high pressure

Gidgie · Post by **Gidgie** » Tue Mar 07, 2006 11:52 am

Lately I've been having a fight with my machine. Note....I really do mean the machine, NOT the mask. Every night I wake several times, just enough to slap down the ramp button,then back to sleep. Eventually I will wake completely (in self defence!) with the pressure up around 18 or 19. This morning it was 20! I have no idea what pressure I am supposed to be at, and my DME seems to think the darn thing will only go as high as it needs to. But this morning! I feel like my eyeballs have been peeled, my throat scoured out with a wire brush and talk about sinuses!........My brain is a shivering mass, cowering in the back of my skull. The rest of me......well, you could HEAR me walk, (though I don't think you'd want to) Any thoughts before I head out to give my DME an attitude adjustment?

snoozalot · Post by **snoozalot** » Tue Mar 07, 2006 12:15 pm

I would definitely learn what your titration needs to be, based on your sleep study. Then, I would go into the setup and verify that the setting is correct.

Sometimes, the DME leaves the pressure setting at 4-20, ignorantly thinking that the machine will find the correct setting. This is wrong!
The machine should be set for a 4-5 cm range in order to operate properly, or you will be bounced all over the board. It could also cause you to develop centrals if your pressure is set too high.

You really need to find out where you need to be, and how close your settings are to your needs, or this just won't work.

Bob

PEELS · Post by **PEELS** » Tue Mar 07, 2006 12:16 pm

Gidgie,

Wow, no mask problems with the pressure up to 20. That's great.

Now, the question is "what should your maximum pressure be set at?" Because you are using an Auto CPAP the machine is adjusting the air pressure to the level that it senses you need to clear your airway. Some on this forum have mentioned the possibility of Central Apneas that the CPAP machine cannot correct.

Did you have a sleep study using a CPAP? If so, you should ask your Healthcare provider for a copy of the report. That should tell you your degree of Apnea and the maximum pressure level your DME should have set the machine at. It should also mention if you had any central apneas.

snoozalot · Post by **snoozalot** » Tue Mar 07, 2006 12:22 pm

I would definitely learn what your titration needs to be, based on your sleep study. Then, I would go into the setup and verify that the setting is correct.

Sometimes, the DME leaves the pressure setting at 4-20, ignorantly thinking that the machine will find the correct setting. This is wrong!
The machine should be set for a 4-5 cm range in order to operate properly, or you will be bounced all over the board. It could also cause you to develop centrals if your pressure is set too high.

You really need to find out where you need to be, and how close your settings are to your needs, or this just won't work.

Bob

TerryB · Post by **TerryB** » Tue Mar 07, 2006 5:31 pm

I'm brand new to this theropy as you can tell by my post count, but wouldn't mouth leaks also cause the machine to take off trying to reach a pressure with a large (no offense) leak?

TerryB

NightHawkeye · Post by **NightHawkeye** » Tue Mar 07, 2006 6:45 pm

TerryB wrote: . . . wouldn't mouth leaks also cause the machine to take off trying to reach a pressure with a large (no offense) leak?

Sometimes not, as I've discovered over the past few weeks fighting this very problem.

My observations are that one of three things happen.
1) The machine can go oscillatory as happened to me one night last week. (I've only had this happen once, but it is kinda wild to wake up to a machine which is continually raising and lowering pressure irregardless of how I'm breathing.)
2) The machine senses a large leak and then backs down from its pressure.
3) With a relatively constant leak the machine simply compensates for the extra ventilation and continues automatically adjusting pressure. In this latter case it appears from the data I've seen that the treatment effectivity is not compromised much, or maybe not at all.

Regards,
Bill

Gidgie · Post by **Gidgie** » Tue Mar 07, 2006 6:58 pm

Talked to my DME today.........Will be seeing him tomorrow. He just couldn't believe it when I said it was ramping up even while I was awake! Checked that again this afternoon, needing a nap after last nite. Stated awake for a while, reading, and watched the pressure climb to 9 while I was awake. Fell asleep, woke up an hour later with the pressure at 16, and the leaks starting. Oh yes, I have high pressure leaks, and like I said once before in a previous post, they're like a freight train rumbling through. Any way, eventually the guy said 'bring it in with you tomorrow'. But I know.....I just know.....He says, I'm on auto, and the machine "knows" what pressure I need. I read that to mean that he doesn't! That'll be the day!

Snoredog · Post by **Snoredog** » Tue Mar 07, 2006 8:13 pm

First thing we need to know is WHAT is your titrated PRESSURE supposed to be?

Sounds to me your machine may not be setup correctly or your DME is setting you up for failure in order to push their money making straight cpap model.

If the DME has programmed the machine in cpap "mode" and enabled a timer of any kind, then the machine will start at a lower pressure and increase as time goes on. OR if setup incorrectly (AFLE or AUTO mode) and then they established a "timer" setting in the field 00:00 this could/would enable a special split-night mode which could do the same thing. When the machine is set to any Auto mode the timer has to be at zero or 00:00. No ramp is applicable.

