For those that use auto CPAP

For the record, "MY selected pressure" was NOT my prescribed pressure.......far from it. And, I kicked my sleep doctor to the side of the road as soon as I got my prescription in hand. He was a jerk.


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I was originally prescribed straight cpap in 05. It was a resperonics brick w no data. Initially symptoms definitely improved but after a few months, something was wrong, so I got re-titrated and went from 6 to 8.5 cm. I believe that this is partially due to the therapeutic pressure creep that sometimes happens the first few months of xpap therapy.

During this time, I read much wisdom from the veteran posters on this fine forum, and learned that many had good success with apaps and with the range set as min pres = titrated pressure up to a high pres of just a few cm above the minimum.

I also read that some found (through careful observation) that if one used the epr (such as aflex), then it might be a good idea to set the min just a half cm above titrated to prevent occlusions at the end of exhalation.

Talked to my doc who cheerfully wrote me a new Rx for an apap, and I then carefully, and slowly experimented w pressures to find the sweet spot. Doc was completely cool w me doing this. (Possibly because I was able to clearly describe what I wanted to do, and report back with cogent summaries, including graphs.) IIRC, my doc also was going to mainly apap Rxs for most of his osa patients. As he put it, if you have a cold or a couple of glasses of wine or just sleep in a different position, then your therapeutic pressure can change, hence the need for an apap. As w most docs, he was not aware of the critical importance of raising the min press to somewhere near the titrated pressure, thus obviating the need to strangle a few times with obstructive occlusions every time the machine searches for the sweet spot. Not his fault, there was not much in the published lit about this, as I recall.

Everyone is different, but I have had wonderful success w my apap with the pressure range set as describe above. (Average ahi = 0.2) I never give med advice; however, I would recommend that apneic patients consider this setup as they discuss therapy strategies with their docs.


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Very helpful responses, thanks. Would anyone be able to direct me to literature (book or journal) specifically targeting reasoning for APAP and methods of APAP approaches that are clinically tested?

Captain_Midnight wrote: As he put it, if you have a cold or a couple of glasses of wine or just sleep in a different position, then your therapeutic pressure can change, hence the need for an apap.

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Good point. I travel, and that means different beds, different altitudes, different humidities. All of these can affect my pressure needs. Sometimes, I need to take a muscle relaxer for pain, and that can increase my needs. Also, when I am congested due to allergies or cold, my narrow airway gets even colder. I don't have to worry about it as I know my machine can handle it and take care of me.

bavinck wrote:If you use auto CPAP is it because your doc prescribed it, or because you have chosen to set it up yourself that way? I am interested in the percentage of people on Auto vs constant, and reasoning for auto.

I had done my research before going for my sleep study, so when my sleep doc was ready to prescribe a fixed pressure, I requested a range of pressures (and, thus, and auto-CPAP machine) to handle any changes in my sleep patterns (such as travel with different beds and pillows, etc.). The cost difference is pretty minimal above the cost of a machine with full efficacy data (and I would not want to be without that data to monitor my progress).

After 18 months, my pressure rarely changes more than half a cm of pressure. When I'm at a hotel, or some other unusual situation, then by looking at the data, I often see that the pressure has gone up 1.5 cm for a bit a few times a night.

So to your question about research from medical journals, etc., I have none.

Good Luck!

bavinck wrote:Very helpful responses, thanks. Would anyone be able to direct me to literature (book or journal) specifically targeting reasoning for APAP and methods of APAP approaches that are clinically tested?

From what little I have seen most studies use it set at 4-20 and then say "See, it is not a good machine to use"

Blackspinner writes: From what little I have seen most studies use it set at 4-20 and then say "See, it is not a good machine to use"

This is my observation as well. I recall reading here a few years back that a wide open pressure range on an apap is a "prescription for failure" for the reasons that it requires the patient to be in frank airway occlusions just to find a happier pressure setting.

I don't see all the studies on PubMed, but I catch a lot of them, and (perhaps I've missed them) but I'm still waiting to see an apap/cpap crossover study that sets the min apap pressure at titrated pressure.

One would hope that clinical researchers and manufacturers read forums such as this, and might eventually learn from patients' successes.

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