High pressure bad for the heart ?

I usually, only expect from my "DME" (I am french, and have the equivallent of your DME) to provide me with the masks I want.
Anyway, she told me this morning, when she realized, that I was taking the most liberties with the level of pressure indicated by my doctor, that a high pressure might strain my heart...

Does this make any medical sense?

Thank you for your opinion

Dog Slobber's answer, below, is better.

Albatros wrote: ↑

Thu Dec 08, 2022 11:58 am

I usually, only expect from my "DME" (I am french, and have the equivallent of your DME) to provide me with the masks I want.
Anyway, she told me this morning, when she realized, that I was taking the most liberties with the level of pressure indicated by my doctor, that a high pressure might strain my heart...

Does this make any medical sense?

Albatros wrote: ↑

Thu Dec 08, 2022 11:58 am

I usually, only expect from my "DME" (I am french, and have the equivallent of your DME) to provide me with the masks I want.
Anyway, she told me this morning, when she realized, that I was taking the most liberties with the level of pressure indicated by my doctor, that a high pressure might strain my heart...

Does this make any medical sense?

Thank you for your opinion

Not until you get to pressures higher than most home PAP machines can produce, (ie, you need a specialized machine to go to those pressures).

how high is too high?

my machine is set to a maximum of 25, though the highest i've actually seen on my charts is when it hit 23 point something.

i don't think i'm experiencing anything bad for my heart.

No. Our heart doctor told my husband and I to both have a sleep study done and to go on a pap machine to PROTECT OUR HEARTS as we both had Atrial Fibrillation back then. The AFib is gone for both of us.

Ask about the effects of untreated sleep apnea.

Not just the heart but kidneys liver lungs.

Your DME (or whatever their French title is) is NOT a doctor.
--just a lowly salesperson.
Treat them with only as much respect as they deserve-
-which appears to be questionable.

zonker wrote: ↑

Thu Dec 08, 2022 5:13 pm

how high is too high?

my machine is set to a maximum of 25, though the highest i've actually seen on my charts is when it hit 23 point something.

i don't think i'm experiencing anything bad for my heart.

Generally, higher than 25, from what I've heard (Rubicon).

Which is part of the reason, reportedly, that most machines top out at 25 and only a *very* few specialized ones go to 30 (like the Resmed iVAPS machines). There are some masks who's vent charts to up to 40.

palerider wrote: ↑

Thu Dec 08, 2022 7:55 pm

zonker wrote: ↑

Thu Dec 08, 2022 5:13 pm

how high is too high?

my machine is set to a maximum of 25, though the highest i've actually seen on my charts is when it hit 23 point something.

i don't think i'm experiencing anything bad for my heart.

Generally, higher than 25, from what I've heard (Rubicon).

Which is part of the reason, reportedly, that most machines top out at 25 and only a *very* few specialized ones go to 30 (like the Resmed iVAPS machines). There are some masks who's vent charts to up to 40.

is this why sleep doctors want you to go through bilevel first before graduating to ivaps?

or am i getting machine types confused?

zonker wrote: ↑

Thu Dec 08, 2022 8:10 pm

palerider wrote: ↑

Thu Dec 08, 2022 7:55 pm

zonker wrote: ↑

Thu Dec 08, 2022 5:13 pm

how high is too high?
my machine is set to a maximum of 25, though the highest i've actually seen on my charts is when it hit 23 point something.
i don't think i'm experiencing anything bad for my heart.

Generally, higher than 25, from what I've heard (Rubicon).
Which is part of the reason, reportedly, that most machines top out at 25 and only a *very* few specialized ones go to 30 (like the Resmed iVAPS machines). There are some masks who's vent charts to up to 40.

is this why sleep doctors want you to go through bilevel first before graduating to ivaps?
or am i getting machine types confused?

Well, I don't think so. More a case of iVAPS being a very specialized machine for very specialized things, more so even than the ASV. So the general thinking is that most people are adequately served by a CPAP/APAP, some need more than that, but are fine with a normal (preferably) auto bilevel machine, but if you've got CSA, and none of the previous, less expensive machines took care of you, then you graduate up to the $$$ ones ($3300ish for an ASV, vs $1800ish for a VAuto).

If you have any of a number of lung diseases, then you might end up needing the ST-A machine, which is the name that Resmed gives it's iVAPS, which is another non-invasive ventilator, along with the ASV, but the function of the iVAPS is very different. While the ASV monitors your breathing and tries to ventilate you up to a percentage of what you've been breathing, the iVAPS gets programmed with your height, so it can estimate how much 'dead space' there is in your respiratory system, ie, the trachea and bronchia that lead from your oronasal cavity into your lungs where gas exchange can start to happen, and the iVAPS (which stands for intelligent Volume Assured Pressure Support) will then make sure you're inhaling enough to get you adequate ventilation.

This comes in because if you're not making enough of an effort to breathe, an ASV can, eventually, not be doing anything as your breathing effort decreases, whereas the iVAPS will maintain ventilation.

That's the long way of saying "it gets complicated.

What is "good for the heart" is good sleep and good 02. But that doesn't always make pressure self-adjustment questions cut and dried in a blanket-statement sort of way, in my opinion.

For an otherwise-healthy adult being treated solely for OSA, pressures up to 25 when needed to stabilize the airway are unlikely to cause problems unless they cause discomfort or leak or otherwise disturb sleep. Making sure AHI is getting lower from an adjustment is the thing that makes patient adjustments for optimization so beneficial in a fail-safe way.

However (as a hypothetical), an uneducated elderly heart patient with a history of arrhythmia and heart failure and ejection and valve issues and some lung trouble and, and, and, . . . would probably not want indescriminately to dial wing because of the potential for destabilizing sleep-breathing with CO2 washout, which could lead to centrals and waxing-waning patterns that could disturb sleep and put unneeded stress on an already fragile cardiovascular system.

Therefore, as a matter of logical policy, a DME's hands are tied when a patient brings up thinking about changing his own pressure, since the DME can't risk some irresponsible and unhealthy patient messing up his own therapy then saying to his doc: "I told the DME I was gonna play around with pressures, and they said it was fine and I could do whatever I want with zero negative potential."

Is that an excuse for the lying and the scare tactics of some DMEs? No. But we still do well to understand the basis for it in the context of the flawed system that wasn't designed with any priority for educated self-optimizers but was designed more for the safety for the lowest common denominator in a worst-case scenario.

In my opinion.

palerider wrote: ↑

Thu Dec 08, 2022 8:37 pm

Well, I don't think so. More a case of iVAPS being a very specialized machine for very specialized things, more so even than the ASV.

thanks. that makes sense.

lazarus wrote: ↑

Thu Dec 08, 2022 9:18 pm

Is that an excuse for the lying and the scare tactics of some DMEs? No. But we still do well to understand the basis for it in the context of the flawed system that wasn't designed with any priority for educated self-optimizers but was designed more for the safety for the lowest common denominator in a worst-case scenario.

In my opinion.

this makes sense as well.

who are you and what have you done with lazarus?

zonker wrote: ↑

Thu Dec 08, 2022 9:50 pm

what have you done with lazarus?

I think he may have escaped along with one of those earlier avatars.