ways to lower my cpap pressure

This area is for CPAP Mask and CPAP Machine Related Questions used in the treatment of Sleep Apnea.


ways to lower my cpap pressure

Postby colleentalb » Tue Aug 16, 2005 4:25 pm

I was diagnosed just over a year ago with severe OSA (I think my rating was 102). My doctor explained with the cpap that I have the average pressure setting is around 10 or 12, but that mine is 16. I've always had trouble with the seal and getting comfortable and the soar throat/dry mouth. Right now I just have the nose mask but I'm just now learning about options - such as different masks, cpap machines, etc. - but the one thing my PCP keeps mentioning is how big my tonsils are and that getting rid of them might "cure" my OSA (actually I've seen 2 in the past couple of months and they both said the same thing). My RT said with a rating like mine that the tonsils weren't the issue. Who do I believe and has anyone else out there had any situation like this?

I know another way to lower the pressure would be to loose weight, but I can't seem to do that either. I've heard success stories about people who were over-weight and used the cpap, then had more energy for exercising, lost weight, life is great. I'm so not there yet. I know I'm getting sleep at night finally, but some advice on anything I can do to get on that road.

Overall, I'm just wondering if doing things to lower my pressure setting will help me sleep even better.

Thanks!
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Lowering the Pressure

Postby sleepydave » Tue Aug 16, 2005 6:00 pm

Hi Colleen!
I think the only thing you can say definitely is that nothing is definite. How a particular patient responds to surgery and weight loss is entirely individual, I've seen the whole gamut from great results to none at all. One thing though, I think the RT is little (a lot) out of bounds predicting surgical outcomes, especially with such absolute certainty. On the other hand, the prediction by the surgeons of a cure also seems a little aggressive. (Let me tell you a story though. We did have an overweight young lady with, coincidently, an AHI of 102 who, with surgery, although extensive, and weight loss got her AHI down to 3.0. That's rare, though, real rare. I mention it to point out, though that it's not impossible.) Yeah, I know this is no help. But I'm the sleep lab guy, and I'm up here, and they're your doctors, and they've seen and examined you. If they're that positive, though, you gotta think that tonsil removal should allow you to at least lower your pressure somewhat. How much? Don't know, but 16's a lot, and if you could get to say 10, that might be a little more tolerable. And don't forget, upper airway surgery is not to taken lightly either, especially someone with severe sleep apnea. The mortality rate from tonsilectomy is about 1 in 16,000, but that's taking all comers. If you have OSA, are markedly overweight, maybe are hypertensive, have a small airway, are difficult to intubate, these are all risks that need to be considered. Here's a decent, if somewhat involved article about surgery, anesthesia and OSA:
http://www.arabmedmag.com/issue-15-01-2005/pneumology/main02.htm
Hope this helps.
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Postby colleentalb » Wed Aug 17, 2005 9:23 am

Thanks for the tips, sleepydave! I did find them very helpful.

After talking to my mother last night, I discovered that my unusually large tonsils are causing all sorts of other problems, like frequent ear infections and sinus problems. She regrets not having them taken out when I was a child, but my doctor at the time (who was also her father) insisted it wasn't necessary. So a tonsilectomy is in my future, now it's just a question of when and how. I appreciate the link on severe OSA and anesthesia and I will definitely take that into consideration.

Thanks!!!
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Postby idzeeboo » Wed Aug 17, 2005 1:50 pm

I do NOT recommend changing your pressure settings without your doctor's approval. That being said, every CPAP machine has its own way of changing the settings, usually via the buttons on the front. As for me, I have a Respironics RemStar Plus. I found an instruction manual for its settings (for professional use) on Ebay for $3.95. It is the exact manual that a health care provider would use to set it up. Use of such a manual would provide you with the necessary information to change ALL your settings on your own... but again, I do not recommend it.

(And for those wondering, I did purchase the manual for mine out of curiosity -and the fear that my CPAP may somehow 'lose' its settings after a power surge or something) :-D
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take control of your CPAP

Postby rpad » Wed Aug 17, 2005 2:35 pm

I purchased my CPAP machine from a provider over the internet. With the machine came two instruction booklets, one for the user (me) and the other for the durable medical equipment provider. The second one includes instructions for changing settings.

I have found it very helpful to know how to lower and raise the pressure. I have been using CPAP for 15 months and have adjusted the settings twice on my own to great benefit. I raised the setting from 8 to 10 after I had gained 10 pounds and the change made the therapy more effective. I dropped it down to 9 after I lost a few pounds and was suffering a bit from mouth dryness. It is working just fine now.

