Relationship of titration pressure and 95% pressure level

Anonymous wrote:*starting to pull hair out*

Surely someone has gone to a sleep lab and been given a titration number. And surely someone has set their apap up so that titration number is within the range of their Apap settings. And surely someone has kept a record of their 90-95% average number over time. And surely someone has compared that number to their titration number? Is it about the same or lower or higher...that's all I am asking.

You're trying to compare apples, oranges and bananas and all you're getting is fruit salad. AND, you've given us NO information to go on.....just some pressure numbers....and a question.

My sleep study showed I still had events at a pressure of 16 and my sleep doctor wrote the prescription for 18. I've had excellent results with pressures between 10 and 12, even though on an Auto (set to 10 - 15), my 90% pressure would run between 13 and 14 (mostly driven up by it trying to completely stop my snoring). At a pressure of 12, I have almost NO snoring and reasonable AHI numbers. At a pressure of 10, I actually have lower AHI numbers but significantly more snoring.

Just looking at 90 - 95% numbers and trying to compare them to the titration numbers generated in a few hours of lousy sleep in a sleep lab won't get you anywhere. You have to look at the WHOLE picture......and over a period of time.

Den

I appreciate all input to my question...I really do. All I want to know is how the 90-95% number compares to the titration number for a few different people. Thanks for your input.

You're trying to compare apples, oranges and bananas and all you're getting is fruit salad. AND, you've given us NO information to go on.....just some pressure numbers....and a question.

My sleep study showed I still had events at a pressure of 16 and my sleep doctor wrote the prescription for 18. I've had excellent results with pressures between 10 and 12, even though on an Auto (set to 10 - 15), my 90% pressure would run between 13 and 14 (mostly driven up by it trying to completely stop my snoring). At a pressure of 12, I have almost NO snoring and reasonable AHI numbers. At a pressure of 10, I actually have lower AHI numbers but significantly more snoring.

Just looking at 90 - 95% numbers and trying to compare them to the titration numbers generated in a few hours of lousy sleep in a sleep lab won't get you anywhere. You have to look at the WHOLE picture......and over a period of time.

What you are telling me is you are totally ignoring your titration pressure and the pressure the sleep doctor advised. If I want to do the same thing, where would I start to optimize my pressure levels. Right now my 95% pressure has been in the 12-13 range...with AHI in the 5 range and AI in the 1 range. Given that where would you set the apap?

2 cm under and 2 cm over your 95% range would be a good place to start.

Also most people are found to be close to 10 cm. so 2 under or 2 over that, should fit most people at least it's a good guess to start from.

But you need the correct machine and software, so you can tell what's going on.

Join In and fill in your profile, without that everything is just a guess based on AVG, I'm guessing you don't use a Remstar, my Fav.. Jim

I don't ignore my Sleep Dr, I tell him what I do, and show him my printouts (Which he can't do) and he sets me up for another appt in 3 months to make his car payment. It works for both of us.

Anonymous wrote:

You're trying to compare apples, oranges and bananas and all you're getting is fruit salad. AND, you've given us NO information to go on.....just some pressure numbers....and a question.

My sleep study showed I still had events at a pressure of 16 and my sleep doctor wrote the prescription for 18. I've had excellent results with pressures between 10 and 12, even though on an Auto (set to 10 - 15), my 90% pressure would run between 13 and 14 (mostly driven up by it trying to completely stop my snoring). At a pressure of 12, I have almost NO snoring and reasonable AHI numbers. At a pressure of 10, I actually have lower AHI numbers but significantly more snoring.

Just looking at 90 - 95% numbers and trying to compare them to the titration numbers generated in a few hours of lousy sleep in a sleep lab won't get you anywhere. You have to look at the WHOLE picture......and over a period of time.

What you are telling me is you are totally ignoring your titration pressure and the pressure the sleep doctor advised. If I want to do the same thing, where would I start to optimize my pressure levels. Right now my 95% pressure has been in the 12-13 range...with AHI in the 5 range and AI in the 1 range. Given that where would you set the apap?

I actually TRIED the prescribed pressure.....for about an hour. However, I had little faith in my sleep doctor and doubted the prescribed pressure.
Since I had purchased a machine that recorded the nightly statistics along with the software to interpret it, I felt confident that I could/would adjust my pressure for the optimum results. I just pulled the pressure of 10 out of my butt. It sounded like a reasonable place to start.....not too low and not too high. I was very pleasantly surprised to find out that I did very well at that pressure.

