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Wide Open vs Narrow range
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OpalRose Offline

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Machine: PR System One REMstar Auto 560 with A Flex
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Other Comments: Started CPAP Therapy October 23, 2014

Sex: Female
Location: Northeast Ohio, USA

Post: #1
Wide Open vs Narrow range
(11-11-2014 12:20 PM)PaulaO2 Wrote:  Go you! Are you the one who had the high centrals with the titration? If so, those should go down with use.

And you have an AUTO. Why do you have it set to just a single pressure? Is 9 the prescribed pressure? If it is, consider setting the range to, say 7 -11 then let it run that way for ten days.

Hi Paula
I am new to this too. Own an auto Cpap, but doc left it set at 4 to 20. Should I leave it set that way? According to Sleepyhead, the pressure has never gone over
12 and the 90 % pressure usually stays around 8 or 9. My sleep study showed that I should be at a constant 9, but I only slept for 2 hours. Stopped breathing 33 times in one hour. My AHI has been between 2 and 3.5 per hour since starting CPAP on Oct. 23' 2014. Just curious about the pressure as I have read a few comments that a setting left at 4-20 isn't good, but I don't known why. Thanks for your help.

OpalRose
12-03-2014 07:54 PM
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Galactus Offline

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Machine: Phillips Respironics System One PRS1 DS760P Auto BiPAP
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CPAP Pressure: E/I 13/20 PS 4/7 BiFlex 3
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Other Comments: Sleep can be a good thing.

Sex: Male
Location: USA

Post: #2
RE: Outstanding DME!
(12-03-2014 07:54 PM)roe1549 Wrote:  
(11-11-2014 12:20 PM)PaulaO2 Wrote:  Go you! Are you the one who had the high centrals with the titration? If so, those should go down with use.

And you have an AUTO. Why do you have it set to just a single pressure? Is 9 the prescribed pressure? If it is, consider setting the range to, say 7 -11 then let it run that way for ten days.

Hi Paula
I am new to this too. Own an auto Cpap, but doc left it set at 4 to 20. Should I leave it set that way? According to Sleepyhead, the pressure has never gone over
12 and the 90 % pressure usually stays around 8 or 9. My sleep study showed that I should be at a constant 9, but I only slept for 2 hours. Stopped breathing 33 times in one hour. My AHI has been between 2 and 3.5 per hour since starting CPAP on Oct. 23' 2014. Just curious about the pressure as I have read a few comments that a setting left at 4-20 isn't good, but I don't known why. Thanks for your help.

4-20 to quote someone else is good if you're baking a pie. But for you and me the cpap wide open at default settings of 4-20 is usually a bad setting. Based on what you said the data shows I would set it at 7-13. That would give you a better range with far less changes, and likely feel better for you as well.

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12-03-2014 07:58 PM
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Ghost1958 Offline

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Machine: PRS1 Series Sixty Auto Aflex
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Post: #3
RE: Outstanding DME!
My set pressure from the lab was 15. The set lab pressure ive found thru experience doesnt really have to much meaning. Other than on that one night your at the lab.

For instance. With a nasal mask my pressure never goes over 12 max. And AHI numbers never go above 1.5.

FFM or Total face pressure sometimes goes as high 18 to clear things out. And AHI will run between less than one to as high as 3.

Different masks, nasal vs FF bad nights etc about make a single titrated pressure based on one night of sleep irrelevant.


Ive learned now what my range needs to be set at depending on what mask im using but that took a lot of studying encore and SH daily with the masks I use to get to that point.

Glad to hear you got a good machine and a good DME. Your on your way!!!
12-03-2014 09:10 PM
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PaulaO2 Offline
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Post: #4
RE: [split] Wide Open vs Narrow range
This is what I did when I went from a brick (non-data capable) CPAP to an autoPAP. My set pressure was 12. I set the minimum for 10 and the max for 16. Then I watched the data for two weeks or so. I kept messing with it, making slow changes. I quickly realized that my prescribed pressure was way too low based on the data.

For you, it will be much easier and not take as long. My suggestion would be: To determine your range, look over the data for the past few weeks. Note what the Median, 95%, and the Max pressures have been. Then set your minimum pressure to what the median usually has been. Set the max for a point or two above the typical 95% unless there have been several Max pressures higher than that. Then set it for that Max. Then sit back and collect data for at least two weeks.