During my annual visit to my sleep doctor last week I told him what I had done and he said that he had no problem with my making the adjustments on my own and that I only really needed to contact him when major changes occur. He said it has been his experience that the more patients know the more likely they are to stick with it.

It sure works that way for me. It seems that much of the therapy is personal. Why else would there be so many mask options. I fiddle with mask fittings constantly and alternate between two different masks (full face and nasal pillow) to get optimum results and minimize face marks. I think my face must be "non-standard."

So, learn all you can about your equipment and do what you need to do to make it work for you.
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Lower, not Lower

Postby sleepydave » Wed Aug 17, 2005 4:18 pm

Hi all!
I believe that the spirit of Colleen's question, and certainly my response, was: What can one do to change one's physical condition that would allow one to reduce their prescribed CPAP pressure? So of course, I'm in complete agreement with idzeeboo about getting a physician's order, and in the cases we're talking about here, the new pressures cannot be determined without a complete sleep study. Often, only 1-2 cmH2O pressure changes make huge differences in the patient response, so the company line will always be to strongly discourage arbitrary fiddling with the settings. That said, in a controlled environment (that means physician-guided), minor changes are often done without the aid of follow-up studies. I don't think I have a problem with that. We usually repeat sleep studies when there has been a weight change of 10% (either way) so in a gain of only 10 pounds, I'd kinda find it hard to justify the expense and time of a study in that case. Especially when we know that weight can frequently fluctuate, and you can't get tested 3 or 4 times a year. If anything, I think it's admirable that you're paying that close attention to your therapy and doing that fine-tuning. To say nothing of the AutoCPAP crowd who do daily readouts (all right, that might be a little much) but you get the point.
But I don't think widespread proliferation of the setting change codes is a good idea, I would bet the majority of changes that would be made would be somewhere between wrong and detrimental.
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Re: take control of your CPAP

Postby Daniel » Wed Aug 17, 2005 5:03 pm

rpad wrote:I purchased my CPAP machine from a provider over the internet. With the machine came two instruction booklets, one for the user (me) and the other for the durable medical equipment provider. The second one includes instructions for changing settings.

I have found it very helpful to know how to lower and raise the pressure. I have been using CPAP for 15 months and have adjusted the settings twice on my own to great benefit. I raised the setting from 8 to 10 after I had gained 10 pounds and the change made the therapy more effective. I dropped it down to 9 after I lost a few pounds and was suffering a bit from mouth dryness. It is working just fine now.

During my annual visit to my sleep doctor last week I told him what I had done and he said that he had no problem with my making the adjustments on my own and that I only really needed to contact him when major changes occur. He said it has been his experience that the more patients know the more likely they are to stick with it.

It sure works that way for me. It seems that much of the therapy is personal. Why else would there be so many mask options. I fiddle with mask fittings constantly and alternate between two different masks (full face and nasal pillow) to get optimum results and minimize face marks. I think my face must be "non-standard."

So, learn all you can about your equipment and do what you need to do to make it work for you.


My questions to you based on what you have said above are How do you know it works for you? Changing settings by 1 or 2 cms might not cause great problems, but where do you draw the line? Why did you bother with a sleep doctor at all? Are you aware of the possible damage being done to major organs ?

Knowledge truly is a great thing, but a little knowledge is a very dangerous thing, and I think that is what you have. Mask fittings are purely a comfort thing but to increase pressure without guidance can lead to Central Sleep Apnoea which can kill you, to reduce it too much can leave the therapy worthless. Why do you think that sleep labs employ technicians to deal with these matters ?

If you were fully aware of the dangers of incorrect treatment or lack of treatment particularly relating to the incidence of stroke, heart attack, renal problems etc I doubt you would fiddle with pressure settings.

I believe your actions to be very irresponsible, however that relates to your own health, thankfully.

Daniel
The untreated Sleep Apnoea sufferer died quietly in his sleep..
Unlike his three passengers who died screaming !


The first 40 years of childhood are by far the hardest
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Re: take control of your CPAP

Postby rpad » Fri Aug 19, 2005 5:06 pm

Daniel wrote

"My questions to you based on what you have said above are How do you know it works for you? Changing settings by 1 or 2 cms might not cause great problems, but where do you draw the line? Why did you bother with a sleep doctor at all? Are you aware of the possible damage being done to major organs ? "

Thanks for your comments.

