Is High Pressure Dangerous?

I was titrated at 7 about 1.5 years ago. Gradually with doctor's consent I increased my lower pressure to 10. Frustrated by still high (~2) AI I raised it to 11. At 11, I was getting better AI ( < 1 ) . But I was getting some air in the stomach, which was more of a problem at bedtime that in the morning. I started to go downwards on pressure and set it at 10.8. AI starts to go up. Should I keep the lower pressure at 11? My upper limit is 14 and the 90th percentile hoovers around 12.6.

- Atab

Higher pressures are only dangerous when they cause centrals, however as we raise pressure we cause discomfort. That's why we need to find the least pressure that gives us the best results (Sweet Spot).

As you have found out the more pressure the more trapped air in us. (GAS) Also the more pressure the higher the leak factor, including mouthbreathing. Most people don't induce centrals at under 10 CM, after that you need to pay more attention. With the software you can the Sweet Spot easier, just keep the leak rate low so the numbers are correct. Jim

atab wrote:I was titrated at 7 about 1.5 years ago. Gradually with doctor's consent I increased my lower pressure to 10. Frustrated by still high (~2) AI I raised it to 11. At 11, I was getting better AI ( < 1 ) . But I was getting some air in the stomach, which was more of a problem at bedtime that in the morning. I started to go downwards on pressure and set it at 10.8. AI starts to go up. Should I keep the lower pressure at 11? My upper limit is 14 and the 90th percentile hoovers around 12.6.

- Atab

Maybe it's the fact that you're using a range of pressures. You didn't mention what EPR setting you were using (if any).

Have you ever tried CPAP mode (maybe 11 cm.) and varied your EPR settings?


Den

Thank you for responses.

As you have found out the more pressure the more trapped air in us. (GAS) Also the more pressure the higher the leak factor, including mouthbreathing. Most people don't induce centrals at under 10 CM, after that you need to pay more attention. With the software you can the Sweet Spot easier, just keep the leak rate low so the numbers are correct.

Jim, Currently I have no problem of leaking. I use full face mask, so mouthbreathing is also not a concern.

You didn't mention what EPR setting you were using (if any).

Den, I am not currently using EPR.

Have you ever tried CPAP mode (maybe 11 cm.) and varied your EPR settings?

May be I should try CPAP mode at 11. I will do that and report. Should I be trying EPR?
I was on 2 (as per DME's instructions) at the beginning. Then setting it at 0 showed some
improvement. I never went back. Now that I'm more knowledgeable (thanks to you all),
I think the improvement could have been due to the increase of effective pressure.

My stomach gets bloated in the evening. Is it usual that this happens late in the day?
When I'm on CPAP overnight, shouldn't bloating be in the morning if it is due
to pressure?

- Atab

Some people find that increasing the pressure by 1 cm H20 for each "level" of EPR helps their numbers. So you might try straight CPAP at 13 with an EPR of 2, and compare it to straight CPAP at 11.

I have found stomach problems to be less since I have started sleping on my back with my body elevated at a slight angle. The head wants to lean back slightly

atab wrote:May be I should try CPAP mode at 11. I will do that and report. Should I be trying EPR?
I was on 2 (as per DME's instructions) at the beginning. Then setting it at 0 showed some
improvement. I never went back. Now that I'm more knowledgeable (thanks to you all),
I think the improvement could have been due to the increase of effective pressure.

My stomach gets bloated in the evening. Is it usual that this happens late in the day?
When I'm on CPAP overnight, shouldn't bloating be in the morning if it is due
to pressure?

- Atab

If you're doing fine without EPR, I'd hold off on enabling it for the time being. See how the fixed pressure works first.

Don't know what to advise about the "bloating".......unless it's something you're eatin' during the day......
Yeah, normally people complain of bloating (aerophagia) when they awake in the morning.


Den

my pressure is 17 and i turn my machine on without epr.i got used to the pressure.

Last night I had CPAP mode, pressure 11, no EPR. AI was 1.0. AHI 4.4. I'll try this for a week.
I have a feeling that I might have to go higher because 95th percentile on Auto mode
was around 12.6, 12.8.

By the way, does EPR 1 means reduce exhale pressure by 1cm? (EPR units is cmH2O).
In that case doesn't increasing the pressure by 1 and setting EPR to 1 completely nullify
EPR? You were breathing out to a pressure x earlier, now to x+1-1.

Appreciate all your comments.

- Atab

atab wrote:Last night I had CPAP mode, pressure 11, no EPR. AI was 1.0. AHI 4.4. I'll try this for a week.
I have a feeling that I might have to go higher because 95th percentile on Auto mode
was around 12.6, 12.8.

By the way, does EPR 1 means reduce exhale pressure by 1cm? (EPR units is cmH2O).
In that case doesn't increasing the pressure by 1 and setting EPR to 1 completely nullify
EPR? You were breathing out to a pressure x earlier, now to x+1-1.

Appreciate all your comments.

- Atab

Yes. If you have your CPAP pressure set to 11 and your EPR to 1, then your "effective" pressure at the point where your exhale effort ends and your inhale effort begins is going to be 10 cm.


Den

Den,

My point is slightly different. As Jeff said, it is usual strategy that if you have to use EPR at level 2, you then increase the pressure by 2. My point is that if you had a pressure of, say, 10 before by doing the above you end up with a pressure of 10 again throughout your exhale period. So, if were uncomfortable (in exhaling) before you are still uncomfortable because you are exhaling into the same pressure. Therefore, if you are going to compensate by increasing pressure, I can't see the point of using EPR.

- Atab

Your treatment pressure is what you set it at, Say 11CM.

Your EPR level is set at 2, When you breath out you will be breathing out against a pressure reduced by 2 CM, or 9 CM effective pressure.

When you stop breathing out, the pressure goes to 11 CM again. Jim

If you collect full data, it will show up as a slightly lower avg pressure than 11 CM, due to the part of the time you were under pressure relief.