Post Reply 
Wide Open vs Narrow range
Author Message
Ghost1958 Offline

Advisory Members

Posts: 957
Joined: Aug 2014

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: #11
RE: [split] Wide Open vs Narrow range
(12-04-2014 09:20 AM)roe1549 Wrote:  Thanks everyone! There is a lot to learn. One question though...what does the opti start on the system one do?

Opti start when enabled will reset its min starting pressure after 30 hrs of use based on events pressure rises etc etc to the optimum starting pressure for you and the mask your using.

However though it will start at this new pressure by itself if you have no events for it to respond to for the first 5 or 10 minutes I forget which, it will drop back down to the original min pressure the machine was set for.

To have the machine use the new optimum min pressure all the time you will need to go into the clinical settings and reset your min pressure to what opti start determined.


I will if I change masks or based on what im seeing on software will enable Opti start, let it calculate the best min pressure, reset min to that pressure and then turn off opti start until I change mask styles or my software results look like my min is either to high or to low.

If you leave it enabled it may or may not change your starting min every thirty hours based on what the machine determines it needs to be or if it needs changed at the end of that 30 hr period.

But again unless you reset your min pressure manually to the pressure Opti start has picked it will simply drop or raise to your last manually set min pressure if you have no events.
12-04-2014 05:50 PM
Find all posts by this user Post Reply Quote this message in a reply

Donate to Apnea Board
AshSF Online

Advisory Members

Posts: 356
Joined: Oct 2014

Machine: PRS1 D560TS
Mask Type: Nasal pillows
Mask Make & Model: ResMed P10, Bkup: Airfit F10 & Quattro Air
Humidifier: PRS1 60 series with Heated Tube
CPAP Pressure: 8 - 8 w/ Aflex 3
CPAP Software: SleepyHead

Other Comments: Using APAP mode with fixed pressure

Sex: Male
Location:

Post: #12
RE: [split] Wide Open vs Narrow range
(12-04-2014 03:17 PM)Galactus Wrote:  
(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.
My 90% pressure has ranged b/w 10.6 to 11.1 cm H2o. So the machine is covering a lot of ground from 4 to 10.6. My peak pressure goes up to 14.5.

Although, as you correctly pointed out, if my 90% pressure was 15 or higher, this strategy of leaving it wide open at 4-20 may not work to avoid clusters of events.

But how will a newbie like myself know whether 4-20 will get him to 0.5 AHI or is it 5-20 or 10-20? All one can do is start from 4-20, give it 7-14 days to settle and them bump up the pressure 1 at a time, until the desired result is achieved.

If I followed the prevailing conventional wisdom of setting the range of +2 and -2 from the 90% pressure, I would be sitting at a range like 8-12. This will give me higher pressures than I need most of the time, And on the other end, it may not tackle the events that PRS1 60 does by going up to 14.x cm H2o occasionally.

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.
12-04-2014 06:01 PM
Find all posts by this user Post Reply Quote this message in a reply
Galactus Offline

Advisory Members

Posts: 1,388
Joined: Jan 2014

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.

Sex: Male
Location: USA

Post: #13
RE: [split] Wide Open vs Narrow range
(12-04-2014 06:01 PM)AshSF Wrote:  
(12-04-2014 03:17 PM)Galactus Wrote:  
(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.
My 90% pressure has ranged b/w 10.6 to 11.1 cm H2o. So the machine is covering a lot of ground from 4 to 10.6. My peak pressure goes up to 14.5.

Although, as you correctly pointed out, if my 90% pressure was 15 or higher, this strategy of leaving it wide open at 4-20 may not work to avoid clusters of events.

But how will a newbie like myself know whether 4-20 will get him to 0.5 AHI or is it 5-20 or 10-20? All one can do is start from 4-20, give it 7-14 days to settle and them bump up the pressure 1 at a time, until the desired result is achieved.

If I followed the prevailing conventional wisdom of setting the range of +2 and -2 from the 90% pressure, I would be sitting at a range like 8-12. This will give me higher pressures than I need most of the time, And on the other end, it may not tackle the events that PRS1 60 does by going up to 14.x cm H2o occasionally.

