Best lower and upper pressure settings - APAP

LinkC wrote:

Jayjonbeach wrote:Right, but there is one Optimal pressure that works best for you on CPAP, the one that will eliminate the most apneas, your 90/95% pressure.

You are confusing terms again. 90% pressure applies ONLY to APAP, not CPAP. And it's definition has nothing to do with eliminating the most apneas. It may or may not be "the pressure that works best for you". It is simply the pressure at OR BELOW which you spent 90% of your time. While it is expressed as a singular pressure, it actually represents the RANGE of pressures between your lower limit and your 90%.

Well I'm not confused but maybe what I wrote wasn't clear, though anyone should hopefully be able to deduce that CPAP being a constant pressure, means being at the same pressure 100% of the time....I was refering to someone's 90/95 on APAP since that what this thread is about

So Link, since you seem to allude to knowing the answer to this question lets put it out there and see what you really think; Just what pressure IS the one that eliminates the most apneas, and the one that after a Titration if you are to go on CPAP, is the one you should use on CPAP?

- Titrated Pressure
- 90 or 95% Pressure (depends on machine)
- Arbitrary Number between the minimum used and the 90/95
- Average pressure
- First two points are virtually the same thing
- None of the above and some other answer

Also, if someone has NOT had a sleep study and titrated themselves at home with an APAP machine, just what pressure are they going to use if the switch to CPAP? (for the sake of the question, assume someone put a range of 8 to 12 and their 95% is 10.4, average pressure is 9.4)

Jayjonbeach wrote:I was refering to someone's 90/95 on APAP since that what this thread is about

Jayjonbeach wrote: Right, but there is one Optimal pressure that works best for you on CPAP, the one that will eliminate the most apneas, your 90/95% pressure. THAT is where a lower limit set will likely serve the majority best, at least logically and it works for me I tried it many different ways and I've seen many other people say the same here in these forums.

Actually the thread was about minimum and maximum settings for someone who was given an RX of 9 cm. OP was just wanting ideas on minimum and maximum on APAP. No one mention 90/95 percentile. OP is newbie has zero experience yet. Let's not confuse him any more than he is already.

I am going to show you 2 reports of mine, last 2 nights. One has a 90% pressure of 16 cm, the other has 11 cm 90%. Base on your statement I should use 16 as my minimum all the time?? I don't think so. It might work for you but that 90% number is just a number and not the holy grail of numbers. It is too easily skewed and often is.

And that is EXACTLY why someone should NOT trust a Titration in the first place, it is based on one nights sleep, often a VERY Bad one, in a strange bed, strange setting, different temps etc etc and it is only based on one single night (or often a couple/few of hours) of sleep.

This is why going home with an APAP after and setting the machine 2 below and 2 above is a great exercise, for 2 weeks.

Oh, and it looks like your likely a perfect candidate for APAP....

LinkC wrote:

Jayjonbeach wrote:Right, but there is one Optimal pressure that works best for you on CPAP, the one that will eliminate the most apneas, your 90/95% pressure.

You are confusing terms again. 90% pressure applies ONLY to APAP, not CPAP. And it's definition has nothing to do with eliminating the most apneas. It may or may not be "the pressure that works best for you". It is simply the pressure at OR BELOW which you spent 90% of your time. While it is expressed as a singular pressure, it actually represents the RANGE of pressures between your lower limit and your 90%.

Since Link has once AGAIN posted bad info to the forums and of course has not answered my question in the above post as clearly he is yet AGAIN the one confused and hasn't done his homework AGAIN, here is the answer to help the OP and clear up the confusion for anyone else wondering based on actual studies:

http://ajrccm.atsjournals.org/cgi/conte ... /167/5/674

http://ajrccm.atsjournals.org/cgi/conte ... type=HWCIT

http://ajrccm.atsjournals.org/cgi/content/full/162/1/94

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2080751/

http://www.journalsleep.org/Articles/291110.pdf

http://chestjournal.chestpubs.org/conte ... 7.full.pdf

Summary of those studies/articles, Home Titration is as good as in lab and some info suggests it can be better depending on how many lab studies were done, how long you actually slept, what machine is being used at home, etc, etc though the lab has advantages too as it does consider more variables, it all depends of course but the point is there. It is also mentioned that the importance of Flow Limitation not only for Titration but for Treatment is a critical piece of info, sorry Devilbiss users.

You'll notice that they mention the PEFF value a lot, which is defined in the below link as: The effective pressure level (Peff) is the one that abolishes obstructive breathing disorders including inspiratory flow limitation and snoring in every sleep stage and body position

http://respiratory-research.com/content/9/1/56

And how is PEFF arrived at you ask, well I'm so glad you asked, from the link above: Then when completing an automatic CPAP titration, Peff value usually corresponds to the 90th or 95th percentile of the cumulative night time pressure response

Been discussed many times before and of course in this forum, one thread of note:

viewtopic.php?f=1&t=29916&st=0&sk=t&sd=a

So to summarize, you do NOT go home and put your machine on 2 below and 2 above your Titrated pressure and LEAVE IT THERE. You DO put in on 2/3 below and 2/3 above for 2/3 weeks for Titration or Titration checking purposes, THEN if you are switching to CPAP, you use your 90/95 percentile averaged over the time period as the one OPTIMAL pressure to set the machine on, just as I've been saying. As for the minimum pressure in APAP AFTER 2 to 3 weeks I already posted my thoughts on it in the prior posts and the logic behind it. I choose to use my OPTIMAL pressure setting as do many others, the one that eliminates the most apneas and enjoy no "Apnea Slippage" as can be an issue with the "conventional wisdom" method. I also don't care about the comfort of a pressure 2cm lower as I don't have gas issues or arousals and care much more about having the LEAST AMOUNT OF APNEAS which to me and many is the most important part of therapy (along with compliance), and it works, this way my AHI is < 1 which I could not achieve any other way. YMMV, of course, and without compliance your apneas will surely be higher so if having a little lower pressure makes the whole thing more bearable for you and you actually use the machine versus not using it, then the answer there for a person in that boat is obvious.

