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Death by CPAP?
Topic Started: Jul 6 2011, 07:19 PM (2,950 Views)
johnomg
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Hi All,

I've been reading quite a bit about adjusting your machine yourself, both the pro's and the con's, as most of us know Doctor's and Supplier's don't want us to access the Clinical Menu let alone make adjustments ourselves, whereas most users are ok with doing it as long as your careful and know a bit about what your adjusting and why, I fall into the latter group.

However, throughout all the discussions I have seen there is one thing that is still not clear to me and that is: What damage can I do to my machine or myself if I Self Adjust?

I mean:
- Can I ruin my machine?
- Will my eyeballs pop out of my head in the middle of the night?
- Can I damage myself somehow? (lungs, throat, nose etc...)
- Will I suddenly whizz around the room like a burst balloon?
- Why shouldn't I self adjust? (don't tell me I don't understand it, tell me what harm I can cause)
- Can I kill myself?
I'm interested in both sides of the coin.

For example I was Titrated at 15cmh20, my first loan machine was set to that and I woke up with such a sore chest the next day, it was like my lungs had over inflated all night. I'm now on a APAP machine with my min at 8, the max at 18 and it averages out at about 10 a night with a AHI reading around 2-4. If I had listened to the "don't touch it" school of thought I don't know if I could have put up with the sore chest and might have given up on CPAP altogether. For me self adjustment was a matter of comfort while trying to maintain a low AHI.

So seriously, what are the Dangers of Self Adjusting your CPAP machine?

Cheers
John
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zonk
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Congrats on taking charge for your own healthcare , most of us here have been diagnosed with OSA , CPAP therapy is the accepted treatment and between consenting adults what they do in their bedroom it is their own business and no body else .
So it goes without saying that you can tweak with your machine to optimize your own therapy , you are right that the APAP does a good job for you and respond to your needs all night and every night ,don,t have to worry about cpap police or that you can harm yourself as i read one of ResMed chief saying that the only way cpap can harm you if it fall on your head . :bigwink:
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johnomg
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Thanks for the response zonk,

So far we have:
Pro - Opitimize your own therapy.

Con - You can dent your noggin if it falls on your head while your adjusting it.

Cheers
John
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archangle
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You can get ineffective therapy. Suppose you need 15 and you set it to 6 because you feel more comfortable at that pressure. You may now have untreated apneas. Or suffer from poor sleep and attendant problems.

There are a number of reports that too high a pressure may cause more central apneas.

You could screw it up, have problems and make yourself quit.

Tinkering with the machine might interfere with your doctor's efforts to determine the best course of treatment.

Maybe (MAYBE!!!) CPAP is somewhat addictive in some sense and increasing your pressure might make your more dependent on CPAP.

High pressure can cause mask and leak problems, ear problems, or gas problems.

Bilevel and ASV machines have even more potential for harm.
Click here for information on the most common alternative to CPAP treatment.
Get the free SleepyHead software here.
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zonk
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archangle
Jul 6 2011, 09:03 PM
You can get ineffective therapy. Suppose you need 15 and you set it to 6 because you feel more comfortable at that pressure. You may now have untreated apneas. Or suffer from poor sleep and attendant problems.

There are a number of reports that too high a pressure may cause more central apneas.

You could screw it up, have problems and make yourself quit.

Tinkering with the machine might interfere with your doctor's efforts to determine the best course of treatment.

Maybe (MAYBE!!!) CPAP is somewhat addictive in some sense and increasing your pressure might make your more dependent on CPAP.

High pressure can cause mask and leak problems, ear problems, or gas problems.

Bilevel and ASV machines have even more potential for harm.

http://s7.zetaboards.com/Apnea_Board/topic/8487870/1/
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johnomg
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zonk my friend, I'm confiscating your Ctrl, C and V keys for the rest of this thread :tongue-out:


Hi and thanks for the responses archangle. I think you raise some vaild points and if you don't mind I'm going to condense them a bit.

So far we have...
Pro:
- Opitimize your own therapy.

Con:
- You can dent your noggin if it falls on your head while your adjusting it.
- Ineffective Therapy.
- May cause increased central apneas.
- Negates your doctors recommended treatment plan.
- High presure may become addictive and/or cause problems with equipment or your health.

I feel it's important to list the Con's so that people "new" to a CPAP machine don't think they can just jump in and adjust away, my own adjustments have been in very small increments and then given a few days to see how I react to them. I think if people are aware of the potential to make a "boo-boo" then they will want to become more informed before making adjustments, they will make adjustments in small steps and most importantly monitor what those adjustments do for/to them.

Cheers
John
Edited by johnomg, Jul 7 2011, 02:42 AM.
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Steven
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johnomg
Jul 6 2011, 07:19 PM
I was Titrated at 15cmh20

I'm now on a APAP machine with my min at 8, the max at 18 and it averages out at about 10 a night with a AHI reading around 2-4.
From a pressure of 15 to an average pressure of 10 - I think you have answered your own question!

How can "correcting" your required pressure by 33.33333333% be wrong?
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JudgeMental
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Zonk's reference link, as well as SuperSleeper's added article (inserted within that link) plus the post from Archangle is the appropriate response to your post.
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johnomg
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Hi Steven,

I'm from the School of Thought that it is ok to adjust if your careful and at least partially informed, as you said I have adjusted to a pressure which is way more comfortable for me and I'm getting a AHI much lower than the Sleep Study did, they only got me down to 13 (mind you that was over the whole night as they were adjusting pressures) and now I'm around 2-5.

