will increasing CPAP pressure eventually give improvement?

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will increasing CPAP pressure eventually give improvement?

Postby frank » Thu Mar 08, 2007 5:31 pm

For many years, I have struggled with sleepiness, depression and foggy thinking, and finally was diagnosed with OSN. I have had four sleep studies. The most successful indicated that I have severe apnea during REM sleep (no breathing for > 1 min). I began CPAP treatment at a pressure of 11, had little benefit, and over many months moved up to the current pressure of 22, the maximum my machine will deliver. This also gave little improvement, and now the doctor suggests I go to a pressure of 27 on BIPAP. I am wondering if anyone has had a similar experience, and if a higher pressure eventually does the trick. Thanks to all for a great forum.
frank
 

Re: will increasing CPAP pressure eventually give improvemen

Postby Daniel » Fri Mar 09, 2007 4:28 am

frank wrote:For many years, I have struggled with sleepiness, depression and foggy thinking, and finally was diagnosed with OSN. I have had four sleep studies. The most successful indicated that I have severe apnea during REM sleep (no breathing for > 1 min). I began CPAP treatment at a pressure of 11, had little benefit, and over many months moved up to the current pressure of 22, the maximum my machine will deliver. This also gave little improvement, and now the doctor suggests I go to a pressure of 27 on BIPAP. I am wondering if anyone has had a similar experience, and if a higher pressure eventually does the trick. Thanks to all for a great forum.


I think there is something seriously wrong here.

Did you get a copy of your sleep study report ? If not, you should get one. Pending this, do you have any other info, the AHI (not just REM), blood ox sat levels, sleep structure.

Why 4 sleep studies ? Severity of the apnoea is not based on the length of time during which you stop breathing, but the frequency of events over 10 seconds.

Were there any more studies carried out to justify bringing your pressure to 22..........and now possibly 27 ?

What type of doctor are you attending ?

Please post back with more detail.

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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Increased pressure COULD help, but...

Postby m_k_rich » Fri Mar 09, 2007 12:21 pm

...4 sleep studies does seem like a lot. I see a pulmonologist; their practice has a lot of CPAP users and the staff are really knowledgeable about diagnosis/treatment/equipment etc. If you're currently being treated by your primary physician, maybe it's time to shop for a specialist.
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Postby Linda » Fri Mar 09, 2007 12:42 pm

Hi Frank,

I'm with Daniel, something's not right and in order for us to help with questions and suggestions, we need to know more. And Frank is also right, it might be time for other medical opinions.

My question (and I harp on this to ad nauseum here. lol) is about your mask and your breathing. What kind of mask do you use? If it's a nose-only mask, are you mouth breathing? I would think this is something the sleep studies would have picked up on, especially by the fourth try! If you are having any significant leakages, either from a bad-fitting mask or from mouth breathing using a nose-only mask, then you might not get relief no matter how much pressure they throw at you.

And when you say four sleep studies, what do you mean? There are actually two parts to a full sleep study -- the diagnostic part, and the titration part (where they repeat the study with you using the cpap). Sometimes both parts are done in one night but usually over two different nights. Were the four studies really two? And when were they, how far apart, were they at the same sleep study center? As Daniel said, you should have the sleep study reports. But that is usually a summary description. And although that gives a lot of important and valuable information, if the polysommography graphs are available to you, you might want to get those, especially if you ever go for a second opinion or yet another sleep study center.

I have a pressure of 18 using a bipap. I also have weak lungs, so dealing with that high pressure might be more difficult for me than most people, I don't know. But irregardless, anything over 18 is mighty high and terribly hard to get used to. And there's no point in trying if something isn't right. Yes, some people do need very high pressures, but that is rare. What if you fix some other issue causing the problem and you're using a pressure of 22 or higher, what would that do to you, there are dangers there as well. So you are very wise to be asking these questions, very smart.

Let us know more and how things are going.


Linda
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your questions, and my response

Postby frank » Sat Mar 10, 2007 1:34 pm

hi all—here are some details and responses to your questions.

I am going to a university-based sleep center, ant the physician is a neurologist. Does anyone go to a center where there is a multidisciplinary approach, e g. where multiple disciplines discuss patient cases?


I'm with Daniel, something's not right and in order for us to help with questions and suggestions, we need to know more. And Frank is also right, it might be time for other medical opinions.

My question (and I harp on this to ad nauseum here. lol) is about your mask and your breathing. What kind of mask do you use?
full face mask—seems to fit ok. mouth breathing was a problem.
If it's a nose-only mask, are you mouth breathing? I would think this is something the sleep studies would have picked up on, especially by the fourth try! If you are having any significant leakages, either from a bad-fitting mask or from mouth breathing using a nose-only mask, then you might not get relief no matter how much pressure they throw at you.

And when you say four sleep studies, what do you mean? There are actually two parts to a full sleep study -- the diagnostic part, and the titration part (where they repeat the study with you using the cpap). Sometimes both parts are done in one night but usually over two different nights. Were the four studies really two? And when were they, how far apart, were they at the same sleep study center?

i had one sleep study (winter 2006) and 3 titration studies since then. one of the titration studies failed. The last titration study (winter 2007)—went to pressure of 25 and found I was still having apneas. They say my events are mainly during REM, and much worse when sleeping on my back. Doctor says I am a very unusual case—requiring such high pressure, and particularly surprising as I am not overweight and in good health. Doctor recently prescribed change in pressure to 27 on CPAP, but machine will not go this high (don’t you think the doctor should know this?) new plan is to get BIPAP with pressure of 27. Also suggests sleeping on my side

As Daniel said, you should have the sleep study reports. But that is usually a summary description. And although that gives a lot of important and valuable information, if the polysommography graphs are available to you, you might want to get those, especially if you ever go for a second opinion or yet another sleep study center.

good idea—will ask to see those next time.

I have a pressure of 18 using a bipap. I also have weak lungs, so dealing with that high pressure might be more difficult for me than most people, I don't know. But irregardless, anything over 18 is mighty high and terribly hard to get used to. And there's no point in trying if something isn't right. Yes, some people do need very high pressures, but that is rare. What if you fix some other issue causing the problem and you're using a pressure of 22 or higher, what would that do to you, there are dangers there as well. So you are very wise to be asking these questions, very smart.

what are the possible problems of using high pressure?

In summary, I am willing to try the BIPAP at higher pressure. My goal is to get to the pressure that reduces apneas to a tolerable level. I have not been told about any risks of high pressure. What are they? We have not discussed surgery—should I? I have not seen my titration studies, but will ask to see those at my next appointment (3 months away!) Like most of us with OSA, I hate the machine, but will gladly use it if I get relief. However, I am losing confidence in the system. Any suggestions would be greatly appreciated.

many thanks!!
frank
 



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