It could very well be that you need high pressure of 18 or 19cm, but that would then be the WRONG machine for you, if your pressure truly is 18 or 19cm then you would need a Bi-PAP machine for greater exhale relief against that kind of pressure.

Lastly, the machine could be defective. I own 2 Remstar autos, they are NOT prone to runaways like other machines. Leaks can cause them to increase pressure but not up to 20cm. Check that clear silicone gasket or coupler between the humidifier tank and the machine. If that coupler has been pushed into the machine too far it will leak at the tank and cause the machine to go nutso. Remove the hose from the tank, turn on the machine and put your hand or thumb over the hole and listen for leaks.

rested gal · Post by **rested gal** » Tue Mar 07, 2006 8:42 pm

Gidgie, by chance do you have GERD (acid reflux disease)? Or, bad allergies that might be causing swollen tissue in the throat?

Positive air pressure can push back collapsed throat tissues, but it cannot push aside swollen tissue. So, if you happen to have either of those ailments, you might want to be sure they are well under control. Just a thought.

Nov 05, 2005 subject: SUCCESS AT LAST-GERD,420E, PRILOSEC AND BENADRYL

Darth Vader Look · Post by **Darth Vader Look** » Tue Mar 07, 2006 8:42 pm

The coupler from the heated humidifier to the APAP have a metal washer in them to help stop the coupler from going on too far. Not sure if this is new or not. As Snoredog has posted it wouldn't be surprising to find that the DME set the unit up improperly. Maybe these people should get direct training from the manufacturer before being able to push their products.

Gidgie · Post by **Gidgie** » Tue Mar 07, 2006 10:54 pm

Thanks for all the input, folks. I have a sneaking suspicion that DME didn't set something up right, as I did have high pressure problems from the first night and he told me I'd need to get used to it. Well, I guess I did, to a certain extent, as I've managed to keep on! Hate feeling like a wind tunnel tho......I guess I just hit the wall........And what about when I was awake? Am I to understand that I can't keep my own airway open when I'm awake? If that's the case, I'm in the wrong place, doin' the wrong thing......somebody, measure me for the coffin, will you?

NightHawkeye · Post by **NightHawkeye** » Wed Mar 08, 2006 5:03 am

Gidgie wrote:And what about when I was awake? Am I to understand that I can't keep my own airway open when I'm awake?

Gidgie, I have the same problem. Sometimes when I'm awake the machine will either go up to a high pressure or stay there. If I just turn the machine OFF and back ON again, it will go right back up to high pressure in a few minutes. The only way I've found to bring the pressure back down is to take some anti-histamine before putting the mask back on.

Apparently the machine is trying to clear my clogged sinuses. I can still breathe just fine (I think), but I am aware that my sinuses are partially clogged. When my sinuses get this way, it's a little more difficult to exhale, so I guess that's what the machine senses and raises pressure to try to improve things.

Just wanted to let you know you're not the only one who's had this problem.

Regards,
Bill

Jim Eads · Post by **Jim Eads** » Wed Mar 08, 2006 10:06 am

Could the machine be set to CPAP with a pressure of 20 and a 2 hour ramp time?

Jim

Gidgie · Post by **Gidgie** » Wed Mar 08, 2006 7:43 pm

Today I decended upon my DME in righteous wrath. After what I've been reading here I don't think the man's too saavy. First, he thought I was snoozing when I was checking(read-spying) on the machine, watching it sneak up to 9 yesterday. Told him I was reading, and I don't read in my sleep! Then he thought my mouth was open, but I just grinned and told him that with a ff mask it didn't matter, but no. Had the good grace to look embarrassed, and promise never to ask me that one again, But...! Getting him to make pressure adjustments was something else. He thinks I need 20, I said anything over 16.5 I was waking and fighting with. He said"how about 19? I said 16, and if it didn't work out we could change it again. '18?' I shook my head "think like a cat", I told him, "everything is meant to be played with. By now he's getting a funny kind of 'what do I do now?' look and offers, with a hint of desperation "How about splitting the difference? 17? I nod. Really scientific, Is'nt it? We don't do REAL sleep studies here. You get sent home with a oxemeter(sp?) for the nite. That's it. After that it's somewhere between hit & miss and the reading of smart cards. Where would I be if it wasn't for you folks? So, now we have some parameters to work with, tho not the best 6 to 17 is quite a spread. But if things improve, I may have better luck...But guess what? The snores have definitely stopped, now all I have is a nasty case of sinus burn!

Goofproof · Post by **Goofproof** » Wed Mar 08, 2006 9:36 pm

It sounds like you are a master at holding your own, you have to remember when he comes down a number you need to go down a number too, he will get confused and you can get the pressues you want.

You really need the software and reader, it sounds like the DME is clueless.