APAP, should you hit max range (now w/report)

I've searched the forum but couldn't find an answer, so here I go. The max on my APAP is 12 and only hit it >40 minutes out of 8-9 hours a night. I'm feeling good and my AHI is >3 most nights.

But I have to ask those of you with APAP, do you hit your max or should it be set at the setting in which you no longer hit it.

Depends on WHY you're hitting the max. If it's for "valid" events, that's one thing......if it's because of leaks or snores (that aren't affecting your therapy), then that's another.
If you're having events (apneas, etc.) while you're at the max pressure, it's either not high enough or the increased pressure may be causing them.
In my opinion, the critical setting is the minimum pressure. If it's too low, it has too far to go to prevent most of the events.


Den

My experience: titrated at 10, doc set CPAP at 11, lost a lot of wt, home titration with loaner APAP & recording oximeter, set CPAP to 9 & recommended APAP & Hybrid FFM, insurance denied medically necessary APAP, months go by arguing back & forth...insurance wins by denying APAP of course, get APAP, based on loaner APAP data I think pressure range of 6 to 12-15 is good, talk to doc who thinks 6-15 is best even tho I'll likely never need to go high but just in case I need the headroom it'll be there (I had no evidence of centrals so OK to go to 15). Most I've ever seen has been 14.6 on a badly congested night when I was coughing and mouth breathing (thank goodness for the Hybrid FFM). My monthly 95thcentile averages 10.4 with most nightime awakenings it's at 6.9-9.8 and AHI=1.4 with AI=0.

If I were bumping the top range, I'd first verify it wasn't leak-caused pressure increases, if not, then I'd call my doc and suggest increasing upper limit IF I didn't have centrals emerge at increased pressure in my sleep study.

Wulfman wrote:...critical setting is the minimum pressure. If it's too low, it has too far to go to prevent most of the events.

I agree tho I gotta admit that last night, after my mask fit test, when I switched to on, by my third breath it had gone from 6.8 to 8.6 so it must have detected something (long exhalations maybe)...the ResMed APAP can increase pressure quickly when needed.

Muse-Inc wrote:My experience: titrated at 10, doc set CPAP at 11, lost a lot of wt, home titration with loaner APAP & recording oximeter, set CPAP to 9 & recommended APAP & Hybrid FFM, insurance denied medically necessary APAP, months go by arguing back & forth...insurance wins by denying APAP of course, get APAP, based on loaner APAP data I think pressure range of 6 to 12-15 is good, talk to doc who thinks 6-15 is best even tho I'll likely never need to go high but just in case I need the headroom it'll be there (I had no evidence of centrals so OK to go to 15). Most I've ever seen has been 14.6 on a badly congested night when I was coughing and mouth breathing (thank goodness for the Hybrid FFM). My monthly 95thcentile averages 10.4 with most nightime awakenings it's at 6.9-9.8 and AHI=1.4 with AI=0. If I were bumping the top range, I'd verify it wasn't leak-caused pressure increased; if not, I'd call my doc and suggest increasing upper limit IF I didn't have centrals emerging at increased pressure.

I've seen this scenario mentioned before, but it doesn't make sense to me. The insurance provider is going to pay EXACTLY the same amount of money to the DME regardless of which CPAP is given to the patient. It's the SAME insurance code. So, HOW would the insurance provider "win"? (what are they winning?)


Den

Wulfman wrote:I've seen this scenario mentioned before, but it doesn't make sense to me. The insurance provider is going to pay EXACTLY the same amount of money to the DME regardless of which CPAP is given to the patient. It's the SAME insurance code. So, HOW would the insurance provider "win"? (what are they winning?)

I'd had the CPAP for 23 months. They denied my doc's medically necessary switch to APAP request. They just didn't want to pay for another machine...medical rationing at its finest IMHO .

Muse-Inc wrote:

Wulfman wrote:...critical setting is the minimum pressure. If it's too low, it has too far to go to prevent most of the events.

I agree tho I gotta admit that last night, after my mask fit test, when I switched to on, by my third breath it had gone from 6.8 to 8.6 so it must have detected something (long exhalations maybe)...the ResMed APAP can increase pressure quickly when needed.

Well, those ResMed APAPs are just plain "WEIRD"....... I don't know who would want to own one of those things.....


Den

I have leaks under control so that's not causing me to hit the max. I'm guessing it is happening if I move to my back or other positional factors.

Also I'm very leery of too high of a top end as I am scared to death of centrals. I don't know if centrals are something to fear but the though of them just make me afraid to going to sleep.

Imacpaper wrote:...Also I'm very leery of too high of a top end as I am scared to death of centrals. I don't know if centrals are something to fear but the though of them just make me afraid to going to sleep.

Me too! They just sound so durned freakish. Check your sleep study and see if you had any...you do have a copy right? There is likely to be a chart of pressures tested and the events (or none) at each pressure.

Wulfman wrote:...Well, those ResMed APAPs are just plain "WEIRD"....... I don't know who would want to own one of those things.....

Gee, me neither

Muse-Inc wrote:

Wulfman wrote:I've seen this scenario mentioned before, but it doesn't make sense to me. The insurance provider is going to pay EXACTLY the same amount of money to the DME regardless of which CPAP is given to the patient. It's the SAME insurance code. So, HOW would the insurance provider "win"? (what are they winning?)

I'd had the CPAP for 23 months. They denied my doc's medically necessary switch to APAP request. they just didn't want to pay for another machine...medical rationing at it's finest IMHO .

That situation could be fixed by the manufacturers to everyone's monetary benefit.
A few years back, I made the argument that the manufacturers should ONLY make APAPs (for the CPAP category). They all have too many models that they're putting out and they all have differences inside the cases. If they only made ONE model, it would cut their manufacturing costs, big time. That model would be a data-capable APAP.......which (of course) could be set to either CPAP or APAP mode. And, the software should also be included with the machines.


Den

I have my study and no sign of centrals and as I said my AHI are low at my pressures I just want to now if all things being okay should you be hitting the max sometimes or should it be set at just above what you hit.

Imacpaper wrote:I have leaks under control so that's not causing me to hit the max. I'm guessing it is happening if I move to my back or other positional factors.

Also I'm very leery of too high of a top end as I am scared to death of centrals. I don't know if centrals are something to fear but the though of them just make me afraid to going to sleep.

Depending on what pressures they took you to in your sleep study and if there were any noted in your sleep study, that would be the only reason to have any concern. If they took you much above 10 cm. and none were noted, you shouldn't be worrying. If you have the software and you see clusters at higher pressures (when none are showing up at lower pressures).....OR.....if the length of the apneas is considerable, then those MIGHT be indicators.

Personally, I advocate using a single pressure whenever possible.......or a very tight range of pressures.


Den

Imacpaper wrote:I have my study and no sign of centrals and as I said my AHI are low at my pressures I just want to now if all things being okay should you be hitting the max sometimes or should it be set at just above what you hit.

OK. Don't worry about them then.
What is your pressure range?
If you actually have the Encore software, you should be able to "see" what types of events are causing your pressure increases......as they are visible on the reports.


Den

My pressure range is 10cm-12cm. As I said I hit the 12 a few minutes each night. This range is fine for my AHI and lowered my VS enough to allow me sleep well.

Maybe I answered my own question, if it ain't broke don't fix it. Yet I still wonder is the max number a setting you should or shouldn't hit?