New User - pressure setting 8, what do you guys think?

[CMAmedchick]

Hello everyone!

I am newly diagnosed with severe OSA and I am still waiting for my insurance to approve my CPAP machine. The tech at the sleep lab told me that I was extremely lucky that I only needed a pressure of 8 to keep my airway open. Does that sound pretty low to you guys? My AHI index on my first night's study was 52, which they said was quite high. I'm merely curious as to what a normal pressure range is to someone with severe OSA. Thank you so much for any information you can give.

[kaiasgram]

Hi Jelly -- The AHI does not determine the amount of pressure one needs to hold their airway open. Severity is a frequency issue (AHI: mild, moderate, severe). Pressure is an anatomical issue -- how much pressure is needed to hold your airway open so you can breathe. You could have mild apnea but need a lot of pressure for your airway to stay open. Conversely, you can be severe (like you) but need a relatively low amount of pressure to keep your airway open.

It is nice that you don't need a tremendous amount of pressure -- makes it easier to adjust to sleeping with the machine.

Welcome to the forum.

[LSAT]

You should start with the pressure you were titrated at...in this case 8 if you will be using fixed pressure,. If it is determined that you should use an auto pressure range, your pressure would be about 7-12. You will not know if these pressures are right for you until you have used the unit for a week or two.

[SleepyWabbit]

I'm new also and recently received my results. I was given a pressure setting of 12. I had an AHI of 45 and an RDI of 47.
Each one of us is different and unique.

[49er]

Hi Jelly -- The AHI does not determine the amount of pressure one needs to hold their airway open. Severity is a frequency issue (AHI: mild, moderate, severe). Pressure is an anatomical issue -- how much pressure is needed to hold your airway open so you can breathe. You could have mild apnea but need a lot of pressure for your airway to stay open. Conversely, you can be severe (like you) but need a relatively low amount of pressure to keep your airway open.

It is nice that you don't need a tremendous amount of pressure -- makes it easier to adjust to sleeping with the machine.

Welcome to the forum.

Hi Jelly,

In addition to Kaiasgram's exellent points, you may find that many sleep doctors and ENTs are very ignorant about this issue. Keep that in mind when discussing pressure issues.

49er

[chunkyfrog]

Pressure and efficacy data don't even interest many doctors unless you're lucky and your doc is a geek.

[Vermonter]

I personally feel straight set pressure CPAP machines are obsolete and not effective in treating OSA. There are too many variables where your pressure could change during the night. Automatic machines are the way to go.

[avi123]

CMAmedchick, my first sleep study showed that I should use 6 cm pressure on CPAP for plain OSA. It was wrong and should have been 12 cm, which I found later.

[tedburnsIII]

I personally feel straight set pressure CPAP machines are obsolete and not effective in treating OSA. There are too many variables where your pressure could change during the night. Automatic machines are the way to go.

Disagree.

My medically defined 'optimal' titrated pressure at the lab was 12cm, and I later learned was recommended by the sleep doctor and by a later-seen pulmonologist, who stated he would've prescribed straight CPAP.

But referring cardiologist prescribed Auto 6-15cm. I must say that Auto 6-15cm no doubt is easier to satisfy Compliance requirements than straight 12cm. My most recent Auto setting was 11-14cm.

After months of overnight oximetry testing and fine AHI's at a variety of Auto settings, I'm going straight CPAP now at 11.5cm.

The overriding reason appears to be that I sleep better at a constant pressure, and my titration study showed clearance of all supine events with adequate
02 sats at or near that pressure. I could 'get by' at 9-15 or 9-12 but I give weight to the lab titration as I have 02 sat/desat issues. I also seem to have a higher incident of >95% saturation at the higher pressure of 11 or 11.5, with less frequent Sp02 events.

And when using Auto say at 9-15cm, my average pressure would be 9.5 or 10cm. But such a pressure would not maximize 02 in my case, which may differ from yours.

So go with what you prefer, Auto or straight CPAP. IMO it's all good. If your doctor feels that you should go CPAP, or APAP, ask why, and does it really matter? Sleep doc may know something we do not.

[tedburnsIII]

CMAmedchick, my first sleep study showed that I should use 6 cm pressure on CPAP for plain OSA. It was wrong and should have been 12 cm, which I found later.

If lowest sat was @89%, by definition it would not be an 'optimal' pressure, and would likely need to be higher, according to the Clinical Guidelines, due to low Sa02/Sp02.

Following chart contains my titration in the split-night study where 12cm was determined to be the optimal pressure. My Sa02 minimum did not exceed 90% until at that level of 12cm, though RDI/AHI was perfect at 9cm and above:

[avi123]

I personally feel straight set pressure CPAP machines are obsolete and not effective in treating OSA. There are too many variables where your pressure could change during the night. Automatic machines are the way to go.

Hi, by any chance are you from Wilmington where my wife attended hi School?

No, at 50 you're too young.

You're wrong about your statement b/c an Auto CPAP is contraindicated by the Practice Guidelines - American Academy of Sleep Medicine, for persons who suffer from Central Sleep Disorders; cardiac problems, chronic obstructive pulmonary disease (COPD), and a few other medical conditions.

[Vermonter]

I personally feel straight set pressure CPAP machines are obsolete and not effective in treating OSA. There are too many variables where your pressure could change during the night. Automatic machines are the way to go.

Disagree.

My medically defined 'optimal' titrated pressure at the lab was 12cm, and I later learned was recommended by the sleep doctor and by a later-seen pulmonologist, who stated he would've prescribed straight CPAP.

But referring cardiologist prescribed Auto 6-15cm. I must say that Auto 6-15cm no doubt is easier to satisfy Compliance requirements than straight 12cm. My most recent Auto setting was 11-14cm.

After months of overnight oximetry testing and fine AHI's at a variety of Auto settings, I'm going straight CPAP now at 11.5cm.

The overriding reason appears to be that I sleep better at a constant pressure, and my titration study showed clearance of all supine events with adequate
02 sats at or near that pressure. I could 'get by' at 9-15 or 9-12 but I give weight to the lab titration as I have 02 sat/desat issues. I also seem to have a higher incident of >95% saturation at the higher pressure of 11 or 11.5, with less frequent Sp02 events.

And when using Auto say at 9-15cm, my average pressure would be 9.5 or 10cm. But such a pressure would not maximize 02 in my case, which may differ from yours.

So go with what you prefer, Auto or straight CPAP. IMO it's all good. If your doctor feels that you should go CPAP, or APAP, ask why, and does it really matter? Sleep doc may know something we do not.

My cardiologist would disagree with you.

[Vermonter]

I personally feel straight set pressure CPAP machines are obsolete and not effective in treating OSA. There are too many variables where your pressure could change during the night. Automatic machines are the way to go.

Hi, by any chance are you from Wilmington where my wife attended hi School?

You're wrong about your statement b/c an Auto CPAP is contraindicated by the Practice Guidelines - American Academy of Sleep Medicine, for persons who suffer from Central Sleep Disorders; cardiac problems, chronic obstructive pulmonary disease (COPD), and a few other medical conditions.

Just because you disagree with me doesn't make me wrong.

Nice try though.

[avi123]

Thanks tedburnsIII, if you came in 2010, you could have saved me the headache of taking a subsequent lab titration.

[palerider]

I personally feel straight set pressure CPAP machines are obsolete and not effective in treating OSA. There are too many variables where your pressure could change during the night. Automatic machines are the way to go.

Disagree.

My cardiologist would disagree with you.

you'll find that your cardiologist is not alone in that disagreement