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Titration Question
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Stargazer Offline

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Posts: 100
Joined: Apr 2014

Machine: ResMed S9 AutoSet
Mask Type: Full face mask
Mask Make & Model: ResMed Mirage Quatro
Humidifier: H5i
CPAP Pressure: 10-15
CPAP Software: ResScan SleepyHead

Other Comments:

Sex: Male
Location: Carolina Coast

Post: #1
Titration Question
Just upgraded to the AutoSet, finally. At my request, btw, not the doc's.

Question: My titration was changed from 11 to now having a range of 10-15. Does this range seem normal? Can't reach the doc but the DME rep confirmed this was his new order. I have not seen nor talked to him as of yet about my progress so I am a bit baffled with this range.

Note: I have been doing great w/ the 11 straight setting. I just wanted the upgrade for the flexibility that the AutoSet offers. His new numbers seem strangely high but as I am very new to this, wanted other more experienced opinions.

A good laugh and a long sleep are the best cures....
05-01-2014 12:10 PM
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Bama Rambler Offline

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Posts: 213
Joined: Feb 2014

Machine: Respironics System One DS460TS
Mask Type: Full face mask
Mask Make & Model: F&P Simplus
Humidifier: DS6T
CPAP Pressure: 15 cmH2O
CPAP Software: SleepyHead EncoreBasic

Other Comments: xPAP, Best thing since sliced bread!

Sex: Male
Location: Southwest Alabama

Post: #2
RE: Titration Question
Given that your old script was for 11 straight CPAP, it's completely understandable that the new range is 10 to 15 cmH2O.

I don't know why you think 10cm is high when the old number was 11cm.

Once you look at the data you can tell if it's optimal for you. You'll see if the pressure is staying on the low side of the range of if it keeps bumping the high setting.
05-01-2014 12:49 PM
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justMongo Offline

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Posts: 3,857
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Machine: ResMed VPAP Auto (S9)
Mask Type: Full face mask
Mask Make & Model: ResMed Mirage Quattro
Humidifier: ResMed H5i
CPAP Pressure: 18 IPAPmax - 11 EPAPmin, PS=5
CPAP Software: Other Software

Other Comments: μολὼν λαβέ

Sex: Male
Location: Калифорния

Post: #3
RE: Titration Question
The machine will "hunt" for optimal pressure each night.
The numbers make perfect sense based on your previous Rx.

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.
05-01-2014 12:52 PM
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Stargazer Offline

Preferred Members-2

Posts: 100
Joined: Apr 2014

Machine: ResMed S9 AutoSet
Mask Type: Full face mask
Mask Make & Model: ResMed Mirage Quatro
Humidifier: H5i
CPAP Pressure: 10-15
CPAP Software: ResScan SleepyHead

Other Comments:

Sex: Male
Location: Carolina Coast

Post: #4
RE: Titration Question
(05-01-2014 12:49 PM)Bama Rambler Wrote:  I don't know why you think 10cm is high when the old number was 11cm.

I maybe didn't articulate what I was thinking very well. I thought the range would be on the lower side of 11 with maybe a high mark of 12-14.

It seems strange that the lowest range is one tick below 11. 11 has been great with little or no AHI's so I'm a little skeptical of having it as high as 15.

A good laugh and a long sleep are the best cures....
05-01-2014 01:37 PM
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justMongo Offline

Monitors

Posts: 3,857
Joined: Sep 2013

Machine: ResMed VPAP Auto (S9)
Mask Type: Full face mask
Mask Make & Model: ResMed Mirage Quattro
Humidifier: ResMed H5i
CPAP Pressure: 18 IPAPmax - 11 EPAPmin, PS=5
CPAP Software: Other Software

Other Comments: μολὼν λαβέ

Sex: Male
Location: Калифорния

Post: #5
RE: Titration Question
It won't go to 15 unless it detects that you need to.
Read out the data after a few days and see where the pressure goes up to.
It might hit 15 after a cluster of events.
You can lower the upper limit after you watch it for a while; and satisfy yourself that 15 isn't needed.

Keep in mind every night is different; and you may change over time. 11 may be good now, but two years from now?

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.
05-01-2014 01:54 PM
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Stargazer Offline

Preferred Members-2

Posts: 100
Joined: Apr 2014

Machine: ResMed S9 AutoSet
Mask Type: Full face mask
Mask Make & Model: ResMed Mirage Quatro
Humidifier: H5i
CPAP Pressure: 10-15
CPAP Software: ResScan SleepyHead

Other Comments:

Sex: Male
Location: Carolina Coast

Post: #6
RE: Titration Question
(05-01-2014 01:54 PM)justMongo Wrote:  Keep in mind every night is different; and you may change over time. 11 may be good now, but two years from now?

