Replies to This Discussion

Permalink Reply by RockRpsgt on November 25, 2009 at 9:07am

Sorry Andy I had a busy night at work. I did not get to finish the post that I started. As I began to explain in my earlier post it is possible for someone that has been on PAP for a while to have a drop in their pressure needs. This can be especially true if a person uses the PAP as a means to further develop healthier habits. Weight loss is not always needed. Just the act of being on PAP and being healthier can cause this.

In your case your sleep doc chose a a pressure either based on your AHI from the diagnostic study, or from his/her previous experiences. 10cm is a good middle road to start with for a trial run. Having the data from that trial allowed your tech to do a more efficient titration. I do not believ that the sleep team in question is using all of their resources in Christine's case. It is tough to say without knowing what they are thinking. Now if you had not had the trial run on CPAP it is possible that your initial pressure needs could have been a little higher. This is based on the knowledge of the residual effects of CPAP or the Hysteresis Phenomenon.

The residual effect of CPAP is a lasting drop in AHI even when someone stops using CPAP for a few days. Studies have shown this drop to be as much as 15 events per hour. This is the reason why a persons pressure needs may drop after some time on PAP therapy. This is also the reason that some labs require patients to not use their PAP unit for a few nights prior to retitration. The hysteresis effect is basically the same thing except that it says that a persons pressure needs may drop due to being on PAP continuously. Either explanation is due to muscle building, toning or memory in the airway.

In Christine's case I was arguing against the way the Auto machine was being used. If you turn it around the same argument can be made for why an auto machine with a restricted range could be useful for the above reasons. i hope all that made sense. I kind of feel like I am babbling this morning.

• ▶ Reply

Permalink Reply by Duane McDade on November 25, 2009 at 9:50am

Wow! This is something I did not want to do, but I had to this disussion is going the wrong direction 7-17 cm auto! What? I might be out shooting people while drinking wine coolers ,but I'm not stupid enough to tell people to use auto CPAP with a difference of 10! Autos can be very effective if a difference of 2-3 is used. I was just passing by O.M.F.G.!!!!!! I'm off to go and shoot empty wine coolers ......I'm OUT!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!

• ▶ Reply

Permalink Reply by Mary Z on November 25, 2009 at 10:29am

Duane, please explain for those of us not as knowledgeble as you are what you mean. No offense intended, I'm new to understanding these numbers. My Doc has my respect and trust- he's good and he sets my numbers, but I like to understand the concept.
So please give us your thinking/rationale on this subject.

Thanks,
Mary Zimlich

Duane McDade said:

Wow! This is something I did not want to do, but I had to this disussion is going the wrong direction 7-17 cm auto! What? I might be out shooting people while drinking wine coolers ,but I'm not stupid enough to tell people to use auto CPAP with a difference of 10! Autos can be very effective if a difference of 2-3 is used. I was just passing by O.M.F.G.!!!!!! I'm off to go and shoot empty wine coolers ......I'm OUT!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!

• ▶ Reply

Permalink Reply by Andy on November 25, 2009 at 1:00pm

Hi Rock,

Thanks for the more detailed response. And my apologies to anyone who feels I'm hijacking this thread. I'm thinking that my questions are relevant, but if not, then we can take them to a separate thread.

That said, do I understand correctly that use of xPAP over time actually strengthens the airway? I would have thought that it would make the airway more reliant on PAP...

So, over time, then, I can expect my airway to strengthen, thereby requiring a lower CPAP pressure? Is there a guildeline as to how long that would take? Is there a recommendation as to when a patient should be re-titrated?

And, is there any benefit to using an auto PAP device? Wouldn't it tend to find the optimal numbers over time, thereby using the lowest effective pressure?

Oh, and one more thing... is there a reference to the complete article that you had linked?

Thanks!

.

• ▶ Reply

Permalink Reply by RockRpsgt on November 25, 2009 at 10:29pm

In theory yes Andy that is what I am saying. The decrease though could be small if at all significant. The downfall is that by not using your PAP your AHI will eventually return to it's original severity.

Andy said:

Hi Rock,

Thanks for the more detailed response. And my apologies to anyone who feels I'm hijacking this thread. I'm thinking that my questions are relevant, but if not, then we can take them to a separate thread.

That said, do I understand correctly that use of xPAP over time actually strengthens the airway? I would have thought that it would make the airway more reliant on PAP...

So, over time, then, I can expect my airway to strengthen, thereby requiring a lower CPAP pressure? Is there a guildeline as to how long that would take? Is there a recommendation as to when a patient should be re-titrated?

And, is there any benefit to using an auto PAP device? Wouldn't it tend to find the optimal numbers over time, thereby using the lowest effective pressure?

Oh, and one more thing... is there a reference to the complete article that you had linked?

Thanks!

.

• ▶ Reply

▶ Reply to Discussion

• ‹ Previous
• 1
• 2
• 3
• 4
• Next ›
• Page