What range for APAP

[Satsleep]

This is my first post, but I have lurked for awhile and learned a lot from this forum. Now it is my turn to ask a question which I have searched the forum for an answer without success.

My sleep study recommended CPAP at 10. I want to go to Apap instead of Cpap. My regular doctor is agreeable but does not know what minimum - maximum range he should order. What range to start with would you suggest? Also I am looking at the Auto Set II with EPR and he needs to reccommend an EPR setting as well. The DME suggests starting the EPR at 3. Does this sound right?

Thanks

Larry

[BleepingBeauty]

This is my first post, but I have lurked for awhile and learned a lot from this forum. Now it is my turn to ask a question which I have searched the forum for an answer without success.

My sleep study recommended CPAP at 10. I want to go to Apap instead of Cpap. My regular doctor is agreeable but does not know what minimum - maximum range he should order. What range to start with would you suggest? Also I am looking at the Auto Set II with EPR and he needs to reccommend an EPR setting as well. The DME suggests starting the EPR at 3. Does this sound right?

Thanks

Larry

Hi, Larry, and welcome to the forum.

Generally speaking, when people decide to try APAP, the recommendation here is usually to set the machine 1-2 cms below and above the titrated pressure. (A tight range will allow the machine to more quickly reach the pressure needed to prevent impending events.) With your titrated pressure of 10, you might want to try APAP settings of 8-12 or so. Then keep an eye on the data for a week or more and see how things are going. (It's also important to go by how you feel.)

EPR is a comfort feature which reduces the exhale pressure by the level of EPR chosen (i.e., EPR1 = a 1cm drop in exhale pressure; EPR3 = a drop of 3cms on exhale). My advice: Try the settings without EPR first and give yourself a little time to get used to the pressure; if you're having difficulty exhaling against the pressure, then try EPR at 1. If you're still having trouble, try EPR at 2, etc. EPR is something you can change anytime you want, without having to involve your doctor or DME.

Any change you make should be utilized for at least a few days (a week is better) before making any other change. Only change one thing at a time, so you can determine definitively what works and what doesn't.

Hope that helps.

[Satsleep]

Thanks for the suggestion. While I have not found a post directly dealing with this question I have seen several where there was a range of 4-6 around what was recommended, so I had thought that is probably what it should be. One thing I don't understand is why one should just make the maximum the maximum the machine is capable of which is usually 20?

Larry

[Hawthorne]

There is no problem at all in leaving the maximum at 20 cm as long as you do not have Central Apnea events. That wide a range can bring them on. If you don't have that problem then 20 cm as a maximum is no problem, in my opinion.

Also, if you are aroused (maybe not fully wakened) by pressure changes, a wide range can leave you feeling very tired but the odds are you will never go to 20 cm. You will probably stay in about a 4 to 6 cm range.

It is the minimum pressure that is the most important generally. You want it high enough to prevent as many events as possible and not be so low that it takes a long time to reach your therapy level. You will want your minimum to be 8 or 9 cm, with a titrated pressure of 10 cm.

[gasp]

I'm uncertain if the Auto Set II is data capable or if it allows you to read your own data. I now know that if I hadn't been able to read my own data I wouldn't have been able to post reports that allowed people on the forum to make recommendations on pressure changes. I have the Respironics AFLEX which is made to be either a CPAP or APAP. It has 3 settings for exhale relief and I use the maximum relief setting of 3. I love this machine, but admittedly have never had another to compare it with. Someone would have to wrench it out of my hands to try another : )

The result in changing my pressure was having a much lower AHI. I see near zero AHI and am very, very, rarely over 5. I started out with an APAP

[Satsleep]

I'm uncertain if the Auto Set II is data capable or if it allows you to read your own data.

The Auto Set has a data card that can be read by software, but I do not know what information it tracts.

Larry

[ozij]

Larry,
If you press and hold the right and left buttons for a few seconds, you will get into the "Review" menu that will show you your results. You can't change anything with it. Make sure you attempt the review before noon, since at noont the display rolls over and resets to zero waiting for the next day's data. A day is noon to noon.

[gasp]

I'm uncertain if the Auto Set II is data capable or if it allows you to read your own data.

The Auto Set has a data card that can be read by software, but I do not know what information it tracts.

Larry

Ah, then you have your mission before you : ) Find out from forum members who know about how to get and interpret the machines data for yourself : ) Of course your doctor can help, but getting to know for yourself helps you to associate the data with how you physically feel, changes you make like new masks, machines, etc., and their impact on the numbers.

[rested gal]

One thing I don't understand is why one should just make the maximum the maximum the machine is capable of which is usually 20?

Larry

I agree with Hawthorne. I think it's fine to have the maximum of the range set at 20... IF... a person is sure they have leaks well under control. Using a machine that can show overnight AHI/Leak info, or using software to see the leak rate lets you "be sure" about leak problems / lack of leak problems.

