Effects of higher than needed pressure settings?

What are the effects of a cpap or bipap patient using pressure that is higher than necessary?

Are these effects, if any, dependent upon where in the scale they are applied? For example, does *unwarranted* raising pressure from:
(A) 6 to 9
(B) 10 to 13
(C) 15 to 18
all have the same effect on the body of this cpap or bipap user?

Do you know of any documentation for your opinion?

Andy

Patients can also become uncomfortable if the pressure is set inappropriately high

Link

Nothing said about harming the patient...

Overtitration is a comfort thing(Uncomfortable)....under titration doesn't do the job. Most Sleep labs will add 10% to a titrated pressure to make sure the patient is titrated.

If you are a Bi Level user....synchronization is just as important as the pressure! High pressure settings(Above and beyond what you need) will not overcome poor synchronization....been there done that!

Most sleep labs use Respironics machines with digital auto trak....So no synchronization guidelines are given to the patient via prescription! If you are a Bi-Level user and do not get a Respironics machine, you need to have an RT synchronize the machine with your breathing for you...if not you will be just sucking wind!

The only side effect of using a pressure higher than what you need is that you will induce central apneas...only if you are prone to having centrals. If you are not prone to having centrals...it will just be harder to exhale and you may not sleep soundly.

Joe A wrote:
If you are a Bi Level user....synchronization is just as important as the pressure! High pressure settings(Above and beyond what you need) will not overcome poor synchronization....been there done that!

Most sleep labs use Respironics machines with digital auto trak....So no synchronization guidelines are given to the patient via prescription! If you are a Bi-Level user and do not get a Respironics machine, you need to have an RT synchronize the machine with your breathing for you...if not you will be just sucking wind!

The only side effect of using a pressure higher than what you need is that you will induce central apneas...only if you are prone to having centrals. If you are not prone to having centrals...it will just be harder to exhale and you may not sleep soundly.

Thanks for replying, Joe,

What does synchronization mean?

How does one know if they are prone to having centrals? Because they show up on the sleep studies? I had one central apnea show up. Do you need only one or a dozen to be "prone?"
(I use a BiPap Pro 2).

Are there any rules of thumb as to how much unnecessary pressure does one need before they may induce central apneas?

Andy

I am really confused How do I know if I am getting the right pressure from my machine? I am finding that I am still getting up in the morning very tired and grumpy.
After about a 5 day period I have to sleep on and off during a one day period without my CPap to 'catch up' on what feels like lost sleep.
When I am sleeping with my cpap I feel as though I am part of the way awake and the rest of me is awake. ANYONE ever gone through something like this? I am getting frustrated! HELP!

This is the results of too high a pressure

Are you on a straight cpap that ramps up to a set pressure? may be to high. I have the auto and it ''senses'' what I need, WHEN I NEED IT. Not what some RT set, who by the way, have they asked you how you're doing? Eithe the DME or RT?

patlgirl wrote:I am really confused How do I know if I am getting the right pressure from my machine? I am finding that I am still getting up in the morning very tired and grumpy.
After about a 5 day period I have to sleep on and off during a one day period without my CPap to 'catch up' on what feels like lost sleep.
When I am sleeping with my cpap I feel as though I am part of the way awake and the rest of me is awake. ANYONE ever gone through something like this? I am getting frustrated! HELP!

Patigirl,
Something is not right regarding your treatment! Are you mouth breathing after you fall asleep? That will cause you much grief, and usually you can tell by dry mouth and waking up in the middle of the night gasping for air. If I were experiencing your problem I would take my machine back to my DME and make sure they have the correct pressure set to correspond with your prescription. If it is, then I would talk to your doctor about getting you an apap machine on loan for a month to determine what is going on while you are sleeping and where you should be titrated. A night in a hospital room may not be a true picture of your sleep patterns. When your therapy is correct you should never sleep without the hose!!

patlgirl wrote:I am really confused How do I know if I am getting the right pressure from my machine? I am finding that I am still getting up in the morning very tired and grumpy.
After about a 5 day period I have to sleep on and off during a one day period without my CPap to 'catch up' on what feels like lost sleep.
When I am sleeping with my cpap I feel as though I am part of the way awake and the rest of me is awake. ANYONE ever gone through something like this? I am getting frustrated! HELP!

Could be a LOT of things. Mask leak, too low of a pressure, or you might have other issues that are causing you not to sleep well... How long have you been on CPAP?

