narrow your "active" APAP range by increasing minimum

Updated main post and title to include "rested gal"s info on the significance of the low end of the range. Please also read her excellent links on the subject of "narrowing the range" in her Nov 12, 2011 10:24 am post below.

This may help other relatively new folks. My attempt to "pay forward" all of the great advice I have read on this site.

I have been on the hose for a little over a month with a pressure range from 8-20.

Went in for my follow-up and my doctor and DME both said I need to stay on APAP because my air pressure needs change throughout the night.

During the visit, my doctor did something that really helped me. He narrowed my "active" APAP range by raising my minimum from 8 to 10. He also brought down the top end, primarily as it didn't seem to be needed.

The doctor said he preferred a narrower range for comfort and also wanted to adjust my min up a little to further cut back on the apnea events. Most of my apnea activity and time spent the last month had been in the 8-10 range with much lower activity / time spent at the higher pressures. He suggested we narrow my range to 10-13 (after discussion we settled on 10-15).

I slept much better last night. I woke up less and I was able to switch back to using the more comfortable nasal pillows instead of the full nasal mask.
(With the old lower 8 minimum, I couldn't fall asleep with my small nose pillows due to a perception of not enough air flow, the medium pillows had better airflow, but seemed to blow more air around the room which bothered me.)

So, if you are new to CPAP and find you are waking up for no apparent reason, it may be your body is reacting to the changes in pressure. For me, narrowing the pressure range seems to have helped a lot.

You're preaching to the choir here. We tell people that all the time!

The problem is some prescribing doctors don't even understand that (!), others could care less--they just do a follow-up on the demand of the DME for the purpose of a compliance check. They give no thought to comfort or efficacy.

Sounds like you've got a good one-a "keeper"!

Not to make people jealous after some of the "bad doctor" stories I have read here...

My doctor actually told me "I'd like to change your range but it is negotiable". He explained why he wanted to change it and what the benefits might be. He also clearly led me to believe I was welcome to come back if it needed to be adjusted.

During the course of our conversation, he suggested 10-13, 8-13 and our final compromise with my input of 10-15. What he was saying about narrowing the range made sense and I was having no problems with 8 (could go straight to 8 with no "ramp" up), so I figured I could give the new low of 10 and narrower range a try.

I feel fortunate to have a good doctor who listens and seems to want to work with me as a patient. He is a sleep medicine / pulmonary specialist, so maybe that helps as well.

It does sound like you have a good doctor, Java Time. That's great!

About "narrowing the range" (just my opinion) -- it's usually not necessary to change BOTH ends of the range to "narrow" it. What really matters is setting the minimum pressure up high enough to try to prevent most apneas right from the get-go.

It was raising the minimum pressure from the " 8 " he had first prescribed that made your therapy go better. The higher minimum pressure of 10 was the trick. Dropping the max down from 20 to 13 probably had nothing to do with your therapy (and your sleep) going better.

He could have left the max at 20 and simply raised the minimum to 10, and you'd probably have had the same good results you felt at 10 - 13. Raising the minimum pressure setting to " 10 " was the meaningful change.

If leaks are under control, then dropping the max down from one "unused" pressure (20) to just another "unused" pressure (13) doesn't make any difference. However, if your machine has been hitting 13 occasionally, but never has used any higher pressure than 13, then I'd want the max pressure to be set for at least one or two cms above the most it ever had to use. I'd want at least a little ceiling of "unused" pressure set up there for the max -- just for the possible random night more pressure might be needed. That unused ceiling could be 14, or 20, or 100 (yeah, I know there's no such thing as "100" ) ... my point is that unused pressure is just ...unused pressure. So it doesn't matter what the maximum pressure is set for, if it's a pressure that's never going to be needed anyway.

It's the minimum pressure setting that matters the most when using an autopap, imho:

Results: 1st night with Auto A-Flex (topic started by TSSleepy)
Two nights graphs posted using pressure range 4 - 20 and 10 - 20
viewtopic.php?p=349073#p349073

November 2008 Just got an APAP (topic started by turbosnore)
viewtopic.php?p=319619#p319619

October 2008 Turning off Aflex and Cflex (topic started by DoriC)
viewtopic.php?p=307265#p307265

September 2008 New Guy - Need Help w/Settings (topic started by alanhj13)
viewtopic.php?p=294319#p294319

Wulfman, DreamStalker, and ozij explain why autopaps make changes slowly.
December 2008 Why adjust APAP. Isn't it auto? (topic started by oxygenium65)
viewtopic.php?p=323218#p323218

rested gal,

Those links are great! Thank you!

Totally agree the narrowing came from raising the low end and the doctor explained that as well. My "active" range the past month where I've spent 98% of my time was 8-12, so in effect he didn't touch my high end. Thanks for pointing that out and I updated the first post to reflect this info.

Also agree about having a safety net of +2 above my normal pressure range. The doc did let me add that during our conversation.

All of the experienced folks on this site allowed me to be much more prepared to talk to the doctor which really helped me participate in the discussion instead of just sitting there with no input.

I also am following several comments on this site and just ordered an SD card reader today so I can start using the sleepyhead software.

Thanks all for the help rested gal and CPAPtalk community!

You and your good doctor are both doing a super job with your therapy, Java Time. Way to go!

Thanks for putting in the additional information about his thinking regarding "narrowing" the range. I like the way he thinks.

Java, ain't you the lucky one! You have a Dr who actually understands how these machines work! Our Dr set our machine at 5-18 "to let the machine do it's job". I knew from educating myself here that didn't make sense if my husband was titrated at 13cms so I went home and changed the settings to 11-15cms. When we went back 30days later and he read the data, he just patted me on the back and said "good job"! A waste of time and we never went back. Through further experimenting we learned that he does better on straight pressure. Knowledge is power!