Will post a seperate thread on all this eventually...

Jayjonbeach wrote:Oh, and it looks like your likely a perfect candidate for APAP...

Were you referring to me? Yes, it is obvious I am probably a good example of why a person might do better with APAP.
But should something weird happen and I don't have my APAP and I only had CPAP available what pressure would you think I should set it at? If a 90% number is optimal by your statement then one might assume that I should use 16 since I sometimes need it.

This has been a great discussion thread. I cannot tell you what the best pressure settings would be. What I can say is that I have been increasing my mimimum pressure from 4. I got as high as 7 but didn't feel as though I slept well. I went back to my brief history and noticed that I had a six day period where my min pressure was 5 and I had experienced the lowest AHI's. Last night I set the minimum pressure back to 5 (down from 7). This morning my AHI was .4, max pressure hit 5.3, and I felt like I slept well.

For me it appears I don't need my Rx pressure of 8. I've also noticed that I have less dryness of mouth with the lower setting. BUT I have only had this machine and software for three weeks. The long term needs to be recorded before I conclude the lowest setting possible is the way to go but that's the way I'm leaning. Will that work for you? Probably not.

Larry

I hope you just stopped reading after this post. I think you had good advice at that point.

jimnsc wrote:Sounds good to me - 8 and 11 it shall be. Appreciate it Pugsy and LinkC.

Lizistired wrote:I hope you just stopped reading after this post. I think you had good advice at that point.

Yeah, it did seem to go to hell didn't it? LinkC and JayonBeach have had the same debate in other threads. I doubt this will be the last one either. I don't normally stick my nose in these debates but I just couldn't let a blanket percentile number be given as the holy grail of numbers that will work for the "majority" as it was put. Especially in a thread that a newbie might read. So much back and forth opinions and possible confusion for a new user. It's like anything else with cpap treatment there are many possible variations to every aspect of treatment as there are people using cpap. Each person has to decide what works best for them and not try to mimic what someone else does or says.

You got it right Pugsey. There is no "one size fits all".

Larry

I am enjoying this thread; very enlightening. Thanks to all who contribute.

Jayjonbeach wrote:Since Link has once AGAIN posted bad info to the forums and of course has not answered my question in the above post...

The OP got the info he asked for. No sense in confusing him with esoteric theories on self-titration. As to your "question", I have no interest in answering taunts from unappreciative and belligerent users. Nor do I have time for your nonsense.

Have a nice day!

LinkC wrote:

Jayjonbeach wrote:Since Link has once AGAIN posted bad info to the forums and of course has not answered my question in the above post...

The OP got the info he asked for. No sense in confusing him with esoteric theories on self-titration. As to your "question", I have no interest in answering taunts from unappreciative and belligerent users. Nor do I have time for your nonsense.

Have a nice day!

LOL - it aint my nonsense, those ARE the FACTS, based on ACTUAL STUDIES, which cant be disputed, and it was obvious you didn't know the answer anyway since you once again posted incorrect info in the forums. (This is now at least the 5th time, I can point them all out if you'd like....)

Maybe do a little reading in your spare time, you know, so when you give advice it might actually be correct once in a while...

The old adage, God gave us 2 ears, 2 eyes and ONE mouth for a reason....

You have a great day now too Link!

Pugsy wrote:

Jayjonbeach wrote:Oh, and it looks like your likely a perfect candidate for APAP...

Were you referring to me? Yes, it is obvious I am probably a good example of why a person might do better with APAP.
But should something weird happen and I don't have my APAP and I only had CPAP available what pressure would you think I should set it at? If a 90% number is optimal by your statement then one might assume that I should use 16 since I sometimes need it.

That 'statement' is exactly what all those studies I linked are concluding, see the PEFF definition in the post, which is not mine.

Again that is why one night is not a good judgement of someone's optimal pressure. Not only that, people that do better on APAP often will not have one good optimal pressure, hence why they do better with a machine that can vary it according to how they are sleeping.

One week my optimal pressure might be 12, the next I could be very stressed out and its closer to 13, for that week.

That was why I said, "put in on 2/3 below and 2/3 above for 2/3 weeks for Titration or Titration checking purposes, THEN if you are switching to CPAP, you use your 90/95 percentile averaged over the time period as the one OPTIMAL pressure to set the machine on.

Of course that will hardly be "optimal" for someone who needs APAP, as their needs always seem to vary and CPAP does not have the ability to adjust to their needs. In your example likely your Optimal Pressure will be lower than 16, and that one night when you needed 16, you're SOL.

LinkC wrote:Common wisdom is 1 below and 2 above. (8-11 in your case)

Jaysonbeach wrote:Having said that, if I was JUST Titrated at 9, I would check it by setting the machine on something like 7/8 and 12/13/14.[/quote}

Gosh you seemed to like my advice to the OP!

The "nonsense" was your tit-for-tat childishness...

The fact that you note and can quote from past discussions where you perceive others are incorrect speaks volumes. Kinda spooky...

I'll let you have the last word. Your type can't resist...

LinkC wrote:

Jayjonbeach wrote:Right, but there is one Optimal pressure that works best for you on CPAP, the one that will eliminate the most apneas, your 90/95% pressure.

90% pressure applies ONLY to APAP, not CPAP. And it's definition has nothing to do with eliminating the most apneas.

Now look up, oh about 10 posts, and see what all the studies concluded, it sure doesn't agree with what you said there!

Don't make me drudge out all the other posts now, where again FACTS proved you wrong....