Can too high of a pressure hurt you?

[btesterman]

I just raised my pressure from 6 to 7. That certainly isn't a drastic increase and it makes it much more comfortable to breath through the Swift LT so I'm not worried but I was just wondering if there is any danger of ever raising your pressure TOO much? Why would doctors not set your pressure a couple cm above what they found to be the minimal to achieve a good AHI if your pressure number was low? Can you become dependent upon a higher pressure? Is it an issue of effectiveness vs. comfort?? Just curious.

[KatieW]

For me, too high a pressure causes aerophagia (gas). Also, the higher the pressure, the more possibility of mask leak. And in some people, too high a pressure can cause central apneas.

An "average" pressure is 10 cm H2O, so your pressure shouldn't cause any of these. Lucky you!

[GumbyCT]

I just raised my pressure from 6 to 7. That certainly isn't a drastic increase and it makes it much more comfortable to breath through the Swift LT so I'm not worried but I was just wondering if there is any danger of ever raising your pressure TOO much? Why would doctors not set your pressure a couple cm above what they found to be the minimal to achieve a good AHI if your pressure number was low? Can you become dependent upon a higher pressure? Is it an issue of effectiveness vs. comfort?? Just curious.

For some people 6cm can be waay too loow and not provide enuff air for them to feel comfortable. 7cm I seriously doubt will cause any troubles.

While centrals are certainly a possibility with higher pressures than yours - centrals are really NO worse than Obstructives.

Keep that in mind when the naysayers come to tell you - you could die from too much O2 ....lmao.

You sound as if 7cm makes you feel better. Before you are done you might find 8 or 9 to be even better

[JohnBFisher]

... I was just wondering if there is any danger of ever raising your pressure TOO much? Why would doctors not set your pressure a couple cm above what they found to be the minimal to achieve a good AHI if your pressure number was low? Can you become dependent upon a higher pressure? Is it an issue of effectiveness vs. comfort?? Just curious.

Two issues come to mind:

First, when the pressure it higher than necessary, it can make it harder to breathe out against the constant pressure. If it's harder to breathe it can actually awaken you or at least cause an "arousal" (bring you from deeper sleep to back to ligher sleep). That's why if you need higher pressures (over 15 or so), sleep doctors will usually switch to BiLevel. It makes it easier to exhale against the pressure if the exhalation pressure is lower than the inhalation pressure.

Second, often as the pressure increases it triggers central sleep apneas. So, you try to keep the pressure as low as is effective. That's the advantage of an APAP machine that automatically adjusts the pressure up and down to give you the most effective pressure as you need it.

But can people use much higher pressures? Sure. My peak pressure (during inhalation) is often "off the chart" at 23cm H2O. That's three times as much pressure as your CPAP pressure. But my exhalatino pressure is only about 8cm H2O. While it takes a while to adjust to that pressure, it certainly does not hurt me. Quite the contrary, it makes a huge difference for me. (But then my machine adjusts the pressure up and down based on how well I am breathing).

[peppi]

6 or 7 IMO is too low. I would start at around 8.
My doctor set me up originally on a range of 4-8. Once I learned how to set it myself that lasted about 1.2 seconds.

I'm now on 8.6 - 12.2 and looking at my charts over the past two months, the actual range is setting around 9.6-10.2 so Im happy.

BTW, You will notice with every passing night you will need more air to push open those crappy swift Nazal pillows.
Modify your mask using the Breeze dialators and your restricted air problems will be gone.
I just did, and its like night and day.

I live in Orlando too, just south of Apopka and I'll be glad to do a mod for you if you dont feel comfortable doing it yourself. Just get the breeze dialators on cpapauction.com.
I paid a whole $4.99. Best $5.00 I ever invested in to get a good nights sleep without Oxygen deprevation or seizure.
Plus I doubt I will ever need to replace these better quality pillows for the life of the cheap res-med mask. I expect the mask to last a year or so. The Breeze Dialators I expect to last many more years than that.

Also, you may look into the Breeze pillows, they may be more comfortable for you than the Dialators since the pillows dont go into the nostrils that far. I cut the dialators back about 1/4" so they feel more like a pillow. Since I did that, they are very comfortable and I dont even notice I'm wearing them with NO leaks.