Answers: 1) I sleep fully and wake up refreshed. 2) My doctor draws the line, not me. I change settings within guidelines. 3) I see a sleep doctor to get a diagnosis and treatment plan. 4) Please refer me and other posters to the medical references that say slight changes to pressure settings on CPAP machines cause organ damage or central sleep apnea. I hope you are mistaken about this. The potential for law suits is enormous and could mean the end of CPAP treatments, at least here in the U.S. Thanks in advance for your thoughtful reply.
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Postby rested gal » Sat Aug 20, 2005 2:45 am

rpad, I too have found this to be helpful. For me, more than just "helpful":

I have found it very helpful to know how to lower and raise the pressure.


There are some people who should not touch the buttons of a VCR, much less those on a "medical device". But for reasonably intelligent people who have spent a great deal of time researching this kind of treatment and who have a good understanding not only of the treatment but also their own health issues, taking more control of one's own cpap treatment can be a good thing.

I personally think the best way to go about that is with an autopap and the software for it.

An intelligent person who is otherwise healthy except for having plain vanilla OSA is more than capable of tweaking his/her cpap treatment pressures safely, imho. A clear understanding of the consequences of "under-treatment" if one lowers the pressure is more important, I believe, than having concerns over raising the pressure a few notches.

Of course the more underlying health problems a person has, the more important it is to have doctors to consult.
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Re: take control of your CPAP

Postby Daniel » Wed Aug 24, 2005 7:30 pm

rpad wrote:Daniel wrote

"My questions to you based on what you have said above are How do you know it works for you? Changing settings by 1 or 2 cms might not cause great problems, but where do you draw the line? Why did you bother with a sleep doctor at all? Are you aware of the possible damage being done to major organs ? "

Thanks for your comments.

Answers: 1) I sleep fully and wake up refreshed. 2) My doctor draws the line, not me. I change settings within guidelines. 3) I see a sleep doctor to get a diagnosis and treatment plan. 4) Please refer me and other posters to the medical references that say slight changes to pressure settings on CPAP machines cause organ damage or central sleep apnea. I hope you are mistaken about this. The potential for law suits is enormous and could mean the end of CPAP treatments, at least here in the U.S. Thanks in advance for your thoughtful reply.



Before giving my thoughts on CSA I think we need to look at your initial posting of 17th August. There are a number of discrepancies between that posting and the current one under reply:

On 17th August you stated: ' I have been using CPAP for 15 months and have adjusted the settings twice on my own to great benefit During my annual visit to my sleep doctor last week I told him what I had done and he said that he had no problem with my making the adjustments on my own and that I only really needed to contact him when major changes occur'

On 19th August you stated: 'My doctor draws the line, not me. I change settings within guidelines.'

These statements are poles apart. In the first instance you advocate strongly to do whatever is necessary, without referral, to make cpap work including the adjustment of pressure up or down, which I believe to be totally irresponsible, while in your second posting you advocate working within medically approved guidelines. What exactly is your stance in this regard ?

Now, regarding CSA. There have been a number of mentions in other forums and newsgroups along with some studies, mainly carried out during the mid to late 90's. I'll list some of the more pertinent:

1995 Study by CE Sullivan, University of Sydney concluded that the subjects could not use nCPAP above their upper limit because of hypoventilation and/or frequent central apneas. This appears to have been a retrospective study of 413 patients between the years 1980 and 1993.

University of Wisconsin-Madison, Veterans Administration Hospital, Madison. Study concluded that controlled mechanical ventilation at increased frequency reset respiratory rythmn and inhibited respiratory motor output.

There appear to be other studies from The University of Manitoba, Canada concluding same.

I received these details from a respiratory technician and was reluctant to ask for the full details.

My own personal favourite is a posting from Doug Ruth (deceased), a regular poster to the ASSD newsgroup in the mid to late 90's. Doug suffered from Central Apnoea, among other illnesses and unfortunately took his own life as a result of depression. He carried out a lot of research, some of it follows:

Central Apnea refers to a 'glitch' in the Central Nervous System where the brain forgets to send a signal to breath. Central events can be triggered by overpressure of an xPAP.
Doug's theory was based on existing publications, primarily a report titled 'Errors and risks in administration of nasal respiratory therapy of obstructive sleep apnea' Medlar UID 95342842, Pneumologie Vol. 49 Suppl 1 pp.190-4....
.... 'we observed mask leakages which lead to insufficent positive airway pressure therapy and an occurence of short central apnoeas during NREM sleep after arousal or wakefullness periods. Finally we observed in 5 patients during treatment with cpap and bipap an unexpected appearance of long central apnoeas up to 110s and central hypoventilations of up to 5 min accompanied by excessive hypoxaemia and cardiac arrhythmias'............(the report continues).

