CPAP Pressure Settings (2024)

Table of Contents
How to Determine the Proper Pressure Setting for a CPAP Machine Take Our Quiz to Know Your Sleep Apnea Risk Factors That Affect the Pressure Setting of a CPAP Device How to Tell if Your CPAP Pressure Is Properly Set Signs Your CPAP Pressure Is Too Low Signs Your CPAP Pressure Is Too High APAP Machines Frequently Asked Questions About Our Editorial Team Jay Summer,Staff Writer Dr. Abhinav Singh,Sleep Medicine PhysicianMD References Learn More About CPAP Online CPAP Stores That Take Insurance Is It Safe to Buy and Use a Used CPAP Machine? Can You Get a CPAP Machine Without Insurance? Can You Buy a CPAP Machine Online? Can You Buy CPAP Supplies In Store? Can You Buy a CPAP Machine in Store? Should You Use Distilled Water for a CPAP Machine? What Is a BiPAP Machine? What Is a CPAP Machine? CPAP Recalls: What You Need To Know What is CPAP Compliance? EPAP Therapy As A CPAP Alternative Aerophagia: Symptoms, Causes, and Treatment CPAP Dry Mouth: How to Stop It Common Side Effects of CPAP Sleep Apnea Treatments Without CPAP Does Insurance Cover CPAP? Before and After CPAP Machine Effects: How Your Body Changes Do You Need a Prescription For a CPAP Machine? What Are Micro CPAP Devices and Do They Work? CPAP and COVID-19 How Do I Purchase a CPAP Machine? The Link Between Sleep Apnea and Teeth Grinding CPAP: Continuous Positive Airway Pressure BiPAP vs. CPAP Machines: Breaking Down the Differences How to Use a CPAP Machine for Better Sleep What Are the Different Types of CPAP Machines? CPAP Benefits If I Snore Do I Need CPAP? APAP Machines: A Guide to Treatment How Much Do CPAP Machines Cost? CPAP Mask Types What Does CPAP Stand For? And Other PAP Acronyms How to Choose a CPAP Mask Based On Your Sleep Position APAP vs CPAP How to Clean a CPAP Machine Other Articles of Interest Sleep Apnea Sleep Solutions Snoring Sleep Disorders FAQs References
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Jay Summer is a health content writer and editor. She holds a B.S. in psychology and master's degrees in writing and public policy.

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Dr. Abhinav Singh Sleep Medicine Physician

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Dr. Abhinav Singh

Sleep Medicine Physician

Dr. Singh is the Medical Director of the Indiana Sleep Center. His research and clinical practice focuses on the entire myriad of sleep disorders.

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Table of Contents

Key Takeaways

  • CPAP pressure levels, as determined by a sleep specialist, are typically the lowest amount of pressure needed to to keep the airway open.
  • The pressure setting is crucial to treating sleep apnea and reducing symptoms.
  • Anatomy and sleep habits factor into the appropriate pressure level.
  • Speak to your doctor about recalibration if you experience discomfort, breathing difficulties, and a lack of symptom improvement.

People with obstructive sleep apnea (OSA) stop breathing for brief intervals during sleep due to a blocked or collapsed airway. Continuous positive airway pressure (CPAP) machines are commonly prescribed to treat the condition. The devices deliver pressurized air to help normalize breathing. The right amount of pressure is critical to effective CPAP therapy, as pressure that is too low or too high can create adverse side effects.

We discuss how CPAP pressure is measured, the various factors that determine pressure needs, and the signs and symptoms that suggest your pressure level might need adjusting. It is important to contact your doctor if you believe your CPAP machine settings need to be adjusted. Pressure settings should only be changed under the guidance of a medical professional.

How to Determine the Proper Pressure Setting for a CPAP Machine

Pressure in a CPAP machine is measured in centimeters of water pressure (cm H2O). Settings vary based on the device, but most CPAP machines have a pressure range of 4 cm H2O to 20 cm H2O. The average pressure setting for people with OSA is around 9 cm H2O Trusted Source National Library of Medicine, Biotech InformationThe National Center for Biotechnology Information advances science and health by providing access to biomedical and genomic information.View Source .

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A CPAP titration study is the most common method used to determine an appropriate pressure level. Similar to a sleep study, the assessment is usually done overnight at a sleep center or hospital. Sensors are attached to the sleeper’s body to monitor oxygen levels, breathing, heart rate, brain waves, and body movements. A physician or sleep specialist calibrates CPAP pressure levels until the lowest amount of pressure needed to keep the airway open is determined.

