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Rule of thumb for top pressure setting?
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TheManseHen Offline

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Posts: 243
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Machine: RedMed A10 Airsense 10 Autoset
Mask Type: Nasal pillows
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Humidifier: One that came with machine
CPAP Pressure: 7.6-14.0 EPR 3
CPAP Software: ResScan SleepyHead

Other Comments: Started C-pap Boxing Day 2014. Tortured sleep more or less since 2000. Trigeminal Neuralgia.

Sex: Female
Location: San Francisco

Post: #1
Rule of thumb for top pressure setting?
Hi Y'all,
Is there a rule of thumb, all things being equal, that one tends to set the top pressure at in relation to one's 95% pressure? Say, one whole unit over?

Example if one's 95% is 12.38, would one generally aim for 13.38 for wiggle room? Or is that more or less than is advised/necessary?

No you are not doctors...I got that. Just wondering what typically is aimed for.

The Manse Hen
3 terrible days in row and counting.
Called Doctor today, will see if he get's back to me.
02-20-2015 02:26 AM
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Ghost1958 Offline

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Machine: PRS1 Series Sixty Auto Aflex
Mask Type: Nasal mask
Mask Make & Model: F&P Eson
Humidifier: PRS1 with Heated Hose
CPAP Pressure: 10.5 min 16 max
CPAP Software: SleepyHead EncoreBasic

Other Comments: Moderate to Severe SA Obstructive. Rapid O2 desat off the machine.

Sex: Male
Location: KY

Post: #2
RE: Rule of thumb for top pressure setting?
I watch the pressure graph and see if its "hitting the ceiling" ie going to the max its set for and staying there for long periods of time like 15 min or so. If it is then Ill bump up a half cm or maybe a whole cm. Once ive reached a point where the machine isnt hitting the max pressure for very long at all or just bumping it then Ill go up another full CM or maybe two.

Honestly with the auto the max isnt the real question. It will only go as high as it needs too. What will drive it to go higher than it would likely need too is the min pressure being set to low, simply because it takes longer for it get up to a pressure thats accomplishing anything. And events happening as its climbing that probably wouldnt have happened or alot less of them occurring if the min pressure is closer to what it needs to be to be effective.
02-20-2015 02:41 AM
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Sleeprider Online
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Machine: Resmed Aircurve 10 Vauto
Mask Type: Nasal pillows
Mask Make & Model: Resmed Airfit P10
Humidifier: Resmed Climateline
CPAP Pressure: Auto Bilevel 18/9, PS 3
CPAP Software: ResScan SleepyHead EncoreBasic

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Sex: Male
Location: Where they make Respironics

Post: #3
RE: Rule of thumb for top pressure setting?
The top pressure setting can be left wide open and the machine will only increase as far as necessary to address flow limitations and snores. On the other hand, if high pressure causes other problems like aerophagia, central apnea or disturbed sleep, the user may choose to limit the top pressure to a point between the mean and 95% level. It's a trade off. The number one goal is getting a good night sleep and avoiding OA. Limiting pressure may enable a few hypopnea to get by, but that may be a good trade for less sleep disturbance.

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02-20-2015 02:01 PM
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quiescence at last Offline

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Posts: 753
Joined: Nov 2014

Machine: REMstar System One with Autoflex
Mask Type: Full face mask
Mask Make & Model: Quattro AirFit F10
Humidifier: yes typical setting = 4
CPAP Pressure: 5-13 Autotritrating CPAP
CPAP Software: SleepyHead EncoreBasic

Other Comments: CMS-50F Plus oximeter /w SPO2 Assistant software. Avowed mouth-breather switching to nose-breathing

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Location: US

Post: #4
RE: Rule of thumb for top pressure setting?
exactly, I ditto Sleeprider!

I changed my upper to 13.5 because of that one night that I got to 15 and hated it. All the remaining nights were well under 13.5, so I could prevent badness without a nasty increase in AHI.

QAL

Dedicated to QALity sleep.
You'll note I am listed as an Advisory Member. I am honored to be listed as such. See the fine print - Advisory Members as a group provide advice and suggestions to Apnea Board administrators and staff concerning Apnea Board operation and administrative policies. Membership in the Advisory Member group should not be understood as in any way implying medical expertise or qualification for advising Sleep Apnea patients concerning their treatment.
(This post was last modified: 02-20-2015 04:12 PM by quiescence at last.)
02-20-2015 04:09 PM
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justMongo Offline

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Machine: ResMed VPAP Auto (S9)
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Post: #5
RE: Rule of thumb for top pressure setting?
That's sort of the wrong end of the stick as the Brits would say.

The rule of thumb that many use is:
One runs with ample top end pressure such that over a series of nights the MAX does not hit the top setting.
Then take the 95% pressure from that series; and set that at the max pressure.

Remember -- all posts are opinions; and we all have them.

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.
02-20-2015 04:16 PM
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quiescence at last Offline

Advisory Members

Posts: 753
Joined: Nov 2014

Machine: REMstar System One with Autoflex
Mask Type: Full face mask
Mask Make & Model: Quattro AirFit F10
Humidifier: yes typical setting = 4
CPAP Pressure: 5-13 Autotritrating CPAP
CPAP Software: SleepyHead EncoreBasic

Other Comments: CMS-50F Plus oximeter /w SPO2 Assistant software. Avowed mouth-breather switching to nose-breathing

Sex: Male
Location: US

Post: #6
RE: Rule of thumb for top pressure setting?
yep. see your point, and my point is still valid. I got what I was looking for, and confirmed that ever since I have not gotten anywhere near that max, never once pegged out. oh, and I won't sample the aged seafood leftovers again, cuz that is what triggered the awful night.

