Pressure settings

[Sleepster]

....So raising you max does not mean the machine will stay there but will give it enough headroom to go that high if it senses it needs to..as mine does

It's great that it works that way for you. For some patients the machine spends way too much time at the max pressure, so setting the max at a lower value is necessary for them.

[Sleepster]

Unless somebody has other medical issues at play, the only danger of the maximum pressure being set too high is the danger of it causing non-compliance.

Don't you think that a high CA index can cause desats and arousals? Basically, the same problems associated with a high OA index.

[jgjones1972]

Unless somebody has other medical issues at play, the only danger of the maximum pressure being set too high is the danger of it causing non-compliance.

Don't you think that a high CA index can cause desats and arousals? Basically, the same problems associated with a high OA index.

As I had stated earlier in that post; I would place PAP induced Centrals in the "Trouble Acclimating" category. I believe that if your pressure is high, but you stick with it and acclimate - the Centrals will likely fade away with time (unless there are medical issues at play other than simple OSA).

I'm pretty skeptical about all of these claims of the newer Autos routinely "running away" with the pressure.

You have to take into account that the machine is designed to try to eliminate every single obstructive event - not just get the AHI down to 5. It stands to reason that the machine will likely hit significantly higher pressures than would be prescribed with the aim of only eliminating any more than 5 an hour.

[skyler]

I don't see you having this problem, but when I used an autoset the pressure would go higher to deal with apneas and the higher pressure would cause more apneas and the pressure would go higher- a vicious cycle. Be careful raising/changing pressures to fast. I'd give it a month between changes.
Good luck

[jgjones1972]

I don't see you having this problem, but when I used an autoset the pressure would go higher to deal with apneas and the higher pressure would cause more apneas and the pressure would go higher- a vicious cycle. Be careful raising/changing pressures to fast. I'd give it a month between changes.
Good luck

The new AutoSets detect CA and do not raise pressure in response to apneas occurring with a clear airway. Higher pressures can cause CA, but the AutoSet will not raise pressure in response - eliminating that vicious cycle. Of course, AHI could get worse with higher pressure because CAs are factored in; but, any increase in pressure is due to obstruction.

I have yet to hear of high pressures causing increased OA.

Some acclimate slowly, some quickly. Some are patient and can tolerate poor sleep, others can't. If I had been stuck with a pressure too low for a month, I would have given up on PAP. Some would give up if pressure is optimum for eliminating obstructions, but is too uncomfortable to sleep or CAs eliminate the benefit. It is a personal decision that people should make an informed decision about based on their own unique situation. The bottom line, though, is that someone with simple OA is more likely to realize greater health benefits long-term if they acclimate to the pressure needed to optimize reduction of OAs; rather than settling for a lower pressure that confounds the treatment of obstruction. How long it takes to acclimate and how it is achieved is a personal issue; but, pressure induced CAs are most likely to subside with time - OAs from untreated obstruction are not.

I personally slept my first night with PAP with an Auto CPAP set to 4 - 20 and only woke up once, early on, with the pressure at 19 and the mask floating on my face like a small hover-craft. I cinched the mask down, went back to sleep and woke up in the morning feeling better than I had felt in 20 years. I dealt with and eliminated pressure induced CAs, aerophagia, ear popping and having a hard time exhaling against the pressure by just sticking with it, not by lowering the pressure. It was easier to do because of the way I felt in the morning. If I had lowered the pressure to reduce the side-effects, then I probably would have reduced the benefit. With reduced benefit, I probably would have given up on PAP.

Just my 2 cents.

[Sleepster]

The new AutoSets detect CA and do not raise pressure in response to apneas occurring with a clear airway.

That's the claim of the manufacturer. And I've no doubt it's true, probably for the majority of patients. But not for everyone.

The machine has to be able to reliably distinguish between a CA and an obstructive event such as a OA or a hypopnea. That's the first hurdle. The second hurdle is to adjust the pressure accordingly. Of course, if it doesn't clear either hurdle the patient needs to intervene.

The bottom line is this. Don't just assume your machine is treating your apnea successfully. Always check your data and monitor your therapy.

This is not as time consuming as one might think. After an initial few months of getting things under control, I now check my data monthly and make adjustments of 0.5 cm to my pressure. Some people can skip that initial few months and adapt right away. I wasn't so lucky, but now I'm doing great!

Without my CPAP machine I'd be waking much earlier and having headaches from the lack of sleep.