It's very unlikely, in my non-medical opinion, that most people (with leaks under control) are going to approach pressures anywhere close to 20. Statistically, it's said that a pressure of 10 keeps the airway open for most people with Obstructive Sleep Apnea. A ceiling of unused pressure is simply not going to be used....unless leaks drive the pressure up. Thus the importance of knowing that leaks are not a problem.

My sleep study recommended CPAP at 10.

If my prescribed CPAP pressure were 10 and I saw that I didn't have leak issues, I'd set the ResMed autopap for and of these ranges, depending on what "fulltime" EPR level I enabled:

EPR off -- pressure range 8 - 20
EPR 1 -- pressure range 9 - 20
EPR 2 or 3 -- pressure range 10 - 20

I'm not a doctor. That's just the way I'd set the AutoSet II, if it were me.

[Satsleep]

Thanks everyone for taking the time to help me with your knowledge and advice. I have suggested to my Doctor an initial setting of 8 to 12 and I will get the software and monitor the leaks and other data. Once I am satisfied with how it is working then I will consider changing the maximum to the 20. Thanks Rested for bringing up the EPR setting and how that effects the minimum. I had not thought about that.

I still have some questions about the maximum settings. I have read on this board references to bad things happening if the pressure is too high, but not what those bad things are. Why is too high of a pressure bad? Say somebody should have a pressure of 10 and set a CPAP at 20 -- what bad things would happen?

Larry

[ozij]

Assuming you have healthy lungs:
Too much pressure will dsiturb you, may by hard to exhale against will keep you from breathing properly, disrupt your sleep. If your pressue is too high, you'll know - therapy won't be refreshing.
Additionally, the higher the pressure the greater the chance of swallowing air (aerophagia) and bloating -- unpleasant, and sometimes very painful. This is true even if the pressure it not too high; it happens to some people at their correct pressure.

[SleepingUgly]

EPR off -- pressure range 8 - 20
EPR 1 -- pressure range 9 - 20
EPR 2 or 3 -- pressure range 10 - 20

Rested Gal, how would you set it if he was using Cflex Plus at the various possible settings of 1, 2, or 3? Same?

[Blue Waters]

Thank you all for the info here.

I have a Resmed Autoset Vantage S8. I'm feeling that i'm not getting as good night's sleep I used to. I progressively gained weight and used an ageing mask for a long time. I recently bought the new FX mask; the leakage is much better now. 0.06-0.10 range. Even though I feel like I'm NOT nice and fresh in the morning, the AHI number looks "good"; it's 4.5 averaged over the month.

Years ago, during titration my pressure was prescribed at 9 cm. At that time I got a CPAP and a full face mask. That was like torture, since I can hardly breathe from my nose unless my nostrils are opened...

A few years later, I got the Autoset S8 and the Swift II nasal pillows. The autoset was set to work in the 6-20 cm range. I am now feeling that I need to up the minimum pressure. The 6 months history on my APAP is showing a pressure of 9.6. I'm thinking that this is the median pressure. Or is it the 95th percentile?

Given that the APAP is showing me a recent "historical" pressure of 9.6, I'm going to up the minimum pressure to 7 to start my experimentation. Will that be too high? What do you people think? Or should it be set more around 7.6 or so?

Thanks!

[yardbird]

I usually start off a new machine set to range 2 down and 3 up from titrated pressure. Then I look at the data after a week. What was my low pressure useage? How long was I at that low pressure? What was the high? How long at the high pressure? AHI? Any Apneas?

If I'm titrated at 10 and have the range set at 8 to 13 .... and if I see I spend a lot of time with the pressure bottomed out and never hit the high, then I slide the range down to 7 to 12. Still bottomed out without touching the high? ... 6 to 11.

Spend 33% of the night bottomed on 6, but hit that max of 11 a few times. Small jump in the number or duration of Apneas.... leave the bottom at 6 and bump the top of range back up to 12. Not touching 12 and apneas gone. Leave it this way and watch.

I won't set mine lower than 6 as I've been doing this long enough now that I know 4 is uncomfortable and I don't feel like I'm getting enough air. My apneas are related to sleeping position as I'm sure is true of many folks with OSA. Certain positions I get into apparently require more pressure to prevent airway collapse. I want to make sure that pressure is available.

In general I would think that 1 or 2cm down and 3 up is a great starting point. But everyone's OSA is different so you need to be able to see the data if you're going to make your own adjustments. And you make adjustments s...l...o...w...l...y as has been said. Make sure you're not just "chasing the numbers". If you're hitting the high pressure limit a lot, is it from leaks? If you have leaks, then the data is kind of secondary. You have to fix leaks first.

Take your time. Go slow.

[Blue Waters]

Thank you yardbird for your post. I'm upping the minimum pressure from 6 to 7 and I'll watch the summary readings in the morning for the next 3-4 days without changing anything else. Unfortunately I don't have the USB cable and the software; I might have to get these too...