Keep in mind that 4-11 isn't really that wide of a setting overall, especially compared to 4-20. If you were using ramp on a 15-30 cycle you would be at your base when the machine kicked in. I'm set 11-18 max 20, which is pretty equivalent.

Good you did get my point on being 15 or over, that was what I was trying to say.

As a newbie I agree with you 100%, if you don't have a titrated script with a number then using opti start and wide open for a week would get you to a starting point. However the OP here listed a pressure set which is why I said don't waste time with the low setting and get setup narrower.

I'm not certain the prevailing wisdom is +/-2, imho it is +/-4 along with flex and or pressure support. If I were you and 90% was 10 I would have set 8 (because under 8 for me I can't breathe) if you are comfy you could go 6 and top of 14. That would cover you all around, and allow no discomfort at the low end.

For me I was 18 and given a brick at 18 flat. When I got my bipap I initially set it at 13-20 I felt much much better at those settings and I am still tickling it now to get it exactly where I want it. But I can tell you it covers me all around and the narrower setting allows the PRS1 a faster reaction time during the hunt and peck and it helps me breathe better without that low initial pressure feeling.

If everyone thinks alike, then someone isn't thinking.
Everyone knows something, together we could know everything.
(This post was last modified: 12-04-2014 07:49 PM by Galactus.)
12-04-2014 07:48 PM
Find all posts by this user Post Reply Quote this message in a reply

Donate to Apnea Board
PsychoMike Offline

Advisory Members

Posts: 551
Joined: Aug 2013

Machine: ResMed S9 AutoSet
Mask Type: Other
Mask Make & Model: Varies with mood, ResMed F10 is my primary
Humidifier: ResMed H5i
CPAP Pressure: 12-17
CPAP Software: SleepyHead

Other Comments: asthma, cyclist upgraditis, just a little crazy (honest :D )

Sex: Male
Location: Alberta, Canada

Post: #14
RE: [split] Wide Open vs Narrow range
I find that leaving the top end open isn't really an issue....gives the machine whatever play it needs to deal with any events that pop up. An open bottom end is more of an issue.

First, most people don't tolerate their mask well at a pressure of 4 cm H20...they complain of a feeling of suffocation. Second, if you need a pressure of 9 (foe example) to effectively splint your airway, then the machine needs you to have an event (impacts your sleep) before it can start to react. Once you're stable for a bit, it'll try to reduce your pressure again toward the 4 cm H20. You'll start having events again until it bumps the pressure back up. It becomes a constant tug of war between stopping events and trying to get back to the minimum pressure, with your sleep suffering through the process. Sure, it's not as bad as not using the machine, but it is not as effective a therapy as it could be.

Myself, I find that a min pressure setting 1-2 below my 95% pressure usually gives me my best results. I can tolerate the pressure and don't have the "tug-o-war" between a collapsing airway and minimum pressure. Of course YMMV Smile
12-05-2014 12:34 PM
Find all posts by this user Post Reply Quote this message in a reply
Post Reply 


Possibly Related Threads...
Thread: Author Replies: Views: Last Post
  Why Are AHI High When Wide Awake? Dreams of Green 7 670 10-18-2016 09:35 PM
Last Post: 0rangebear
  Please HELP! New CPAP user .. 3.5 weeks in .. AHI still avg high 4 - mid 6 range mikeuva123 20 1,299 07-25-2016 07:48 AM
Last Post: computerbudda
Arrow [CPAP] nose surgery = open air way = Bi pap doesn't work? TMONK 6 569 06-17-2016 06:07 PM
Last Post: richb
  fixing open mouth jxyzobrien 22 2,291 05-16-2016 08:09 PM
Last Post: surferdude2
Question Help understanding sleep report and setting APAP range. allynpsych 5 912 04-20-2016 12:57 PM
Last Post: allynpsych
  Need some advice on APAP Range settings chill 35 2,460 04-13-2016 03:27 PM
Last Post: palerider
  [CPAP] Nasal mask - open mouth - air comes out terrycva 2 666 04-03-2016 06:40 AM
Last Post: DeepBreathing

Forum Jump:

Who's Online (Complete List)