The item's of more interest to me are the Con's as I see posts and information that says you should not self adjust but it's not clear what the "Dangers" are if you do.



Hi JudgeMental,

Yup I know zonks link was relevant, but man it's some big technical thread, I was just looking for short concise opinions on Pro's and Con's that people could glance at and especially newbies like me could understand easily. In no way did I mean to offend zonk or belittle the post/link, I was just joking with my comment about confiscation of the PC keys. If zonk did take offence then I apologise.

I didn't think I said archabgle's post wasn't appropriate, I actually liked it because it mentioned some things I wasn't aware of, previously I would have assumed the Higher the Pressure the less the OSA, now I know that too much Pressure may have the reverse effect.

Cheers
John
Edited by johnomg, Jul 7 2011, 05:43 PM.
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johnomg
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EDit: Bugger it posted the same response twice, removed this copy of it
Edited by johnomg, Jul 7 2011, 05:23 PM.
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zonk
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Hi john
No offense confiscate any key you wish , i don,t know what they mean .
I don,t much about this subject and still learning and have a long way to go , as you have noticed there some expert here which i do take notice of their wisdom and recommendations and :great-info:
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Steven
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johnomg
Jul 7 2011, 05:20 PM
I would have assumed the Higher the Pressure the less the OSA, now I know that too much Pressure may have the reverse effect.
I ASS-U-ME you are referring to too high a pressure causing Centrals?

Although that is repeated often & even by some professionals, "I" have never been able to find a reliable study that proved that connection.

Not saying it ain't so, but "I" am reluctant to believe it until I find some more convincing evidence.

ONLY con I can think of is whether there are any negative effects from long-term use of too high a pressure. But, in your case, you are going lower & not higher.
Edited by Steven, Jul 7 2011, 06:59 PM.
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johnomg
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Hi zonk and thanks.

Hi Steven,

I was paraphasing what archangle said and obviously mucked it up (I think), yep that's what I meant and thanks for the feedback on it. I agree with you as well, if I can maintain a AHI of 2-4 at a lower pressure and still feel good then surely that has to be better in the long run, in reality while I'm upping my min pressure to try and stop my snoring it's the machine that is deciding what I need, sometimes it gets up to 15, but the average is always around 10. Maybe I should set it to 15 on CPAP and see if it drops to 0, but to be frank I don't like the pressure at 15, it hurts me :'(

BTW ... How did you know I was a Donkey in a previous incarnation???

Cheers
John
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HeadGear
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johnomg
Jul 7 2011, 07:09 PM
I agree with you as well, if I can maintain a AHI of 2-4 at a lower pressure and still feel good then surely that has to be better in the long run, in reality while I'm upping my min pressure to try and stop my snoring it's the machine that is deciding what I need, sometimes it gets up to 15, but the average is always around 10. Maybe I should set it to 15 on CPAP and see if it drops to 0, but to be frank I don't like the pressure at 15, it hurts me.
Generally, a lower pressure is ideal, if it still gives you optimal treatment! Lower pressure equates to fewer unwanted side-effects. I'm sure you will find a good CPAP point, but that will be an average based on a somewhat variable target, and not always the best. That is a strong argument for staying on APAP with an optimized, narrow range. Probably safer, too!
Edited by HeadGear, Jul 7 2011, 08:21 PM.
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Ltmedic66
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Steven
Jul 7 2011, 06:45 PM
johnomg
Jul 7 2011, 05:20 PM
I would have assumed the Higher the Pressure the less the OSA, now I know that too much Pressure may have the reverse effect.
I ASS-U-ME you are referring to too high a pressure causing Centrals?

Although that is repeated often & even by some professionals, "I" have never been able to find a reliable study that proved that connection.

Not saying it ain't so, but "I" am reluctant to believe it until I find some more convincing evidence.

ONLY con I can think of is whether there are any negative effects from long-term use of too high a pressure. But, in your case, you are going lower & not higher.
I have seen higher pressures causing centrals mentioned in several studies and peer reviewed papers. I have also seen varying pressures, such as BIPAP, implicated in generating centrals in some patients. With some, the increased centrals resolve over time while with others they do not.

Here are a couple quotes from a study titled "The Use of Auto-Titrating Continuous Positive Airway Pressure for Treatment
of Adult Obstructive Sleep Apnea" by Berry, Parish, and, Hartse. I have found similar issues mentioned in several other studies and papers in my reading.

"Other patients with OSA may have central apneas after arousals that are sometimes prompted by excessive pressure. While CPAP has been reported to decrease the AHI in both idiopathic central apnea, and central apnea associated with congestive heart failure, in many patients, increases in pressure will not decrease events or may increase the problem."

"Boudewyns et al. published a case report describing the appearance of central apneas occurring during APAP titration. The
apneas occurred as pressure was increased. Some of the events seemed to occur post arousal. Of note, central apneas may also
occur during manual CPAP titration. However, central apneas could conceivably result in APAP devices delivering a progressive
increase in pressure. This action may not be effective in inducing a resolution of these events. If excessive pressure triggers
arousals, this action could cause central apnea in some patients."

The risk appears to be greatest among people with congestive heart failure and certain neurological conditions, but it has been observed in simple OSA patients as well.

I am convinced that high pressures, increases in pressure, or variations in pressure can increase centrals in some patients.

For me, I would count "potential of increasing central apenas" in the Con column.
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