Pressure is Better

cashman · Post by **cashman** » Mon Dec 21, 2009 5:25 pm

Thanks for all the advice. I posted earlier this week that I was having trouble breathing with the CPAP. So using info from this site, I "hacked in" to my machine last night and increased the pressure from 6 to 9. What a huge difference! I slept for about 4 hours total with the CPAP on (2 hours more than my previous best). I think the 4 hours on the cpap was way better than the "8" hours I was getting before. Feeling good today (not 100% but really good). Looking forward to "hosing it up" tonight.

flylow · Post by **flylow** » Mon Dec 21, 2009 6:08 pm

Congratulations!!!! By the way, you didn't hack into your machine in the same way you don't hack into your house thermostat to make the right climate choice for you.... stop thinking you are doing something wrong.

Do you have the software to see the detailed data and how it is going for you?

montana user · Post by **montana user** » Mon Dec 21, 2009 6:19 pm

I have also increased my machine from original setting. The only thing I want to caution you on is if you are over titrating yourself( way too much pressure), you can cause central apneas, thus making things worse! This is how we in the sleep lab know we have overtitrated a patient. But if your feeling good, I assume your still in a safe pressure zone.

cashman · Post by **cashman** » Mon Dec 21, 2009 7:21 pm

So far so good. I was getting really frustrated that I had to go see my doc (at $150+ per visit) every time I needed an adjustment. I did try 10 but that felt like way too much so bumped it back to 9. Am really interested to see how I feel after a few nights of sleeping well. Have been suffering frm poor memory, lack of concentrration, motiviation etc.

flylow · Post by **flylow** » Mon Dec 21, 2009 9:47 pm

cashman wrote:So far so good. I was getting really frustrated that I had to go see my doc (at $150+ per visit) every time I needed an adjustment. I did try 10 but that felt like way too much so bumped it back to 9. Am really interested to see how I feel after a few nights of sleeping well. Have been suffering frm poor memory, lack of concentrration, motiviation etc.

If you don't have the software, you need to get it. You can post detailed reports here for help in seeing how it is really going. Inducing centrals is a real concern although I think it would be highly unlikely at a pressure of 9.

rested gal · Post by **rested gal** » Tue Dec 22, 2009 12:56 am

From my page of links to "Central Apnea" discussions...
Links to Central Apnea discussions
viewtopic.php?p=22702
_____________________________________________
viewtopic.php?t=14225
Page 2

The phenomena of pressure-induced central apneas is tossed around far too freely. The vast majority of people do not get centrals because of ultra-therapeutic CPAP levels. BiLevel, Pressure Support (PSV) and Proportional Assist (PAV) Ventilation are another matter. You need some mechanism to drive the pCO2 below the sleeping apneic threshold, and plain old CPAP rarely is able to do that. OK, if you wanna argue that CPAP increases base lung volume (Functional Residual Capacity)(FRC), and since that increases gas exchange, some people can generate centrals that way, fine. But it's not as many as you might think.
SAG
_________________________________________

SAG ("StillAnotherGuest") is an RRT, RPSGT, and manager of an accredited sleep lab.

I agree with flylow about this:
"highly unlikely at a pressure of 9"

Patrick A · Post by **Patrick A** » Tue Dec 22, 2009 12:59 am

rested gal wrote:From my page of links to "Central Apnea" discussions...
Links to Central Apnea discussions
viewtopic.php?p=22702
_____________________________________________
viewtopic.php?t=14225
Page 2

The phenomena of pressure-induced central apneas is tossed around far too freely. The vast majority of people do not get centrals because of ultra-therapeutic CPAP levels. BiLevel, Pressure Support (PSV) and Proportional Assist (PAV) Ventilation are another matter. You need some mechanism to drive the pCO2 below the sleeping apneic threshold, and plain old CPAP rarely is able to do that. OK, if you wanna argue that CPAP increases base lung volume (Functional Residual Capacity)(FRC), and since that increases gas exchange, some people can generate centrals that way, fine. But it's not as many as you might think.
SAG
_________________________________________

SAG ("StillAnotherGuest") is an RRT, RPSGT, and manager of an accredited sleep lab.

I agree with flylow about this:
"highly unlikely at a pressure of 9"

Interesting post and a lot of good information. Thanks RG

Jaylee · Post by **Jaylee** » Tue Dec 22, 2009 1:00 am

I am glad it is working out for you

Rebecca R · Post by **Rebecca R** » Wed Dec 23, 2009 3:22 pm

rested gal wrote:From my page of links to "Central Apnea" discussions...
Links to Central Apnea discussions
.............

I agree with flylow about this:
"highly unlikely at a pressure of 9"

I searched the forum for "central apnea" because my doc mentioned the possibility of pressure induced apneas, but I never found any of the posts you listed. Thanks Rested Gal!

Unfortunately I had a case of information overload. I am still in the stage of "Brainfog & still feeling lousy...got the card reader...oh no, leaks!, more than the lcd screen indicated! gotta fix the leaks...tried alot of stuff...tape--no, FFM--no, pantyhose to stabilize mask (thanks SleepyT), found your photos restedgal...worked like magic overnight (my variation makes me look like a bankrobber)...need to titrate now that I fixed the leaks" stage. I don't know if that's a stage, but it's where I'm at.