If you want to optimize your therapy, make sure you have the software to interpret your statistics. Just reading the numbers in the LCD panel doesn't give a good enough picture of what's happening.
Do you snore? Your machine (as I understand it) is pretty aggressive on killing snoring.
What mask do you have? Make sure that if you have a nasal mask, that you aren't leaking air out your mouth. Options are taping or getting a full face mask.
Don't be afraid to switch to single pressure and make adjustments to see what THOSE numbers look like. Pick a pressure and try it for at least a week at a time. Just because you have an "Auto", doesn't mean a range of pressures will treat your condition better than straight pressure. You'll also probably sleep better with single pressure.
Since you stated that your machine is set to 8 - 12, you may be having events at the lower pressures that is raising your AHI.

My suggestion would be to set your machine to the single pressure of 10 cm and see what the numbers look like. You first have to prove that your titration pressure doesn't work before setting it elsewhere.

Try it and let me/us know how it worked.

Good luck,

Den

I have an apap as well and find that the 90% or 95% value is intended to give you a sense of where you spent most of the night. In my case I have my range at 13-16.5, though I seem to do best around 13 or 14. On most nights I find that I spend more than 95% of the time below 14. However, it is not unusual that during a deep sleep the system will kick me up to 15. This is what I've always used the APAP for, to allow me to keep the normal range at a relatively low level which will deal with most of my apnea but enough in reserve when my body goes low and needs more to keep the airway open.

There should be no necessary relation between the titration level and the 90 or 95% values. However, if you're properly titrated and the machine is working well, it will tend to deal with most apneas without the need to bump the pressure up, which will leave the 90 or 95% value either right at your titration value or very close to it.

Hope that helps.

Happy FA(a newbie here, but an 11 year CPAP user)

HappyFA,

Welcome to the forum!

It's always good to see more long-time hoseheads contributing here.

Best wishes,

Den

There should be no necessary relation between the titration level and the 90 or 95% values. However, if you're properly titrated and the machine is working well, it will tend to deal with most apneas without the need to bump the pressure up, which will leave the 90 or 95% value either right at your titration value or very close to it.

Thanks for responding. What is your titration value? Is it within the 13-16.5 range you have your machine set at?

So you are saying the 90-95% value should be close to ones titration value...assuming the machine is working correctly and one was titrated properly. Right? That's what I have been asking..if they are close or if the titration is typically a little above the 90-95% level or below.

My titration value was between 13 and 13.5. 13 is my minimum pressure. So when I check the 95% value it is usually at 13, though on occasion it's at 13.5. However, the maximum value of pressure and a review of the actual minute by minute flow shows that usually two or three times a night the pressure climbs to 14 or 14.5 for a period of a few minutes.

It would seem to me that the idea is that you don't want the auto-titration feature to be doing too much work and you want the pressure set at a point where the titration value/minimum pressure will deal with your pressure needs for at least 90-95% of the time. For those with a CPAP machine the titration value is set at a level so that 90 or 95% of the time the pressure will be accurate.

Again, hope this helps you.

Your titration pressure if set correctly, is always more than your 95% pressure. That is because your titration pressure is suppose to stop the maxium events. The 95% pressure is the pressure required to stop 95% of the events.

But it doesn't matter the titration pressure is a baseline, that changes through the night and your life. That is why we use the auto, so the pressure can be the lowest we need to be treated, at all the time we use the machine correctly. (If you have mouthleaks or excessive leaks, the machine isn't being used correctly, so all bets are off.) Jim

Jim and Happy....thank you very much. That's exactly the sort of information I was seeking. I have a much better understanding of the relationship now.

HappyFA

I have a Remstar auto and the software. How do yo check the minute by minute flow pressures that occurred thru the night?

I was titrated at 13 and used straight cpap for a year at 13. A few months ago a got an apap, set it at 7-13 (figuring if I was okay at 13 then it'd be safe place to set the maximum). My 90% runs around 8.5 with an AHI of less than 1.

I had looked at about a weeks worth of data before my laptop died, which is really the best way to analyse your pressure. The max pressure never went above about 10.

Aside from being able to look at the data, what I really like about the apap is the comfort of much lower pressures for most of the time. The spikes happen when I"m sleeping so I don't know the difference.

blctech wrote:HappyFA

I have a Remstar auto and the software. How do yo check the minute by minute flow pressures that occurred thru the night?

It's in your reports.

Den

xzombie wrote:I was titrated at 13 and used straight cpap for a year at 13. A few months ago a got an apap, set it at 7-13 (figuring if I was okay at 13 then it'd be safe place to set the maximum). My 90% runs around 8.5 with an AHI of less than 1.

I had looked at about a weeks worth of data before my laptop died, which is really the best way to analyse your pressure. The max pressure never went above about 10.

Aside from being able to look at the data, what I really like about the apap is the comfort of much lower pressures for most of the time. The spikes happen when I"m sleeping so I don't know the difference.

For YOU, it's working. For our "Guest", with a ResMed Vantage, no software and an AHI of 5.0 (or more)......and who STILL doesn't understand.....it may take awhile longer.

Den