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Thoughts on setting minimum and maximum pressures
#1
I'm about 45 days into this journey and am just getting settled in with tolerating cpap. I started at 4-20 on pressure. I immediately lowered the maximum as my normal pressure seems to be in the 8-12 range and occasionally the Autoset S9 would quickly go up to 20, which of course blew my mask off, woke me up etc. So I lowered the max down to 13 and also brought the minimum up to 6.5 which was about the lowest I saw on rescan. Over the last month I have brought up the minimum pressure to 7.8 and lowered the maximum to 12.0.

I'm still not sleeping great nor have great energy but I think it is improving.
Over the last 30 days my median pressure was 9.1, 95th percentile 11.4. My average AHI is 1.7. My median leak is 2.4 and 95th percentile 30.6

I have looked at several threads on the forum but am curious as to members thoughts on setting "ideal" minimum and maximum pressure levels.

What worked for you in determining what was right for you?

Disclaimer: (I have virtually no medical support staff on this so I am on my own to figure this out)

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#2
(02-18-2014, 01:30 PM)tahoemark Wrote: I'm about 45 days into this journey and am just getting settled in with tolerating cpap. I started at 4-20 on pressure. I immediately lowered the maximum as my normal pressure seems to be in the 8-12 range and occasionally the Autoset S9 would quickly go up to 20, which of course blew my mask off, woke me up etc. So I lowered the max down to 13 and also brought the minimum up to 6.5 which was about the lowest I saw on rescan. Over the last month I have brought up the minimum pressure to 7.8 and lowered the maximum to 12.0.

I'm still not sleeping great nor have great energy but I think it is improving.
Over the last 30 days my median pressure was 9.1, 95th percentile 11.4. My average AHI is 1.7. My median leak is 2.4 and 95th percentile 30.6

I have looked at several threads on the forum but am curious as to members thoughts on setting "ideal" minimum and maximum pressure levels.

What worked for you in determining what was right for you?

Disclaimer: (I have virtually no medical support staff on this so I am on my own to figure this out)
The proof is in is it working for you? According to the averages you posted, I'd say yes. So if it aint broken, don't be fixing it. Monitor it and if you see your ahi climbing a little, then raise the max a little, then monitor for awhile again before you change it anymore. Your ahi is a little higher than mine, but then so is most everybody. I run around .7 most of the time, at a max pressure of 15, min of 12, start of 7, 20 minute ramp.

What works for me might not at all be what works best for you. But what works for you takes a while to evaluate, so just enjoy that your ahi's are low, probably you're snoring is non-existent, and all is well in the neighborhood.


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#3
The pressures you are using seem to be controlling the events (based on AHI).

I took my bottom number up closer to my median FIRST because I like more air and 2nd because it didn't seem that useful to start lower and let the machine play catch up IF I liked the higher setting anyway.

If possible, leave enough HEADROOM on the max to allow the machine to do it's job but based on the AHI it is doing that.

Are you SLEEPING when you get to sleep or waking up a lot?

Waking up due to mask leaks is almost as bad as waking up due to apnea.

Sweet Dreams,

HerbM
Sleep study AHI: 49 RDI: 60 -- APAP 10-11 w/AHI: 1.5 avg for 7-days (up due likely to hip replacement recovery)

"We can all breathe together or we will all suffocate alone."
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#4
Although everyone is different, you should have a difference of about 10 and your high should be at least 2 or 3 more than your 95th percentile. There is no use limiting your pressures too much or you may as well use a straight CPAP? For example mine is 5-15 with my 95th around 12. You also need to let it settle for a few weeks at a time. With the sleeping and energy it normally takes most people 3-6 months for people to start to feel the real effects of CPAP.
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#5
(02-18-2014, 01:30 PM)tahoemark Wrote: What worked for you in determining what was right for you?
Its matter of trial and error, I can set the minimum pressure a bit higher but 9 feel most comfortable with no ramp or epr, any lower would feel not getting enough air to breathe. Sleep is not about numbers but rather about a good night sleep, once a good sleep pattern established and leak under control .... numbers improve too (not the other way around)
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#6
I'm baffled. Doesn't the center have to set your prescription? How do you know what to set it at, even with software, as I was told if it was too high it could cause chest pain, etc.
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#7
Ultimately, its about getting leaks and side effects under control. Ideally we spend as much time at low pressure as possible, although as zonk said sometimes you can feel like you're not getting enough air. In my case I found lowering the max really cut down on leaks which, while they were not really bad, were enough to disrupt my sleep. Your numbers look pretty good so you may want to think about leaving it there for a bit.
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#8
"I'm still not sleeping great nor have great energy but I think it is improving.
Over the last 30 days my median pressure was 9.1, 95th percentile 11.4. My average AHI is 1.7. My median leak is 2.4 and 95th percentile 30.6"



Hi,
If I'm not mistaken , believe 95th percentile leak of 30.6 is too high is it not? Other more experienced members can comment on this but should it not be 24 or less ?
Can someone verify this please?
Thanks,
3
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#9
tahoemark, what is your prescribed pressure? Your range should at least cover the prescribed pressure and go a little higher.
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 OPINIONS ONLY AND NOT NECESSARILY STATEMENTS OF FACT.
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#10
(02-18-2014, 04:17 PM)bareablesleep Wrote: I'm baffled. Doesn't the center have to set your prescription? How do you know what to set it at, even with software, as I was told if it was too high it could cause chest pain, etc.

The prescribed way is for the DME supplier (or Resp Therapist) to set your pressure in accordance with the doctors actual "prescription".

There is no legal or technical reason you cannot set your own pressure; it involved learning how to use the "Clinical Menu" settings or using software like Rescan.

Chestpain is possible, I suppose, but you don't read of many people complaining of that on the forums, and if so it would likely be at VERY HIGH pressures.

Most people who are changing their own pressures are dealing with doctors who left the machine "wide open" (e.g., 4-20) or working on their own with no Doc to advise.

I moved my pressure INITIALLY because it wasn't high enough to make me COMFORTABLE breathing through the max.

Even now, at 12-14, I can't even tell the machine is pushing air without opening my mouth or something.

It feels like NORMAL breathing to me.
Sweet Dreams,

HerbM
Sleep study AHI: 49 RDI: 60 -- APAP 10-11 w/AHI: 1.5 avg for 7-days (up due likely to hip replacement recovery)

"We can all breathe together or we will all suffocate alone."
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