Part of his theory was that it is not uncommon for many OSA patients to have a few CSA events, however it does raise a concern when a person is found to have some CSA 'tendency'. It may not take much excessive XPAP pressure to trigger additional CSA events. Titration in this situation is a difficult balance of having high enough pressure to overcome the OSA, without triggering CSA events. This might explain his aversion to people playing with their XPAP settings without a doctors supervision.

To take this a step further, it raises the question of using APAP devices on patients who have been documented as suffering from central events..........I'm getting back to my pet hate (APAP) and the difference in algorithims being used.

Anyone wanting to differ in opinion, please do your own research first, as I have used up my favours.

Daniel
The untreated Sleep Apnoea sufferer died quietly in his sleep..
Unlike his three passengers who died screaming !


The first 40 years of childhood are by far the hardest
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Postby rpad » Fri Aug 26, 2005 10:55 am

Daniel wrote

"These statements are poles apart. In the first instance you advocate strongly to do whatever is necessary, without referral, to make cpap work including the adjustment of pressure up or down, which I believe to be totally irresponsible, while in your second posting you advocate working within medically approved guidelines. What exactly is your stance in this regard ?"



Thanks for your careful reading of my comments. I also appreciate the medical references you provided. I did a literature survey of the National Institutes of Health Medical Library and confirmed your point about the possible connection between excessive pressure and incidences of central sleep apnea. However, I did not find any studies that showed a relationship between excessive pressure settings and cardio problems, blood pressure, or organ failure. I'd be very interested in any leads you have into this.

Interestingly, I did find a study that showed a high rate of efficacy for patients who self-titrated their own CPAP machines, based on qualitative feedback, such as snoring. This was done under supervision with instructions over the phone to save money on doctors' visits. The patients who followed this protocol seemed to adjust better to the treatment. Sounds like a promising approach to me.

My "stance" on all of this is the following: Take control of your own treatment, understand how your equipment works, and be prepared to tweak masks and machines, in order to have the best possible experience and results. All of this should be done within guidelines established by your doctor. This is the procedure I followed as my post said, although perhaps not clearly enough.

You see, the literature review confirmed my view that too many sufferers are unable to stick with treatment because of the cost, complexity, and comfort issues with masks and machines. Your "stance" that patients should take the prescribed treatment and do no tweaking without consulting the doctor or having additional sleep studies is impratical and expensive. I submit it is somewhat unethical since your approach would prevent too many many sufferers from getting treatment and relief. Perhaps you have easier access or can more easily afford visits to the doctor or sleep studies than most of the sufferers I know or have read about.
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Postby rested gal » Fri Aug 26, 2005 11:15 am

Can Patients with Obstructive Sleep Apnea Titrate Their Own Continuous Positive Airway Pressure?

Thanks to "mikesus" for finding and posting on cpaptalk.com the above link to a study comparing treatment results from sleep clinic titrations vs titrations done by patients making their own pressure adjustments while using CPAP.

This was a study in which patients were educated in how/why to change their treatment pressures themselves. They were given the "keys" to how to change pressure and allowed to "drive" their own machines.

Excerpts below:

Can Patients with Obstructive Sleep Apnea Titrate Their Own Continuous Positive Airway Pressure?

Michael F. Fitzpatrick, Christi E. D. Alloway, Tracy M. Wakeford, Alistair W. MacLean, Peter W. Munt, and Andrew G. Day

Departments of Medicine and Psychology, Queen’s University, Kingston, Ontario, Canada

"An educational model in which the patient is empowered with the understanding and ability to make decisions regarding treatment has been demonstrated to be successful in other medical conditions (16). We reasoned that a similar educational approach might be successful in patients with OSA who require CPAP treatment."
(My note: think of the way diabetics are educated and allowed to self-administer insulin.)

"A strategy that empowers the patient with OSA with the freedom to alter CPAP appropriately in response to altered upper airway physiology is inexpensive and may prove advantageous in the latter situation and in the long-term management of the patient."

