Setting pressure higher than doc prescribes

rmcrob · Post by **rmcrob** » Tue Jun 05, 2007 7:16 am

I've been using a start-up pressure of 8 cm H2O for a month. I'm pretty sure I still had some apnea events at 8.

Last week I had a titration study. During the titration study the tech got me up to 12, and I slept like a baby.

The doc called a few days after the titration study and said that 8 was "almost perfect" and he wanted me to change the pressure to 9. (He said the DME would call and tell me how to do that, but since I have access to the information here in this forum, I don't need to be told. In fact, based on the tech's information from the titration study, I had already set it to 12 and backed it off to 11 before the doc called.)

I am really sleeping good with the pressure at 11. I tried 10 one night, and it's ok too, but 11 is better.

Are there any problems that could come up by my having the pressure set higher than the doc recommends? Is this a case where I just need to be responsible for my own health care and do what works for me instead of what the doc wants me to do? How is the doc likely to react to me when he finds out I'm going against his advice? Or will he find out if he reads my card (Respironics Remstar Pro M-Series)?

It is a great thing, this forum. I get something helpful almost every day. Thanks, y'all.

bdp522 · Post by **bdp522** » Tue Jun 05, 2007 8:35 am

It would depend on what was seen in the titration. Did you have any central or mixed events? I'm all for self treatment but you have to know what's going on.
Do you have the software? You also show a nasal only mask, do you mouth breathe or mouth leak? Instead of jumping right to 12 or 11, I would have worked my way up a little at a time.
If you can post some charts the more experienced members here could give you some better ideas of whats going on.

Brenda

Slinky · Post by **Slinky** » Tue Jun 05, 2007 9:17 am

What the hay! In my mind its all in how you FEEL! Are you feeling more rested, more alert?? If so, I'd just leave the pressure where it is at and play dumb. Unless he really and truly does look at the data he isn't going to have the slightest idea that you did anything other than what you were told. Or it was an innocent mistake. I'd just be sure to tell him how much better you are doing since he told you to up the pressure, preferably before he glances at the data if possible.

tangents · Post by **tangents** » Tue Jun 05, 2007 9:52 am

Are there any problems that could come up by my having the pressure set higher than the doc recommends?

Yes, there are problems with pressure that is too high. This is dangerous ground, asking us this question. Just be careful to realize that we are not your doctor.

Is this a case where I just need to be responsible for my own health care and do what works for me instead of what the doc wants me to do?

Again, I would exercise some caution. Being able to see your data is important for you, if you are going to take control of your own health. Also, I'm not certain whether the Encore Pro detects Central Apneas?

How is the doc likely to react to me when he finds out I'm going against his advice?

You need to be prepared for the worst - he could dismiss you as a patient (this happened to me.)

Or will he find out if he reads my card (Respironics Remstar Pro M-Series)?

Certainly he could find out, but at this juncture you could claim "operator error" in setting it wrongly if that's what you wanted to do. That's why the medicals don't want us setting our own pressures in the first place, they're afraid we might "blow" our brains out.

I hope your doctor is receptive to talking to you, and discussing pros and cons of pressure settings to come up with the ideal treatment for you. That would be the ideal treatment approach.

Good luck with your therapy. I mean no disrespect to this forum, who have helped me tremendously.

Cathy

Goofproof · Post by **Goofproof** » Tue Jun 05, 2007 9:53 am

Slinky wrote:What the hay! In my mind its all in how you FEEL! Are you feeling more rested, more alert?? If so, I'd just leave the pressure where it is at and play dumb. Unless he really and truly does look at the data he isn't going to have the slightest idea that you did anything other than what you were told. Or it was an innocent mistake. I'd just be sure to tell him how much better you are doing since he told you to up the pressure, preferably before he glances at the data if possible.

As in Feet going numb, inject 60 more units of Insulin, make you feel better. Jim

At my house, I call that treatment by Ky windage.

rmcrob · Post by **rmcrob** » Tue Jun 05, 2007 10:23 am

I guess my AHI before CPAP was something like 65. That's relatively severe, huh?

I haven't seen the report from the titration study yet, but my average AHI during the month before the titration study (at 8 cm H2O) was still something like 15, according to the statistics on the machine.

The original sleep study didn't show anything but OSA, that is, there was no mention of CSA.

My inclination is to split the diff with the doc and try ten for awhile. I'll let the proof be in the pudding. I just don't want to hurt myself. I was simply asking people more experienced than I whether I was thinking wrong.

My broader medical experience is that I need to think for myself. The docs aren't really any smarter than I am, and they certainly don't care as much about successful treatment as I do. But they do have knowledge and experience that I lack. As do you all.

