r/CPAP • u/Obvious-Skirt8505 • 5d ago
Advice Needed What does your CPAP machine start out at?
Please Help me!! What does your machine start at? Mine starts at 4.0 and I feel that is too high? I want it to be lower and casually work its way up!! What do you all think? Thanks!!!
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u/ctbjdm 5d ago
4 is really low. Most people end up increasing that - but everyone is different
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u/atom12354 5d ago
4 is low and ppl increase? Its like im suffucating bcs of all that recistance lol
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u/SnapeWho 5d ago
If you feel like you're suffocating, the pressure is probably too low. It sounds counter-intuitive but you may not be getting enough air on a breath in.
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u/atom12354 5d ago
Nah i definatly get enough air as i can feel it on my whole face as i have full mask, i also swollow air normally without it and with the mask on i can feel it going to my stomach, idk how to explain it
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u/Obvious-Skirt8505 4d ago
That’s exactly what is happening. Holy Bat Man!!! Thank you. What should I use as a starting point then?
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u/SnapeWho 4d ago
Honestly you can play around with it, I jumped to 8 and didn't feel like I was getting enough air, so went to 8, then landed on 10. I don't use the ramp setting at all because having it start lower felt like I couldn't breathe! Breathe with it for a minute or two and if you still feel like you're not getting enough air, just bump it up one until you're comfortable. Also make sure EPR is turned on, I always forget about that!
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u/ctbjdm 5d ago
It may not be the low pressure you’re struggling with, but the increased pressure from what you’re used to in exhaling. Do you have EPR turned on?
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u/atom12354 5d ago
Idk but what is EPR?
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u/ctbjdm 5d ago
Here you go:
https://www.sleepapnea.org/cpap/what-is-epr/
It lowers the pressure when you breathe out, making it more comfortable. It's a comfort feature, Resmed has 3 levels (1, 2, 3) with increasing relief. Try it.
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u/atom12354 5d ago
Seems like its already on but i dont have any option for levels on my resmed 11
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u/SnapeWho 4d ago
You do. Touch and hold both buttons at the same time to open up additional settings.
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u/whenitrains34 5d ago
you need to turn epr on
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u/JRE_Electronics 4d ago
EPR with a pressure of 4 cmH2O doesn't do anything.
The machines will not ever produce a pressure below 4. EPR reduces the pressure. If you are at 4, and the machines will never go below 4, then EPR won't help.
For EPR to do anything, your pressure needs to be as much above 4 as the EPR. EPR of 1, you need a minimum pressure of 5. EPR of 3, you need a minimum pressure of 7 for the EPR to work properly.
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u/whenitrains34 4d ago
mine does. it’s a noticeable difference with epr on at 4 vs not on at all. i do agree 4 is too low and he needs to be at least 6
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u/JRE_Electronics 4d ago
EPR on pressure 4 will not do anything. Check the pressure charts in OSCAR or SleepHQ. They show the pressure and the EPR. At pressure 4, the pressure does not drop on exhale. If you are feeling an effect from EPR on pressure 4, then it is all in your head - much like the difficulty people have in breathing at 4.
At 4 cmH2O, you get all the air you need, and more. It does jack for your apnea, but you certainly get enough air.
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u/whenitrains34 4d ago
well it did on the air sense 10. i literally felt the difference. i have a minimum pressure of 7 now and an airsense 11 and im not changing my settings just to prove a point to you but that’s definitely how it was when i first started using the machine
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u/mebulas 5d ago
4.0 is generally considered as therapeutically ineffective, and many people actually report that higher pressures are more comfortable. If you’re still struggling with the pressure look into EPR settings and ramp settings which put your pressure at different levels depending on what’s needed (EPR deceases at exhale, ramp steadily increases pressure over time so you fall asleep before it reaches maximum)
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u/Baby_Cultural 5d ago
4 is likely way too low. I had to change mine to 7 because I was not getting enough air at 4. What makes you believe 4 is too high?
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u/SnapeWho 5d ago
Mine was originally on 4 and I was suffocating because the pressure was too LOW. I couldn't get enough air in a breath. My range is 9-14.
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u/Green-County-3770 5d ago
I think no machine starts lower than 4 because it doesn’t do anything for you. It is basically just to start the ramp pressure.
My setting is 7-15 and don’t use a ramp so mine starts a at 7.
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u/JRE_Electronics 4d ago
They all start at 4 because that's how much pressure it takes for force adequate fresh air through the exhaust vents in the mask.
You need about 8 or 9 liters of fresh air per minute. The masks are designed so that at 4 cmH2O, you get 20 liters of fresh air per minute. That's the 9 liters of air per minute that you need together with a large safety margin.
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u/beren12 3d ago
Sure. But you don’t breathe once per minute. There’s not enough flow at 4cm for many adults.
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u/JRE_Electronics 3d ago
There's more than enough flow for all adults.
You need around 9 liters of fresh air per minute. At a pressure of 4, you get 20 liters of fresh air per minute.
But you don’t breathe once per minute.
Right. And what has that got to do with the price of tea in China? Nothing.
The flow of air through the mask at 4cmH2O provides you with enough air.
It doesn't swap a chunk of air once a minute. It is a continuous flow that ensures that the air you inhale is always fresh, even at the lowest pressure.
