AirSense AutoSet - different approach to titration?

General Discussion on any topic relating to CPAP and/or Sleep Apnea.
SleepyTony
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AirSense AutoSet - different approach to titration?

Post by SleepyTony » Tue Feb 06, 2024 6:38 am

Hey,

I've been titrating my CPAP for a few weeks now trying to find the sweet spot. There's a few things I don't understand when it comes to self-titration. A lot of resources claim that you should ideally keep your minimum pressure 1-2 cm below your median. This doesn't really make much sense to me. AirSense AutoSet works by increasing minimum pressure AFTER it detects an OA to prevent further events... then it steadily drops the pressure all the way back to the set minimum. And another OA occurs. Shouldn't the ultimate goal be to ideally prevent ALL OAs?

Even if your AHI is 1, of which it's an OA every hour of your sleep then your sleep still gets disrupted quite a lot... I find myself definitely less rested if my OAs are distributed throughout the night than if they're clustered together in a single event.

Shouldn't we be aiming to have our minimum pressure very close to 95%? That way we'd theoretically prevent any OA from occurring. This is of course if you can tolerate the pressures in your 95% and don't develop a lot of centrals due to the higher pressure...

What do you think?

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Pugsy
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Re: AirSense AutoSet - different approach to titration?

Post by Pugsy » Tue Feb 06, 2024 7:00 am

SleepyTony wrote:
Tue Feb 06, 2024 6:38 am
Shouldn't the ultimate goal be to ideally prevent ALL OAs?
IMHO that's an unrealistic goal and if that's the only goal it will probably drive a person nuts.

My own personal goal.....sleep good and feel good no matter what the "numbers" say.

AHI of 0.0 doesn't necessarily mean a person has slept great and will feel great the next day as evidence by all the people who come here with sub 1.0 AHI numbers yet they complain of crappy sleep and feeling crappy when they thought they should feel like superman/superwoman.
SleepyTony wrote:
Tue Feb 06, 2024 6:38 am
Shouldn't we be aiming to have our minimum pressure very close to 95%? That way we'd theoretically prevent any OA from occurring.
Not necessarily the holy grail of "numbers" that 95% number. It's too easily skewed to the high side by relatively short periods of time at a higher number. There are situations (like REM stage sleep pressure needs) where the 95% number isn't necessarily where the minimum pressure needs to be.

You want to use a minimum pressure of 16 ALL NIGHT LONG just to take care of REM related pressure needs and REM compromises of maybe 20 % (if we are lucky and normal) when the other 80% of the night a minimum of 9 cm does a great job holding the airway open???? That's what I would have to do if I followed your reasoning and while I could maybe do it....I sure don't want to. My own OSA is 5 times worse in REM stage sleep (this is a common known fact) and sometimes I need a LOT more pressure during REM.

People need to be able to look at and evaluate the big picture and not just a single "number" because "numbers" alone don't tell the whole story.

I prefer a case by case evaluation of pressure needs myself instead of blanket statements that don't take into account the big picture.

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Dog Slobber
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Re: AirSense AutoSet - different approach to titration?

Post by Dog Slobber » Tue Feb 06, 2024 7:04 am

OAs are not the only metric that the ResMed algorithm responds to.

When the algorithm detects snore, flow limitations and hypopneas it also increases pressure. Responding to these, prevents all or most OAs.

Setting your minim pressure against your median (median what???) or 95% (95% of what???) is nonsense. There's no magic measurement that one sets the pressures to and that's the sweet spot.

To find ones optimal, minimum pressure, set the minimum pressure to a value close. This can be arbitrary if absolutely new or your median pressure if you have some history. your then use your machine, gather statistics. You then adjust, typically upwards, you're looking to flatten the pressure trace, reduce abrupt swings, reduce flow limitations and events.

When on a pressure, stay there a while, don't let a single night influence. as you get closer, the increments should get smaller and smaller.

A goal of 0 OAs is unreasonable, I get them all the time, but not getting them is no big deal.

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ChicagoGranny
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Re: AirSense AutoSet - different approach to titration?

Post by ChicagoGranny » Tue Feb 06, 2024 12:33 pm

SleepyTony wrote:
Tue Feb 06, 2024 6:38 am
Shouldn't the ultimate goal be to ideally prevent ALL OAs?
No, the end goal is to feel energetic and without excess sleepiness the next day.

If you want to pour over statistics, start clicking on the Events tab in the OSCAR Daily View. See how long your OAs are. In my case, the short apneas are inconsequential to how I feel the next day.