When should range for autopap be reduced

Since I received my Autopap the pressure range has been set at 8-15cm

For a while I have been looking at my sleep reports with Encore pro. I noticed that my 90 percentile pressure is at 11cm where I have very few events - most of the time <3. However when I look at the number of minutes per night on this pressure that number is actually very low compared to 8cm where I have many more events but spent apparently most of the time.

Is it time to narrow the range closer to 11cm to make it let's say 10 to 15?

any advice would be appreciated. And if you have instructions to do it it would be great. (M series Autopap with C-flex)

I would have it at 8 to 12. Why raise your low pressure number when that is apparently where you have problems? Lowering the higher one (narrowing overall, which is usually more effective) makes sense, but unless you feel 8 is in someway inadequate, even in straight Cpap terms, I wouldn't change it.

Hi Flopsoft
Have you had many or any events up in the upper range? You said that a majority of the events are happening at your lowest setting of 8. When you have event's does teh machine ramp up and catching them and then dropping back down and your having them again?
I would think if your machine is catching them or not if you are having most of your events at your lowest pressure which is 8 that increasing it would decrease the events. If it were me I would increase the lower setting up to 9 and try that for a while and see what the data tells you. No sense in jumping all the way up to 11 if you don't have to.

Gerry

You can download the instructions from here:

http://www.apneaboard.com/CPAP%20Adjustment.htm

And/or, you can use these instructions:


Hold down the <- -> buttons while plugging in the little power cord in the back, wait for 2 beeps release buttons. Then press the + key to enter setup mode, use the <- -> buttons to move to the next field, use the -/+ keys to decrease/increase values, when set press the On/Off button to exit Setup.

Therapy Mode = CPAP/AUTO
CPAP Pressure = NN (only appears in CPAP mode).
AutoMax = 20 cm (default)
AutoMin = 4.0cm (default)
C-Flex Setting = Off, 1, 2 or 3
Ramp Time = (0:05 to 0:45)
Ramp Start Pressure = 4.0cm (can be from 4cm to AutoMin pressure).
Mask Alert = On/Off (beeps on large leak, mask removal).
Auto Off = Off (turns off machine on large leak/mask removal) Suggest leaving it "Off"
Split Night Time = Off (options are Off, 120, 180, 240) Should be "Off"
Show AHI/Leak = On (enables logging to display) Suggest leaving it "On"
Patient Reminder = Off (days to remind you that you get a new mask w/Insurance).
returns to Therapy Mode
Pressing On/Off exits Setup




==========Resetting LCD Display Data====================

To reset LCD Therapy data (does NOT erase any data from SmartCard):

1. Hold down the (<-) (->) buttons while plugging in the power on the back,
wait for 2 beeps or 5 seconds, release buttons.
2. Press the (->) key and navigate to Therapy screen.
3. Press and HOLD down the (-) minus key for 5 seconds and/or until therapy data is reset to Zero.
4. Press the (->) key to scroll back to main menu, press (+) key to enter Setup or
On/Off button to exit.

I also think the range you mentioned is logical, too.


Den

I would say 8-12, or even 9-12 would be good. Since your 90% is 11, no more than 12 at the top is necessary. The higher you can tolerate the lower limit, the faster the autopap will respond to events. So either of those two ranges would be good. A 3-5 cm range is good---the closer you can get the two pressures and still sleep well without awakening, the better it is. As long as your AHI is 5 or less, you are catching enough events for a beginning. As you get used to the autopap, the closer you can set them to your ideal pressure.

How do I post an encore pro table? I would like to have your input on how to interpret the data. I think I may not completely understand what the data really mean. what I do see from a few months ago is that the 90% pressure has increased from 11 to 13. What I am trying to figure out is how to set the range. before I was put on autopap my cpap setting was 11cm fixed. Then for autopap the range was set at 8-15cm. If possible I would like to narrow this range to improve therapy - if there is a benefit of doing so.

Unless a person were having great difficulty with leaks, I personally see no reason to lower the maximum pressure. Unused pressure up there will simply be just that... unused pressure.

To me, "narrowing the range" means raising the minimum pressure -- not necessarily lowering the maximum pressure.

I do think it's good to have the minimum pressure set fairly close to (or even "at") the prescribed pressure so that the autopap can prevent most events right from the get-go.

Example (assuming leak rate is normal):

Say you have your machine set for a range of 8 - 20. You see on your data that the machine never uses more pressure than 14 for you, but you're still having apneas and hypopneas sneaking through for an AHI of 5.0 (with a Respironics machine.) You want to eliminate more of those events.

I think the solution is to raise the minimum pressure. Perhaps use a range of 9 - 20, or 10 - 20, or 11- 20...whatever it takes minimum-pressure-wise to lower one's AHI to an acceptable level.

The maximum pressure can be left where it is. Unused pressure up there is...unused pressure. It would be ok to lower the max if you want to, as long as you kept the max set for more than what you've seen your machine go up to, but it's not really necessary to lower the max, imho.

I think a lot of people who raise the minimum AND lower the maximum, both at the same time, and who report better results from "narrowing the range" are really seeing better results from raising their minimum pressure. The max, even though lowered, was still set for a level of "unused pressure", so in most cases (not all) really didn't have have anything to do with the better results.

The minimum pressure is the most important pressure to "set right", imho.

Your logic is perfect.

Obviously 8cm is not enough to prevent your apneas. And while the machine is bumping up to an effective level you are getting events. That's the biggest drawback to an auto machine. If you raise your starting point (lower limit), you will eliminate some or all of those.

Lowering your upper limit is pointless, as you apparently never reach it anyhow. Raising or lowering the upper makes no difference unless you make it too low.

Most of the time I run CPAP at my 90% pressure; and every few months I do APAP for a week to ensure the 90% hasn't changed. When I use APAP, the range is -1 to +2 of the 90%.