"The study protocol empowered each patient with the knowledge and capability of directing his or her own CPAP treatment during the self-adjusted CPAP treatment limb. This strategy has not previously been employed in CPAP treatment of OSA, but systematic evaluations of similar management approaches for other medical disorders have generated very positive findings and have been demonstrated to facilitate cost-effective treatment of those conditions (16, 51–53)."

"In summary, this study demonstrates that self-titration of CPAP in patients with OSA is as efficacious as manual titration in a sleep laboratory, with similar subjective and objective outcomes, and CPAP compliance. Clearly, for this strategy to be successful, the patient must understand when and how to change the CPAP. Although the patient population studied did include a wide age range, this strategy would not be feasible for intellectually disadvantaged patients and those with physical handicaps that would severely limit vision and/or manual dexterity. Nonetheless, the findings from this study imply that routine overnight polysomnography is unnecessary for the purpose of CPAP titration in many patients with OSA, provided that the patient is given some basic education and support."
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Postby Daniel » Fri Aug 26, 2005 5:27 pm

rpad wrote:Daniel wrote

"These statements are poles apart. In the first instance you advocate strongly to do whatever is necessary, without referral, to make cpap work including the adjustment of pressure up or down, which I believe to be totally irresponsible, while in your second posting you advocate working within medically approved guidelines. What exactly is your stance in this regard ?"



Thanks for your careful reading of my comments. I also appreciate the medical references you provided. I did a literature survey of the National Institutes of Health Medical Library and confirmed your point about the possible connection between excessive pressure and incidences of central sleep apnea. However, I did not find any studies that showed a relationship between excessive pressure settings and cardio problems, blood pressure, or organ failure. I'd be very interested in any leads you have into this.

Interestingly, I did find a study that showed a high rate of efficacy for patients who self-titrated their own CPAP machines, based on qualitative feedback, such as snoring. This was done under supervision with instructions over the phone to save money on doctors' visits. The patients who followed this protocol seemed to adjust better to the treatment. Sounds like a promising approach to me.

My "stance" on all of this is the following: Take control of your own treatment, understand how your equipment works, and be prepared to tweak masks and machines, in order to have the best possible experience and results. All of this should be done within guidelines established by your doctor. This is the procedure I followed as my post said, although perhaps not clearly enough.

You see, the literature review confirmed my view that too many sufferers are unable to stick with treatment because of the cost, complexity, and comfort issues with masks and machines. Your "stance" that patients should take the prescribed treatment and do no tweaking without consulting the doctor or having additional sleep studies is impratical and expensive. I submit it is somewhat unethical since your approach would prevent too many many sufferers from getting treatment and relief. Perhaps you have easier access or can more easily afford visits to the doctor or sleep studies than most of the sufferers I know or have read about.


I agree entirely in taking control of your own health, because nobody else will. I am involved with a support group and this is something that is strongly advocated, however within medical guidelines.

My corelation between cardiac damage etc is based on the fact that if CSA is introduced you are back to a similar situation, ie untreated apnoea which is likely to bring about these problems.

Through 'taking control' of my OSA problem I keep in close telephone contact with the sleep clinic and can agree certain actions if required. I also keep in contact with my dme supplier, thankfully I haven't needed a lot of change over the past 5 years, however in the mid 90's I did need quite a lot of help. Costs in this regard are negligible.

In Ireland compliance (long term) rates to cpap therapy are between 80/85%, based on a study carried out in 2003 (comprising questionaires to sleep clinics (only 20 in the country), dme suppliers (only 6) and our support group). This figure compares favourably or better than most other European countries. I believe that the UK is only c.60% compliant. Access to clinicians (once diagnosed) is relatively easy. They also work with the dme suppliers who employ nursing staff to interrogate cpap equipment (when requested) and return the results to the clinics. This obviously saves time and money. The major university and teaching hospitals (which comprise the bulk of the clinics) have vigourous follow up programs through regular clinics (appointment) to ensure compliance problems can be dealt with in the early post diagnostic stage. They have facilities for direct telephone contact with technicians and sleep nurse specialists. The dme companies also provide a rental scheme for cpap equipment which ensures a relatively seemless service in the event of breakdown. They have also proved helpful in helping with compliance issues. All in all a fairly good system, which seems to work most of the time. Our support group also provide back up through meetings and an annual conference each May.

This system relates mainly to the 'public health system'. Private clinics would not normally provide such back up and use the dme suppliers to provide them with information from cpap and auto adjusting machines. Their services are however improving as they aim to match the public health system.

