Which reported pressure metrics are most important?

[old dude]

Speaking generally, using an AS10 Autoset machine (running pretty much wide open), do you consider the max pressure hit, the 95% pressure or the median pressure to be the most important in evaluating therapy?

[Fetou]

I like to see relatively low deviation from the median. My AHI has gone down significantly as it has gotten tighter to the line.

[jnk...]

Speaking generally, using an AS10 Autoset machine (running pretty much wide open), do you consider the max pressure hit, the 95% pressure or the median pressure to be the most important in evaluating therapy?

I consider the metric "running pretty much wide open" to be the most significant one in your question.

Getting the minimum up to within one or two cm of what is needed to prevent apneas is the first goal, in my opinion. And sometimes someone feels more comfortable and more rested using an even higher minimum pressure than that.

For APAP, I don't worry about "max pressure hit," as you put it, since I tend to keep the max wide open and the pressure doesn't run away for many people with the Autoset algorithm, I don't think.

The 95% pressure and median pressure can spark ideas for thinking about pressure, but they are more hints and side information than they are directly related to making specific pressure-range decisions for APAP. I consider all those numbers to be significant for someone who is using an APAP temporarily to try to find a single workable pressure for subsequent straight-CPAP treatment, but I don't consider those numbers all that relevant for someone trying to find an optimized APAP range of pressures for long-term APAP treatment.

Hey, just me.

[LSAT]

I agree with jnk...Find the best minimum and let the max wide open. Min will generally be a couple less than 95% figure.

[Pugsy]

Min will generally be a couple less than 95% figure.

Not necessarily. My minimum is 7 but my long term average 95% pressure is between around 12 with occasional trips to 16 cm or so.
Plus I even use EPR at 3.
Long term AHI average is less than 1.0 and a fair chunk of that is probably SWJ.

[palerider]

Speaking generally, using an AS10 Autoset machine (running pretty much wide open), do you consider the max pressure hit, the 95% pressure or the median pressure to be the most important in evaluating therapy?

None of those matter, 95 is just the new max, it has no real significance, it s the pressure curve that's important, in correlation with the flags.

[palerider]

For APAP, I don't worry about "max pressure hit," as you put it, since I tend to keep the max wide open and the pressure doesn't run away for many people with the Autoset algorithm, I don't think.

For the vast majority, the max pressure is immaterial, you're right.

[palerider]

Min will generally be a couple less than 95% figure.

Not necessarily. My minimum is 7 but my long term average 95% pressure is between around 12 with occasional trips to 16 cm or so.
Plus I even use EPR at 3.
Long term AHI average is less than 1.0 and a fair chunk of that is probably SWJ.

Yup, basing anything on the 95 number is a rookie/lazy move.

[Wulfman...]

Speaking generally, using an AS10 Autoset machine (running pretty much wide open), do you consider the max pressure hit, the 95% pressure or the median pressure to be the most important in evaluating therapy?

This is a little confusing.
Your profile says this:
Additional Comments: Pressure 9.4 Min-->12.4 Max

Most of us don't consider that pressure range as "wide open"....... In fact, that's a pretty narrow range.

Another part of the equation is "What are you planning to do to improve your therapy?" (presuming it can be improved).

Also, what is your criteria for "evaluating" your therapy?

Personally, I usually suggest increasing the minimum pressure until it eliminates almost all of the events.


Den

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[old dude]

Speaking generally, using an AS10 Autoset machine (running pretty much wide open), do you consider the max pressure hit, the 95% pressure or the median pressure to be the most important in evaluating therapy?

This is a little confusing.
Your profile says this:
Additional Comments: Pressure 9.4 Min-->12.4 Max

Most of us don't consider that pressure range as "wide open"....... In fact, that's a pretty narrow range.

Another part of the equation is "What are you planning to do to improve your therapy?" (presuming it can be improved).

Also, what is your criteria for "evaluating" your therapy?

Personally, I usually suggest increasing the minimum pressure until it eliminates almost all of the events.


Den

.

Den, I'm sorry-that is confusing.

I've been using the pressures listed in an attempt to control leaks but have very recently tried opening up the max to try and catch more events.

Seems like it's a no-win trade off.

I've just reset my machine for 11 min--> 20 max; barring anything weird I'll try that for a week or two and see what happens.

[palerider]

Den, I'm sorry-that is confusing.

I've been using the pressures listed in an attempt to control leaks but have very recently tried opening up the max to try and catch more events.

Seems like it's a no-win trade off.

So, what are your settings now, and why is it a no-win trade-off?

[old dude]

Den, I'm sorry-that is confusing.

I've been using the pressures listed in an attempt to control leaks but have very recently tried opening up the max to try and catch more events.

Seems like it's a no-win trade off.

So, what are your settings now, and why is it a no-win trade-off?

PR, I just edited my post but to over simplify it's this: I've learned from the wisdom here how to optimize my therapy. My case, while pretty extreme at titration, is still at this point just obstructive. But there's evidently something unusual about my face shape and just when I get my therapy right the leaks spin out of control. So whichever way I go, it's pretty much gonna be a compromise.

I remember you yourself as well as Pugsy saying that when minimum pressure is raised high enough to cover most events, it's not unusual to see max pressure needs come down some. (I do pay attention!) So maybe I'll get lucky-I can handle 11-12 cm with no problem.

[palerider]

PR, I just edited my post but to over simplify it's this: I've learned from the wisdom here how to optimize my therapy. My case, while pretty extreme at titration, is still at this point just obstructive. But there's evidently something unusual about my face shape and just when I get my therapy right the leaks spin out of control. So whichever way I go, it's pretty much gonna be a compromise.

Then you need to refit the mask at higher pressures, or you need a different mask.

[old dude]

PR, I just edited my post but to over simplify it's this: I've learned from the wisdom here how to optimize my therapy. My case, while pretty extreme at titration, is still at this point just obstructive. But there's evidently something unusual about my face shape and just when I get my therapy right the leaks spin out of control. So whichever way I go, it's pretty much gonna be a compromise.

Then you need to refit the mask at higher pressures, or you need a different mask.

I'm now on number 14, all FFM. Had to struggle to even find that many and have forgotten most over the years.

As far as fitting, given a very large head I just pretty much have to get the biggest available. Contrary to popular advice, from there it's just a matter of how tight I can stand the headgear. I've been using a Quattro Air for years, with the headgear from an F&P Eson grafted on because that's what fits. No chance with the standard headgear.

[zoocrewphoto]

When looking at data, I think the pressure GRAPH is the most important.

If it is going up and down a lot, then it should be narrowed a bit so that it doesn't go up much, except some occasional spikes. Even if the ahi is great, lots of ups and down could disturb the sleep. If there are a lot of obstructive events, then an active pressure graphs means the minimum is too low.

And personally, I think the minimum is more important than the max. Get the minimum right, and you won't have as much up and down, and it may not go as high when it does go up.

If the max is topping out, then I would raise the max unless there are other problems.

I really don't care about the 90%/95% number. And I don't like reading the charts of numbers. They don't show the context. I want to see if the events if are in clusters or spread out. And I want to see if the pressure is going up and down a lot. I would then make adjustments to get that pressure line more even.