Question on pressure range for APAP

Due to an insurance requirement, I was DX'ed with sleep apnea by a home study. I was found to have an AHI of 59.5. My Doctor reviewed my results and then my Insurance company set me up with a provider they are contracted with to provide me with a machine. I was given a PR System One APAP, which I have been very happy with so far. I was not given a titration, so the machine has been set for a range of 4-20. As I understand this will automatically adjust to my pressure requirements. I have been on the box for 2 months, with a 90% pressure of 18. Should I leave the pressure range alone, or set it at 2 below and two above my 90% pressure? My Doctor did not say anything to me at my follow up, and is currently out of the country on vacation. I have a follow up set with him in December. I am having decent numbers, but my AHI has never been under 5. I feel great during the day, and am responding well to therapy otherwise. I don't want to hurt my progress, but if I can get the machine to work better then I will. I have not purchased the software for my machine yet, but may have too. I'm kinda out on my own here, but with the support of this site, I feel like I'm in good hands.

Detcord, I think I'd bump up the bottom pressure and leave the top alone for now. The usual recommendation is a spread of 4, although some folks manage well with a bit more difference. Since you're maxing out at 18, I'd leave the top alone. You might see that max number come down a bit if you raise your bottom number, too.

In other words, try setting the machine to min 16, max 20.

That minimum of 4 is way too far away from the therapeutic pressure you need.

Wow, thanks for the quick advice. I did set the bottom up to 6 as 4 felt like I was not getting any air at all. I will set the Minimum to 16 and see if that helps. Thanks again.

detcord wrote:Due to an insurance requirement, I was DX'ed with sleep apnea by a home study. I was found to have an AHI of 59.5. My Doctor reviewed my results and then my Insurance company set me up with a provider they are contracted with to provide me with a machine. I was given a PR System One APAP, which I have been very happy with so far. I was not given a titration, so the machine has been set for a range of 4-20. As I understand this will automatically adjust to my pressure requirements. I have been on the box for 2 months, with a 90% pressure of 18. Should I leave the pressure range alone, or set it at 2 below and two above my 90% pressure? My Doctor did not say anything to me at my follow up, and is currently out of the country on vacation. I have a follow up set with him in December. I am having decent numbers, but my AHI has never been under 5. I feel great during the day, and am responding well to therapy otherwise. I don't want to hurt my progress, but if I can get the machine to work better then I will. I have not purchased the software for my machine yet, but may have too. I'm kinda out on my own here, but with the support of this site, I feel like I'm in good hands.

No. It will adjust the pressure upwards as it detects events. It may or may not reach the ideal pressure at some point, but will also reset itself back to lower pressures at other times. It's best to set the minimum pressure to where it takes care of almost all of the events (so they don't occur in the first place) and so the pressure changes don't disturb your sleep. But, it won't "automatically" go from a pressure of 4 to a pressure of 15 because it doesn't know what it needs till it gets there.

Having the software to use with an APAP/Auto is a "must" in my opinion.

https://www.cpap.com/productpage/respir ... eader.html


Den

Welcome to the forum, detcord!

I agree with the others in regards to raising your minimum pressure and the software. But one major thing you need to monitor is your System Leak, which can be checked on your machine. Major leaks may be raising your pressure, as the machine attempts to compensate for the loss of therapy air. They can also cause the AHI to be inaccurately reported.

You didn't mention which mask you're using, but if it's a nasal pillows or nasal mask you may be losing therapy air through an open mouth. You may need to use a full face mask. With any mask, leaks can occur from the pillows/cushion when you're deep asleep, when you may not notice it. If excessive leaks are a problem, you definitely need to address that first and foremost. When the air leaks from mask or mouth, it isn't keeping your airway open effectively. If you let us know what your reported System Leak is and which mask you're using, we may be able to give you some advice regarding that.

It's terrific that you are feeling much better during the day, but it would be good if you can get your AHI below 5.0. Please let us know how you're doing.

I agree with Den. You should titrate yourself with software.

Before making changes you also need to be certain you have all leaks under control. Otherwise you run the risk of chasing your tail trying to find the right pressure settings. You need the software to determine if you really have the leaks under control.

If you buy the software you can get it for $99 (cpap.com).

The link Den gave you is the software PLUS a memory card reader. That's a good deal if you need a card reader. Many computers and printers have memory card readers built in and the work fine with this card. I use the memory card slots on my printer.

Here is a little more detail. I use a Resmed Ultra Mirage II nasal mask and a chinstrap. I don't believe I have any leak issues. My machine reading shows 0 large leaks. I don't notice any dry mouth issues in the AM either. Sounds like I am gonna have to pony up for the software to manage my therapy more efficiently.

detcord wrote:Here is a little more detail. I use a Resmed Ultra Mirage II nasal mask and a chinstrap. I don't believe I have any leak issues. My machine reading shows 0 large leaks. I don't notice any dry mouth issues in the AM either. Sounds like I am gonna have to pony up for the software to manage my therapy more efficiently.

Sent you pm.
Please also list your equipment in the user profile section; that would help other's guide you better.

Detcord,
(The usual disclaimers about not being a sleep doctor!)
I would also not be too quick in raising pressure. Do it in stages of 2 cm or so, and in your case, just the lower pressure. Make sure at each stage your leaks are controlled, and don't proceed higher until they are. The higher you go in (especially minimum) pressure, the worse your leak problem will become. Wait a week or so between changes, and note what is happening to your AHI. If you can see or deduce both AI and HI with the on-screen numbers on that machine, this is good. (But get that software on order!)
If your apnea is typical OSA, you should see obstructive apneas (AI) decrease in your numbers to near zero. Typically, this happens by 10 cm in most people. If at that point, you are still 'maxing out' at 18, try a low setting 2 cm higher than where your obstrucitve apneas disappear. If your 90% pressure decreases, where to it is significantly lower, lower you high pressure until your low-high range is no less than about 3 cm. (It doesn't hurt to try straight CPAP, either, if your 90% pressure comes way down to near your low pressure. Some people find that more comfortable than the varying pressure of APAP.) In both of these cases, you could consider your lower number to be your titrated pressure. If you haven't seen your AI decrease or disappear by 12 cm, it is time to talk to a doctor. You may have more than just simple OSA.
While doing this, keep an eye on 'nonresponsive events', open-airway apneas' or 'central apneas'. If you see a sustained increase in these kinds of events, you may be experiencing pressure induced central apneas, sometimes called 'complex sleep apnea syndrome' or 'CompSAS'. For this, you really do need to tell your doctor. But I bet in your case this won't happen, because you are already experiencing pressures as high as 18+ cm.
In any case, good luck! And get that software. It makes doing this kind of thing much easier.