Well, you hit it on the head; that's exactly why I wanted the machine!

Excellent advice as always. Thanks, Mongo and all!

A good laugh and a long sleep are the best cures....
05-01-2014 02:09 PM
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Tez62 Offline

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Posts: 837
Joined: Feb 2013

Machine: Resmed S9 Autoset
Mask Type: Full face mask
Mask Make & Model: Resmed Mirage Quattro
Humidifier: Resmed
CPAP Pressure: 5-15
CPAP Software: SleepyHead

Other Comments:

Sex: Male
Location: Melbourne, Australia

Post: #7
RE: Titration Question
(05-01-2014 01:37 PM)Stargazer Wrote:  
(05-01-2014 12:49 PM)Bama Rambler Wrote:  I don't know why you think 10cm is high when the old number was 11cm.

I maybe didn't articulate what I was thinking very well. I thought the range would be on the lower side of 11 with maybe a high mark of 12-14.

It seems strange that the lowest range is one tick below 11. 11 has been great with little or no AHI's so I'm a little skeptical of having it as high as 15.

Stargazer, there maybe a reason why they set your minimum at 10 but I do agree with you, my Sleep Specialists suggests a range difference of 10, so my minimum is 5 and my maximum is 15, I would ask the question why they have set those pressures, not saying they are wrong.
05-01-2014 04:19 PM
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trish6hundred Offline

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Posts: 6,453
Joined: May 2012

Machine: Resmed S9 AutoSet for Her
Mask Type: Full face mask
Mask Make & Model: Fisher & Paykel Simplus
Humidifier: H5i Heated Humidifier
CPAP Pressure: 10 - 7-20 Cm H2O
CPAP Software: Not using software

Other Comments: I started CPAP in 2008. Totally blind since birth.

Sex: Female
Location: Missouri, USA

Post: #8
RE: Titration Question
Hi Stargazer,
Those numbers sound normal. You could try it for a couple weeks and check your data for trends over time and see how things look.
Good luck to you with the new machine.

trish6hundred
05-01-2014 04:23 PM
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robysue Offline
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Posts: 1,247
Joined: Oct 2013

Machine: PR Dreamstation BiPAP Auto
Mask Type: Nasal pillows
Mask Make & Model: Swift FX
Humidifier: PR Dreamstation humidfier
CPAP Pressure: min EPAP = 4; max IPAP = 9;
CPAP Software: SleepyHead EncoreBasic EncorePro

Other Comments: Papping since September 2010

Sex: Female
Location: Buffalo, NY

Post: #9
RE: Titration Question
By starting out at 10cm, your machine won't have to "chase" events that happen when the pressure is far below your titrated needs.

You say things are good with 11cm. I take it that means that not only is your AHI nice and low, but that you are also feeling good and have no serious problems with leaks or aerophagia. If that's the case, there's really no need to start at a pressure any lower than 10.

As for the cap at 15: Chances are you won't hit it or you won't hit it often. If you do start hitting it a lot, it will probably be due to the machine chasing what it thinks is snoring and/or flow limitations. If that causes a lot of problems, you can either call the doc (and request the max pressure be lowered) or you can just lower it yourself.
05-01-2014 05:12 PM
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robysue Offline
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Advisory Members

Posts: 1,247
Joined: Oct 2013

Machine: PR Dreamstation BiPAP Auto
Mask Type: Nasal pillows
Mask Make & Model: Swift FX
Humidifier: PR Dreamstation humidfier
CPAP Pressure: min EPAP = 4; max IPAP = 9;
CPAP Software: SleepyHead EncoreBasic EncorePro

Other Comments: Papping since September 2010

Sex: Female
Location: Buffalo, NY

Post: #10
RE: Titration Question
(05-01-2014 04:19 PM)Tez62 Wrote:  Stargazer, there maybe a reason why they set your minimum at 10 but I do agree with you, my Sleep Specialists suggests a range difference of 10, so my minimum is 5 and my maximum is 15, I would ask the question why they have set those pressures, not saying they are wrong.
Tez,

I'm a bit surprised that your sleep specialist recommended such a wide APAP range. Do you regularly come close to hitting your max setting?

A lot of people find that a very wide APAP range can create as many or more problems than it solves. Many people find the wide swings in pressure wake them up. Others find that while the mask was well sealed at their min pressure setting, once the machine raises the pressure by 8-10cm, the mask loses its seal and the leaks wake them up.

While your sleep specialist seems to be happy with recommending a 10cm difference between min and max pressure, many sleep specialists want the range much narrower. It's often recommended that the starting APAP range be set with a min pressure of 1-2cm below the titrated pressure and the max pressure setting be set 1-3cm above the titrated pressure, with a total difference between min and max pressure of somewhere between 3 and 6 cm.
05-01-2014 05:17 PM
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