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[Pressure] Is there any reason not to use the maximum pressure when using ranges?
#1
Is there any reason not to use the maximum pressure when using ranges?
I've enjoyed my Devilbiss DV54 for a few years now with a range setting of 3-5 without any apparent issue and a stableish AHI of 5-7. As of late I had a few tired streaks with AHI reaching 10. While investigating this I noticed I was increasingly spending more time at my pressure plateau of 5, up to 18%. I upped the range to 3-6 and immediately saw an improvement but a few more days passed and I see myself again plateauing, most probably from a bad night but it got me wondering why I'm not just fully relying on the machine and letting it use the full range. I have been having a hard time seeing any reasoning on why the range should be limited or not besides for the lower end for people having comfort issue with low pressure.

TL;DR; Is there any reason not to use the full range of 3-20 on my machine and letting it adjust as events come up?
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#2
RE: Is there any reason not to use the maximum pressure when using ranges?
some leaks will run the machine up to 20 as will some unusual sleep patterns that the machine misinterpreted.
I'd use min 6 max 15 and review.

do you use the smart code?
http://www.devilbisshealthcare.com/produ.../smartcode
mask fit http://www.apneaboard.com/wiki/index.php...ask_Primer
For auto-cpap, from machine data or software. You can set the min pressure 1 or 2cm below 95%. Or clinicians commonly use the maximum or 95% pressure for fixed pressure CPAP, this can also be used for min pressure.
https://aasm.org/resources/practiceparam...rating.pdf
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#3
RE: Is there any reason not to use the maximum pressure when using ranges?
(05-05-2019, 09:52 AM)frankzzz Wrote: I've enjoyed my Devilbiss DV54 for a few years now with a range setting of 3-5 without any apparent issue and a stableish AHI of 5-7. As of late I had a few tired streaks with AHI reaching 10. While investigating this I noticed I was increasingly spending more time at my pressure plateau of 5, up to 18%. I upped the range to 3-6 and immediately saw an improvement but a few more days passed and I see myself again plateauing, most probably from a bad night but it got me wondering why I'm not just fully relying on the machine and letting it use the full range. I have been having a hard time seeing any reasoning on why the range should be limited or not besides for the lower end for people having comfort issue with low pressure.

TL;DR; Is there any reason not to use the full range of 3-20 on my machine and letting it adjust as events come up?

An AHI of 5-7, if a valid and consistent fact, is not what health professionals and what the insurance industry would term 'salutary'.  It's not good for you. The heavy, heavy majority of people who come here for browsing, curiosity, or for help, universally strive for an AHI well below 5, 5 being just outside the upper limit used by the health insurance folks and by the medical profession.

We don't know anything else about you, your history, what has changed in your circumstances lately, what may endure in the way of changes, how old your device is, and so on.  Also, we don't have several days' worth of data that we ask people to submit here, redacted as appropriate (stripped of personal information).  If you machine is data capable, and if it has an SD card, it would be useful, and necessary, to have you post screen shots of the readouts in OSCAR, a newly developed software available to us here on the forum.

Would you be able to do that for us?  There are some very experienced and dedicated people here who can help you to get better performance if they can be afforded your data.
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#4
RE: Is there any reason not to use the maximum pressure when using ranges?
I used the DV 54 for years.

It depends. My pressures tend to be very stable and I handle very high pressures very well so the high being on a max makes no difference.

On the other hand for someone that suffers from aerophagia you definitely want to manage the high pressure tightly.

I am in favor of running fairly wide open for one night to see how both the machine and the user respond and use that info to optimize settings.
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#5
RE: Is there any reason not to use the maximum pressure when using ranges?
Well I didn't mean to get in detail but more to know if in a general sense, there were reasons to keep the max rate down.

The bigger story was that I was tested 10 years ago at 105 AHI (sadly not a typo, was a mess before having a CPAP). I was diagnosed with a CPAP at constant 8 but through weight loss I was able to get that pressure lowered periodically as I was getting more central apneas up to the point where the minimum pressure of 4 on my machine wasn't low enough to prevent getting too many central apneas. 

