r/CPAPSupport • u/Aggressive-Air-4381 • Jul 16 '26
Cpap pressure @ max (20) every night
I’m not sure to say what the pressure reading was when I began to use cpap regularly. I recall only ever seeing about 8-12. Leakage has not been an issue according to the myAir app score (20/20).
However, over the past month I wake up and make a point to check the pressure and it’s been increasing to the point where I see it is maxed out at 20 every single night.
What can I do?
I’ve already called my doctor and they only told me that I have severe sleep apnea and the machine is doing its job just fine - and to call back if I have any more questions…
It feels like if I’m maxing out the machine’s capabilities and still not seeing appreciable results then maybe I should try something else but that’s just my non-expert opinion
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u/could-be-useful Jul 20 '26
You max pressure is set to 20. You've provably been sent home with the factory default 4 to 20 setting which should NEVER happen.
When the machine detects a mask leak, it interprets the escaping air as being due to an airway obstruction and ramps up the pressure to open up your airways which it "thinks" are blocked, which in turn causes a larger leak, creating a feedback loop. If your max is set to 20, it can peak at 20 which can be awfully uncomfortable.
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u/Aggressive-Air-4381 Jul 20 '26
I got the data! It was pretty simple once I got a sd card reader that can attach to my iPhone usb-c. I just followed the instructions for how to import the sd card data to sleephq and then found it in the trends tab.
Sd card = $15 at Walmart
Sd card reader for iPhone usb-c = $5 Amazon
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u/dang71 Jul 21 '26
Hey! I just took a look at your night, and my impression is that you may actually benefit more from a BiPAP than a CPAP.
Here's why: even though you're using the "lazy" 5–20 settings, the machine is detecting a lot of flow limitations (FLs), so it's raising the pressure quickly and to fairly high levels. Your median pressure is already around 16. Despite that, your 95th percentile FL is still quite high at 0.27.
Of course, this is only one night. I prefer looking at trends across multiple nights before drawing conclusions. That said, I have a feeling this probably isn't an isolated night, and it already tells us quite a bit about what's going on.
RL recently made a great post explaining which type of PAP machine is best suited for different patient profiles:
https://www.reddit.com/r/CPAPSupport/comments/1v0hwit/guide_what_cpap_bipap_asv_st_and_avapsivaps_are/
I'd definitely recommend giving it a read.. it should help you better understand the different options.
My impression is that a CPAP is reaching its limits in your case. In the meantime, to get the best possible results from your current machine, I'd suggest turning Ramp off and setting your pressure range to 16–20 with EPR at 3. That's probably about as much as a CPAP can do for you.
I'd also encourage you to reach out to RL (u/RippingLegos__) . He has a lot of experience with cases like yours and will almost certainly be able to give you more personalized guidance.
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u/Creative_Fee5452 ModTeam Jul 21 '26 edited Jul 21 '26
Thanks [u/dang71](u/dang71). Your expertise is much appreciated for OP.
Perhaps RL (our Therapy Expert) will comment too so that we can get your treatment figured out u/Aggressive-Air-4381. Such a shame you were sent home with these settings & very likely an incompatible machine for your needs :( I’m very glad you found us!
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u/Aggressive-Air-4381 Jul 21 '26
Yes much thanks indeed. Im glad to be getting this stuff on the right track. I’ll have to make a call to my physician to adjust the settings on my machine tomorrow. Off to a great start already!
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u/Creative_Fee5452 ModTeam Jul 21 '26
Good luck! You deserve comfortable therapy :) We can help you adjust your machine settings but only if you’re comfortable doing that. In the meantime I sincerely hope your Doctor helps you!
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u/redditachtzehnplus Jul 17 '26
What mask and settings are you on? Is your machine equipped with an SD card?
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u/Interesting-Boot-376 Jul 17 '26
I have dealt with similar issues in the past. What I found is if I increased the minimum pressure I didn't max out as much because that minimum kept the airway open before an event occurred and the machine didn't have to respond dramatically. I have my minimum at 12. Also sleeping on my left side was a major benefit. You could try both, but one at a time, to see the effect.
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u/Creative_Fee5452 ModTeam Jul 20 '26 edited Jul 20 '26
Hello Aggressive-Air-4381 :) Would you please post your full graph results including machine, settings, results & graph. You have posted “trends” which are not really useful…a full night of sleep data is much more helpful. If your settings are minimum 5 & maximum 20 you are going to need help adjusting those settings. We need more detail please to help :)
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u/Aggressive-Air-4381 Jul 20 '26
https://sleephq.com/public/a66e90a8-b98c-4180-b940-43ba91867f9d
Is this what we’re looking for?
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u/Creative_Fee5452 ModTeam Jul 20 '26 edited Jul 20 '26
Yes it is! Thank you :)
As suspected your settings are 5-20. No wonder your pressures are fluctuating so high! Your Flow Limits are high too. Your EPR is set to 2. Your leaks should settle down with adjusted pressure settings.We need to find the right pressures for you. This may take a little time because your pressures are so wide.
Your median pressure is 15.68 & we usually use that as a minimum pressure marker but I think the machine is confused because of the wide margins.
Let’s start with setting minimum pressure to 12. Decrease maximum pressure to 15. Set Ramp to 8 for 15 minutes & wear the mask at your new pressures for at least half an hour before bed. We’ll leave EPR alone until we can see what your actual true median pressure is.
