Is "more pressure than needed" a problem?

[ZzzCatcher]

Being a clueless newbie, I thought my provider had gotten info from my sleep doctor, so when I went in and they had my trial period results and a nifty new CPAP all ready for me, I paid for it and took it home, etc. Well, I went for my followup today, and my doctor told me he was prescribing me an APAP, since my apnea was extremely positional, so when I wasn't in a problematic position, I'd be getting more pressure than I needed with a CPAP. The results of my trial period showed the variable pressure did the trick, dropping me from 50+ API to 3.

I've contacted my provider, and I imagine they'll be willing to exchange the machine, since the APAP will be more expensive, getting them more money. But on the off-chance they're jerks about it, is getting more pressure than needed actually an issue? Could I just shrug and live with the CPAP?

[Pugsy]

I would get what the doctor thinks is best...the apap.
While there might not be any apparent problems with using more pressure all night right now...there's a chance it could maybe be a problem later.

Problem being maybe aerophagia or something along those lines. In very rare situations maybe central apnea triggering.
I am currently using a fixed pressure machine but I really do better with auto adjusting because I need higher pressures in REM than in non REM. I can make this work but it isn't ideal and the auto adjusting is a lot nicer to start out the night with since I can use about 5 to 7 cm lower starting out than I can if I use fixed pressures. REM accounts for about 20% of the total sleep time...so I have to use more pressure than I really need for 80% of the night just to cover the 20 %. It's doable but having done both...I prefer auto adjusting.

You are in Canada so the suppliers do things a little differently up there but to answer your question.....yeah, you could most likely get by with fixed pressure without serious problems and do quite well.
But what if something changes and you might really benefit from adjustable pressures??? It might be a lot harder to get one later.

[Julie]

If a doctor (up here) writes a script for something, the dealer has to provide it. And take back the other one. Is there a problem I'm missing? Does ADP or OHIP cover anything there?

[chunkyfrog]

Many of us enjoy better therapy, and greater comfort with an apap.
The beauty is that ANY of them can also be run in straight cpap mode if needed.

[dlby]

I broke into mine and turned base or starting pressure down.
It's an auto machine so it will get where it needs to be.

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[TASmart]

I broke into mine and turned base or starting pressure down.
It's an auto machine so it will get where it needs to be.

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Not the best approach. It takes time for the machine to get to the most effective operating pressure, and the lower your starting pressure the longer it takes for you device to get to your best pressure. If course if you cannot sleep due to a high stating pressure the a low starting pressure or better yet a ramp can accommodate that. I think the best base pressure is slightly lower than your 95% number, or if CA is cropping up a down near the average is a better starting place.

[TASmart]

There is no mention in the literature of Barotrauma caused by commercial CPAP devices.

[nanwilson]

There is no mention in the literature of Barotrauma caused by commercial CPAP devices.

============

You are a real hoot. And illogical too.
You cant prove a negative and you certainly have not read everything on the subject.

Too bad you dont know half of what you think you know and that you dont know what you think you know is not so.

I just read it in a doctor's paper.
It clearly stated that too much pressure can cause barotrauma.

You are the illogical one... if your pressure is set higher, say 20, and you only need 10 to catch the apneas, then the machine will never go above 10.... when and why would it go higher, its not programmed to do so and will only do so if it NEEDS to. You could just leave the setting to 20, but it will never go there. Example: my machine is set from 10 -15, but has never gone (in 7 years of use) above 13, I set it that way just in case I had a REALLY bad night and it needed to go to 15.. but NEVER has.

[TASmart]

If you have a reference to the "doctors paper" whatever the hell that is, I would love to be educated. Give me a citation. I did do some level of research in the literature, and the only mention is of some kind of hospital home brewed CPAP running at 50-55 PSI - and xPAP run at up to up to 20 cm h20 and I believe ASV up to 25 cm h2o. So please let me know so I can learn!

[TASmart]

Thank you for your help in educating me.

[chunkyfrog]

Somebody is confusing cpap with ventilation devices . . ."most cases occur in patients receiving mechanical ventilation."
(from the medscape site)
REAL science mandates CITATIONS.
If one refuses, and merely repeats the claim, it cannot be accepted as truth.

[ajack]

@ tas, I'd go further and say it should be totally dismissed, if someone is unable to support their opinion.

@ dlby, generally speaking with an auto, the minimum is set a bit under the median/mean pressure and maximum is set 1 or 2cm above the 95% number.

A good rule would be...If you can blow up a balloon without a lung rupture, you have more than enough ability to handle the 20cm or more.

[ccbac]

ONE SIZE FITS NOBODY

now if it was really high then yes barotrauma is a concern especially with large tidal volume

your needs may change enough to require bipap

+1, best troll-reply ever!
You are really cute

[ZzzCatcher]

OP here - my provider is going to switch me for a new APAP, as I'd hoped. Waiting for them to reply to my email, I'd preemptively gotten myself geared up to offer up veiled threats (they sold me the machine without a valid prescription, technically, so I was going to mention that if they were "sorry, no exchanges"). But they weren't needed. And on another positive note, it looks like they charged me for a mask I didn't buy, so that should make me net out even for the more expensive APAP.

Thanks to those who offered useful responses!