Fl Andy,
In some cases, too much pressure, or pressure when it is not needed, can be more of a problem than no pressure. One case where too high a pressure is contraindicated is when a person has asthma. See the following link
http://www.sleepapnea.org/asthma-osa.html

I've also read, although I can't find the link right now, that too high a pressure can cause central apneas, as opposed to obstructive apneas.

So just arbitrarily upping the pressure is probably not a good idea. If you think your current pressure is not correct, and don't want another sleep study, try using an apap. Either rent one for a couple of weeks or purchase one.

Debbie (snoozin')

Fl Andy:

With a BiPAP, the low and high pressure need to be in Sync with your breathing in order to ensure proper splinting of the airway. If your IPAP and EPAP sensitivity settings are incorrect for your beathing, no amount of pressure will provide adequate therapy.

I suffered for two months thanks to my DME leaving these at the default settings! They didn't even know that the settings existed!!! Took me two weeks to work out the settings myself....Today I feel Great!!!!!!!

A respironics machine has digital Auto Trak, which will self adjust, however, it still doesn't work for all interfaces.

Centrals will show up on your sleep study, if so BiPAP is wwhat they usually give you to reduce overall average pressure. Centrals are usually treated with a 6 cm spread between IPAP and EPAP.

If you need say 16 CM to splint your airway....it is very difficult to exhale aginst 16 CM! So then they may go to BiPAP at 16/12. There is pressure inside youre chest cavity, so splinting the airway is not as difficult on the exhalation phase of breathing.

As for how much pressure overage causes Centrals....I have no idea! But sleep labs will often add a cm to a titration for good measure which for most CPAP users is 10% or so.

Joe A wrote:Fl Andy:

With a BiPAP, the low and high pressure need to be in Sync with your breathing in order to ensure proper splinting of the airway. If your IPAP and EPAP sensitivity settings are incorrect for your beathing, no amount of pressure will provide adequate therapy.

I suffered for two months thanks to my DME leaving these at the default settings! They didn't even know that the settings existed!!! Took me two weeks to work out the settings myself....Today I feel Great!!!!!!!

A respironics machine has digital Auto Trak, which will self adjust, however, it still doesn't work for all interfaces.

Centrals will show up on your sleep study, if so BiPAP is wwhat they usually give you to reduce overall average pressure. Centrals are usually treated with a 6 cm spread between IPAP and EPAP.

If you need say 16 CM to splint your airway....it is very difficult to exhale aginst 16 CM! So then they may go to BiPAP at 16/12. There is pressure inside youre chest cavity, so splinting the airway is not as difficult on the exhalation phase of breathing.

As for how much pressure overage causes Centrals....I have no idea! But sleep labs will often add a cm to a titration for good measure which for most CPAP users is 10% or so. (from Joe A.)

Fl Andy,
In some cases, too much pressure, or pressure when it is not needed, can be more of a problem than no pressure. One case where too high a pressure is contraindicated is when a person has asthma. See the following link
http://www.sleepapnea.org/asthma-osa.html

I've also read, although I can't find the link right now, that too high a pressure can cause central apneas, as opposed to obstructive apneas.

So just arbitrarily upping the pressure is probably not a good idea. If you think your current pressure is not correct, and don't want another sleep study, try using an apap. Either rent one for a couple of weeks or purchase one.

Debbie (snoozin')


Andy Follows:

Thanks JoeA and Debbie.

I just KNEW i had heard that too much pressure (unneeded pressure) can/does cause central apneas. When I wrote this post originally I did not want to appear to be an alarmist, so I simply asked the question - rather than state an unsupported fact.

I later remembered where I had heard that - after i had started this thread. But since it was "hearsay" and non-documented, I did not post a follow up in this thread.

*After* I got a copy of my titration study from my doctor, I had occasion to talk with the sleep tech who did the titration. She said that my OA's stopped at a pressure of 11, that I still had one hypopnea at 12, nothing at 13, but at 14 one central apnea showed up, so she stopped.

She said that as soon as "she caused a central she had to stop." If you look back at my titration study that Derek so well formatted on a different thread, it confirms this exactly.

She set my *cpap* pressure at 13. I was later changed to a bi-pap, with the pressure set at what the DME thought was best and was agreed to by my Internist.

I encourage members of this message board to not unknowingly encourage other member to experiment with increasing pressure settings that have not been prescribed by a doctor. I agree completely with Titrator Ted that a sleep study is necessary to set settings, and not by arbitrary AutoPap experimentation. IMHO that is dangerous. Also IMHO we should be clear to new members that an AutoPap should not be considered a replacement for a sleep study unless so prescribed by a doctor.

Just my two cents,
Andy