Any changes you make, you want to make slow. You want to collect data for each one.

You also want to note each change you made. The date of each one! That way you remember when. Yes, SH can keep track of it for you but writing it down helps, too.

As for why the wide open isn't as good...well, it's just a matter of taming the machine. By limiting it, you are forcing it to work its best within those limits. And it can do a much better job that way, too. When you fall asleep, it is already there, at your range, ready to do its thing, instead of slowly climbing from the bottom to where it needs to be.

PaulaO2
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12-03-2014 09:53 PM
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AshSF Offline

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Post: #5
RE: [split] Wide Open vs Narrow range
You may want to use Optistart feature of the PRS1 60 series Auto. That will take care of start pressure.

My experience with pressure changes:
I started my 60 series Auto with a 4-20 range (as my physician suggested). I stayed on it for 45 days and my AHI settled to < 0.5 with an occasional 1.x within 15 days. So why bother with changing any pressure if the machine is doing its job AND I feel good thruout the day. I analyze my data with sleepyhead everyday and actually look at my waveform with a fine toothed comb. My steady state RDI is less than 3. Flow limit index is ~2.0.

I got an urge to experiment and raised my min to 5. Stayed on it for 11 days. The AHI was still ~0.5.

I raised the min again to 6. Have been on it for 14 days. My AHI is a shade above 0.5 but its statistically insignificant increase.

So my AHI is essentially same at 4-20, 5-20 and 6-20.

The stated objective of PRS1 is to give you as little pressure as possible to make it more comfortable. So IMHO, if the machine feels you are doing great on 4 cm H2o at a certain point in the sleep, so be it. There are advantages of lower pressures, as long as the AHI number is acceptable. I trust the PRS1 algorithm to decide whats best. And it is working so far. I don't know how it will be as time progresses. YMMV.

Started APAP 4-20, Closed range to 7.5-14, then straight 8.0 w/ Aflex 3
RDI always below 1. But sleep much much better at straight pressure.
Started on F10, Tried Quattro Air successfully. Finally settled on P10.
12-03-2014 11:27 PM
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Ghost1958 Offline

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Machine: PRS1 Series Sixty Auto Aflex
Mask Type: Nasal mask
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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: #6
RE: [split] Wide Open vs Narrow range
(12-03-2014 11:27 PM)AshSF Wrote:  You may want to use Optistart feature of the PRS1 60 series Auto. That will take care of start pressure.

My experience with pressure changes:
I started my 60 series Auto with a 4-20 range (as my physician suggested). I stayed on it for 45 days and my AHI settled to < 0.5 with an occasional 1.x within 15 days. So why bother with changing any pressure if the machine is doing its job AND I feel good thruout the day. I analyze my data with sleepyhead everyday and actually look at my waveform with a fine toothed comb. My steady state RDI is less than 3. Flow limit index is ~2.0.

I got an urge to experiment and raised my min to 5. Stayed on it for 11 days. The AHI was still ~0.5.

I raised the min again to 6. Have been on it for 14 days. My AHI is a shade above 0.5 but its statistically insignificant increase.

So my AHI is essentially same at 4-20, 5-20 and 6-20.

The stated objective of PRS1 is to give you as little pressure as possible to make it more comfortable. So IMHO, if the machine feels you are doing great on 4 cm H2o at a certain point in the sleep, so be it. There are advantages of lower pressures, as long as the AHI number is acceptable. I trust the PRS1 algorithm to decide whats best. And it is working so far. I don't know how it will be as time progresses. YMMV.

I sort of agree that setting max isnt really a cast in stone thing on an auto. But alot cant breathe with a min setting of 4. Im one of em.

And since my O2 drops rapidly with back to back OSAs I like my min high enough the machine gets the job done faster than it can climbing all the way up from 4. My AHI numbers can be 1 or less but four or five OSAs close together can bring my O2 sats into the low 60s so I run the machine to avoid that by having min high enough to prevent it.

8 is about as low as I feel like Im getting enough air.

