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Peter Farrell, the Founder of ResMed, is notorious in the Sleep Medicine establishment for saying “The only way you can get injured by one of our machines, at least the low level ones, is if somebody picks the goddamn thing up and slams you over the head with it.”

But still RTs and other sleep professionals cringe at the idea of letting a patient adjust his or her own pressure settings, based on the notion that high pressures can kill you.  Furthermore, they say that no amount of disclosure to the patient of possible risks will justify letting the pressures change without a doctor's say so.

What's the truth?


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I guess before CPAP machines are being released in the public it will pass lot of examinations, so meaning CPAP had been tested and proven safe...So there is nothing to be worried...:)

 

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cpap sleep apnea

On this whole business, I don't trust the doctor who originally put me on CPAP or the original CPAP supplier. I increased the pressure on my machine after I found a hack for it and did better. I may increase it again as it doesn't seem to be working to help me sleep. I may try to find another doctor, but my insurance company seems to cover the ones fruther from my home and not the

one(s) closer. Figures, doesn't it?

The polysomnographes have been witness to the patient that has been over titrated. This can lead to poor sleep and Central Sleep Apnea events. Central apnea can cause a decrease in blood SpO2 levels.
This can set off a chain of events leading to tachycardia including ventricular tachycardia and even Ventricular fibrillation.
“If” you are prone to tachyarrhythmia then you are at risk for severe outcomes from messing with pressures.
We all know that untreated Apnea may lead to increased obesity, and type 2 diabetes. It stands to reason that over titration can/may put you at risk for the very illness you wanted to avoid.....why would you want to place yourself in at the smallest risk of harm?

This is an amazing rant/blog discussion.  This caught my attention from below ...

 

J N K commented:

If the patient can do simple addition and subtraction on a first- or second-grade level and has a full-data machine, the patient would see AHI go up if overtitration occurred and centrals increased, and the patient would then go the other direction to achieve the lowest AHI. It's that simple, that easy.

I have been using a CPAP for more than 17 years ... and never once have I been able to see my own AHI unless I'm wrapped in wires in a sleep study.

 

Stats tend to elude me when I am sleeping ... and I'm to cheap to buy S/W for my present CPAP ... I'll wait till someone posts it on 2cows ...

 

 

There are contraindications for the use of CPAP.  They are listed in the use and care booklet that comes with the machine.  One contraindication is pathologically low blood pressure.
1cmwp can be the difference between overtitration and optimal presure. How sly of you to throw conn's statements back at the techs jnk. As I have said before if you do not know all of the parameters surrounding your treatment then tweaking is a bad idea. I am talking personal health issues, environmental factors, and where your doc stands. The first two could affect your health. The third your wallet.

j n k said:

So, who overtitrated those patients?

 

A self-tweaker would never do anything to increase his AHI, since that would defeat the whole purpose of it. All 10-second pauses in breathing (including central apneas) are scored and reported by home machines as apneas, so no self-tweaker would induce centrals. That's why it is a nonissue in the context of self-tweaking.

 

 

 

  Tell me, how did you convince your doctor to even look at the information you provided, let alone believe it.  My doctor claims "I don't have high blood" pressure and tells me "if I don't want tro see it high stop taking it.  Needless to say, I now have a different doctor.  Only this one won't give me a referall to a specialiast suggtested by a surgeon who wants to operate on my bad back after I see a vascular specialist because I have poor circulation in my legs.  I am caught between a rock and a hard place.

   But I agree, if cpaps can be dangerous for a layman to adjust, then why do they allow production and prescription of cpap machines that adjust themselves automaticaly.

Rooster said:

Every year in this country, home accidents result in more than 20,000 deaths while an additional 21 million people are treated for injuries, according to the Home Safety Council, a nonprofit safety education and resource group. I have looked and looked for five years now and have yet to find one death, let alone a reported injury, from a CPAP machine.

If you really want to reduce the risk of accidental death or injury to patients, forbid them from going near bathtubs or showers!

But that would not give some in the sleep business the control they want, so don't expect to see them campaigning against bathtubs or showers.

As an aside, my sleep doctor is fully aware of how I optimized my therapy (< 2 AHI) after her sleep lab and my previous sleep lab could not get me titrated below 32 AHI. In fact she expects me to bring copies of my CPAP printouts on every visit and keep her updated on what pressure I am using.
I think they are not  dangerous to someone with sleep apnea as it would be very dangerous to not use one, IE dying in my sleep, I think I will take the risk by using my CPAP any time compared to not using it .From another perspective one would soon complain if pressure wasnt allowed to be adjusted by the user and how many users would be screaming about the nanny state and freedom of choice.A bit like cigarettes really,we know they kill us the govt know they kill us ,so they carry a warning on the pack ,We choose weather or not to smoke.
To treat or not to treat that is the question... at the end of the day to take treatment or not is in the hands of the patient.
If your MD, DO, PA, NP will not listen to you time to find another healthcare provider.
Most of you know my story. Invasive Cardiac Electrophysiology Ablation Tech, Polysomnographer, and was a non-compliant nPAP user.
In the end I refused nPAP and dropped dead while at work from sudden cardiac death. Minor brain damage occurred. My brain did heal. (my wife would argue that point). I now have a pacemaker and defibrillator. I gambled and lost.
Sleep guide is a great place to argue your points and hear both sides-BUT please consult your healthcare provider or find a new one.
Learn from my pig headed ways.

I have changed my settings. Lowered them actually. My machine F&P sleepstyle 600 was set on 7, which is actually pretty low. But this machine felt like I was in a wind tunnel. 

 

Also, I would appreciate it if the cursing were edited from the article

 

Thank you.

When I was first given my CPAP, they instructed me on how to adjust the settings.  Also, after having to bring my card in after the first three months, no interest has been shown in seeing how my machine is doing.

 

Perhaps they recognized that I'm intelligent enough not do something stupid?  I'm curious about that, but not to the point at which I'd make the effort to talk to them about it.

I have had cpap for at least 10 yrs and no one has ever shown me how to change settings.  I get my care through the VA and they need to justify their jobs by denying me that info so I must have them change it.  But they messed up when they sent me my last new  machine.  They sent both the users manual and the doctors manual.  Nice right.

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