YMMV and you don't gotta agree with me. I'm just as happy either way.
(This post was last modified: 02-20-2015 04:22 PM by quiescence at last.)
02-20-2015 04:21 PM
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Sleeprider Online
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Machine: Resmed Aircurve 10 Vauto
Mask Type: Nasal pillows
Mask Make & Model: Resmed Airfit P10
Humidifier: Resmed Climateline
CPAP Pressure: Auto Bilevel 18/9, PS 3
CPAP Software: ResScan SleepyHead EncoreBasic

Other Comments:

Sex: Male
Location: Where they make Respironics

Post: #7
RE: Rule of thumb for top pressure setting?
(02-20-2015 04:16 PM)justMongo Wrote:  That's sort of the wrong end of the stick as the Brits would say.

The rule of thumb that many use is:
One runs with ample top end pressure such that over a series of nights the MAX does not hit the top setting.
Then take the 95% pressure from that series; and set that at the max pressure.

Remember -- all posts are opinions; and we all have them.

That is very close to the way the PRS1 Pro with Auto IQ works. It sets the CPAP pressure at the 90% level from an APAP trial period, then does checks every 30 hours and can further adjust pressure. What I don't like about that is you're forced to use a pressure that you only need 10% of the time, and still can have events that require higher pressure get through.

With an APAP there is no need to limit the maximum pressure unless there are overriding concerns for adverse effects like aerophasia, CA, and disturbed sleep. I'm still in the habit of setting a maximum pressure because the older machines would sometimes "run-away" and increase pressure beyond any reasonable need, but I set it above the 95% pressure.

With APAPs maximum pressure is not nearly as important as getting the minimum pressure right.

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02-20-2015 04:28 PM
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TheManseHen Offline

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Posts: 243
Joined: Jan 2015

Machine: RedMed A10 Airsense 10 Autoset
Mask Type: Nasal pillows
Mask Make & Model: Resmed Airfit P10
Humidifier: One that came with machine
CPAP Pressure: 7.6-14.0 EPR 3
CPAP Software: ResScan SleepyHead

Other Comments: Started C-pap Boxing Day 2014. Tortured sleep more or less since 2000. Trigeminal Neuralgia.

Sex: Female
Location: San Francisco

Post: #8
RE: Rule of thumb for top pressure setting?
Thanks Fella's,
Helpful, that. My C.A's for the last four days have finally tipped the scale and exceed my O.A's. Last night by nearly 2 to 1 in the Central's favor.

Studies have shown that typically, CPAP induced central's fall away at about 8 weeks. Well the 26th of this month is my 8 week mark. We shall see. But either they are having a last ditch party in there, or the Doc is going to have to tinker with what works for me.
I am working at getting my lower pressure up. Good to know that really the issue is the lower being just right with auto, more than the top being just so.

I was thinking with a narrow range, one might have less wakings from run aways but it makes sense that the bottom number affects that all the more if it's too far from the sweet spot.

Other than Ramp time (5 mins and I'm seriously tempted to dump it, but as i'm in the phase of adjusting to increasing lower pressure, it seems prudent to keep it as an "escape" button so to speak, comfort wise.

The Manse Hen 4 horrible nights and counting.
Guess what I've discovered, Central's don't make for urinary changes in me like the Obstructives do. Interesting.
02-20-2015 04:32 PM
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Sleeprider Online
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Posts: 3,302
Joined: Dec 2014

Machine: Resmed Aircurve 10 Vauto
Mask Type: Nasal pillows
Mask Make & Model: Resmed Airfit P10
Humidifier: Resmed Climateline
CPAP Pressure: Auto Bilevel 18/9, PS 3
CPAP Software: ResScan SleepyHead EncoreBasic

Other Comments:

Sex: Male
Location: Where they make Respironics

Post: #9
RE: Rule of thumb for top pressure setting?
Susan, any chance you can post a detail chart from SH showing what's going on?

Limiting the high pressure is valid for exactly the kinds of issues you're raising here.

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(This post was last modified: 02-20-2015 04:42 PM by Sleeprider.)
02-20-2015 04:41 PM
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quiescence at last Offline

Advisory Members

Posts: 753
Joined: Nov 2014

Machine: REMstar System One with Autoflex
Mask Type: Full face mask
Mask Make & Model: Quattro AirFit F10
Humidifier: yes typical setting = 4
CPAP Pressure: 5-13 Autotritrating CPAP
CPAP Software: SleepyHead EncoreBasic

Other Comments: CMS-50F Plus oximeter /w SPO2 Assistant software. Avowed mouth-breather switching to nose-breathing

Sex: Male
Location: US

Post: #10
RE: Rule of thumb for top pressure setting?
(02-20-2015 04:32 PM)TheManseHen Wrote:  Guess what I've discovered, Central's don't make for urinary changes in me like the Obstructives do. Interesting.

yeah, centrals are you thinking you do not need to breathe and obstructives are you thinking you must breathe but can't. I imagine this may play a part in triggering mechanism for urine concentration.

I don't know for sure...

QAL
02-20-2015 04:48 PM
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