Dr Rx specified APAP 4-20 cm/h2o. Should it be narrower?

[Jeannh]

Newbie here. I've had my home 'sleep study and titration' with an APAP (4 nights on the APAP). My sleep study report (no graphs) showed events occurring at pressures 4-11 (nothing in 12-20). The recommendation from the study was CPAP set to 10, with flex of 3. Dr and I agreed on a ResMed S9 APAP w/EPR. Here's my question:

He specified the pressure on the Rx as the default of 4-20. From my titration, it seems like that's pretty broad. By the time I turn it off for a bathroom break 3-4 times a night, won't I spend all my time ramping up at lower than seemingly therapeutic pressure?

Could he be trying to do an extended titration (see him a month after I get the equipment)? It seems to me like the sleep study recommendation is more like 7-10 cm/h2o, if I account for the Flex/EPR. As a newbie, I'm hesitant to change the settings as soon as I get it home, but I've given myself 3 months to adjust, and I want to hit the ground running.....

Input welcome, Jean

[Wulfman...]

It's possible that your doctor prescribed the APAP with that range so the DME would give you an APAP, as opposed to a straight pressure machine or even a non-data-capable "brick".
Ideally and initially, you want to set the new machine to the pressure that your sleep study showed was optimal......10 cm.
It would be beneficial to at least TRY that pressure for a period of time to see how well it works for you. It's not hard to tweak the pressures from that starting point, if necessary.
The problems with using a range of pressures is disturbed and fragmented sleep from the changing pressures and increased leaks from those pressure increases and changes.
Most (knowledgeable) people who use an APAP in a range of pressures use a narrower range of pressures (if it doesn't disturb their sleep).

Den

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[STL Mark]

There are some advantages to leaving the machine wide open at first. My guess is that he will make changes at your 30 day followup. I agree that this is an extended titration. He may feel that getting the patient compliant at a lower pressure is more important than hitting them with their titration pressure from the start.

My advise is to put up with it for 30 days and get past the initial compliance period if it was purchased by insurance. If you see problems discuss it with the doctor's office. You may learn more from the Autoset data than what was gained from the in home study.

[Sir NoddinOff]

Let's give your sleep doc the benefit of a doubt and hope that he/she want's to observe your pressure swings and then 'dial you in' after a few weeks or a month. If they don't or won't do that, then I'm thinking that's kinda lazy doctoring. Good you picked up on this early

[Jeannh]

Thank you all - what a wealth of knowledge here!
Jean

[zoocrewphoto]

I would add that most people find pressure of 4 or 5 to be smothering. We won't really smother, but it feels that way. If you find that the low pressure bothers you, try setting your range for 6-20 and see if that feels more comfortable.

[jnk]

Manufacturers advertise their machines as being designed to work at full range, 4-20. And that works just fine for some. So there is no harm in trying it for a while to see how that works for you.

Some on this board have found that eventually raising the minimum pressure helped them to solve problems or to make them feel their very best in the mornings. Others, as stated earlier, find their sleep most restful at one pressure all night if their needs don't vary.

What some find is that setting the minimum within a cm or two of what is needed to prevent apneas works well for them. Others set the minimum at exactly the point they need to prevent apneas. If the machine pressure isn't running away to higher pressures for no reason and there are no comfort issues at higher pressures, then there is no need to lower the maximum pressure.

You will eventually figure out what works best for you over time. Until then, especially at first, running a machine the way the doc wants it to run may make the doc happiest. Some docs get their feelings hurt when brand new patients start dial-winging for no reason right away. There will be plenty of time for you to tweak the setup later if you need to. The idea is to get the best treatment possible as comfortably as possible, but some get great, comfortable treatment right away at a full range of APAP pressures.

Just my opinion.

[Captain_Midnight]

For some reason, the advice given to physicians is to prescribe APAPs wide open with a range of about 5-20. I recall reading here several years back, that this is a "prescription for failure", with the reason being that with a wide open APAP range, a patient must be in frank apneic occlusions for the machine to begin the process of ramping up the pressure to eventually reach the therapeutic pressure. There is no persuasive reason to be in apnea. I also recall advice hereabouts that the most effective pressure ranges for apaps were fairly narrow ones, maybe a couple of inches of h20 or so. (If the upper pressure of the range is too high, you may get pressure spikes that will either leak or wake you up.) You don't want more than you need.

My doc was just fine with me using my daily Encore data as feedback to adjust my lower pressure upward, using a narrow range, until after several weeks (months? I forget) that I reached my therapeutic sweetspot. For me, this is 9.5 - 12, and now my ahi averages 0.3. Interestingly, the 9.5 lower pressure is a smidge higher than my titrated cpap pressure, however sometimes when using EPR (such as AFLEX), one needs an additional half an inch or so of pressure to overcome the occlusions that can occur at the end of exhalation). Needs vary on this, one suspects.

I won't give you advice on how to proceed, other than to check with your doc and see if he or she minds if you do some prudent self-titration. Good luck finding the right pressure range, it can serve you very well.


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[Jeannh]

I'll call him today and ask- thank you!