Thread Closed 
Fixed vs auto pressure ?
Author Message
SaldusMiegas Offline

Advisory Members

Posts: 227
Joined: Apr 2015

Machine: ResMed AirSense 10 AutoSet
Mask Type: Nasal pillows
Mask Make & Model: P-10, F&P Simplus
Humidifier: integrated
CPAP Pressure: Rx:14, Set:Auto 8.0-15.0
CPAP Software: ResScan SleepyHead

Other Comments: Woot! P-10 pillows plus Ruby chinstrap for side-sleeping mouth breathers

Sex: Male
Location: Virginia

Post: #1
Fixed vs auto pressure ?
Saw my sleep doc today for the first followup appt after starting therapy 2 months ago.

My initial prescription based on a titration study was a constant number.

After a couple of weeks of high AHIs I turned on auto mode and based on the data and advice from members here I narrowed the range down to a span of about 4cm and continued on auto mode. Btw the high-ish AHI was the number predicted by the titration study, but I wanted to try for AHI below 5 which I think is the goal.

I am avoiding mentioning numbers because my question is philosophical and I use other threads for detail analysis and feedback on specific data.

Today the doc (PA) said auto mode is good for zeroing in to about 95% on the therapeutic pressure and next step is to peg a constant pressure at the therapeutic level. Then he said he would advise the DME to set the pressure (never acknowledged nor asked if I was messing with it).

So I asked if they always prefer constant and he said yes it helps eliminate incidents if you remain constant at the therapeutic level.

So I am left to wonder about a few things...

.. It makes sense to me that once you know the best setting then a constant pressure level would eliminate the incidents normally required to ratchet up to therapeutic level in auto mode and thereby reduce AHI.

.. I also have observed that determining this therapeutic level takes some experimenting. My initial titration study recc was 4 cm away from today's recc based on my going rogue and setting the machine on auto. If I hadn't done that we could be six months of 60-day tweaks to arrive at this number.

.. I'm not sure we have determined it yet because my AHI is still high-ish. But I'm willing to set to the level we (i.e. my trusted apnea board experts) and my Doc PA all agree is pretty close and see if the AHI outliers go away.

So bottom line question: is the constant pressure the way to go (if it can be determined) or is auto pressure preferable while accepting that incidents are required to arrive at the optimum pressure each night to make them go away?

Any thoughts?

Saldus Miegas
(This post was last modified: 06-11-2015 11:26 AM by SaldusMiegas.)
06-11-2015 10:01 AM
Find all posts by this user

Donate to Apnea Board
PaytonA Offline
Wiki Editor
Monitors

Posts: 3,007
Joined: Dec 2013

Machine: ResMed S9 VPAP Auto
Mask Type: Full face mask
Mask Make & Model: Resmed Mirage Quattro
Humidifier: H5i(distilled-top up)
CPAP Pressure: VAuto MinE14.0 MaxI 20.6 PS4.0
CPAP Software: ResScan SleepyHead

Other Comments:

Sex: Male
Location: Orange County,California

Post: #2
RE: Fixed vs auto pressure ?
In my opinion, the answer to your question depends a lot on the patient's situation. If the person can comfortably sustain the constant pressure, especially if it is on the high side, then I think that the constant pressure may give one more protection from the odd event sneaking through. It may also be more comfortable for people who are very sensitive to changes in pressure.

Auto units are probably more beneficial for patients who have to deal with aerophagia or pressure induced central apneas. One can use a lower average pressure and still have the PAP respond to events and/or precursors to keep the events in check. There are probably some other pressure induced problems that I have not thought of that might make it more beneficial to use auto CPAP.

Just my thoughts.

Best Regards,

PaytonA
06-11-2015 11:41 AM
Find all posts by this user
big_dave Online

Advisory Members

Posts: 411
Joined: Apr 2012

Machine: PR System One DS560
Mask Type: Nasal pillows
Mask Make & Model: F&P Pilairo Q or ResMed Mirage Activa
Humidifier: PR System One
CPAP Pressure: 14 - 20
CPAP Software: SleepyHead

Other Comments: Former ResMed S8 Autoset II user

Sex: Male
Location: Eugene, Oregon

Post: #3
RE: Fixed vs auto pressure ?
It sounds like you're on the right track. I believe some people do best on fixed pressure, but others (like myself) do best using auto mode. The only way to find out is by trying both and seeing which works best.
06-11-2015 12:12 PM
Find all posts by this user

Donate to Apnea Board
under pressure Offline

Preferred Members-2

Posts: 139
Joined: Feb 2014

Machine: ResMed Airsense 10 Autoset
Mask Type: Full face mask
Mask Make & Model: F&P Simplus
Humidifier: Integrated
CPAP Pressure: 11 - 14
CPAP Software: ResScan SleepyHead

Other Comments: Also use F&P Icon Auto and Z1 Auto for travel and Backup

Sex: Male
Location: Colorado

Post: #4
RE: Fixed vs auto pressure ?
We don't sleep exactly the same night after night, so why use the same pressure every night?

