can too high of pressure prevent treatment?

[zackds]

Waxing and waning of the air flow isn't part of the auto adjusting pressure algorithm..I don't think.
Mainly because it usually means nothing unless the other stuff that the auto adjusting algorithm is designed to fight...flow limitations, snores, etc....is also present.

ah that makes sense then
i guess its just a matter of finding out if those are
partially obstructive events
or central type of events
or it could be me awake without realizing it before i turn the machine off?
i hope its not the last one

[zackds]

So I know many people who have already posted are speaking from their personal experiences and that can be valuable. As a technologist I will tell you that overtitrating a patient can cause induced central apneas and is one of the reasons that cpap titration is done in the lab. People are very diverse and complex and there is no hard and fast rule for pressure. Sometimes a patient with a high AHI can be fixed with a low pressure and sometimes a patient with a low AHI can take a very high pressure to fix. I am glad to hear you are finding successful results with your own use. However I do urge caution when controlling your own pressure. Please take it slow as this is something normally done in a lab.

In regards to centrals being forever, that is not always the case. Sometimes drug interactions can cause central apneas in an individual.

ok i will do
is there a reason generally why some people
require a higher pressure when they have a low ahi?

[ChicagoGranny]

However I do urge caution when controlling your own pressure. Please take it slow as this is something normally done in a lab.

Welcome to the 21st century.

In summary, this study demonstrates that self-titration of CPAP in patients with OSA is as efficacious as manual titration in a sleep laboratory, with similar subjective and objective outcomes, and CPAP compliance.

https://www.atsjournals.org/doi/full/10 ... 0204-360OC

[palerider]

So I know many people who have already posted are speaking from their personal experiences and that can be valuable. As a technologist I will tell you that overtitrating a patient can cause induced central apneas and is one of the reasons that cpap titration is done in the lab.

See, now, this is the kind of thing that causes problems.

Yes, technically, you're correct, too high a pressure (why use jargon? "overtitrating") can cause central apneas, it's rare, (5-15% of people depending on which study you want to look at), and not mentioning that it's a RARE phenomenon is misleading. Please don't be misleading.

Sometimes a patient with a high AHI can be fixed with a low pressure and sometimes a patient with a low AHI can take a very high pressure to fix.

Exactly what I was saying just the other day in another thread...

However I do urge caution when controlling your own pressure. Please take it slow as this is something normally done in a lab.

This kind of talk is not welcome in this forum.

In regards to centrals being forever, that is not always the case. Sometimes drug interactions can cause central apneas in an individual.

And other things, like too much pressure in a small minority of people, or too much pressure support.

[Ariseal]

I apologize if I came across as advising against self titration. Please understand that is not the case. By all means if it works for you and others please continue to do so. Many people can't afford an in lab titration or have a desire to do so. All I was honestly trying to say is imo it might be better to take it slow than to wildly jump pressures without a plan or acclimation time.

Sorry for the technical jargon, it was not deliberate obfuscation just that is how I know to refer to it by training and education.

As for the percentage cause on the centrals, that was also not deliberate I promise. I did not say rare because on the job I have just been reminded to be careful of it.just because it can happen not a specific frequency of occurrence. If it was covered in school it was long enough ago that I had forgotten that particular statistic.

The only argument I would make is even if rare if there is no need or logical reason to rush the the self pressure adjustment then why take a risk even if minor when it could still be done at home but carefully and controlled,thus reducing or even virtually eliminating the risk. I never meant to alarm anyone though.

[palerider]

All I was honestly trying to say is imo it might be better to take it slow than to wildly jump pressures without a plan or acclimation time.

Ok, yeah, that fits in with what we're trying to do here... learn how to read your data, and make *informed* decisions to alter pressure.

Sorry for the technical jargon, it was not deliberate obfuscation just that is how I know to refer to it by training and education.

Jargon...

A main driving force in the creation of technical jargon is precision and efficiency of communication when a discussion must easily range from general themes to specific, finely differentiated details without circumlocution. A side-effect of this is a higher threshold for comprehensibility, which is usually accepted as a trade-off but is sometimes even used as a means of social exclusion (reinforcing ingroup-outgroup barriers) or social aspiration (when intended as a way of showing off).

It has it's place, but people "in" any field need to be careful when talking to non-professionals, lest the be completely incomprehensible. Besides, not jargoining your speech makes you more approachable, especially by people who are trying to learn.

As for the percentage cause on the centrals, that was also not deliberate I promise. I did not say rare because on the job I have just been reminded to be careful of it.just because it can happen not a specific frequency of occurrence. If it was covered in school it was long enough ago that I had forgotten that particular statistic.