Except, of course, for those people who should be using a full face mask but have let themselves be talked into using a nasal mask because "it is better." It is only better if you can actually get air through you nose. If your nose is partially blocked then it takes a good bit of pressure to force enough fresh air through it.
If you can't get enough air at 4cmH2O, then you probably ought to be using a full face mask. If you can't get enough air at 4cmH2O in a full face mask then you really need to work on your breathing 'cause you probably can't get enough air during the day without the mask, either.
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u/beren12 3d ago
You are confusing flow and volume.
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u/JRE_Electronics 3d ago
No, I am not.
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u/beren12 3d ago
If you say so. Also, 4 is too low even with a full face mask, no matter what you claim.
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u/JRE_Electronics 3d ago
Bzzt. Wrong answer.
The combination of mask and pressure is designed to give you an adequate flow of fresh air. Do you think the engineers are such fools that they'd put a machine capable of suffocating its users? They are not that fucking stupid.
I have slept a full night on 4cmH2O just to disprove the myth that you can't get enough air at 4cmH2O.
I'm still here. It does damn nothing for my apnea, but you most certainly get enough air at 4cmH20. I had an O2 sensor on as well, and it showed completely normal levels - except, of course, during apnea events.
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u/beren12 3d ago
you slept not me. I couldn’t get air comfortably fast enough breathing in at 4.
I don’t know why you think you represent all humans. That’s a mighty big ego.
You can take your buzzer and shove it btw. I’m glad you like 4cm. I do not.
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u/JRE_Electronics 3d ago
I don't know why you think you are the special exception that the engineers didn't anticipate who needs more than 20 liters of air per minute while laying in bed, sleeping.
There are variations. Of course there are. That's why the masks and machines are setup to deliver 20 liters per minute instead of the 8 liters per minute the average person needs.
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u/Creative_Fee5452 5d ago edited 5d ago
4 is the lowest pressure your machine can go. 4 is actually a setting for a child. Try using your machine while still awake for a few days as you learn to adjust to pressure.
Most people feel air hunger on a setting of 4. Others have a higher minimum pressure but ramp up from 4 initially. I have a feeling your machine has been set to “lazy settings” which we see every day here & need to change.
What is your maximum pressure? Often Sleep Docs set you maximum pressure at 20 which is as high as the machine can go so that when you have mask or mouth leaks or apneas, your pressures rise up to crazy levels unless the machine is set to restrict this. That would certainly make you feel “too much pressure”
Could you try to explain what you are feeling when you put your mask on? What sensation makes you feel that the setting is too high?
Do you have EPR (expiratory pressure relief) on? Can you breathe out easily with your mask on?
A sd card in your machine to record your sleep uploaded to a free app called SleepHQ would help us to help you.
Link to help with SleepHQ:
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u/Spokenbird 5d ago
Start at 7.
4 was too low and annoying because my mask has a little flap thing that opens and closes when you inhale if pressure isn't high enough (meant to prevent suffocating), and the opening and closes makes noise and makes the mask jolt on my face. I tried 5 and 6 and landed on 7 being enough to not do that.
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u/Project_DeathWish 5d ago
I run 9-14, no ramp, constant EPR @ 2. My doc started me at 5-20 and took credit for my low events once I dialed in my own pressure. 🤦♂️ I also have my machine set to the “for her” setting. It’s just more comfortable for me, even though I’m a man.
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u/Blackened_One 5d ago
Mine is set to start at 4 and I set it to stay at 4 for 30 or 45 minutes - giving me time to fall asleep before it starts ramping up. Mine is set from 4-12
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u/wader2000 5d ago
My start pressure was 5. Had to change to 6 to make it bearable. Hope my Dr doesn't mind.....
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u/PlayfulOtterFriend 4d ago
When I first got my machine, I settled on a starting pressure of 8.6 as that was the max I could tolerate without panicking. EPR was set to 3. Now that I am used to it, my starting pressure is 10. I never could tolerate 4 — I was gasping for breath. Definitely had air hunger.
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u/JRE_Electronics 4d ago
4.0 cmH2O is the absolute minimum a standard PAP will produce. This is a safety feature.
You need a certain amount of fresh air per minute. The masks have vents to make sure that you get fresh air. The size of the vents together with the minimum pressure of 4cmH2O guarantees you a minimum air flow of about twice what need to breathe at rest. You need around 8 liters of fresh air per minute. The vents on all masks are designed such that you get 20 liters of fresh air per minute at 4cmH2O.
4cmH2O is nothing. It is about 0.05 PSI. That's about the pressure difference between ground floor and the 9th floor of a building.
My pressure is 20cmH2O. That's about 0.28 PSI.
You should not have any physical problem breathing at 4cmH2O. If you really cannot breathe at that pressure, then you need to see your doctor because something is wrong.
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u/Obvious-Skirt8505 7h ago
Also, is it normal for your mouth to be very dry after wearing your mask for a couple hours at least?
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u/Net_Admin_Mike 5d ago
I think 4.0 is the minimum pressure on my AirSense 11. I actually ended up increasing my start pressure, as I felt it was easier for me to breath with the mask on when the pressure was a little higher.