Why are the pressure needs going UP with weight loss?

[TamieJP]

Hi, my name is Tamie. My husband has lost 130 pounds but his pressure needs are increasing. He's on Bi-Pap 12/17 but it's not enough. We can't increase the pressure to his new prescribed levels though because of eustation tube dysfunction. The ENT is talking about doing a trach.

WHY would his pressures be increasing? Is there another Dr we should see?

Thanks, Tamie

[Heavy Zs]

I am not a doctor, and I don't play one on TV, but; when you lose large amounts of weight (130 - wow), often there is more skin "hanging" around than is needed to hold together the new body. Perhaps this is true of the inside airways as well. The same tissues that were obstucting breathing initially may have shrunk in volume, but the skin tissue itself may not have.

Of course a qualified ENT person would likely know the answer better than I, but I would have thought a little nip and tuck with the laser would clear up the loose tissue if that was the case. Not that I am advocating any surgery, but if my theory on excess loose tissue was correct it would follow logically. I know the trach is something I wouldn't rush into, but at least it is reversible if you find a solution later.

[Wulfman]

Hi Tamie.

Welcome to the forum.
I think we need a little more information to go on.

How was it determined that your husband needs more pressure?

Did he have another sleep study?

What (specific) equipment is he using? (make/model of Bi-PAP and mask)
If the Bi-PAP is data-capable (most are, but there are a few that aren't), software may be available to verify the pressure needs and/or whether there are problems with mask (or mouth) leakage. This data could be monitored on a more-frequent basis.


Den

[jnk]

The questions Den asks and the points he makes are important ones.

There are machines called auto-bilevels that can be set to a range of pressures. One of those may, or may not, be helpful for the situation you partially describe. The upper limit of auto-bilevels can be restricted to keep it from going too high.

Trachs can be very effective, I hear. And if it is eventually no longer needed, such as when someone wants to transition back to xPAP therapy, I have also heard that trachs generally heal well. So I wouldn't hesitate to try it.

Keep asking questions. But as Den said, more info from you would be very helpful.

[ww]

Hi, my name is Tamie. My husband has lost 130 pounds but his pressure needs are increasing. He's on Bi-Pap 12/17 but it's not enough. We can't increase the pressure to his new prescribed levels though because of eustation tube dysfunction. The ENT is talking about doing a trach.

WHY would his pressures be increasing? Is there another Dr we should see?

Thanks, Tamie

Please post the exact machine and mask your husband is using and the results of his initial sleep study and the latest one that has determined to raise his pressure. If the machine is data capable, then either get someone to download it and print it or do it yourself as the software (if capable) is inexpensive compared to his health. You can look into all these things in a couple of days, but surgery (for me) would be a last resort. If a trach was an optimum fix, we would all have them instead of cpap machines.

[Muse-Inc]

Like the others, what made you post the following? How do you know this? Sleep study? Symptoms?

...his pressure needs are increasing. He's on Bi-Pap 12/17 but it's not enough....ENT is talking about doing a trach.

Is this the doc who prescribed the sleep study and been overseeing your hubbie's care? If not, then a consult with an accredited AND experienced pulmonologist-sleep doc might be in order. If it were me, I would want another sleep study before I considered surgery UNLESS it were an immediate life-threatening situation.

...WHY would his pressures be increasing?

That's the $64K question, isn't it. Gotta be a reason...excess skin is a thought. I lost 53#s and need less pressure to stent open my airways...I've got lots more to lose. Tell hubby congrats on the wt loss, it's a challenge to lose that much!.

Good luck on getting some answers. Please post what you're told so we can all learn -- thanks!

Oh, and welcome aboard!

[sagesteve]

Ditto with jnk and Wulfman..also, don't forget centrals. Central sleep apnea is a disorder in which your breathing repeatedly stops and starts during sleep due to lack of respiratory effort. Unlike obstructive sleep apnea, in which you can't breathe normally because of upper airway obstruction, central sleep apnea occurs when your brain doesn't send proper signals to the muscles that control your breathing. Central sleep apnea is less common, accounting for less than 5 percent of sleep apneas.

[DarkSideOfTheMoon]

I was watching a show where a guy lost a lot of weight. Even though he had more to do, they needed to remove his "breasts". During the surgery his lungs improved just from not having the extra skin weight.