Range of CPAP Pressure : CPAP VS APAP

I was diagnosed with sleep apnea and began CPAP in December 2018. I did a home study and then an overnight in a sleep center.

I use a Philips Dreamstation with a heated humidifier and tubing, silicone head mask with nasal cushion, and a chin strap. Air setting 6; humidity 3. I use the Philips DreamMapper app to track the AHI’s.

Sleep quality improved dramatically using the CPAP. No snoring or gasping; literally awake feeling rested and refreshed for the first time in my life. AHI’s stay below 5 generally.

In March 2019, I had partial knee replacement surgery and in May 2019, I had shoulder rotator cuff repair surgery. The anesthesia during the surgery and the pain medications after seemed to affect my AHI’s. I think a major factor also is that I have had to sleep on my back since both surgeries, which gives me higher readings than when I sleep on my side. Note: I was told that unless my AHI’s were sustained at 15 or higher during the recovery, I should not worry.

I do believe that medications affect my AHI’s.

I started tracking a correlation. I also noted that what foods I ate from dinner to bedtime also affected my AHI’s. And now I am experimenting with taking some an hour or more before bedtime. Still tracking both meds and foods, as well as the timing.

I take Celebrex and Tylenol now. Have stopped stronger meds.
Sugar in any form or food (even fruit) is the food that seems to most negatively affect my sleep quality.

Update: I checked w my CPAP supplier and Medicare compliance rep and learned that my device can be set for a range of pressures. So I am meeting w my doctor next week to discuss changing my static pressure to a range.
If anyone uses a range, please share your experiences with that.
Thanks!

Hi Louise, I have been using a Dreamstation with humidifier for the last 14 months, but my machine is a bipap, which blows two different pressures timed to my average breath times. It blows air in at a level of 12 when I am inhaling, and in at a level of 8 when I am exhaling. It is very comfortable because if I don’t breathe, it delivers a breath, and I breathe comfortably. It also takes away the effort of exhaling. Not sure what you mean by a range.

Definitely agree meds affect AHIs, as does food (my rule is no eating after 9pm) and alcohol. For me, it is not only the types of food I eat, but the quantity also. A fuller stomach = less room to breathe. My AHIs are usually under 5, but sometimes spike as high as 23.0.

Thanks! I will ask about the bipap also.
Here’s a link that explains the differences:

Wow thank you for sharing your journey with us.

Saw my dr today. She wants me to have my machine checked/serviced, and if it is working correctly, she is going to order another titration sleep study to see what is causing the change, and if Bi-Pap would be better.
As an aside, the DME company I got it from said they do not actually “service” machines, but they have you bring it in and they check it (and the heated hose, etc), on you.
Has anyone had a machine “checked”?

Followup: My DME company’s respiratory technician ran a thorough diagnostic of my CPAP machine. I was able to watch him check all the settings, features, parts, and power supply. He even turned on a feature that shows a weekly and monthly average AHI on the device. DreamMapper app on my phone gives data for each day, but not averages. It does give nice 14,30,60,&90 day bar charts, which give a visual tracking, but not averages. He gave me a printout of the test and results to share with my doctor.
My machine is working perfectly, so the change is in me.

To my surprise, my doctor called me right back after I dropped off the report showing my machine is fine. Instead of scheduling another sleep study, she referred me to a Pulmonologist who specializes in Sleep Apnea. I called him for an appointment and his first new patient appointment is months away! But as his receptionist was booking me for that, someone called on another line and canceled for tomorrow, so I am going tomorrow! Seems serendipitous. I have to take my CPAP machine with me. I will update after this appointment.

Update after meeting with my new Pulmonologist/Sleep Apnea/Respiratory Specialist MD:
I am now using APAP for a six-week period. Then I return to this specialist MD and we will discuss the results.
I thought he was going to set the range at 4-12, but he was reading my data on his computer and talking with me, discussing options; it looks like it is set for 6 to 10 now.
He suggested I experiment w using the ramp feature settings. And he turned on several features in addition to the APAP, so I reread the manual to get familiar with those: Flex at 3; One day, 7 day, & 30 day AHI averages; PreHeat for the Heated Humidifier; a Diagnostic check of the machine.
I set the ramp to start at 4 and ramp for 10 minutes. I’m going to set it perhaps at 20 tonight. And I’m going to preheat the humidifier.
My AHI last night (first night at new APAP range) was 7.2, so no # improvement (I know it takes days/weeks to adapt), but I fell asleep faster, only woke up once, and felt better/more rested when I woke up than I did at 6.4 the day before.
He also wants me to keep track of times during the day when I am sleepy or fall asleep.
He also wants me to have my husband tell me if I ever snore or gasp in my sleep. I have not done either since the first night I started using the machine.

I reread the manual for my DreamStation to familiarize myself with all the new changes the new doc made and the new screen readouts he activated. And I reviewed some of the Help, FAQs, Coaching videos on the DreamMapper App.Two gleanings here:
1)I was told at the device training session to clean the water chamber once a week and the manual says every day. I have done the 30 minute soak wash once a week, recently started leaving the water chamber (and the heated tube) out to air dry every day after emptying it in the morning, and yesterday started giving it a daily short wash with the mask.
2) In one of the short coaching videos on the app, they say that if your mask whistles, there is not enough water in the water chamber of the humidifier. Interesting, as this is not stated in the FAQs, troubleshooting, or guidelines. Mine whistled once when I first started using it, even though I had filled it to the max line, so I have filled it to just above that line (very very close) ever since, and have not had that issue again.
I also browsed through other posts here. The comments by davidp and shugemann about the role our bodies play ring true with me.
I sleep better and get better readings when I get 8 hours of sleep, am hydrated, exercise, and eat moderate amounts of nutritious food.

Update. DME company called Wednesday and said the dr wanted my APAP set to 6-12 range (not 6-10), so I started that. Much better. Waking up once. AHI lower/better each night; down to 2.7 last night. Also, one of the new screen displays shows what pressure I’m using 90% of the time: 11 first night and 10 last night. (Note: Sleep study was 6 constant. I had tried 7 constant and it was uncomfortable so had gone back to 6 CPAP). The APAP RANGE, so far, is much better. I feel rested and awake below 5, and energized when I am below 3.
Note: I am using the ramp at 4 for 20, and am preheating the humidifier, and am washing and air drying the water chamber as well as the mask daily. Air drying tube daily. Wash/soak everything weekly. Change parts as directed.
Dr also added the Flex comfort feature and changed the heated humidifier to Adaptive.

Flex feature evidently makes the exhale more comfortable. Dr chooses the setting ( I believe he set mine at the highest).

October 14, 2019
Today was my 7-week “trial of APAP” follow up with the pulmonologist/sleep apnea doctor.

He said it would take at least 4 weeks for my body to adjust and decide if the APAP and the prescribed range & settings are correct. The last 3 weeks I have done much better. And these last 2 weeks, I also changed/increased the humidity setting and I have had “normal/no apnea” readings every night—except the nights I ate too many starchy carbs and too much sugar.

He gave me two additional “comfort” suggestions to try also:

  1. He suggested either not using the ramp feature at all or setting it for no more than 10 minutes. He believes going to sleep without it is better.
  2. He said I could adjust the humidity and the heat to my preference. No problems with adjusting either or both. The newest machines like mine are safe.

So I am going to stay with APAP at the same pressure range settings for another 6 months.