The Auto if set properly can use a range to handle varying conditions such as weight changes, different sleep positions, varying alcohol intake, different stuffiness with seasonal allergies, other seasonal changes due to temp............there are all kinds of variables in our lives that make us sleep differently every night, an auto machine set with the proper range can handle many of these variables to give you an optimum therapy that a fixed pressure can't address.
06-11-2015 01:48 PM
Find all posts by this user
Mark Douglas Offline

Advisory Members

Posts: 513
Joined: Apr 2015

Machine: Sys 1 (60) RemStar BiPAP Auto with Bi-Flex 760P Auto Bi-Level (Variabl
Mask Type: Nasal mask
Mask Make & Model: PR Wisp
Humidifier: PR Sys One heated
CPAP Pressure: RiseTime 3 Fxd E-9.0 / I-11.5
CPAP Software: SleepyHead EncoreBasic

Other Comments: Hashimoto's thyroiditis.

Sex: Male
Location: SW Ohio

Post: #5
RE: Fixed vs auto pressure ?
(06-11-2015 01:48 PM)under pressure Wrote:  We don't sleep exactly the same night after night, so why use the same pressure every night?

The Auto if set properly can use a range to handle varying conditions such as weight changes, different sleep positions, varying alcohol intake, different stuffiness with seasonal allergies, other seasonal changes due to temp............there are all kinds of variables in our lives that make us sleep differently every night, an auto machine set with the proper range can handle many of these variables to give you an optimum therapy that a fixed pressure can't address.

I quite agree.
While everyone is different I think it safe to say no one is absolutely the same day after day or even perhaps hour to hour. I am thinking about trying a fixed setting just so I can say I did however I am becoming consistent @ AHI of below 1 so I think I will wait until I can afford a pulse-oximeter before messing too much with P settings in the hunt for the illusive AHI of -1 :grin:
In view of glaucoma as a potential side effect of cpap therapy I would think maintaining as low a pressures as works for any one individual a worthy goal.

I use my PAP machine nightly and I feel great!
Updated: Philips Respironics System One (60 Series)
RemStar BiPAP Auto with Bi-FlexModel 760P -
Rise Time x3 Fixed Bi-Level EPAP 9.0 IPAP 11.5 (cmH2O)
06-11-2015 02:37 PM
Find all posts by this user

Donate to Apnea Board
zonk Offline

Advisory Members

Posts: 7,908
Joined: Feb 2012

Machine: A10 AutoSet
Mask Type: Nasal mask
Mask Make & Model: Activa LT
Humidifier: Integrated /ClimateLineAir
CPAP Pressure: 9/13
CPAP Software: ResScan

Other Comments: CPAP since Nov 2010

Sex: Male
Location: Australia

Post: #6
RE: Fixed vs auto pressure ?
This debate is never ending
The doctor is pulling the wool over the eyes

Coffee
06-11-2015 06:34 PM
Find all posts by this user
Mosquitobait Offline

Advisory Members

Posts: 746
Joined: Apr 2015

Machine: Resmed AirSense 10 For Her
Mask Type: Nasal pillows
Mask Make & Model: Airfit P10
Humidifier: integrated, Climate line tube
CPAP Pressure: 9-12
CPAP Software: ResScan SleepyHead

Other Comments: RLS and Bradycardia

Sex: Female
Location: Minneapolis

Post: #7
RE: Fixed vs auto pressure ?
Quote: So I asked if they always prefer constant and he said yes it helps eliminate incidents if you remain constant at the therapeutic level.

This is a doctor in a mindset. He's going to use the same hammer for everybody whether they like it or not probably because most of his patients don't question it. In my own case, the goal apparently was to maximize oxygen while minimizing events. In the mean time, I had bought a used machine and brought in my SD card. During titration, the oxygen levels at 8, 9, 10 and 11 were the same. My AHI was much lower (under 1) with my auto settings of 6-12 and no ramp. So, she set it to a range of 8-12. I found I had to add the minimum pressure of 6 and ramp up to 8 over 20 minutes. Going straight to 8 was making me almost dizzy.