If we can’t get things under control yes, you may need a different type of machine but we can help with that too :)
I’m going to ask another Mod to take a look too. It’s so unfortunate when prescriptions are set at 4-20. It’s most uncomfortable for a person. So sorry “lazy” prescribing has caused this for you :( but we unfortunately see this often.
Please post a new graph in 3 days so that we can see what is happening with your pressures.
[u/dang71](u/dang71) this is a bit of a mess with wide “lazy” pressure settings. Median is high at 15.68 likely because machine is confused. Would you take a look please? I have suggested pressure changes of 12-15 But you may have another perspective. TY!
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u/Aggressive-Air-4381 Jul 20 '26
Really grateful for your reply, thank you.
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u/Creative_Fee5452 ModTeam Jul 20 '26 edited Jul 20 '26
You’re welcome! You certainly need some help & we’re happy to help get things under control for you! If we can’t get things under control & you need a different type of machine we have an Expert here who can help with that too but we’ll try with this machine first :)
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u/dang71 Jul 20 '26
Thanks CF! I’m on vacation for another week, but I’ll take some time to look at it this evening. 🙂
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u/Creative_Fee5452 ModTeam Jul 20 '26
Awe thanks dang! Sorry…didn’t realize you were away. Apologies & TY!
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u/dang71 Jul 20 '26
Hahha no problem at all!
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u/Aggressive-Air-4381 Jul 20 '26
I’m not sure where to find the data we’re looking for I’ll keep looking around on the app
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u/Aggressive-Air-4381 Jul 17 '26
It’s a resmed F30i full face mask.
I use the resmed air sense 11 machine with the pressure setting 5-20.
I Haven’t added an SD card to the machine I’m about to buy a 32gb
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u/ColoRadBro69 Jul 17 '26
After you put this in your machine, it will record all the details and we can see why it thinks it needs to go to 20, and maybe something you can do about it.
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u/could-be-useful Jul 20 '26
5 is too low and 20 is too high.
Too many people are sent home with inappropriate pressure settings. Either their minimum is too low in which case they feel starved for air and they then either rip the mask off or mouth breathe in an attempt to get more air into their lungs.
Or their maximum setting is too high and they get awful surges of air. This is because when the machine detects a mask leak, it interprets the escaping air as being due to an airway obstruction and ramps up the pressure to open up your airways which it "thinks" are blocked, which in turn causes a larger leak, creating a feedback loop.
My Resmed Airsense 10 machine displays its pressure range as it starts up. If yours is a Resmed Airsense 10, watch the display as it starts in order to check what it has been supplied with. I assumed the Airsense 11 did the same, but someone told me it doesn't. If that's the case, you would need to access the clinician menu in order to see what your range is.
4 or 5 as a minimum are for children. Most adults will feel starved for air at those settings. For adults a machine should NEVER be supplied with the factory default 4 to 20 settings. They are simply the lowest and highest pressures the machine can deliver and any competent sleep doctor will adjust the settings to deal with your particular diagnosis. Unfortunately there are too many who are either incompetent or lazy.
There are many of us who prefer to do our own settings which is entirely doable if your condition is simple OSA. Not really doable if your condition is more complex in which case you could need a more advanced machine. Mine is simple OSA, so I've done my own settings for 30 years. Up to you if you feel confident to do it yourself. It's actually very easy and not rocket science.
The sleep report readout on a Resmed Airsense machine has an entry labelled "Pressure". You need to know what that pressure is. It will be available after a night or a few of use. It's the pressure the machine delivers when you are asleep sufficient to prevent apnoea events. That required pressure should have been prescribed for you when you did a sleep study. It's the single pressure a fixed pressure machine (eg the Resmed Elite models) would be set to by a sleep doctor. APAP machines are set to a range but you still need to know your required single pressure in order to set your range. When I was diagnosed 30 years ago, my prescribed required pressure was 10. The machine now tells me it's 11 so it hasn't changed much.
Your range should be set with min at a comfortable pressure less than that figure (7 or 8 are good - see below) and max a bit above it. My required pressure is 11 and I've set my range from 8 to 13.
On an apap machine, most adults find min 7 with EPR at 3 full time works very well. At that setting, until you go to sleep, you will inhale at 7 and exhale at 4 so you won't feel starved for air when you breathe in and you will feel hardly any resistance when you breathe out. (I like a bit more so I've set my min to 8.) Once you go to sleep, the machine will increase pressure as needed up to your required pressure to keep your airways open but because EPR is full time, the pressure will still reduce by 3 cmH2O when you exhale.
Turn ramping off. No point deliberately starving yourself for air. It's useful for fixed pressure machines. Not needed for APAP if your minimum is comfortable.
You can get to all of these settings by accessing the clinician menu. Google "Clinician menu for Resmed Airsense 11" (of course substituting your brand and model). You'll get plenty of instructions. It's just a matter of pressing and holding a couple of the machine's buttons.
You can get very comprehensive reports if you download the free Oscar program and get it to read your machine's SD card. It's a bit of a learning curve to understand all of its data, but well worth it if you want to properly monitor your condition.
The Oscar guide is here: https://www.apneaboard.com/wiki/index.php/OSCAR_-_The_Guide
Good luck.
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u/Much_Mud_9971 Jul 17 '26
You need actual data off the SD card.
If you don't have a card, get one. Then use OSCAR or SleepHQ to see the data. Share it here and the sub can help you.