APAP Pressure Range

[Newsgrouper]

I've finally figured out how to download ResScan data. My median pressure is 10.9, my 95% is 13.8 and my maximum is 13.9. What pressure range (high & low) would be appropriate for my APAP?

[Pugsy]

What is your minimum pressure setting now?
What was the prescribed pressure suggested from the titration sleep study if you had one?
How many nights were used in your above listed numbers?

[Newsgrouper]

My minimum pressure is now set at 9. The sleep study (many years ago) said 9.5. The data I listed is from last night, my best night in a long time.

[Pugsy]

Forgot to ask where the max range setting was....I see the max hit 13.9 but where could it have gone and has it ever gone higher than 13.9 in the past?

Do leaks ever wake you up? Do pressure changes seem to disturb sleep? What is the AHI for this "last night but the best night"?

What are you thinking you might need to change in the APAP range? There's more to picking a range than just evaluating the median, 95% and max pressure numbers. Gotta look at the whole picture.

[Newsgrouper]

Thanks Pugsy. The maximum now set at 14. AHI was 2.5. Increase in pressure does not seem to bother me.

[Pugsy]

If you never hit 14 max there is nothing wrong with leaving it at 14. If you ever see hitting that 14 for more than just a little kiss you might want to allow a little more movement in the max.
So essentially you have a 9 cm minimum and a 14 cm max range right now. What were you thinking of altering? Why?

If the AHI is primarily Central in nature you might be able to lower the minimum but if the AHI is primarily obstructive in nature then I don't know if I would want a lower minimum if it were me.

So when evaluating pressure needs we look not only at overall AHI but also the individual components of that AHI.
Plus we also evaluate how you feel....do you notice that you feel better today with this result and these settings? Slept well? Minimal wake ups?

[Newsgrouper]

I slept well and feel good this morning. I did notice that the apneas are more central than obstructive.

[Pugsy]

IF....big if...I consistently had 50 to 75 percent of my AHI being central in nature and that AHI was in the 2 to 3 range then I might think about a lower minimum pressure...slightly lower.
I would evaluate a lot of reports though. Some nights I have zero to 1 centrals total...some nights I have 2 to 3 centrals per hour. Long term my central hourly average is probably less than 1.

Your 2.5 AHI is well within acceptable limits. You slept well, feel decent. There is no pressing urgent need to adjust anything.

I really don't like to say "use this pressure" without explaining the whys and why nots. That's why I asked a lot of questions...to get you to thinking about what you are seeing overall on the reports and not have tunnel vision on a particular set of numbers. If you understand what you are seeing and what changes offer with what results you learn something and you are better able to evaluate possible outcomes.

If you were having leak issues or fragmented sleep maybe secondary to pressure fluctuations..then we would be having a different discussion. There is so much more to this therapy than a few numbers.

[Newsgrouper]

God bless you and thank you Pugsy.

[Slartybartfast]

I've finally figured out how to download ResScan data. My median pressure is 10.9, my 95% is 13.8 and my maximum is 13.9. What pressure range (high & low) would be appropriate for my APAP?

Just for the sake of being controversial here, I wonder why everyone seems to think there's any need to set an upper limit with an S9 Autoset. There's only one person on the forum currently who has needed one. My titration study said 11 cm. I've been running over two years with my (lower) limit set at 8.6 and my pressure has never exceeded 13. Median pressure runs around 9.5.

[avi123]

I've finally figured out how to download ResScan data. My median pressure is 10.9, my 95% is 13.8 and my maximum is 13.9. What pressure range (high & low) would be appropriate for my APAP?

Just for the sake of being controversial here, I wonder why everyone seems to think there's any need to set an upper limit with an S9 Autoset. There's only one person on the forum currently who has needed one. My titration study said 11 cm. I've been running over two years with my limit set at 8.6 and my pressure has never exceeded 13. Median pressure runs around 9.5.

Comment,

Starty, please check my partly finished essay on it and please let me know your take:

viewtopic.php?f=1&t=84314&p=764862#p764862

[archangle]

I've finally figured out how to download ResScan data. My median pressure is 10.9, my 95% is 13.8 and my maximum is 13.9. What pressure range (high & low) would be appropriate for my APAP?

Just for the sake of being controversial here, I wonder why everyone seems to think there's any need to set an upper limit with an S9 Autoset. There's only one person on the forum currently who has needed one. My titration study said 11 cm. I've been running over two years with my limit set at 8.6 and my pressure has never exceeded 13. Median pressure runs around 9.5.

Burkebang and at least one other person had what seemed like a "runaway to max" problem with multiple S9 AutoSets.

The idea of the upper limit may simply be an excess of caution for central apnea sufferers. And to shut up the anti-APAP crowd. I always ran my upper limit on APAP as 20 and never had problems with that.

I've always thought that many CPAP/APAP newbies would benefit from starting with a fairly low max pressure the first few nights, and increase it a little every night until you get to the titrated pressure or the pressure the auto machine finds.

[Slartybartfast]

Avi, I saw data but nothing that told a story.

Archangle, we're in violent agreement regarding the approach to setting pressure. My gripe with advising a noob to set an upper limit is that said noob will like as not set it too low with the result that the pressure keeps crashing into the low ceiling, hampering therapy and obscuring the machine's response to breathing irregularities. Seems like you'd want to set a lower limit and sleep a night or two under the wide open heavens in order to see how high your pressure trends during the night. If your breathing generates a runaway (highly unlikely) it's good to know it right away.

I've seen data posted by a number of folks that shows their pressure peaks flat-topping against the upper pressure limit which is unnecessary and undesirable. Modern auto machines are better than that. That's why they're called automatic. At least my S9 Autoset and Intellipap are.

[Pugsy]

I wonder why everyone seems to think there's any need to set an upper limit with an S9 Autoset

I don't see the need to limit the max in most situations but I got tired of banging my head against the wall explaining that if a person never hits 12 cm pressure it doesn't matter that the max is set at 20. I figured that if they are happy with a max of 14 and they never go past 12...the end product is the same and they feel better with a limited max.
So I just ask if the max is ever reached and if someone says "no"...then I don't bother with elaborating on my personal thoughts and I think most of the forum veterans know what they are.

Of course there are some situations where limiting the max is probably a prudent thing to do but those are special circumstances like pressure changes disrupting sleep, poor sleep in general for unknown reason, aerophagia or maybe more centrals than we are comfortable with.

Now if someone says "yeah, I hit max limit often and sometimes prolonged time"...then we have a different discussion.

So if someone feels like they sleep better with a limited max and that max is never reached, it sort of becomes a moot point so I just back off with my sermon that is causing my fingers to itch. It's not worth getting into a pissing contest over in my mind anyway. Lord knows I can get into enough pissing contests without adding that one to the list.

[avi123]

IMO, to tell posters that it's OK to leave an APAP max pressure above 15 cm is wrong because we all know that the AASM stated clearly that at this pressure and above a BiPAP machine should be seriously considered. So you can't justify doing it by saying that this not your problem but the sleep study should have been taking care of it.