The apnea-hypopnea index (AHI) assesses how many times a person stops breathing or breathes shallowly while asleep, which helps medical professionals determine CPAP pressure settings. Most modern CPAP machines keep track of the sleeper’s AHI, which lets the doctor know if the pressure level needs to be modified.

The sleeper is also fitted for a CPAP mask during the study, which is crucial for effective treatment. CPAP masks come in a variety of styles, including full-face masks, nasal masks, and nasal pillows.After the study, the doctor establishes the optimal pressure range. They can also make recommendations about how to use a CPAP machine.

Take Our Quiz to Know Your Sleep Apnea Risk

To understand if you could have sleep apnea, take our short quiz below to see if you exhibit any signs.

Factors That Affect the Pressure Setting of a CPAP Device

A number of factors determine the severity of OSA and a person’s appropriate CPAP pressure setting. Some are anatomical, while others relate to lifestyle and sleep habits.

  • Anatomical factors: People with craniofacial or upper airway characteristics such as a small lower jaw, a large tongue or tonsils, or a neck circumference greater than 17 inches may be at greater risk of developing OSA Trusted Source Merck ManualFirst published in 1899 as a small reference book for physicians and pharmacists, the Manual grew in size and scope to become one of the most widely used comprehensive medical resources for professionals and consumers.View Source and may require higher CPAP pressure levels.
  • Deviated septum: A deviated septum Trusted Source National Library of Medicine, Biotech InformationThe National Center for Biotechnology Information advances science and health by providing access to biomedical and genomic information.View Source limits airflow through the nose, so a higher amount of pressure may be needed to keep the upper airway open.
  • Body mass index (BMI): People with obesity are more likely to have extra throat tissue that restricts airflow to the lungs. Pressure requirements tend to increase with a person’s weight Trusted Source National Library of Medicine, Biotech InformationThe National Center for Biotechnology Information advances science and health by providing access to biomedical and genomic information.View Source , so people who lose a significant amount of weight usually need to lower their pressure setting.
  • Nasal allergies: Allergies and nasal congestion can make breathing more difficult, thereby reducing oxygen intake. In addition to calibrating pressure settings, a CPAP machine with a humidifier can sometimes help people with allergies. Regularly cleaning filters can also reduce allergen triggers.
  • Sleep position: Back sleeping is generally the least favored sleep position for sleep apnea Trusted Source National Library of Medicine, Biotech InformationThe National Center for Biotechnology Information advances science and health by providing access to biomedical and genomic information.View Source because the pull of gravity puts pressure on the airway. Back sleepers therefore usually require higher pressure settings. Experts recommend side sleeping Trusted Source UpToDateMore than 2 million healthcare providers around the world choose UpToDate to help make appropriate care decisions and drive better health outcomes. UpToDate delivers evidence-based clinical decision support that is clear, actionable, and rich with real-world insights.View Source for people with OSA because it puts less weight on the upper airway.

How to Tell if Your CPAP Pressure Is Properly Set

Proper CPAP pressure levels help alleviate conditions associated with sleep apnea, such as snoring and sleep disturbances. If you are not experiencing better sleep quality after CPAP therapy, you will probably need to consult with your doctor about adjusting your pressure settings.

Signs Your CPAP Pressure Is Too Low

If you still wake up feeling groggy or unrefreshed after using a CPAP machine, your airway might not be getting enough oxygen to stay open. Heavy snoring, feeling like you are choking, or a lack of improvement in high blood pressure Trusted Source National Library of Medicine, Biotech InformationThe National Center for Biotechnology Information advances science and health by providing access to biomedical and genomic information.View Source may be signs that your CPAP pressure is too low. If your AHI does not improve once you have fully integrated CPAP therapy into your sleep routine, it may also be an indication that the settings should be adjusted.

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Signs Your CPAP Pressure Is Too High

Discomfort is the strongest clue that your pressure setting is too high. Struggling to exhale, nose and mouth dryness, or a burning sensation in the throat are common symptoms of excessive pressure. Some people also experience mask leaks, fluid in the ears, and gas or belching from swallowing air.

APAP Machines

If you continue to have issues with pressure settings on your device, your doctor might prescribe an auto-adjusting positive airway pressure (APAP) machine. This device automatically changes pressure levels based on a user’s breathing patterns. The machine starts at a low setting and then increases according to changes in breathing and airway resistance.

Even though APAP machines automatically adjust pressure levels, a physician still needs to prescribe an ideal pressure range suited to your needs. If the range is off, you may experience adverse side effects.

Frequently Asked Questions

How Do I Know If My CPAP Pressure Needs Adjusting?

