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Pressures higher than titration damaging to my lungs?
#11
(11-07-2014, 06:47 PM)surferdude2 Wrote: SleepyDreamCatcher, You have at least three options:

1. Pay her lip service and then do as you think is best based on your own research.

2. Educate her as to the basics of CPAP treatment and the potential for any dangers it presents as well as the safety record it has.

3. Ditch her and fine a doctor well versed in CPAP that is reliable at keeping appointments and reasonably available.

IMHO, I would do option #2 and then immediately thereafter do option #3. You followed her advice and it didn't work and to top it off, she wasn't available as scheduled and needed. The only "No show" fee you can charge her is to not give her the opportunity to do any further disservice to you.

One important thing to keep in mind is that your doctor is basing her advice on a single night's sleep study as versus your ability to monitor several nights using the software that you have.

Unless you're mentally challenged, I'd put more stock in your analysis (and the competent advice you've gotten here) than the doctor's. It likely won't do any good for you to explain that to her - if she's ignorant of these facts, she may not be capable of understanding the explanation.

If she has ulterior motives, such as protecting her income stream, she won't be receptive of any explanation. That'll be the surest tip off to find a better doctor.

Bottom line: Do what you think is best since you're the best judge of how CPAP is working. This isn't rocket science and it isn't dangerous. I have never heard of a single case of CPAP lung damage or of any other bodily organ being damaged by using a CPAP machine with any setting whatsoever.

The biggest danger is to not use CPAP when it is indicated and recommended or using it at a level insufficient to provide the necessary therapy.

EDIT: I just read your post that you made while I was typing. It looks like you were getting excellent AHI results with the doctor's initial settings:

"Prior to switching to auto mode AHI was: June: 0.44, July: 0.27, Aug: 0.22"

Those are excellent numbers!

Perhaps she deserves more credit than she has been given. If you agree, then give her a chance to look over the results you have achieved and see if she agrees that you are doing a great job of shepherding your own treatment although it wasn't all that necessary. You may save the relationship yet but the "No Show" is still bothersome.


Lot's of good stuff to think about here. Yes, the "No Show" was very troubling, especially since I had to cancel my own patients that day (no, not a doctor, but in a medical profession).

Yes, the early numbers were good, except after my initial improvement I didn't continue to see improvements in energy levels. While my AHI graphs were great and I had little to worry about as far as leaks were concerned, my flow limitation graphs were all over the place and I was still having a lot of snoring. I did not... and still do not expect instant 100% recovery, but I do expect improved sleep and functioning to be my end goal. It seems to me that all this doc is concerned with is my AHI. "Your breathing is fine" seems to be her answer whenever I ask a question.


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#12
(11-07-2014, 07:26 PM)Ghost1958 Wrote: If pressure above 14 will damage lungs then I need to sue my sleep doc. My original titration by him and the lab was 6 to 15.

Now its 8 to 18 though have no ideal why the upper pressure was raised since it didnt need to be.

After you sue, send your lawyer to me since my original titration was 20 cm/H2O. I must really be in trouble. Maybe I will develop "lazy lungs". DielaughingDont-know

Best Regards,

PaytonA
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#13
(11-07-2014, 06:08 PM)SleepyDreamCatcher Wrote: Prior to switching to auto mode AHI was: June: 0.44, July: 0.27, Aug: 0.22
Anything below 5 is good results
As for pressure range, I would not use more pressure than is necessary to do the job
An auto not always find an optimum pressure, it can runaway for any sign of snoring or/and flow limitation

Edit: leak below 24 L/m is okay too as long as not causing air leak into the eyes or disturb your sleep
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#14
(11-07-2014, 07:23 PM)lab rat Wrote: Quite seriously, years ago after I had my tonsils removed on ENT advice, my CPAP pressure of 10 suddenly seemed to be inflating my lungs like a damn balloon. It was horrible.

You armchair "experts" may say no damage is done but I disagree.

I had to schedule an urgent appointment to get a revised script with a pressure of 8 then take it with the machine to a clinician for adjustment.

Right.

If someone has certain types of lung conditions (or, for example, if they currently have pneumothorax) then either CPAP should not be used at all or should only be used at low pressures.

I think I read somewhere that, after certain types of nasal surgery or throat surgery, it may be warranted to completely stop using CPAP treatment for up to 6 weeks, to allow complete healing before resuming CPAP treatment.

