"please keep me updated about oximeters "
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How Dangerous are CPAP Machines?
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?
Views: 15045
Replies to This Discussion
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Permalink Reply by lia deneau on
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ROCK, HOW DID YOU KNOW IT WAS ME POLY?! LOL
Rock Hinkle said:Well said Poly.
lia deneau said:Sure.... lets just let everyone tweak their own..thats just brilliant!
Yes, over titration CAN CAUSE DAMAGE.... I have personal witness to patient that was once viable, energetic, ceo that traveled the globe for business and pleasure and mountain climber.... an avid sports man...no he was not obese, just had mild - moderate apnea...
his pulmonologist had the brilliant idea to just slap him on auto pap... then the doc just pulled a pressure number out of thin air...and on and on... the gentlemen ended up haveing to take medical/early retirement and watched his health take a fast nosedive... long story short....he ended up back again in the sleep lab and I performed the study myself...having just noted the man was at the end of the rope ( i say that i did the study myself , because i work days..not nights) so I took it into my own hands... started him out as a diagnostic study...which noted the man in fact did not have central apneas...just mild osa... and then titrated him to 7 cm H20 ...that was his 'SWEET SPOT" he was titrated higher...and then began having the CENTRAL APNEAS .... he was infact overtitrated...
he used his cpap for 2 years at 14 cm H20...that was his problem... his life has been devasted and he blamed the doc...because the doc was the one that made the decision to pap him and not allow the patient to be titrated from the lowest pressure...the doc just as i said before plucked some number out of the air, said start his pap at 12 cm and it was just a mess......
so, in my opinion, expertise...high pressures can be dangerous... now? is the technology of our pap machines good enough to REALLY recognize the diff between osa or central...i sure hope so... tweaking your own pressures...thats a sore subject... just because most all patients THINK their pressure is too high...they note this while awake...not asleep... so they lower it until they think that they can handle it.... this pressure is not necesarily theraputic.... its all trial and error...
i have to also say that having watched my husband closely for years on his cpap I most certainly think, and know that his autopap which is set at a high and a low pressure definatly is better than the straight cpap that he used for years... but, he had a titration study in a sleep lab that gave the doc the perameters to work with.....
in the end, self dosing, self tweeking is it bad?... is it bad to tweek your own insulin, blood pressure meds, blood thinners???
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Permalink Reply by Chris H on
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How about making data and the qualified people to look at it connect .Could be a modem with real time acess to settings.A computer program could send an alert to the Doctor or you that know what you are doing with this stuff to make tweeks as necessary.Good Sleep, Chris
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Permalink Reply by Mary Z on
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Does ResTrax in fact do this very thing? If so, you would need a team motivated to check the data if you called, or once a week, or whatever seemed to make the most sense, More often if you are having problems
chris h said:How about making data and the qualified people to look at it connect .Could be a modem with real time acess to settings.A computer program could send an alert to the Doctor or you that know what you are doing with this stuff to make tweeks as necessary.Good Sleep, Chris
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Permalink Reply by Banyon on
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Mary, How about getting up any morning that you think you had problems during the night and downloading your own data, analyzing it, and then taking care of the problem yourself?
To heck with depending on some doctor or other sleep professional who is poorly motivated to immediately correct any problem I have.
There is a small and fast growing tide of people who can take care of their own therapy. We are going to wash over the sleep professionals who want to control our lives and charge for it. Their fear mongering is transparent.
Fortunately I have two doctors backing me up, understanding that I control my therapy and the machine settings, and offering to write a prescription for anything I need. You will see patients like this more and more. The professionals can rail against it in the forum, but they can't stop it. LMAO.
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Permalink Reply by RockRpsgt on
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I just play a dumb guy on the internet. In real life I actually pay attention to the post, awards, and articles written by my peers. It was not hard to put 2 and 2 together.
lia deneau said:ROCK, HOW DID YOU KNOW IT WAS ME POLY?! LOL
Rock Hinkle said:Well said Poly.
lia deneau said:Sure.... lets just let everyone tweak their own..thats just brilliant!