PM me if interested.

[ozij]

Trust yourself in using pressure that feels comfortable. Everyone is not the same, and what is true for one case in a thousand happens to be 100% true if that case happens to be you.

Too much pressure may cause all the problems mentioned above -- and what is "too much" is defined solely by your body's breathing system.

O.

[DaveMunson]

Yea. I have read that high pressure can induce central apneas.

[GumbyCT]

Who wants to define "High Pressure"?

[JohnBFisher]

Who wants to define "High Pressure"?

I'll take a stab at it. It depends on the patient. Some patients can tolerate 20+cm H2O without any problem. Some at 8cm H2O develop central apneas (and/or ComplexSAS - Complex Sleep Apnea Syndrome). So, the general approach is to apply only as much pressure as is needed to clear the obstructions and no more. Often during sleep titrations the sleep tech will go a few cm H2O over that therapeutic value to see if you can tolerate a slightly higher pressure. That way if you gain some weight the doctor can safely adjust your pressure without the likelyhood of introducing additional problems.

But in short, the quick answer is "It Depends!"

[ftn807]

Just for those that are wondering what it IS like when pressure is too high. I have now experienced it. I have a Respironics PR System One REMstar Auto with A-flex and my original pressure was at 10-14 setting. I was snoring still but the machine did not adjust my pressure greater than 10 as for some reason it didn't "feel" I needed it. My doctor sat me down and tried to see what pressure I could "take" and bump it down a little so I could sleep with the pressure and not awaken. I was able to handle 16 and no leaking. He set me for 14-18 with a ramp start at 12. My first night I woke and it felt like my lungs were hyperinflated. I had never remembered being able to breathe sooo deeply in my life (I have been an athlete my whole life). I also was FULL of "gas" and abdomen felt soo full. I also had to burp a lot as well. I was apparently taking in a lot of air while swallowing in my sleep. My next appt isnt for 3 1/2 weeks (VA "veterans administration" is hard to get appts) and am trying to adjust my settings until I can get back in. I CANNOT sleep without my machine. Its not fun and step up slowly if needed. Too much is difficult to deal with especially if you cant have it adjusted back down easily.

[lee_leses]

JohnBFisher, I really like your answers! I'm learning things!

IMO, anything lower than 8 is fairly uncomfortable for me. I have asthma, and while I don't usually feel short of breath, I don't like pressures less than 8 at all.

I've been playing with the settings on my new PR System One for weeks, and right now 12 with an AFlex of 3 and upper and lower limits of 12 and 16 seems best for me. That is producing an AHI of .2 most nights, and the first real sleep I think I've had in a long long time.

In my sleep studies, I was titrated up to 14 and sent home with a setting of 10. My old Remstar was CPAP only, no CFlex or AFlex and no auto. New machine is a HUGE difference.

I have been inflated before many times, which was why I reduced my old machine to 10 and even 8. I'm not sure if it has something to do with the mouth taping I've been doing, or the auto or AFlex, but my aerophagia seems to be virtually gone, which is VERY exciting to me!

[robysue]

But in short, the quick answer is "It Depends!"

JohnBFisher's entire answer is spot on, but this last phrase is worth repeating. Both "high pressure" and "too high pressure" are patient-dependent.

Many folks here say they can't breath at pressures below 6 or 8 cm. And I'm sure it's true. But routinely advising everybody having problems to bump the pressure up to at least 8cm is silly and misleading. Why? Because there are a number of us (including me) who are very comfortable breathing at pressures as low as 4--8 cm AND whose OSA is well controlled at those pressures. And for some of us even modest increases in pressure trigger real problems with aerophagia and/or additional arousals due to difficulty exhaling against the pressure.

The best advice in this thread in my opinion was given by ozij:

Trust yourself in using pressure that feels comfortable. Everyone is not the same, and what is true for one case in a thousand happens to be 100% true if that case happens to be you.

As long as a modest increase in pressure INCREASES your comfort and doesn't trigger centrals, there's no real problem. Conversely, if you're having problems at a prescribed pressure with aerophagia or exhaling in spite of EPR/Flex, it's worth asking the doc whether there's a chance you've been over titrated and whether the pressure can be reduced (at least slightly).