Can patients safely alter the settings to come up with good results

The self-titration debate mostly ended with the advent of APAP, since basically the machines themselves now choose the maximum pressure each night and most patients need only concern themselves with finding a comfortable and most-effective minimum pressure. So, nothing much to study there. Besides, no doc wants to suggest a study entitled, "Are Patients Better at This Stuff Than We Are?" They are afraid they already know the answer.

Excellent point Harry.

To be fair....I never advocate changing anything just willy nilly without education and understanding of the why behind any changes and the understanding of any potential problems that might arise.
I won't advise anyone with a serious health issue like CHF to do much of anything without having a chat with their doctor first.
I almost always ask a lot of really nosy questions via PMs if I have the least little question as to the overall health of a person.
You all may not see that because some people don't want to discuss that sort of thing publicly and that's their right. I don't ever divulge private information unless I get the okay. I won't even mention that I have that additional information.

Someone (who I am sure knows about this thread and chooses to not participate and that's his right I guess) has said that when we suggest increasing the minimum pressure when someone is using auto cpap (that is already wide open BTW) that it is potentially harmful to the person.

Logically I just can't see it...they are already using a machine with a setting that will go up to 20 cm (more if bilevel) if it thinks it needs to...and it must be going way up for anyone to suggest more minimum...so how is more minimum any more harmful than what the machine is already doing for the bulk of the night anyway. If the machine is going to 7 cm and staying at least there all night from a starting point of say 4 cm...how is changing the minimum to the 7 cm really doing anything any different from what the machine is already doing in auto mode.

Sometimes the machine just needs a better head start. It can't accomplish some of the pressure increases that it needs to do in the blink of an eye. Too often apnea events happen while the machine is trekking up to where it needs to be. This trek can take several minutes and during those minutes apnea events can pop up and slow down the trek (because the machine won't increase the pressure during an apnea event) even more.
It would be nice the apap could respond more quickly but it can't/don't and we have to live with what it is able to do.

As to problems that might come with more pressure....be it minimum or maximum....aerophagia is probably the most common one.
Belly or gut issues.

Sometimes treatment emergent centrals will pop up with more pressure but that is actually very rare. Most of the time if someone is going to have treatment emergent centrals they will be having them no matter what the pressure. I have seen people have truckloads of centrals with as little as 5 cm pressure. Now there might be an occasional rare person who might have centrals pop up with a pressure of say 9 cm...and none with 8 cm...but those instances are actually rather rare.
If it does happen...then we deal with it though. There are options available.

The other problem with more pressure...comfort. Let's face it...higher pressures are a tough nut for some people to crack but again there are options available to make the cracking of that nut easier. Make use of any available exhale relief...use the ramp....go up in teeny tiny increments so the body can adjust more easily.
If we aren't comfortable then we simply can't sleep well. Sleep is the primary goal...without it none of this stuff really matters much does it?
People often say so and so is "only a comfort thing and not related to the therapy itself" but I happen to think that comfort is critical to the therapy. If you don't do the therapy because of some comfort related problem....then the therapy is indeed greatly impacted.

I know that if I wasn't comfortable and couldn't sleep because of lack of comfort...I wouldn't be using cpap and my therapy would definitely suffer. Comfort is critical to the success of the therapy. IMHO.

The pertinent question is, Is it ever harmful for someone diagnosed with OSA to get AHI lower? That is the only question that matters, since self-titration means getting AHI lower.

Unfortunately there are still a lot of people in the medical profession who don't think that patients have the smarts to self evaluate.
The God Complex still exists.
They are still of the mindset that patients shouldn't ever change anything because they are too stupid and doctors know everything and are never wrong (cough, cough).
Good grief...diabetics are taught to self treat and that's a whole lot more dangerous than a little air pressure adjustment.
This cpap stuff isn't rocket science and isn't nearly as complicated or potentially dangerous as diabetes.
Most of it is just common sense anyway. The complicated or special issue stuff is relatively easy to spot and advise appropriately if it pops up. I say "have a chat with your doctor" because of some sort of complicating factor.
Most of the time though...plain jane vanilla OSA is all we are dealing with and it's really easy to fix and not cause any problems.

If people were able to get the customized help they needed from the medical establishment, they would. When they are unable to get what they need that way, they come here where the bottom of the page says, "The information provided on this site is not intended nor recommended as a substitute for professional medical advice."

harrywr2 wrote: ↑

Mon Jan 13, 2020 6:19 pm

Lets review -
The state allows me to smoke cigarettes and marijuana(if i wanted to),drink alcohol, operate a vehicle up to 20 000 pounds, use a nail gun, jump out of a perfectly good airplane and use a 500 psi pressure washer. If I wanted to try heroin I could go to a safe injection site. If I was diabetic I could adjust my own insulin.

In my youth the state compelled me to go to a place where I had a chance of being shot at or blown to bits.

But someone in the medical community thinks its not safe for me to use an air compressor that cant even blow up a ballon. 1/3 of a psi is somehow dangerous?

Actually, it's less than a third of one psi. 20cmh2o is 0.284467 psi
You're so right, "CPAP is dangerous" is ridiculous fear mongering.... from mostly-a-quack.

jnk... wrote: ↑

Mon Jan 13, 2020 7:19 pm

If people were able to get the customized help they needed from the medical establishment, they would. When they are unable to get what they need that way, they come here where the bottom of the page says, "The information provided on this site is not intended nor recommended as a substitute for professional medical advice."

Quite right, nobody that's adequately treated by a doctor and sleeping well goes out looking for help.

We're here because mostlyaquack's people have FAILED US.

The most important thing is that all of us at cpaptalk.com do all we can to make sure this place is a place where scared, confused newbies know they can come without fear of ever being virtually 'shot at or blown to bits.' Let's all help one another to make it so. Speak up when necessary, but use our inside voices so we don't scare the kids as we set an example with our welcoming hospitality. Online forums aren't the Wild West of tough-skinned geekdom anymore. Those days are gone. May they rest in peace.

I tend to believe that the only way that self-titrating can result in harm is when
the providers who do it (and poorly) might not be able to make a living,
and end up on the street, homeless, hungry, and forced to give up golf.

I changed my pressures and just had my annual doctor visit. He printed out a summary for me and never noticed I changed my pressures. I decided not to discuss it with him.

A blog post at CPAP.com has an interesting position on this:

A blog post by David Repasky at CPAP.com wrote:It is not advisable for individuals to adjust CPAP pressure themselves.--https://www.cpap.com/blog/cpap-pressure-high-tell-fix/

jnk... wrote: ↑

Tue Jan 14, 2020 8:06 am

A blog post at CPAP.com has an interesting position on this:

A blog post by David Repasky at CPAP.com wrote:It is not advisable for individuals to adjust CPAP pressure themselves.--https://www.cpap.com/blog/cpap-pressure-high-tell-fix/

He does not state why it is not advisable.

JJR wrote: ↑

Tue Jan 14, 2020 8:32 am

jnk... wrote: ↑

Tue Jan 14, 2020 8:06 am

A blog post at CPAP.com has an interesting position on this:

A blog post by David Repasky at CPAP.com wrote:It is not advisable for individuals to adjust CPAP pressure themselves.--https://www.cpap.com/blog/cpap-pressure-high-tell-fix/

He does not state why it is not advisable.

It is for the same reason that walking around inside your home is "not advisable." After all, you might stub your toe or something.

And if I give you permission to walk around inside your own home and then you stub your toe, you might sue me for having recommended it.

Yes, walking is most certainly not advisable. People get hurt doing it all the time. And if they hold their breath for ten seconds after hitting their toe, they just had a central apnea!!!