Best CPAP Machines for High Pressure Settings (>15 cmH₂O)
Compare the best CPAP and bilevel machines for high pressure settings above 15 cmH₂O AirSense 11, AirCurve 11 VAuto and ASV options explained.
If your prescribed CPAP pressure is above 15 cmH₂O, choosing the right machine becomes more important. While many standard CPAP and APAP machines can reach pressures of 20 cmH₂O, some people find higher pressures uncomfortable, particularly when breathing out. The right choice depends not only on the maximum pressure a machine can produce, but also on whether you need automatic pressure adjustment, pressure relief during exhalation or bilevel therapy.
What Does a CPAP Pressure Above 15 cmH₂O Mean?
CPAP pressure is measured in centimetres of water, written as cmH₂O. It describes the pressure used by the machine to help keep the upper airway open during sleep. A setting of 15 cmH₂O is already towards the higher end of the typical CPAP range. If your prescribed pressure is 16, 17, 18 or 19 cmH₂O, you need a machine capable of delivering that pressure consistently and comfortably.
A standard CPAP or APAP machine may still be suitable. For example, the ResMed AirSense 11 has an operating pressure range of 4–20 cmH₂O, so pressures above 15 are within its specification. However, pressure capability isn’t the only consideration. Some people struggle with the sensation of breathing against higher pressure when they exhale. In these situations, a machine with pressure-relief or bilevel functionality may provide a more comfortable experience.
Prescribed pressures above 15 cmH₂O are within the standard APAP range for machines like the AirSense 11. Bilevel therapy (AirCurve) is not automatically required but may be appropriate when standard CPAP causes exhalation discomfort at higher settings.
Best Machines for High CPAP Pressure
Machine
Pressure Range
Type
Best Suited For
ResMed AirSense 11 AutoSet
4–20 cmH₂O
APAP / CPAP
High-pressure users who still need standard CPAP/APAP
ResMed AirCurve 11 VAuto
Up to 25 cmH₂O
Bilevel
Higher pressures and users who struggle with exhalation
ResMed AirCurve 11 ASV
Up to 25 cmH₂O*
ASV / Bilevel
Specific breathing disorders requiring advanced therapy
ResMed AirCurve 10 VAuto
Up to 25 cmH₂O
Bilevel
Users prescribed bilevel therapy proven platform
*Important note on ASV: The pressure range and therapy mode do not mean the machine is appropriate for every patient. Advanced modes such as ASV require specific clinical indications and must be prescribed by a specialist.
4–20 cmH₂O · APAP/CPAP · Best for 15–20 cmH₂O prescriptions
Why Consider It for High Pressure
✓ Pressure range up to 20 cmH₂O✓ Automatic pressure adjustment (AutoSet)✓ EPR for exhalation comfort✓ Integrated humidification✓ AutoRamp✓ myAir connectivity
The AirSense 11 AutoSet is one of the most straightforward choices when your prescribed pressure is above 15 cmH₂O but still falls within the standard CPAP/APAP range. Its operating range of 4–20 cmH₂O means a prescribed setting of 16, 17, 18 or 19 cmH₂O is within its capabilities. The AutoSet algorithm can automatically adjust pressure throughout the night rather than delivering one fixed pressure. It also includes Expiratory Pressure Relief (EPR), which reduces pressure during exhalation by the selected amount. ResMed also lists AutoSet Response as a comfort feature designed to provide gentler pressure increases for people who have difficulty tolerating higher pressure.
Someone prescribed 15–20 cmH₂O who doesn’t require bilevel therapy. If your prescribed pressure is in this range and you are comfortable and achieving good therapy results, there may be no reason to move to bilevel therapy.
Up to 25 cmH₂O · Bilevel · Separate IPAP and EPAP pressures
Why Consider It for High Pressure
✓ Pressure capability up to 25 cmH₂O✓ Separate inspiratory and expiratory pressures✓ VAuto auto-adjusts for OSA✓ Pressure support eases exhalationFor prescribed bilevel therapy only
If pressure is consistently high and you find it difficult to breathe out against CPAP pressure, the AirCurve 11 VAuto uses bilevel therapy a higher pressure during inhalation and a lower pressure during exhalation. It has an operating range extending to 25 cmH₂O, with separate IPAP and EPAP settings and adjustable pressure support. This doesn’t mean everyone using 16–20 cmH₂O should switch to bilevel therapy. Instead, it may be considered when standard CPAP isn’t sufficiently comfortable or when a clinician determines that bilevel therapy is appropriate.
Best For
Prescribed bilevel therapyDifficulty exhaling at high CPAP pressurePressures requiring >20 cmH₂O
People who have been prescribed bilevel therapy or who have difficulty tolerating high CPAP pressure under clinical guidance. This is a clinical decision not a self-upgrade from standard CPAP.
⚙️
3. ResMed AirCurve 10 VAuto
Up to 25 cmH₂O · Bilevel · Proven established platform
Overview
✓ Operating range 2–25 cmH₂O✓ Separate IPAP and EPAP pressuresEstablished bilevel platform
The AirCurve 10 VAuto is another bilevel option capable of pressures considerably higher than the 15 cmH₂O mark. ResMed lists an operating pressure range of 2–25 cmH₂O for the AirCurve 10 VAuto/S platform. Its main advantage for high-pressure users is the same basic principle as the AirCurve 11 VAuto: separate pressure levels for inhalation and exhalation. It can be worth considering if you’re looking for a bilevel machine but don’t necessarily need the newer AirCurve 11 platform.