If you consistently experience discomfort during CPAP therapy, or you are not noticing any improvements in your sleep or health, then your CPAP pressure settings probably need to be adjusted. Persistent fatigue, loud snoring, mask leaks, and difficulty exhaling all indicate suboptimal pressure levels. An above-average AHI level suggests that your pressure setting may be too low.

What Pressure Should My CPAP Be Set At?

A physician determines proper pressure settings based on your CPAP titration study and AHI. Your pressure might need to be adjusted later if you lose or gain significant weight, change your sleep position, or start taking certain medications. Always speak with your doctor if you suspect your pressure level needs fine-tuning.

How Do I Adjust My CPAP Pressure?

If you think your pressure level needs adjusting, contact your doctor’s office and bring your CPAP machine to the appointment. Your doctor will evaluate data from the device and make changes as needed. Pressure settings should only be changed under medical supervision.

Medical Disclaimer: The content on this page should not be taken as medical advice or used as a recommendation for any specific treatment or medication. Always consult your doctor before taking a new medication or changing your current treatment.

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Written By

Jay Summer,Staff Writer

Jay Summer is a health content writer and editor. She holds a B.S. in psychology and master's degrees in writing and public policy.

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Medically Reviewed by

Dr. Abhinav Singh,Sleep Medicine PhysicianMD

Dr. Singh is the Medical Director of the Indiana Sleep Center. His research and clinical practice focuses on the entire myriad of sleep disorders.

Learn more about our Editorial Team

References

7 Sources

  1. Farré, R., Gozal, D., & Montserrat, J. M. (2021). Alternative procedure to individual nasal pressure titration for sleep apnea. Journal of Clinical Medicine, 10(7), 1453.

    https://pubmed.ncbi.nlm.nih.gov/33916282/
  2. Strohl, K. P. (2022, October). Obstructive sleep apnea. Merck Manual Professional Version., Retrieved February 8, 2023, from

    https://www.merckmanuals.com/professional/pulmonary-disorders/sleep-apnea/obstructive-sleep-apnea
  3. Yeom, S.W., Kim, M.G., Lee, E.J., Chung, S.K., Kim, D.H., Noh, S.J., Lee, M.H., Yang, Y.N., Lee, C.M., & Kim, J.S. (2021). Association between septal deviation and OSA diagnoses: A nationwide 9-year follow-up cohort study. Journal of Clinical Sleep Medicine. 17(10), 2099–2106.

    https://pubmed.ncbi.nlm.nih.gov/34606442/
  4. Lankford, D. A., Proctor, C. D., & Richard, R. (2005). Continuous positive airway pressure (CPAP) changes in bariatric surgery patients undergoing rapid weight loss. Obesity Surgery, 15(3), 336–341.

    https://pubmed.ncbi.nlm.nih.gov/15826465/
  5. Menon, A., & Kumar, M. (2013). Influence of body position on severity of obstructive sleep apnea: A systematic review. ISRN Otolaryngology, Article e670381, 1–7.

    https://pubmed.ncbi.nlm.nih.gov/24223313/
  6. Kryger, M.H., & Malhotra, A. (2022, August 11). Management of obstructive sleep apnea in adults. In N. Collop (Ed.). UpToDate., Retrieved February 8, 2023, from

    https://www.uptodate.com/contents/management-of-obstructive-sleep-apnea-in-adults
  7. Shafazand, S., & Patel, S. R. (2014). Effect of CPAP on blood pressure in patients with obstructive sleep apnea and resistant hypertension. Journal of Clinical Sleep Medicine, 10(03), 341–343.

    https://pubmed.ncbi.nlm.nih.gov/24634635/

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FAQs

CPAP Pressure Settings? ›

The initial pressure setting for continuous positive airway pressure (CPAP) ventilation treatment for obstructive sleep apnea (OSA) can be determined according to the patient's body mass index (BMI): 8 cmH2O for BMI < 30, 10 cmH2O for BMI 30–35, and 12 cmH2O for BMI > 35.

What are the initial settings for CPAP? ›

The initial pressure setting for continuous positive airway pressure (CPAP) ventilation treatment for obstructive sleep apnea (OSA) can be determined according to the patient's body mass index (BMI): 8 cmH2O for BMI < 30, 10 cmH2O for BMI 30–35, and 12 cmH2O for BMI > 35.

Why do I wake up after 2 hours on my CPAP machine? ›

You may not get the full benefit of treatment if your CPAP settings are incorrect. These settings regulate the pressure of air delivered to your mask. If the setting is too high, you may struggle to exhale and find yourself waking in the middle of the night.

What is normal AHI on CPAP? ›

An AHI score below 5 is considered normal, while a score of 5 to 15 is mild sleep apnea, 15 to 30 is moderate sleep apnea, and above 30 is severe sleep apnea. According to the American Academy of Sleep Medicine, CPAP therapy should aim to reduce the AHI score to below five if possible.