Yes, over titration CAN CAUSE DAMAGE.... I have personal witness to patient that was once viable, energetic, ceo that traveled the globe for business and pleasure and mountain climber.... an avid sports man...no he was not obese, just had mild - moderate apnea...
his pulmonologist had the brilliant idea to just slap him on auto pap... then the doc just pulled a pressure number out of thin air...and on and on... the gentlemen ended up haveing to take medical/early retirement and watched his health take a fast nosedive... long story short....he ended up back again in the sleep lab and I performed the study myself...having just noted the man was at the end of the rope ( i say that i did the study myself , because i work days..not nights) so I took it into my own hands... started him out as a diagnostic study...which noted the man in fact did not have central apneas...just mild osa... and then titrated him to 7 cm H20 ...that was his 'SWEET SPOT" he was titrated higher...and then began having the CENTRAL APNEAS .... he was infact overtitrated...
he used his cpap for 2 years at 14 cm H20...that was his problem... his life has been devasted and he blamed the doc...because the doc was the one that made the decision to pap him and not allow the patient to be titrated from the lowest pressure...the doc just as i said before plucked some number out of the air, said start his pap at 12 cm and it was just a mess......
so, in my opinion, expertise...high pressures can be dangerous... now? is the technology of our pap machines good enough to REALLY recognize the diff between osa or central...i sure hope so... tweaking your own pressures...thats a sore subject... just because most all patients THINK their pressure is too high...they note this while awake...not asleep... so they lower it until they think that they can handle it.... this pressure is not necesarily theraputic.... its all trial and error...
i have to also say that having watched my husband closely for years on his cpap I most certainly think, and know that his autopap which is set at a high and a low pressure definatly is better than the straight cpap that he used for years... but, he had a titration study in a sleep lab that gave the doc the perameters to work with.....
in the end, self dosing, self tweeking is it bad?... is it bad to tweek your own insulin, blood pressure meds, blood thinners???
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Banyon, unfortunately the machine I have- the VPAPIII ST-A, while it shows TV, MV, leaks, RR, Spont T & C, does not show AI and AHI, even on download. This was confirmed by ResMed (finally and with documentation after ResMed rep after rep said that it did- and actually it reported both as 0.0, rather than not reporting anything at all. Misleading). It is essentially a servo vent with timed ventilations and as such they did not think AI and AHI would be necessary. I ended up with this monster of a machine when my last doc ordered a ridiculous 30/25 pressure setting ( could only tolerate 25/22 or the mask leaked all night making for a miserable time of mask adjusting and readjusting ad nauseum- no sleep). I'm waiting to hear from the new doc or dme about switching this useless ( to me, because of lack of useable data) machine out. My present settings are 16/12 and I'm feeling better- not sleepy during the day and not sleeping as long either. It's set as a straight bilevel not timed or auto (won't do auto I don't think). I did just recently tweaked the TiMax and rise time after it kept cutting my inhalations in two. The DME (who is great) counterintuitively shortened both which just made it worse. With my tweaking of these two numbers I can now take a full breath without having it cut into two sections. I look forward to the day when I can check AI and AHI again. Right now I'm having to go strictly on subjective data, which is better. The very high pressures may have been causing centrals which is maybe why I felt worse at that pressure. I don't even take Nuvigil anymore.
Banyon said:Mary, How about getting up any morning that you think you had problems during the night and downloading your own data, analyzing it, and then taking care of the problem yourself?
To heck with depending on some doctor or other sleep professional who is poorly motivated to immediately correct any problem I have....
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Mary said, "I'm waiting to hear from the new doc or dme about switching this useless ( to me, because of lack of useable data) machine out."
I hope that comes quickly for you.
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Permalink Reply by Neal Buckner, LRCP on
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Ok. A practitioners 2 cents here.
For the most part. Simple OSA is just that. Simple. As we age and medical conditions change, changes in PAP may need to occur. Either increase or decreased. For those who are proactive about their treatment and understand what kind of sleep apnea they have, making small changes is probably no big deal.
However, having said that. There is some danger in making changes to your PAP pressure if you don't have a clear understanding of the possible outcomes. Too high of a pressure can be just as bad as a pressure that is too low. More so in some cases.
Central sleep apnea's can be worsened if too much CO2 is blown off due to the increase in ventilation when pressures are too high. Plus the number of sleep disturbances can increase from mask leak and swallowing air. Increasing CPAP pressure in turn creates a higher PEEP. Positive end expiratory pressure. Increased PEEP increases the lung surface area participating in respiration. This increased respiration can lower CO2 levels causing the central chemoreceptor to delay sending a signal to the diphragm to contract. This can cause increased central apneas and hypopneas in turn causing O2 sats to drop due to the decrease in ventilation. Desats cause disturbances.