The problem that *I* have with the whole "ooooh, pressure can cause centrals" (assuming they remember to put the word "can" in there) is that it scares people, unnecessarily. A few gentle centrals aren't going to hurt anybody any more than holding their breath for 10 or 20 seconds now and then does (which happens now and then normally throughout the day as you're moving around)... and it's unlikely that any one person is going to be affected.. So, it's unwarranted fright. Have I seen people with CompSA? yes. Have a seen people that have centrals caused by increased ventilation? yes. but they're still a small minority. Fortunately.

The only argument I would make is even if rare if there is no need or logical reason to rush the the self pressure adjustment then why take a risk even if minor when it could still be done at home but carefully and controlled,thus reducing or even virtually eliminating the risk. I never meant to alarm anyone though.

What's the "risk"? A person just not wanting to breath for a little bit a few times an hour isn't going to significantly affect their SpO2, and it's not going to jolt them out of a sleep stage, or spike their BP... right? so what's the 'risk'?

[Ariseal]

Hmm from my understanding of the issue when central’s are caused due to pressure increase it was frequent centrals that can be similar to Cheyne stokes breathing. I will research this some more and dig out my text books.

[Julie]

To all it may concern - Ariseal is the most 'real' (so far) tech who's ever come here. He's completely opened himself to us - not the easiest thing for anyone to do and seems more than willing to listen and learn. Let's see if we can do the same, not give him a hard time because others have been jerks. Just saying...

[palerider]

Hmm from my understanding of the issue when central’s are caused due to pressure increase it was frequent centrals that can be similar to Cheyne stokes breathing. I will research this some more and dig out my text books.

See if you can find a differentiation between *pressure increase* and *ventilation increase*...

Because I believe the second is more likely to cause cyclic respiratory drive depression.

[Ariseal]

Ok consulted my textbook after digging it out. It reminded me of something. The centrals aren’t caused by raising the pressure to high. They are caused by raising the pressure to fast coupled with too high. That is one of the reasons why techs have a certain time in between pressure increases on a patient beside standard adjustment. The book does not state whether this phenomenon is rare or not or the amount of centrals it causes. I will need to do some further research.

I appreciate the concern Julie, but don’t worry I am not easily offended and I enjoy a good debate especially if it leads to a positive exchange of information to both sides. Small point of clarification, not a complaint or anything but I am actually a she ‍.

[palerider]

Ok consulted my textbook after digging it out. It reminded me of something. The centrals aren’t caused by raising the pressure to high. They are caused by raising the pressure to fast coupled with too high. That is one of the reasons why techs have a certain time in between pressure increases on a patient beside standard adjustment. The book does not state whether this phenomenon is rare or not or the amount of centrals it causes. I will need to do some further research.

The last time I dug into it, the best study I came up with was inconclusive about what actually causes pressure emergent central apnea.

[Lucyhere]

Small point of clarification, not a complaint or anything but I am actually a she ‍.

Yay for our side! I should have known.

[poppi2]

..... They are caused by raising the pressure to fast coupled with too high. That is one of the reasons why techs have a certain time in between pressure increases on a patient beside standard adjustment. .....

This sounds like a caution for techs, rather than a self-titrating patient. If I’m self-titrating, you can be sure that I ain’t setting an alarm to increase the pressure every 30 minutes.

[Ariseal]

Well Pale after further research I have to agree with your conclusion. There doesn’t even seem to be relevant data available anymore concerning rapid pressure increase centrals other than a small blurb here or there. I will ask the Dr. I work for if they can provide any strong medical works that say otherwise.

Heh Poppi not every 30 minutes guideline is 20 minutes and most techs when rapid titrating will do 10 minutes between especially if trying to raise the pressure during a REM cycle.

[palerider]

Well Pale after further research I have to agree with your conclusion. There doesn’t even seem to be relevant data available anymore concerning rapid pressure increase centrals other than a small blurb here or there. I will ask the Dr. I work for if they can provide any strong medical works that say otherwise.

I'm interested in what you hear.

I'll tell you, though, that I'm skeptical of what doctors say, having had experience (personal and related) of doctors spouting apocryphal advice, because they think they know everything... they're DOCTORS after all..

Most recent, I made the mistake of asking my nephrologist what he thought about how my recently badly burned fingers were doing (I figured, he's a doctor, he should know *something*, right? He said "well, they're doing pretty well, but you need to take those dressings off and let them dry out and scab over". which, of course, is the *OLD* standard of wound care. Wounds kept covered and moist heal in half the time, something they were rediscovering in the *SIXTIES!* I just smiled, nodded, went home and changed my dressing, and let re-epithelialization continue.

Heh Poppi not every 30 minutes guideline is 20 minutes and most techs when rapid titrating will do 10 minutes between especially if trying to raise the pressure during a REM cycle.

Honestly, (having read through titration guides, and played with a Resmed lab system) I think that the x cm every y minutes thing is just to give the patient a little time to 'average out'... give 'em a chance to see if the last pressure raise is going to make any difference or not.