How many events per hour are normal with CPAP? ›

An ideal AHI for adults is fewer than five events per hour. Some sleep specialists aim for one or two events per hour as the "safe zone."

What is a good starting pressure for CPAP? ›

Continuous positive airway pressure (CPAP) machines keep the upper airway open by pumping a constant stream of pressurized air into the airway through a mask. Most people receiving CPAP therapy use pressure levels between 8 and 10 cm H20, but the best level varies from person to person.

What are signs your CPAP pressure is too high? ›

Signs Your CPAP Pressure Is Too High

Struggling to exhale, nose and mouth dryness, or a burning sensation in the throat are common symptoms of excessive pressure. Some people also experience mask leaks, fluid in the ears, and gas or belching from swallowing air.

Why does CPAP cause weight gain? ›

A decrease in energy expenditure and an increase in energy consumption as shown by Tachikawa and colleagues (2) are plausible candidates to explain weight gain after CPAP therapy (1).

What is the best position to sleep in with a CPAP machine? ›

Because airway obstructions can be more frequent when sleeping on your back, side sleeping is the recommended sleep position for people with sleep apnea. If you choose to wear a nasal mask, make sure there is a good seal between your mask and your face and soft, flexible headgear to keep your mask in place.

How much weight to lose to get off CPAP? ›

Takeaway. Losing weight when you have sleep apnea can be an effective way to decrease or eliminate your symptoms. Experts recommend losing at least 5% of your body weight, but losing 10% may be even more effective. Weight loss may also help you overcome your need for a CPAP machine.

What is the life expectancy of someone with sleep apnea? ›

Research has indicated that untreated sleep apnea can shorten a person's life expectancy by several years, and according to the American Academy of Sleep Medicine, untreated sleep apnea increases your risk of death by 17% through the short-term and long-term health issues associated with untreated sleep apnea.

What is a bad number for sleep apnea? ›

Severe obstructive sleep apnea means that your AHI is greater than 30. You have more than 30 episodes per hour. Moderate obstructive sleep apnea means that your AHI is between 15 and 30. Mild obstructive sleep apnea means that your AHI is between 5 and 15.

Is an AHI of .8 good? ›

An AHI less than 5 is considered normal, and some patients with severe sleep apnea may be told by their doctor that they can accept even higher numbers so long as they're feeling more rested each morning, experiencing fewer symptoms and their AHI is progressively decreasing.

What happens if I don't use my CPAP for a week? ›

Going a week without your CPAP machine will cause a resurgence of sleep apnea symptoms, leading to poor sleep quality and likely resulting in fatigue. During this period, there might be a slight rise in blood pressure, blood sugar levels, heart rate, and stress.

What does a CPAP machine do when you stop breathing? ›

Rather than starting to work when a person stops breathing, a CPAP machine prevents lapses in breathing from the time a person goes to sleep. The machine provides a continuous flow of air to prevent any pauses in a person's breathing. It delivers mild air pressure to keep the airways open during sleep.

How does your body change after a CPAP machine? ›

Consistent CPAP use can lead to improved cardiovascular health, reduced blood pressure, and a lower likelihood of developing severe heart conditions. Using a CPAP machine reduces the risk of developing diabetes by improving sleep quality and lowering the chances of insulin resistance.

What are the baseline settings for CPAP? ›

A CPAP's pressure level is a numeric value measured in centimeters of water (cm H2O). Many CPAP machines can operate at pressures ranging from 4 to 20 cm H2O. While there is considerable variation between individuals, the average CPAP setting is between 8 and 10 cm H2O.

What is the initial pressure of a CPAP machine? ›

The lowest setting on CPAP machines may be 4 to 5 centimeters of water pressure (abbreviated as cm of H2O or CWP). Most people require more pressure than this low setting. The maximum setting varies with the type of machine, but it could be as high as 25 or 30 CWP.

What are the initial settings for bubble CPAP? ›

Start with 5 L/min of oxygen and 5 L/min of air for a 5kg child, and 3 L/min of oxygen and 3 L/min of air for a neonate. Check and record the flows dialled and the oxygen concentration this provides.

What are the normal IPAP and EPAP settings? ›

The recommended minimum starting IPAP and EPAP should be 8 cm H2O and 4 cm H2O, respectively. The recommended maximum IPAP should be 30 cm H2O for patients ≥ 12 years and 20 cm H2O for patients < 12 years. The recommended minimum and maximum levels of PS are 4 cm H2O and 20 cm H2O, respectively.

References

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