CPAP Pressure Settings for OSA Patients

Initial CPAP Settings

The American Academy of Sleep Medicine recommends a minimum starting CPAP pressure of 4 cm H2O for both pediatric and adult patients, with titration upward based on respiratory events until optimal pressure is achieved 1
The American Academy of Sleep Medicine recommends a maximum CPAP pressure of 15 cm H2O for patients <12 years and 20 cm H2O for patients ≥12 years 1
For patients who cannot tolerate high CPAP pressures or who continue to have obstructive events at 15 cm H2O, the American Academy of Sleep Medicine suggests considering switching to BPAP 2

The American Academy of Sleep Medicine recommends increasing CPAP pressure by at least 1 cm H2O with an interval no shorter than 5 minutes 3
The American Academy of Sleep Medicine suggests continuing pressure increases until respiratory events are eliminated or maximum recommended pressure is reached 3
In split-night studies, the American Academy of Sleep Medicine recommends using larger increments (2-2.5 cm H2O) due to shorter titration duration 3

The American Academy of Sleep Medicine recommends increasing CPAP pressure when ≥2 obstructive apneas (for patients ≥12 years) or ≥1 obstructive apnea (for patients <12 years) are observed 1
The American Academy of Sleep Medicine suggests increasing CPAP pressure when ≥3 hypopneas (for patients ≥12 years) are observed 4
The American Academy of Sleep Medicine recommends increasing CPAP pressure when ≥5 respiratory effort-related arousals (RERAs) (for patients ≥12 years) are observed 4
The American Academy of Sleep Medicine suggests increasing CPAP pressure when ≥3 minutes of loud or unambiguous snoring (for patients ≥12 years) are observed 4

The American Academy of Sleep Medicine recommends that exploration of CPAP above the pressure that controls respiratory abnormalities should not exceed 5 cm H2O 2
The American Academy of Sleep Medicine suggests that this exploration can help reduce residual high airway resistance that may lead to arousals and insomnia 2

The American Academy of Sleep Medicine recommends a minimum starting IPAP and EPAP of 8 cm H2O and 4 cm H2O, respectively 3
The American Academy of Sleep Medicine suggests a maximum IPAP of 20 cm H2O for patients <12 years and 30 cm H2O for patients ≥12 years 3
The American Academy of Sleep Medicine recommends a minimum IPAP-EPAP differential of 4 cm H2O 3
The American Academy of Sleep Medicine suggests a maximum IPAP-EPAP differential of 10 cm H2O 3

The American Academy of Sleep Medicine recommends restarting at a lower pressure that the patient reports is comfortable enough to allow return to sleep if a patient awakens and complains that pressure is too high 2
The American Academy of Sleep Medicine suggests considering switching to BPAP for patients who cannot tolerate high CPAP pressures 2
The American Academy of Sleep Medicine recommends making heated humidification available for patients who develop nasal congestion or dryness during the night 5

The American Academy of Sleep Medicine suggests that higher starting pressures may be appropriate for patients with elevated BMI and for retitration studies 3

The American Academy of Sleep Medicine defines the optimal CPAP pressure as one that eliminates apneas, hypopneas, RERAs, and snoring for at least 30 minutes, including time in supine REM sleep 4