Thanks.

Craig-Tx · Post by **Craig-Tx** » Tue Jun 05, 2007 11:07 am

As was mentioned earlier, we are not Doctors, so use your own judgment on advice given here.

I would definitely get a copy of your recent titration. (The full report, not just a single page summary - should be somewhere around 6 pages if I remember mine correctly.) This will show apneas and pressure on a time scale. Determine what your AHI is at different pressures. Also look VERY closely at the report for Central Apneas.

It is my understanding that higher pressure can lead to promoting Central Apneas. The machines can only determine if you are having an Apnea. I can not determine if the Apnea is a Obstructive Apnea (caused by a blocked airway) or a Central Apnea (Believe to be caused by your brain not telling your lungs to breath.)

If you see any Central Apneas in your report, I would be much more cautious as to raising the pressure.

Goofproof · Post by **Goofproof** » Tue Jun 05, 2007 1:49 pm

Normal is AHI 5 or under, 65 is pretty bad. mine was 150. Jim

That makes your bad, look good. Now I am under AHI .7 avg for the year, but I don't mouthbreath, so the treatment works. Jim

WearyOne · Post by **WearyOne** » Tue Jun 05, 2007 4:58 pm

Hi remcrob!

I have the same machine you do and also fiddle with the pressure just a little. My titration study indicated that 8 did pretty well, where 9 got rid of everything. (The never went higher than 9.) I started at 9, but was having shortness of breath during the day, so he backed me to 8. My numbers were higher than I liked, so I upped it to 8.5, still within the range of my tirtration study. Last night, I bumped the pressure back down to 8, just to see what would happen. The numbers were a little worse, so I'm going back to 8.5 tonight.

If it were me, I wouldn't have a problem changing the pressure up to a point within the range the tech did it in the titration, but I would definitely get that report first, as someone else suggested, You may have have had centrals in the titration study at the higher pressures that you don't know about.

I'm a perfect example of how you cannot always go by how you feel. My numbers are great (1 or less), but I still feel bad--I've got some other things going on that also need to be addressed.

Take care!

Pam

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CPAPopedia Keywords Contained In This Post (Click For Definition): Titration

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CPAPopedia Keywords Contained In This Post (Click For Definition): Titration

gromittoo · Post by **gromittoo** » Tue Jun 05, 2007 5:38 pm

I have a basic M-series Remstar that I got last year to replace a Solo LX that I had for 6 years.

I have a history of knowing when my prressure needs to be increased again. I started out at 6cm, and every 2 years, I would go up 20%. Last August, my sleep study left me at 14, but I know I need to go up again, because my wife witnessed my apneas one night. She could feel my chest rising and falling, yet she would not hear the rythmic sound of my breathing through the mask. Besides, I am walking into walls again.

I saw my sleep doctor this morning, and he suggested we try 16, without a study. The tech in the sleep lab was not in to do the setting, and I can't figure out how to change the pressure on my M-series. With the SoloLX, I could change the settings easily.

I feel fully confident in self titratrating and my expeerience shows that when I get a sleep study, My self titrations were always correct.

Can anybody point me to directions for setting the M-series? I didn't have a chance to call my DME suppplier today, but the last time I had them change it, I had to drive an hour each way to thier facility to have it done,

Snoredog · Post by **Snoredog** » Tue Jun 05, 2007 6:20 pm

my opinion:

You should always base any settings you use on how you feel not what any report says.

Reports including PSG's can be used to guide you, but in the end how you feel should always take precedence.

Your doctor probably feels that the gain wasn't worth the extra pressure, they are probably more concerned that you stick with this therapy then any pressure value used.

If pressure is higher therapy becomes more difficult. Use the lowest pressure you can while getting benefit, if you don't feel any better and only end up with a lower score why tolerate that.

AHI is not the only measurement of that.

tangents · Post by **tangents** » Tue Jun 05, 2007 6:50 pm

gromittoo,

Try this link, Wulfman passed it along to me a few weeks ago.
http://www.cpap-supply.com/Articles.asp?ID=130

Good luck,
Cathy

(Can't get the URL to work, you may have to cut and paste into your browser, sorry )

Craig-Tx · Post by **Craig-Tx** » Tue Jun 05, 2007 7:03 pm

I was rather disappointed when looking at my titration report. During the titration, they started me at 4 (suffocating) went to 5 quickly, and then to 6 not long after. I Stayed at 6 for several hours and never went higher, however my AHI was still around 3 during the study. I figure the tech fell asleep and forgot to check 7.

The funny thing is that my Doctor wrote the Rx for 7. (Which was never tried during the study.)

I'm now running 8, and tempted to try 8.5 or 9 in the near future.