I believe in raising the lower pressure to a level where you have good apnea control.

I don't believe in lowering the higher pressure unless you are having problems with the pressure running away. I like to leave the maximum pressure at 20. If something causes the machine to want to go much about my "normal" pressure, I'd like to know about it and try to figure out why.

As I said, lower the max if you have problems, but I think you should leave it open unless there's a reason not to. My auto almost never goes more than 2 cm above my normal pressure and doesn't stay up there long.

DoriC,
I do feel fortunate with my doctor. After reading this site I had printed out a bunch of info and was prepared to fight for a good APAP machine. I called the nurse to mention what I wanted and she said my doctor normally recommended APAP with humidifiers for new CPAP patients because they had better results. I wasn't prepared for something so easy after reading posts here. But as you say, knowledge is power and that did help me trust the doctor a lot more.

archangle,
For now I'm going to stay with the slightly lower "15" max my doc recomended. That is +2 over anything I hit my first 30 days or so, per the report I have from the DME (thanks again everyone, I knew to ask them for a copy of the FULL report ). I downloaded "sleepyhead" and have ordered the CPAP.com SD card reader. I thought I'd keep an eye on my range, if it starts pushing higher I will adjust the machine and also probably talk to my doctor to see if that concerns him. So far my doctor has been reasonable and helpful.

I don't want to sound too passive though, I did already go into the clinician's menu per several folks suggestion and made sure all options are unlocked on my machine. The only thing the DME had locked me out of was the "mask fit check" and the split-night setting. I left the split night alone, but I turned on the mask fit. Can't think of why they would have chosen to lock me out of the mask fit?

Also, thanks to all of you I do feel in control of "my" machine and if it seems like I need to adjust anything up or down I fully intend to. You have all given me a lot of confidence that as long as I'm reasonable and read the software printouts I can't mess things up too much. At this point I think my doctor has me dialed in pretty good, but I intend to stay a very active partner in this.

You all are the best!

Which SD card reader adapter did you order? Hope not the expensive one. It is not need any cheap generic card reader adapter will work if your computer does not have a SD slot.

I ordered the "SD Memory Card Reader for IntelliPAP, PR System One and S9 Machines" $12.95. So I think I ordered the right one.

Java Time wrote:I ordered the "SD Memory Card Reader for IntelliPAP, PR System One and S9 Machines" $12.95. So I think I ordered the right one.

That one will work just fine. Or even a cheap generic Walmart card reader/adapter will work.

I have no idea what is so special about that other one that is so expensive.

Pugsy wrote:

Java Time wrote:I ordered the "SD Memory Card Reader for IntelliPAP, PR System One and S9 Machines" $12.95. So I think I ordered the right one.

That one will work just fine. Or even a cheap generic Walmart card reader/adapter will work.

I have no idea what is so special about that other one that is so expensive.

because it is from a medical supplier. only a government contract would have a higher price

Java Time wrote:I did already go into the clinician's menu per several folks suggestion and made sure all options are unlocked on my machine. The only thing the DME had locked me out of was the "mask fit check" and the split-night setting. I left the split night alone, but I turned on the mask fit.

You did right to leave the "split night" setting alone.

Split night should always be set to "off" (or zero.) "Split Night" is a feature only on Respironics (and Philips Respironics) autopaps. If you had set a "split night" time of 2 hours (120 minutes), 3 hours (180 minutes), or 4 hours (240 minutes), your machine would start out EVERY night using ONLY your minimum pressure for that many hours. It would not raise the pressure during those hours, even if you were having apneas, hypopneas, and flow limitations. When the time was up, the machine would then switch to autotitration, using the range of pressures it's set for... in your case, 10 - 15.

So, for those first hours (and every night, until you went back in to turn "split night" off) the only treatment you'd be getting would be whatever your minimum pressure of 10 could prevent from happening.

Split Night therapy was Respironics' idea of a way to have an autopap do an ersatz "sleep study" of sorts at home. It was assumed, probably, that the autopap would be left set for its full range of 4 - 20, so the first hours of using "Split Night" would be using the minimum pressure of only 4 cm H2O ... practically no therapy pressure at all for most people. The machine would be gathering the usual "autopap" data -- marking how many apneas, hypopneas, and flow limitations were happening. Then, when the hours were finished, the machine would begin autotitrating for the remainder of the night... using whatever pressure was needed in the 4 - 20 range. Supposedly diagnosing and titrating in one "split night" session. The "90th" percentile number (in the data) would then usually be prescribed as a single pressure for the person to be put on plain CPAP, and the autopap would be taken away to be used for "Split Night" on someone else.

Other than maybe using "split night" one night simply for curiosity's sake, there's no reason for people who are using an autopap as their permanent treatment machine to ever turn on Split Night. And if a person does use Split Night for a night just to see (assuming they have the software) what the data looks like, they'd better be sure to go back into the menu the next day and turn Split Night off or it will keep happening every night.

Several people on this forum have reported that their DME stupidly (thinking it was something to do with "ramp") did mistakenly turn on split night therapy when setting up the machine. It was a very confusing menu setting in the oldest Respironics machines.

For an interesting read about a DME who erroneously turned on "split night" and then tried to CYA (blamed the patient) check out BleepingBeauty's saga:
"A Question re: my AUTOPAP Trial"
April 13, 2009
viewtopic.php?p=359741#p359741

rested gal wrote:You did right to leave the "split night" setting alone... your machine would start out EVERY night using ONLY your minimum pressure for that many hours

YIKES!!!!

Glad I didn't touch that one! As always thanks for the words of wisdom this time and the prior 12,697 times (and counting)!