For patients who are on hospital ventilators, serious lung damage from having too much air forced into their lungs is far more common than it should be, because of ignorance or mistakes on the part of hospital workers who set the target tidal volume too high. The tidal volume is the average quantity of air (volume, not pressure) we breathe in or out in one breath. APAP machines and most BiPAP machines do not have a target for the tidal volume, but many ventilator class machines do, and if the setting for tidal volume (Vt) is set a little too high the lungs will be stressed from being overinflated. If the target is way too high, the machine may go all the way to its max pressure (often 30 or 40 cm H2O or higher on ventilator machines) attempting to force too much air into the lungs.

http://www.apneaboard.com/forums/Thread-...2#pid84532

Membership in the Advisory Member group should not be understood as in any way implying medical expertise or qualification for advising Sleep Apnea patients concerning their treatment. The Advisory Member group provides advice and suggestions to Apnea Board administrators and staff on matters concerning Apnea Board operation and administrative policies - not on matters concerning treatment for Sleep Apnea. I think it is now too late to change the name of the group but I think Voting Member group would perhaps have been a more descriptive name for the group.
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#15
(11-07-2014, 06:39 PM)DocWils Wrote: My suggestion would be to set the pressure range from 5 to 15 and let the machine, since it is an Auto type, titrate itself - it is pretty good at finding the correct range for you. I think your set range may be too narrow in that respect.

On the other hand, some prefer a fairly high Minimum Pressure. A few forum members have shared that they sleep best and feel more rested when their Min Pressure setting is high enough to prevent nearly all obstructive events.

Much more so than Philips Respironics machines, the ResMed APAP machines treat their Minimum Pressure setting as a target which the machine is always slowly returning toward. The "Time Constant" for this is 20 minutes, which means over any 14 minute time frame (unless/until more obstructive events start up again) the pressure relaxes half of the difference toward the Minimum Pressure setting. (In 20 minutes the pressure relaxes more than half, 63% of the way toward the Min Pressure setting.)

For example, on a ResMed AutoSet machine, if the Minimum Pressure setting is 5 and the current pressure is 15, after only 5 minutes the pressure would have already dropped by 2.2 (would have dropped to 12.8). This is a pretty fast rate of drop, so obstructive events won't stay away very long. If the Minimum Pressure Setting had been 10 (instead of 5), the pressure would have dropped only about half as much after 5 minutes.

Membership in the Advisory Member group should not be understood as in any way implying medical expertise or qualification for advising Sleep Apnea patients concerning their treatment. The Advisory Member group provides advice and suggestions to Apnea Board administrators and staff on matters concerning Apnea Board operation and administrative policies - not on matters concerning treatment for Sleep Apnea. I think it is now too late to change the name of the group but I think Voting Member group would perhaps have been a more descriptive name for the group.
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#16
(11-07-2014, 07:23 PM)lab rat Wrote: Quite seriously, years ago after I had my tonsils removed on ENT advice, my CPAP pressure of 10 suddenly seemed to be inflating my lungs like a damn balloon. It was horrible.

You armchair "experts" may say no damage is done but I disagree.

I had to schedule an urgent appointment to get a revised script with a pressure of 8 then take it with the machine to a clinician for adjustment.

A CPAP cannot inflate your lungs. Why? Because unlike your throat and the tissue there, to inflate your lungs, the CPAP would have to push up the very strong diaphragm muscle and the rib cage. Sure, it could inflate them sideways, but then it would have to push other organs out of the way and that's just not going to happen.

What happened was you had a lot of tissue removed from your throat. You and your brain were used to that pressure having that tissue there. And suddenly it wasn't. It had to have felt much different, different enough that you panicked. I know each time I have had my pressure adjusted, prior to getting my Autoset, that it always took me several days or even weeks to get used to the extra air. It was too much!
PaulaO2
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#17
Pulmonary barotrauma, which is what we are discussing here, is almost never seen when dealing with peak inspiratory airway pressures below 40 cm water and sustained pressures less than 35 cm water. As such, it is almost impossible to hurt yourself, even with a BiPAP cranked all the way up to 25 cm of water.

Anyone claiming pulmonary barotrauma, even with a BiPAP cranked all the way up, is either 1) A very "special" snowflake 2) Full of it.

Remember, home medical equipment is usually designed to make it very difficult for you to hurt yourself with, by accident, or intentionally.
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#18
I scuba dive.

There is a ton more potential to damage your lungs breathing off a pressurized tank than you will ever see from CPAP. Especially when you're talking dives at depths greater than 33 feet... when you're into more then one atmosphere.

How many times have you heard about people suing scuba equipment manufacturers over lung damage?

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#19
By way of comparison, scuba diving at a depth of 33' would be like setting your CPAP to 1006 cm H2O ! That's 50 times what a typical CPAP blower can put out. It makes the maximum that a conventional CPAP can supply of 20 cm H2O seem rather puny (and it really is).

My sleep doctor said, "Anybody that claims a CPAP machine damaged their lungs will probably lie about other things as well." Big Grin
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