I followed the links and started reading...but brainfog...realized I had been reading for over an hour, and forgot why I had started, information overload...I never even reached the legendary MOAT, although I read several ominous references and am kind of afraid.

I think I need to back up. Everything takes so much longer in this foggy state. Can you give me a simple rule of thumb (dummied down for brainfog) to newbies regarding when to worry or not worry about pressure induced centrals when increasing pressure? I don't want to go to the MOAT yet...I might never get out at the rate I am going!

cashman wrote:increased the pressure from 6 to 9. What a huge difference! I slept for about 4 hours total with the CPAP

I can't breathe at 6 either. At first I had the ramp set to 30 minutes and I struggled to breathe. I tried without the ramp, but it was too much all at once, so I set it to ramp within 5-10 minutes so I have just enough time adjust my mask while I get used to the increase in pressure. This cpap thing is a constant learning curve. I am at five months and still feel like I just started.

r

MauraAnderson · Post by **MauraAnderson** » Wed Dec 23, 2009 3:40 pm

cashman wrote:Thanks for all the advice. I posted earlier this week that I was having trouble breathing with the CPAP. So using info from this site, I "hacked in" to my machine last night and increased the pressure from 6 to 9. What a huge difference! I slept for about 4 hours total with the CPAP on (2 hours more than my previous best). I think the 4 hours on the cpap was way better than the "8" hours I was getting before. Feeling good today (not 100% but really good). Looking forward to "hosing it up" tonight.

Great news! I'm hoping each night is even better!

- Maura

Gerryk · Post by **Gerryk** » Wed Dec 23, 2009 3:47 pm

Cash, jumping from 6 to 9 is a big jump. Were you titrated at that in a sleep study or did your doc use an auto titrating machine to get that number?

Read what Rested gal said about central apnea's. By jumping your pressure up higher than is needed, you can induce what is called central apnea's. Central apnea's are when your brain just doesn't tell you to breath, where as OSA Obstructive sleep apnea is not breathing because of an obstruction such as collapsed airway.

Gerry

JohnBFisher · Post by **JohnBFisher** » Wed Dec 23, 2009 8:13 pm

Rebecca R wrote:... I searched the forum for "central apnea" because my doc mentioned the possibility of pressure induced apneas, but I never found any of the posts you listed. Thanks Rested Gal! ... Can you give me a simple rule of thumb (dummied down for brainfog) to newbies regarding when to worry or not worry about pressure induced centrals when increasing pressure? ...

Rebecca R, hope you don't mind if I jump in here and answer instead of Rested Gal. Since my recent problems have been due to central apneas I may be able to help answer this question.

As GerryK noted, a central apnea is just an apnea due to the central nervous system not properly triggering normal respiration. However, SOME central apneas are normal in everyone. So, if you have a sleep study that notes you had a few central sleep apneas during the night, they probably won't feel there is much need to address them.

However, when the sleep specialist sees a tendency for you to rouse from deeper sleep to lighter sleep on a consistent basis due to central apneas, then they may start to look into addressing them. Usually they start by trying a BiLevel (a BiPAP or VPAP) unit (sometimes breating against the constant pressure is the problem). If that does not work, they may try a BiPAP S/T (a BiPAP with a backup time, which makes certain you breathe at least a certain number of times per minute). In severe cases, they may move you to an ASV (Auto Servo Ventilator or Adapt Servo Ventilator) unit.

So, how often is often enough to worry about? My last sleep tech indicated a general cut off that she had seen was over 20 central apneas during a sleep study before they would try an ASV unit. They skipped the BiPAP S/T unit for me because the titration study showed that I had six times the number of central apneas as obstructive apneas.

By the way, if I remember correctly you have issues with PLM (periodic leg movement). I had some durng my BiPAP titration sleep study, but none during my ASV sleep study. My neurologist / sleep specialist thinks it was due to the central apneas. Here's hoping you might find some help with that if they help with the central apneas.

Hope that helps! (P.S. Due to the brain fog ... trust me, I understand ... I will probably also PM you to be certain you get this answer.)

cashman · Post by **cashman** » Wed Jan 06, 2010 2:38 pm

Well after a couple weeks of sleeping with the CPAP, I'm beginning to feel rested (at last). Finally settled on a pressure of 10 which has worked consistently well over the last week. Also, I stopped drinking alcohol which has helped me sleep better as well. Just wanted to say thanks to all of you who responded to my questions!

Greg

rested gal · Post by **rested gal** » Wed Jan 06, 2010 7:39 pm

Gerryk wrote:Central apnea's are when your brain just doesn't tell you to breath, where as OSA Obstructive sleep apnea is not breathing because of an obstruction such as collapsed airway.

That's correct.

But...where did I say this?

Gerryk wrote:Read what Rested gal said about central apnea's. By jumping your pressure up higher than is needed, you can induce what is called central apnea's.

The quote I gave in my post was about how the fear of higher pressure inducing central apneas is an exaggerated fear for the most part. Here's the quote again - from the manager of an accredited sleep lab:

"The phenomena of pressure-induced central apneas is tossed around far too freely. The vast majority of people do not get centrals because of ultra-therapeutic CPAP levels."

Yeah, central apneas can be induced with more pressure in some people, but according to what was quoted there, more pressure usually does NOT induce centrals in most people.

I wouldn't hesitate one bit to raise pressure in a leap of two or three or even four full cms from a starting point of 6 cm. But that's just me.

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