[Pressure] My doctor was very angry

[dantavares]

After a titration of only 1 hour of sleep and with nighttime awakenings, I analyzed the graphs and realized that a pressure of constant 13 was low and I went up to APAP min 11.4, Max 16 with respiratory relief of 2. The results were visible, I went from an AHI of 10 - 3 to a maximum of 2. When I took this data to my doctor, he was very (VERY) angry with me, and said that such a high pressure could irreversibly damage my lungs in the long term. Is there truth in this or is it just a conflict of interest?

[Jay51]

Tough question IMO.  I have used several ventilators.  My Pulmonologist said that if I ever feel and chest of lung pain in the morning, the pressure(s) may be too high.  Too high ventilator pressure(s) can cause micro trauma to the alveolar sacs - stretch and tiny tears.  

My pressure are 10 epap max and 20 ipap max.  I have been doing fine using these pressure(s) for a couple of years now.  

I have seen members here use 16 epap and (respiratory relief) of 2 like you say and do fine.  

If you do have any chest or lung pain, then do stop for sure.  

It would be interesting to hear your Dr.'s explanation of why your settings could damage your lungs.  You may ask him for clarification the next time that you see him.

[Nightynite]

Your experience with your Dr is not uncommon. That’s why this platform is here. We use our experience to help others, we leave out the smoke and disinformation.

[dantavares]

Tough question IMO.  I have used several ventilators.  My Pulmonologist said that if I ever feel and chest of lung pain in the morning, the pressure(s) may be too high.  Too high ventilator pressure(s) can cause micro trauma to the alveolar sacs - stretch and tiny tears.  

My pressure are 10 epap max and 20 ipap max.  I have been doing fine using these pressure(s) for a couple of years now.  

I have seen members here use 16 epap and (respiratory relief) of 2 like you say and do fine.  

If you do have any chest or lung pain, then do stop for sure.  

It would be interesting to hear your Dr.'s explanation of why your settings could damage your lungs.  You may ask him for clarification the next time that you see him.

[Sleeprider]

Welcome to a world where a doctor's ego is more fragile than your lungs. 16 cm H2O pressure is surprisingly only 0.2275 psi. You have to blow harder than that every time you inflate an air mattress, so I'll suggest your doc's admonitions are complete B.S. and it was not your lungs at risk, but his ego and need to direct your therapy. I'll assume this idot is a sleep specialist, and it's time to separate and turn your therapy needs over to your regular primary doctor. You have already figured out self-titration from what works and feels comfortable, and that beats an hour of trial and error science every day. In the Sleep Medicine world, a sleep specialist is only needed to sigh-off on your diagnostic sleep study. Once that is accomplished, most of us have a "treating physician". The guy that takes care of our general health needs everyday, is your beat therapy manager for renewing prescriptions. Prove me wrong. I recommend a very Trumpian therapy..."You're fired!". You really don't need a sleep specialist, and you will do much better without that grief.

[mlmollenkamp]

My sleep doctor was curious and inquisitive about my adjusting pressure, probably because she recognized that I had improved my treatment relative to my sleep study.  I now see a nurse practitioner in her practice who is less enthused and gives me a hard time about adjusting.  But she continues to renew my prescription for supplies.... Wait until she sees I switched to an ASV off Craigslist    Best thing I've done for myself in a long time, cost less than a new mattress.  

My experience with self titration is that it takes a very long time to do well, at least for me because I have complex sleep apnea.  The lab titrations can get me below AHI 5 with an APAP, at which point they consider it done and wash their hands of me.  I don't feel great at 4.5, pretty good at 2-3 which I got on my own with APAP.  The ASV gets me to 1 pretty consistently and was super easy to get there.  Life is better.  I agree with Sleeprider, if its not working you own the problem like it or not.  The industry is geared to the patient who has a high AHI, is prescribed an APAP and is a happy camper after.  Home sleep studies have allowed more people to be treated, but don't do squat to titrate, they just wait until the patient either complains enough or is non-compliant.

[dantavares]

Welcome to a world where a doctor's ego is more fragile than your lungs.   16 cm H2O pressure is surprisingly only 0.2275 psi. You have to blow harder than that every time you inflate an air mattress, so I'll suggest your doc's admonitions are complete B.S. and it was not your lungs at risk, but his ego and need to direct  your therapy.  I'll assume this idot is a sleep specialist, and it's time to separate and turn your therapy needs over to your regular primary doctor.  You have already figured out self-titration from what works and feels comfortable, and that beats an hour of trial and error science every day.   In the Sleep Medicine world, a sleep specialist is only needed to sigh-off on your diagnostic sleep study.  Once that is accomplished, most of us have a "treating physician". The guy that takes care of our general health needs everyday, is your beat therapy manager for renewing prescriptions.  Prove me wrong.  I recommend a very Trumpian therapy..."You're fired!".  You really don't need a sleep specialist, and you will do much better without that grief.

[Deborah K.]

GOOD FOR YOU!  Post a couple of Oscar charts and we'll be happy to help you find your best settings.  Copy your Oscar charts using the F12 button  (FN+F12 for Mac).  That usually shows everything we need.  Make sure we can read to the bottom of the flow limits.

[dantavares]

GOOD FOR YOU!  Post a couple of Oscar charts and we'll be happy to help you find your best settings.  Copy your Oscar charts using the F12 button  (FN+F12 for Mac).  That usually shows everything we need.  Make sure we can read to the bottom of the flow limits.

[Deborah K.]

You would do well to raise your pressure settings to 12 to 18. The 12 is because your median pressure is slightly above that, and the 18 is because you are bumping against your upper limit.

Also, your flow limits are very high. If you are not already using EPR, turn it on full-time, set to 3.