I think we are pretty much off the one hymn sheet, however you will note that most cpap companies will protect themselves with a legal disclaimer concerning the adjustment of pressure without medical supervision.

Daniel
The untreated Sleep Apnoea sufferer died quietly in his sleep..
Unlike his three passengers who died screaming !


The first 40 years of childhood are by far the hardest
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Postby Mike » Fri Aug 26, 2005 11:00 pm

Lol Thanks RG! Forgot about that one! The key to that tho is basic education and support. I admit I am one of the AutoPAP users, and find that overall I am slightly higher than my original titrated pressure. (according to the fairly smart machine.) I would say that you comment regarding VCR's and medical devices is true. There are a LOT of folks that think that if 1 tylenol is good, 5 must be GREAT! So much so that the VP of the company had to get on TV and tell people, "Don't take our product if you aren't going to use it properly."

So the take away from this should be, if you think that upping your pressure 5 points and knocking back 5 tylenol is a good idea, step away from your CPAP!! :-D

rested gal wrote:Can Patients with Obstructive Sleep Apnea Titrate Their Own Continuous Positive Airway Pressure?

Thanks to "mikesus" for finding and posting on cpaptalk.com the above link to a study comparing treatment results from sleep clinic titrations vs titrations done by patients making their own pressure adjustments while using CPAP.

This was a study in which patients were educated in how/why to change their treatment pressures themselves. They were given the "keys" to how to change pressure and allowed to "drive" their own machines.

Excerpts below:

Can Patients with Obstructive Sleep Apnea Titrate Their Own Continuous Positive Airway Pressure?

Michael F. Fitzpatrick, Christi E. D. Alloway, Tracy M. Wakeford, Alistair W. MacLean, Peter W. Munt, and Andrew G. Day

Departments of Medicine and Psychology, Queen’s University, Kingston, Ontario, Canada

"An educational model in which the patient is empowered with the understanding and ability to make decisions regarding treatment has been demonstrated to be successful in other medical conditions (16). We reasoned that a similar educational approach might be successful in patients with OSA who require CPAP treatment."
(My note: think of the way diabetics are educated and allowed to self-administer insulin.)

"A strategy that empowers the patient with OSA with the freedom to alter CPAP appropriately in response to altered upper airway physiology is inexpensive and may prove advantageous in the latter situation and in the long-term management of the patient."

"The study protocol empowered each patient with the knowledge and capability of directing his or her own CPAP treatment during the self-adjusted CPAP treatment limb. This strategy has not previously been employed in CPAP treatment of OSA, but systematic evaluations of similar management approaches for other medical disorders have generated very positive findings and have been demonstrated to facilitate cost-effective treatment of those conditions (16, 51–53)."

"In summary, this study demonstrates that self-titration of CPAP in patients with OSA is as efficacious as manual titration in a sleep laboratory, with similar subjective and objective outcomes, and CPAP compliance. Clearly, for this strategy to be successful, the patient must understand when and how to change the CPAP. Although the patient population studied did include a wide age range, this strategy would not be feasible for intellectually disadvantaged patients and those with physical handicaps that would severely limit vision and/or manual dexterity. Nonetheless, the findings from this study imply that routine overnight polysomnography is unnecessary for the purpose of CPAP titration in many patients with OSA, provided that the patient is given some basic education and support."
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Can adjusting your CPAP pressure adversely affect ...

Postby forrie » Thu Jun 04, 2009 5:54 pm

I was given a CPAP (ResMed VPAP AutoSet S8) about a year ago. Since then, about 3 weeks ago, I had additional procedures done in my sinuses (cautery).

I had figured out how to adjust my pressure (on the Internet). My initial setting was prescribed at 6.0 -- it allows increments of .2 so I tried 6.2 and 6.4. 6.4 seems a little higher, as I notice my lungs fill up with air a tad more quickly than 6.2.

6.0 doesn't feel like enough, I find myself sometimes breathing through my mouth to get air. 6.2 seems like that may be optimal, given my current level of congestion.

The study was done with an in-home mechanism, which I don't trust as being 100% accurate.

I use a nasal mask.

In any case, since my surgery, I've had a problem with my blood pressure going whacky - it seems to be calming down - however, I wanted to ask someone here if an adjustment that slight (ie 6.4) could adversely affect your blood pressure during the day. I noticed today that I'm a little more flush than usual.

I have told my doc about this adjustment and he said it shouldn't cause this problem, but...

I would greatly appreciate some advice, etc.

Thank you!
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