Titration Question

[zonk]

After seeing few so called specialists, I've decided to become my own specialist, not because I've a uni degree in sleep medicine but rather knowing what works and don,t works for me and I don,t need a uni degree to know that

Stargazer
You wrote 'I have been doing great w/ the 11 straight setting'
That was with brick, now why not try the same setting for some time and see what the data report (AHI, Leak) on the machine and detailed data on the SD card

[Tez62]

Stargazer, there maybe a reason why they set your minimum at 10 but I do agree with you, my Sleep Specialists suggests a range difference of 10, so my minimum is 5 and my maximum is 15, I would ask the question why they have set those pressures, not saying they are wrong.

Tez,

I'm a bit surprised that your sleep specialist recommended such a wide APAP range. Do you regularly come close to hitting your max setting?

A lot of people find that a very wide APAP range can create as many or more problems than it solves. Many people find the wide swings in pressure wake them up. Others find that while the mask was well sealed at their min pressure setting, once the machine raises the pressure by 8-10cm, the mask loses its seal and the leaks wake them up.

While your sleep specialist seems to be happy with recommending a 10cm difference between min and max pressure, many sleep specialists want the range much narrower. It's often recommended that the starting APAP range be set with a min pressure of 1-2cm below the titrated pressure and the max pressure setting be set 1-3cm above the titrated pressure, with a total difference between min and max pressure of somewhere between 3 and 6 cm.

Robysue, it's probably a bit more about Stargazer than me, but my average 95% pressure over the last year is 11.98, and my average AHI is 1.8, so it works for me and more importantly than the figures is that I feel great.

[JimZZZ]

It's often recommended that the starting APAP range be set with a min pressure of 1-2cm below the titrated pressure and the max pressure setting be set 1-3cm above the titrated pressure, with a total difference between min and max pressure of somewhere between 3 and 6 cm.

Good information to have robysue. If I were to substitute average autoset pressure over the past 30 days for "titrated pressure" would the general recommendation quoted above still apply?

BTW, we have missed your input over the past few days. Hope you're well.

[Stargazer]

Stargazer
You wrote 'I have been doing great w/ the 11 straight setting'
That was with brick, now why not try the same setting for some time and see what the data report (AHI, Leak) on the machine and detailed data on the SD card

Well, I did a horrible job of explaining. My first machine was the Escape. Had it for about 3 days until I managed to get the DME to upgrade to the Elite. Had the Elite for about 10 days and AHI's were at or below 2 every night. Negligible leak rates as well.

Last night was my first night with the AutoSet. AHI was 1.39, 95% leaks 1.2 so just about identical to the Elite with a cpap setting of 11.

Other numbers with the new auto setting: Ave pressure 11.74, 95% pressure 14.72. Min press 10.46, max 15. Setting of 10-15.

Looks like the range was spot on. We'll see what happens upon further use.

[retired_guy]

That sounds great Stargazer. Leave everything as-is for a couple of weeks and see if it doesn't level out even better.

[Stargazer]

That sounds great Stargazer. Leave everything as-is for a couple of weeks and see if it doesn't level out even better.

Awesome! Sounds good, will do!!

[PaytonA]

I am curious. Why would one keep the max pressure at 15 for instance? Why not (exaggerating for emphasis) 20? As I understand it the APAP only hunts for a pressure that it needs to control obstructive events or does this have to do with avoiding some of the possible side effects of higher pressure. On another note shouldn't we all do our mask fitting at the highest pressure that the machine is going to use in order to reduce the possibility of being awakened by mask leaks (not that that is the only source of mask leaks). Just curious.

Best Regards,

PaytonA

[retired_guy]

That would seem to make sense Payton. But like all things in life making sense is not always the thing to do. In my experience the machine gets a tad carried away in it's exuberance to make me a happy camper. So if the "ideal" pressure for me is, say, 14, then the machine will come in at 16 or 18 just to make sure I get it right. Then my mask blows off, or my nose turns inside out, or whatever dastardly deed might befall me. So I like to set my setting at a notch or two above the "just right," so the machine has something to bump up against on occasion, but not so high that the machine can simply have its way with me.

That's my technical opinion.

[Bama Rambler]

Of course if the pressure does stay at the top limit most of the time, it's time to "Bump It Up a Bit! :-)

[Stargazer]

Well, after further evaluation of the data, I have noticed for the first time I have been having central apneas with the new auto setting. Never had them w/straight cpap at 11 cm.

Also, much more apneas in general with longer duration vs hyponeas. I've had 8 and 9 apneas on consecutive nights now with at least 7 hrs of sleep where on straight cpap, I only had one or two per night.

Is that a cause for concern or just bc I need to get used to the new pressure range setting? AHI is still well under 5, however.