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Upper pressure limit setting
I use a Resmed S9 CPAP with a lower pressure setting of 12 cm/H20. My average pressure values observed with Sleephead software is between 14 and 16 cm with excursions to 19 cm. Should I the upper pressure at a value lower than 20 cm? Any other comments on these high pressures?
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In general, the machine only adjusts pressure high enough to resolve obstructive events, such as apnea, flow limitations, snoring and volume reductions and hypopnea. The upper pressure setting is usually more useful as an upper limit if higher pressures disrupt your sleep, or cause central events, and similar problems. We have even seen where pressure too high causes events recorded as patterns of OA and periodic breathing. It would be more relevant to know what your median and 90% pressures are during use, and what your EPR setting is. With a 14-16 average and 95+% at 19, a 20 cm maximum is not unreasonable unless it causes problems. The machine should self-regulate.

Tolerance to higher pressures can be mitigated somewhat by using EPR on your machine, but like with any bilevel, obstructive events and oxygenation are controlled by EPAP, and IPAP is for ventilation and to blow off CO2. Using EPR or a bilevel approach may result in higher IPAP than you would have if using a single pressure. What I'm trying to say is if you are using EPR at 3, you might have a need for higher CPAP pressure than if you use EPR at 0 or 1.
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