Question-changing settings

[notbob]

New to CPAP and was wondering,is it ok to change the settings on your machine? I have the PR REMstar auto system one 60 series. When I got the machine it was set to 9 cm h2o(CPAP mode). I changed it to auto and bumped the pressure to 9.5 for the last week(min 8cm) and my 90% pressure average, according to encorebasic software is 9.5. I've also had a few nights w/ a AHI of more than 5. Now I'm wondering if I should raise it to 10 cm h2o.
If my prescribed press. is 9 cm, am I allowed to change the settings? i.e is the Dr. gonna frown on me changing it from cpap mode to auto, and changing the pressure. Just curious as I have an upcoming appt. for a insurance/compliance check.

[Xney]

I would do it in consultation with your doctor. They usually have a good reason for the setting if you had it set based on a titrated sleep study.

My docs know I can change it and I talk to them about what I might want to try. I wouldn't change it without keeping them in the loop unless they're just ignoring you for some reason. It's perfectly reasonable to try an auto setting to see what pressures are going on for a few weeks, for example, if your machine can do it.

[Sheriff Buford]

When you say "My doctor" are you referring to a Sleep doctor or general practitioner? You are allowed to change your own machine's settings and you are not breaking any laws. That being said, I have always discourage forum members from tinkering their settings until they feel comfortable thru educating themselves here. You can get into trouble real fast.Why did you go to autopap and why did you raise the pressure? What was your ahi prior to raising your pressure?

If I was you, here's what I would do. Go back to the original settings and mode. I'd educated myself, so my doctor, and more importantly myself... I would know what the difference between apap and cpap was, the 90 percentile was, etc... Search here and educate. The forum is here to help you. Work every issue here.

Sheriff

[Pugsy]

Sometimes the medical profession gets all upset if you change your pressures yourself. You may or may not get a butt chewing.
The changes you made were really rather minor in the grand scheme of things.
RX of 9 cm and you use APAP 8 min and 9.5 max. Such a tiny range that it pretty much is real close to straight cpap anyway.
I guess I probably should suggest that you give 9 cm straight cpap a go. There are valid reasons to do so. Like sometimes there is already enough stuff to adjust to besides adding variable pressures into things. Like leaks are easier to manage at constant pressure.
That said. I didn't. My RX was for 8 cm and I used 8 min and 10 max to start with. It became quickly apparent that the machine was maxing out at 10 cm most of the time and my AHI (while lower than pre cpap considerably) was still around 9 or 10.
In my case the AHI did not reduce until my minimum pressure was 10 and I ended up with a wide open range (it suits me but not everyone and the pressure changes never bugged me as I slept right through them). Ended up final results with sometimes I needed a LOT more pressure for some REM events (where my OSA is much worse) but don't need it all the time.

If you want to use APAP and a range....give the machine more room to see where it wants to go. It's obvious it wants to go past 9.5. I would suggest a little bit more of a range if you want to stay in the "tight" range. Maybe 10 or 11 or even 12 .
Remember that it is the minimum pressure that is the most critical though. The machine needs to be able to get to where it needs to be quickly enough to deal with things. It increases in stages and doesn't make huge fast increases.

When evaluating AHI.....remember that if you are having many clear airway events then we don't treat those with pressure because the airway is already open. Example...AHI of 6.0 which may on the surface point to a little more pressure wanted but the central index is 4.0...we don't try to reduce those with more pressure. The remaining 2.0 would be the obstructive component and there really isn't any need to try to reduce a 2.0. So you have to understand what you are seeing and what you are wanting to treat. If your AHI is 6 and almost all of it is obstructive in nature (hyponeas and/or obstructive apneas) then yes we might increase the pressure just a wee bit and if the machine doesn't reach the max and the events don't reduce then the minimum pressure needs adjustment.

Hope I haven't confused you more. Read, read and read some more so that you have a full understanding of what you are wanting to accomplish and how to go about it.

[jweeks]

New to CPAP and was wondering,is it ok to change the settings on your machine? I have the PR REMstar auto system one 60 series. When I got the machine it was set to 9 cm h2o(CPAP mode). I changed it to auto and bumped the pressure to 9.5 for the last week(min 8cm) and my 90% pressure average, according to encorebasic software is 9.5. I've also had a few nights w/ a AHI of more than 5. Now I'm wondering if I should raise it to 10 cm h2o.

Hi,

As long as your doctor is willing to actively work with you, you should probably follow that path. If you get abandoned, then folks will probably feel better about offering you more suggestions.

If you 90% pressure is the same as your max pressure, then I think you do need adjustments. For most people, you want the auto range low number set about 1 to 2 cm below your 90% or 95% pressure (whichever your machine reports). The upper pressure doesn't matter as much as long as it is high enough to prevent max'ing out. The issue you face is that the 90% pressure that you see is limited by your machine settings, and your real world 90% pressure might be even higher. The way folks work around that is to set a wider range, and see where the machine ends up, then gradually tighten down the range.

The caveat is that some folks are pressure sensitive, and adding more pressure can actually cause more events. Your doctor will know about this, so that is still your best path at the moment.

-john-

[notbob]

Thanks to all that replied. I'm definitely planning on work with my sleep Dr., however I don't have a follow up appt. for probably another month or so and I'm anxious to "catch up" on many years of lost sleep.
My original script was for 9cm, and I bumped it .5 and gave it a week or so and it definitely appears as if it should be higher(90% pressure @ 9.5cm) Just wanted to make sure that it was ok to change the settings myself, and if others agreed that i should think about upping the pressure.
Thanks again to all that work so hard on this board. I've gained so much knowledge and have hope of living a much healthier lifestyle thanks to cpap therapy & cpaptalk.com

[archangle]

If your CPAP isn't set right, your therapy may be ineffective or less effective and the risks of apnea may return.

This is true whether you set it wrong or your doctor does.

I screwed up my settings at one time and I was really sick for a while until I figured out why. I'm still setting my own pressure, but I think I know a lot more about what I'm doing now.