That is why almost 3 years ago I went for the Devilbiss as it could go as low as 3. Now for a reason I can't remember, I had it set at a range of 3-5 which got me some good results until very recently which I think is linked to less exercise and gaining a few pounds.

I will try and get that Oscar software but in the meantime I've attached my data from the smart codes just before I changed to 3-6, it gives a good idea of the progression lately.


Attached Files Thumbnail(s)
   
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#6
RE: Is there any reason not to use the maximum pressure when using ranges?
I would have min 6, the max can be 15 or you can have 20. Then review and make further adjustments. You are still getting OA/H at 90/95% of 5cm. So you need more min, move up 1cm to 6. The machine seems to be running at the max 5, so that needs to be moved to a higher number to be out of the way. to 15 or 20. The next result will give more of an idea to what 90/95% pressures the machine uses for treatment. Having min pressure at 90% would be a suggestion and is what philips opti start is.
mask fit http://www.apneaboard.com/wiki/index.php...ask_Primer
For auto-cpap, from machine data or software. You can set the min pressure 1 or 2cm below 95%. Or clinicians commonly use the maximum or 95% pressure for fixed pressure CPAP, this can also be used for min pressure.
https://aasm.org/resources/practiceparam...rating.pdf
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#7
RE: Is there any reason not to use the maximum pressure when using ranges?
I would certainly agree with you regarding the effects of weight on AHI. Last year, I went from 90kg to 78kg and it had a marked effect on my pressure requirement. When I was at my heaviest, I need 15cm to maintain an acceptable AHI but this dropped to 10.5cm when I weighed 78kg. I have since crept back up to 81kg and my pressure requirement has likewise risen to 12cm.

If this is a real correlation, I am amazed that just 3kg weight increase led to a 14% increase in pressure requirement.
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#8
RE: Is there any reason not to use the maximum pressure when using ranges?
Frank the data you posted shows a very low central apnea index (non-obstructive), and your pressure is very low. In general, I would encourage treating the OA and H events as a priority until CA actually exceeds the obstructive rate. Fred mentioned aerophagia, and I don't know if that affects you. My approach to titration is to allow pressure to rise to a level that fully treats obstructive events, but I will lower pressure and accept a higher AHI where aerophagia occurs or centrals exceed obstructive. If central events remain a problem with AHI at unacceptable levels, I would look for an alternative treatment approach, considering ASV or EERS. One thing is certain, I do not consider a non-obstructive index of 0.5 as meaningful against an obstructive index of 5 to 10/hour. You need higher pressure unless there is some physical reason you are keeping it suppressed. I have no problem with Ajack's suggestion, but might cap pressure at 14 max just to see where things go.
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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.
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#9
RE: Is there any reason not to use the maximum pressure when using ranges?
(05-05-2019, 07:45 PM)ajack Wrote: I would have min 6, the max can be 15 or you can have 20. Then review and make further adjustments. You are still getting OA/H at 90/95% of 5cm. So you need more min, move up 1cm to 6. The machine seems to be running at the max 5, so that needs to be moved to a higher number to be out of the way. to 15 or 20. The next result will give more of an idea to what 90/95% pressures the machine uses for treatment. Having min pressure at 90% would be a suggestion and is what philips opti start is.

I'm always a bit scared of too much central apneas as they have nasty headaches in my case. I changed my range to 4.5-12 for last night, had 90% 6.5 and 95% 7, got an AHI of 6.5, non-obstrutive index of 1 but I feel much better than the past weeks. I'll see how it goes as more nights pass. Thanks a lot for the insight Smile

(05-05-2019, 09:33 PM)StevesSp Wrote: I would certainly agree with you regarding the effects of weight on AHI. Last year, I went from 90kg to 78kg and it had a marked effect on my pressure requirement. When I was at my heaviest, I need 15cm to maintain an acceptable AHI but this dropped to 10.5cm when I weighed 78kg. I have since crept back up to 81kg and my pressure requirement has likewise risen to 12cm.

If this is a real correlation, I am amazed that just 3kg weight increase led to a 14% increase in pressure requirement.

Sometimes a difference of around 3KG either way is enough to have an effect on me, especially if it's fat related.
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