Users specifically prescribed AirCurve 10 VAuto therapy or those looking for a proven bilevel platform without requiring the newest hardware generation.
🔬
4. ResMed AirCurve 11 ASV
Up to 25 cmH₂O · ASV / Advanced Bilevel · Specialist indications only
Important: Not a High-Pressure CPAP Upgrade
Specialist therapy not a general upgradeRequires specific clinical assessmentDesigned for central sleep apnoea, mixed apnoeas, periodic breathing
The AirCurve 11 ASV is another advanced bilevel device, but it should not simply be treated as a high-pressure CPAP upgrade. It is designed for particular breathing patterns and conditions, including central sleep apnoea, mixed apnoeas and periodic breathing. Its ASV technology continuously adapts therapy to the patient’s breathing pattern. Although its maximum pressure can reach 25 cmH₂O, that does not mean it should be selected simply because someone needs 18 or 20 cmH₂O. ASV is a specialist therapy that needs appropriate clinical assessment.
Best For
Patients specifically diagnosed and prescribed ASV therapy
Patients specifically diagnosed and prescribed ASV therapy by a sleep specialist. This machine should not be self-selected on the basis of needing a high pressure setting.
CPAP vs Bilevel for Pressures Above 15 cmH₂O
One of the biggest questions is whether a high pressure automatically means you need a bilevel machine.
💡 No a high pressure does not automatically mean you need bilevel therapy. A standard APAP such as the AirSense 11 can deliver pressures up to 20 cmH₂O. If your prescribed pressure is 16 cmH₂O and you are comfortable and achieving good therapy results, there may be no reason to change to bilevel therapy.
The situation is different if high pressure causes any of the following problems:
Difficulty breathing out
Feeling that the airflow is too strong
Frequent mask leaks
Aerophagia or swallowing air
Poor sleep because of pressure discomfort
Difficulty tolerating prescribed settings
In these situations, your sleep clinician or equipment provider may review your therapy and determine whether pressure relief, different settings or bilevel therapy would be appropriate.
The key difference between CPAP/APAP and bilevel therapy for high-pressure users. Moving to bilevel is a clinical decision, not a product upgrade standard APAP covers most prescriptions up to 20 cmH₂O without any need to change device type.
What Should You Look for in a High-Pressure CPAP Machine?
📊
Maximum Pressure
Check the official specification
First, check the machine’s official pressure range. If you have been prescribed 17 cmH₂O, a machine with a maximum of 20 cmH₂O technically covers that setting. However, don’t choose a machine based solely on the maximum number comfort, algorithm and exhalation relief matter too.
🌬️
Exhalation Comfort
EPR and bilevel options
At higher pressures, exhaling can feel uncomfortable. Features such as EPR can reduce pressure during exhalation on compatible ResMed CPAP/APAP machines. Bilevel machines take this concept further by providing entirely separate inspiratory and expiratory pressures.
⚙️
Automatic Adjustment
APAP vs fixed pressure
If your prescription allows APAP therapy, automatic pressure adjustment can help the machine respond to changing pressure requirements during the night. The AirSense 11 AutoSet, for example, automatically adjusts pressure based on detected breathing events rather than delivering the same fixed pressure all night.
Mask Fit at High Pressure
High pressure can make mask leaks more noticeable. A mask that fits well at lower pressures may leak when pressure increases, particularly around the cushion or nasal pillows. For people using pressures above 15 cmH₂O, pay particular attention to correct mask size, cushion condition, headgear adjustment, sleeping position, mouth breathing, and avoiding unnecessary overtightening.
Not necessarily. A higher prescribed pressure does not automatically mean that your machine is failing or that your sleep apnoea is getting worse. Pressure requirements vary between individuals. Your required pressure can also be affected by factors such as sleep position, weight changes, nasal congestion and other aspects of your airway. What matters is whether the prescribed therapy is effectively controlling your breathing events and whether you can comfortably use the treatment.
⚠ Never change prescribed pressure settings without appropriate medical guidance. If your machine frequently reaches its pressure limit, or your AHI remains elevated despite using therapy correctly, speak with your sleep clinician rather than simply increasing the pressure yourself.
Which High-Pressure CPAP Machine Is Best?
🫁
Choose AirSense 11 AutoSet if…
Prescribed pressure is 15–20 cmH₂O
You need standard CPAP/APAP therapy
You want automatic pressure adjustment
You want EPR for exhalation comfort
You don’t require bilevel therapy
⚡
Consider AirCurve 11 VAuto if…
You require pressures above 20 cmH₂O
You struggle to exhale against high CPAP pressure
Your clinician has prescribed bilevel therapy
You need separate inspiratory and expiratory pressures
You need pressure support
Consider AirCurve 11 ASV only if…
A specialist clinical indication is the only appropriate reason to select this machine
You have a specific indication for ASV
Your clinician has prescribed advanced bilevel therapy
Your breathing pattern requires adaptive support
Final Thoughts
A CPAP pressure above 15 cmH₂O doesn’t automatically mean you need the most powerful machine available. For many users, a standard APAP such as the AirSense 11 AutoSet provides enough pressure, with a range up to 20 cmH₂O. For people who require higher pressures or have difficulty tolerating continuous high pressure, a bilevel device such as the AirCurve 11 VAuto may be more appropriate because it can operate up to 25 cmH₂O and provides separate inspiratory and expiratory pressure levels.
The important point is to choose the machine based on your prescribed therapy, pressure requirements and comfort, rather than simply choosing the model with the highest maximum pressure.
info@cpapstudio.co.uk
+44 7899 539620