I prefer to put a max limit on my PRS1 auto but depending on the mask im using that max can be as high as 18.
12-03-2014 11:38 PM
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OpalRose Offline

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Machine: PR System One REMstar Auto 560 with A Flex
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Post: #7
RE: [split] Wide Open vs Narrow range
Thanks everyone! There is a lot to learn. One question though...what does the opti start on the system one do?

OpalRose
12-04-2014 09:20 AM
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PaytonA Offline
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Post: #8
RE: [split] Wide Open vs Narrow range
I apparently do not have many flow limitations that the machine cares about and it registers literally no snore. So the only thing that the machine is left to respond to much of the time is OAs or Hs. For this reason a wide open range would not work as well for me. In fact, when I open up the range on the low end my AHI generally goes up.

If a wide open range of pressures works well for you that is fine but that does not seem to be the general rule.

Best Regards,

PaytonA
12-04-2014 10:16 AM
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zonk Offline

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Post: #9
RE: [split] Wide Open vs Narrow range
Apology-2 in advance, I've not been following this thread but the title grab my attention "Wide Open vs Narrow range"

I'm leaning towards the "narrow range" and minimum pressure close to my therapeutic pressure
Waste of time to have it any lower and would make me feel uncomfortable

As for the maximum, 2 or 3 higher .... ymmv
12-04-2014 03:15 PM
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Galactus Offline

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Machine: Phillips Respironics System One PRS1 DS760P Auto BiPAP
Mask Type: Nasal pillows
Mask Make & Model: ResMed Airfit P10 Nasal Pillow
Humidifier: System One Heated Humidifier + Climate Line
CPAP Pressure: E/I 13/20 PS 4/7 BiFlex 3
CPAP Software: SleepyHead EncoreBasic

Other Comments: Sleep can be a good thing.

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Location: USA

Post: #10
RE: [split] Wide Open vs Narrow range
(12-03-2014 11:27 PM)AshSF Wrote:  You may want to use Optistart feature of the PRS1 60 series Auto. That will take care of start pressure.

My experience with pressure changes:
I started my 60 series Auto with a 4-20 range (as my physician suggested). I stayed on it for 45 days and my AHI settled to < 0.5 with an occasional 1.x within 15 days. So why bother with changing any pressure if the machine is doing its job AND I feel good thruout the day. I analyze my data with sleepyhead everyday and actually look at my waveform with a fine toothed comb. My steady state RDI is less than 3. Flow limit index is ~2.0.

I got an urge to experiment and raised my min to 5. Stayed on it for 11 days. The AHI was still ~0.5.

I raised the min again to 6. Have been on it for 14 days. My AHI is a shade above 0.5 but its statistically insignificant increase.

So my AHI is essentially same at 4-20, 5-20 and 6-20.

The stated objective of PRS1 is to give you as little pressure as possible to make it more comfortable. So IMHO, if the machine feels you are doing great on 4 cm H2o at a certain point in the sleep, so be it. There are advantages of lower pressures, as long as the AHI number is acceptable. I trust the PRS1 algorithm to decide whats best. And it is working so far. I don't know how it will be as time progresses. YMMV.

The key of why this works for you is the information you left out, and that is what the pressure is that maintains your ahi at .5 or below. For some a max pressure of 7 is all they need to maintain an ahi of .5 or below. If that is the case than having the machine set at 4-20 is meaningless as it never rises above say 7 and so it's really set at 4-7 anyway even though it can get to 20.

For someone like me titrated at 18 a setting of 4-20 would mean the machine would waste the first hour of my therapy getting to where it needed to be and likely suffocating me most of the way as I find it almost impossible to breathe with the mask on at below 8.

the OP indicated their pressure which is why I suggested the settings I suggested so as to eliminate the low end wait and difficulty breathing that most experience on the low end of the 4 pressure settings.

My personal unit setting at 13-20 allow me to get right to sleep experiencing no discomfort and allow the machine to adjust as needed all the way through to 20. I also have a bipap which I am using and am setting the lower end down slowly as it rarely seems to rise on epap and stays steady at 13 indicating I might be ok with 12 11 or even lower, but I am experimenting slowly. However my ipap is still always at 16-20 so setting it below would defeat the purpose. YMMV depending on your pressure settings as will the OP's.

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12-04-2014 03:17 PM
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