Do you have heart problems? Do you have blood pressure issues? These are the two where it MAY be in your best interests to have a set pressure. One member indicated that a set pressure would reduce the changes in blood pressure she would experience during sleep. I would guess that this would come from her sleep study, but they didn't do blood pressure during my sleep study. How would you know if the blood pressure is changing? These are things to ponder. Some people simply feel better at a set pressure.
06-11-2015 08:32 PM
Find all posts by this user

Donate to Apnea Board
3porpoise Offline

Preferred Members

Posts: 74
Joined: Feb 2013

Machine: S9 VPAP Adapt ASV
Mask Type: Full face mask
Mask Make & Model: Resmed mirage Quattro
Humidifier: H5i
CPAP Pressure: epap 5 PS 3-8
CPAP Software: ResScan

Other Comments: the world hasn't always been flat

Sex: Undisclosed
Location:

Post: #8
RE: Fixed vs auto pressure ?
Hi SaldusMiegas,
Have you tried a couple nights side sleeping and a couple nights back sleeping to see what the difference is in AHIs and pressures required for each position?
Take Care,
3
06-11-2015 09:23 PM
Find all posts by this user
PollCat Offline
Apnea Board Polling Administrator
Monitors

Posts: 1,576
Joined: Feb 2012

Machine: ResMed S9 Autoset
Mask Type: Nasal pillows
Mask Make & Model: ResMed AirFit P10
Humidifier: H5i Cleanable with ClimateLine
CPAP Pressure: 10 - 18
CPAP Software: SleepyHead

Other Comments: CPAP-ing since 1995; Type 2 Diabetes; Chronic Asthma; Gout

Sex: Male
Location: Westfield, IN

Post: #9
RE: Fixed vs auto pressure ?
Having slept for the majority of years on a cpap at a constant pressure, I discovered that I slept much better on auto. I suspect that the only way to determine which is best for you is to try both ways.


INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED AS MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA.
INFORMATION POSTED ON THE APNEA BOARD WEB SITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
06-11-2015 11:23 PM
Find all posts by this user

Donate to Apnea Board
SaldusMiegas Offline

Advisory Members

Posts: 227
Joined: Apr 2015

Machine: ResMed AirSense 10 AutoSet
Mask Type: Nasal pillows
Mask Make & Model: P-10, F&P Simplus
Humidifier: integrated
CPAP Pressure: Rx:14, Set:Auto 8.0-15.0
CPAP Software: ResScan SleepyHead

Other Comments: Woot! P-10 pillows plus Ruby chinstrap for side-sleeping mouth breathers

Sex: Male
Location: Virginia

Post: #10
RE: Fixed vs auto pressure ?
Thanks to everyone for your thoughts on this. I appreciate the perspectives I hadn't thought about.

The difference between sweet side sleeping and fitful back sleeping is one I can relate to since my AHI in the sleep study varied by sleeping position and it is probably a factor in events over the course of a night on any nights where I spend any time sleeping on my back.

The other medical factors don't directly apply to me (except BP which as you noted we don't normally measure while sleeping) but it's good to know there are other considerations beyond my little fish bowl that our docs have training and get the big bucks to think about. Smile

Based on all the feedback I will go for a week or so with the recommended constant pressure of 14 and see how it compares with the previous couple of weeks of 10-14 auto. If it feels better and drives down the AHI then it stays, else I know why I am rejecting it. Either way is a win.

Gosh it sounds funny to myself to be discussing whether and how I will follow my doc's recommendations in this way. But on the other hand I have the live data to work with and the thoughtful advice from people with a lot of experience successfully treating sleep apnea to augment the one-time every few months consult with a doc who has a ten minute window to review, decide, and discuss it with me. So I'm not dismissing my doc but using you all as an additional resource who have a lot of ground truth to offer.

thanks again to all.

Saldus Miegas
(This post was last modified: 06-12-2015 07:53 AM by SaldusMiegas.)
06-12-2015 07:51 AM
Find all posts by this user
Thread Closed 


Possibly Related Threads...
Thread: Author Replies: Views: Last Post
  ResMed Airsense 10 Auto Set...Runaway Pressure Abnormal86 14 532 11-22-2016 11:39 PM
Last Post: sonicboom
  Which disturbs sleep most? High Pressure or Changing Pressure Rcgop 7 1,259 11-10-2016 07:37 PM
Last Post: Sleep2Snore
  [CPAP] AirSense 10 Auto Set Pressure duffer54 5 306 11-03-2016 09:06 PM
Last Post: duffer54
Question [Pressure] Dream Station Auto Bi pap configuration of pressure support function dangood_47 6 475 10-27-2016 04:37 PM
Last Post: OpalRose
  airsense10 auto cpap(for him) VS DreamStation Auto CPAP DSX500T11 w/HT humid rookiepom 5 858 10-09-2016 07:52 AM
Last Post: stephennic
  Leak fixed (mouth breather for sure) jxyzobrien 13 787 10-02-2016 09:36 AM
Last Post: SuperSleeper
  Auto-Trial –delivers CPAP therapy adjusting pressure 30days ICEMAN 8 1,230 09-24-2016 12:34 PM
Last Post: green wings

Forum Jump:

Who's Online (Complete List)