in a month.

it's a tool, and used properly, can be very useful.

I really don't want to get into that subject. Again.......sometimes they're right and sometimes they're WAAAAAY off.
Personally, I was prescribed much more pressure than necessary.

But, if a person has an in-lab sleep study and titration, then it MAY be a place to start with settings. I've always recommended at least TRYING the titrated/prescribed setting before taking matters into your own hands. (which I did, too.)


Den

.

[brauliox]

Some learnings after 1 year CPAP usage:

Required pressure changes with sleeping position and mask type: increases with fullface mask/supine position and decreases with nasal mask/side sleeping position. I have a Resmed S9 Autoset but, initially, used a fixed pressure. My titration was done with a full face mask and indicated 13 cm H2O pressure and it was carried out using the same S9 model I own!!!

Using the 13 fixed pressure but alternating different masks and sleeping positions, I got inconsistent results night after night, always above 3 AHI, before I learned about how sleeping position and mask type affects the results. I then tried to use the Autoset function, initially with a wide pressure range (9 to 18). Although this strategy was good to confirm my titration results and to understand the influence of mask type/sleeping position, a wide range has no use after titration. On the contrary, large automatic increases on air pressure above your required pressure will cause leaks on the mask and wake you up.

I learned that the best settings is to set the lower limit just under your titration pressure and the upper limit no more than 1 or 2 cm H2O above that. This is enough to accommodate the normal variation on your optimum pressure, but is not enough to accommodate a change in mask type. If you change from nasal mask to full face, you will have to increase your pressures by 1 or 2 cm H2O.

[SewTired]

I was recently diagnosed with OSA. I got a prescription for a CPAP. I couldn't get anyone to sell me an auto machine without a specific prescription for an apap. That is until I found the wonderful folks at cpap.com. On my prescription it calls for a single pressure of 9. I have noticed that my AHI is increasing I assume because I am finally achieving REM sleep (something that I didn't do during either sleep studies.) Having the Airsense 10 I can set my pressure range for whatever I want but I'm not sure what I should set it to. Any suggestions?

A couple of questions. Was your only problem apnea or do you also have a lung or heart problems or high blood pressure? If you don't have lung or heart problems I respectfully disagree with Wulfman. You should go to a range first before a single pressure.

Your titration report should give you the best information. You need the raw data, not a summary. In the absence of info from your titration report, my recommendation is to set your apap to 7-12 and see how that works for you. The lowest pressure that does the job is the safest and very likely, you only need that 9 pressure during REM while most of the rest of the night is at lower pressure.

Yes, I am a newbie, but I can already see that most doctors are still applying a hammer when the technology has advanced to screwdrivers. However, as stated, if you have lung, heart or blood pressure issues, the doctors goal may be different. In my case, for instance, at best, the titration can only get my oxygen up to 91 percent. Looking at my titration, I had pretty much the same results at 8 as I did at 11, which was the prescribed pressure. On auto, most of the night, my pressure is just above 8. It is only higher during the period I am most likely in near REM or REM. My sleep PA has no problem with me changing pressures, but does want to hear from me if things worsen or if I need to go up higher than 12.

Posting data from Sleepyhead is the most useful thing to do.

[Wulfman...]

I was recently diagnosed with OSA. I got a prescription for a CPAP. I couldn't get anyone to sell me an auto machine without a specific prescription for an apap. That is until I found the wonderful folks at cpap.com. On my prescription it calls for a single pressure of 9. I have noticed that my AHI is increasing I assume because I am finally achieving REM sleep (something that I didn't do during either sleep studies.) Having the Airsense 10 I can set my pressure range for whatever I want but I'm not sure what I should set it to. Any suggestions?

A couple of questions. Was your only problem apnea or do you also have a lung or heart problems or high blood pressure? If you don't have lung or heart problems I respectfully disagree with Wulfman. You should go to a range first before a single pressure.

Your titration report should give you the best information. You need the raw data, not a summary. In the absence of info from your titration report, my recommendation is to set your apap to 7-12 and see how that works for you. The lowest pressure that does the job is the safest and very likely, you only need that 9 pressure during REM while most of the rest of the night is at lower pressure.

Yes, I am a newbie, but I can already see that most doctors are still applying a hammer when the technology has advanced to screwdrivers. However, as stated, if you have lung, heart or blood pressure issues, the doctors goal may be different. In my case, for instance, at best, the titration can only get my oxygen up to 91 percent. Looking at my titration, I had pretty much the same results at 8 as I did at 11, which was the prescribed pressure. On auto, most of the night, my pressure is just above 8. It is only higher during the period I am most likely in near REM or REM. My sleep PA has no problem with me changing pressures, but does want to hear from me if things worsen or if I need to go up higher than 12.

Posting data from Sleepyhead is the most useful thing to do.

With all due respects, your response to the OP seems to be quite convoluted and contradictory.
In the first place, the point I was trying to make is that the person needs to know (and evaluate) what specific problems need to be "fixed" before proceeding, and that either fixed pressure adjustments OR a range of pressures MAY work depending on what fixing is needed.

Users need to understand lots of things about their breathing and sleeping characteristics when making some of these decisions. Now.......to be fair, some of these things CAN be discerned by using a range of pressures to see the types of events that get reported and which can affect what the machine will or won't do in response to them........such as flow limitations and snores to name a couple. Auto machine algorithms primarily respond to those two events and not directly to apneas. Consequently, if a person doesn't have those preceding events, the machine may not respond with additional pressure IF apneas may occur.

The OP had a titration and was given a prescription for 9 cm. based on that titration. You state that titration report should give the best information, but then you are arguing that it apparently didn't and now a range is needed. The fact is, we don't have enough information from the OP (what the machine data shows......AHI, leaks or other info) to offer any possible recommendations. Many people don't even get any REM sleep during their sleep studies, so assuming that 9 cm. is adequate for the OP's REM events is premature. And, using lower pressures (minimum pressure in a range) may not be adequate. Also, as I've often said, the pressure changes from ranges of pressures on an APAP MAY have adverse effects on a person's sleep quality by bumping them out of needed sleep stages......and leave them feeling unrested.

These circumstances and characteristics need to be evaluated......both from the sleep study report and from the machine software reports. Just because a person has an APAP and can use a range of pressures, doesn't mean that the machine can deliver "better" therapy than a fixed pressure. There are also arguments that the range of pressures may offer better therapy, too.......again......depending on the person's sleeping and breathing characteristics.

Contrary to what some people have tried to imply, I don't think I've ever made a statement that straight pressure is absolutely "better" than fixed pressure. Everyone is different. It's just that most of the times I've recommended that the person investigate or try using straight pressure is when they've posted that they've been using a range of pressure for a certain amount of time and aren't feeling rested or better.


Den

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[Sticky Fingers]

It's just that most of the times I've recommended that the person investigate or try using straight pressure is when they've posted that they've been using a range of pressure for a certain amount of time and aren't feeling rested or better.

But now you use that same old refrain when the OP is using straight pressure!

[Wulfman...]

It's just that most of the times I've recommended that the person investigate or try using straight pressure is when they've posted that they've been using a range of pressure for a certain amount of time and aren't feeling rested or better.

But now you use that same old refrain when the OP is using straight pressure!

Absolutely NOT!!!
The OP is (apparently) using straight pressure but was inquiring about using a range of pressures......without identifying anything about what he is trying to "fix".

I said:

BOTH methods work IF the person knows what they're trying to fix and the degree of "fixing" that needs to be done.

Den

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