In patients who have later stages of COPD the increase will increase the oxygen levels. Advanced stage of COPD the central chemoreceptor is no longer the receptor used in regulating the respiratory rate. The peripheral chemoreceptor takes over. The peripheral receptor measures blood oxygen. Increasing the O2 levels by way of increased ventilation and respiration also tells the brain the diaphragm does not need to contract. Hyponeas and central apneas increase thus causing the blood CO2 levels to increase.
In short. Please always inform your physician of any changes you have made and get a download done after 2 weeks at the new pressure to ensure the change didn't make things worse.
It is for these very reasons that a licensed professional should be involved with any changes to a prescribed pressure.
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Gosh Neil.... you poorly motivated , fear mongering person you!....No, for real Neil great answer...
I also wanted to say to anyone out there...
How dare you insult me by saying that I am a poorly motivated professional, that I do not have my patients best interest at heart... you know nothing about me, my practice and how IMPORTANT helping people are... those words that you spew feel like hate to me... after watching patients sleep for many years, and working with the worst of the worst at childrens hospital and then seeing idiot parents "DECIDE" to play with their childrens pap therapy becuase they think they dont need it and end up with a coded or dead child....shame on you...
I Highly advocate patients get educated, and I am the first one to tell patients that if the are not feeling any better or having a hard time lets discuss the issues and if this doesnt resolve your problem...please, please, please, compain, howl, or whatever you have to do to get attention...lets face it the DME's followup can be abysmal.... I think that if we all have to work together, physician, patient, and techs and the DME's to make this all work!
Neal Buckner, LRCP said:Ok. A practitioners 2 cents here.
For the most part. Simple OSA is just that. Simple. As we age and medical conditions change, changes in PAP may need to occur. Either increase or decreased. For those who are proactive about their treatment and understand what kind of sleep apnea they have, making small changes is probably no big deal.
However, having said that. There is some danger in making changes to your PAP pressure if you don't have a clear understanding of the possible outcomes. Too high of a pressure can be just as bad as a pressure that is too low. More so in some cases.
Central sleep apnea's can be worsened if too much CO2 is blown off due to the increase in ventilation when pressures are too high. Plus the number of sleep disturbances can increase from mask leak and swallowing air. Increasing CPAP pressure in turn creates a higher PEEP. Positive end expiratory pressure. Increased PEEP increases the lung surface area participating in respiration. This increased respiration can lower CO2 levels causing the central chemoreceptor to delay sending a signal to the diphragm to contract. This can cause increased central apneas and hypopneas in turn causing O2 sats to drop due to the decrease in ventilation. Desats cause disturbances.
In patients who have later stages of COPD the increase will increase the oxygen levels. Advanced stage of COPD the central chemoreceptor is no longer the receptor used in regulating the respiratory rate. The peripheral chemoreceptor takes over. The peripheral receptor measures blood oxygen. Increasing the O2 levels by way of increased ventilation and respiration also tells the brain the diaphragm does not need to contract. Hyponeas and central apneas increase thus causing the blood CO2 levels to increase.
In short. Please always inform your physician of any changes you have made and get a download done after 2 weeks at the new pressure to ensure the change didn't make things worse.
It is for these very reasons that a licensed professional should be involved with any changes to a prescribed pressure.
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First of all , ALL whom are on this forum are first person witnesses to what is and is not happening with sleep.From gasping newbie to advanced professionals in the field. Machines and people are only as good as the info they are programed with.A lack of communication from machine to professional to patient has been and still remains poor. I saw my new sleep doctor today and he said having real time acess to data would be helpful but then he said how would we make that happen?Some computer geek could wright a program to give a redlight warning if data is out of peramiters to upload to some one who know what they are doing to fix it. That missing link and support staff are just a dream at this point. Good Sleep, Chris
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lia deneau said:How dare you insult me by saying that I am a poorly motivated professional, that I do not have my patients best interest at heart...
Calm down. No one said that of you.
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Thanks, Neal.
Neal Buckner, LRCP said:Ok. A practitioners 2 cents here.....Please always inform your physician of any changes you have made and get a download done after 2 weeks at the new pressure to ensure the change didn't make things worse.
It is for these very reasons that a licensed professional should be involved with any changes to a prescribed pressure.
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