Forum · Is there actually a medical reason for a low initial pressure?

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[-] Verne7 +0 points · about 1 year ago

Number one, this is a Airsense 10 (apap) and it doesn't have an 02 sensor. The initial low pressure is like slow suffocation. ie: torture from lack of oxygen. And so, having no 02 sensor, the sleep doctor cannot actually assess whether they are depriving you of oxygen or not.

Not readily obvious, it was only when I was going to throw the whole ball of wax, that I started trying to see why I was having to sleep 11 hours on the machine then 6 hours off the machine to recover. So, I put on my mask and breathed, paying attention. That's when I noticed that trying to draw air through the machine was like trying to breathe through a single straw.

When I raised the low pressure all the benefits started showing up.

My initial pressures were 5-15 EPR 3. I have reset them to 9-16 EPR 2. I am hoping that was my last adjust, so I can see how my body and the AI in the Airsense can adjust to these settings. I have been at 1.05 or lower AHI for the last 9 days. The machine doesn't put me into Afib anymore (yet?), and I am sleeping 7-8 hours instead of the 12 I used to have to sleep to feel rested.

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[-] DanM +1 point · about 1 year ago Sleep Enthusiast

Hi Verne7. Glad to hear you are sleeping better. Most prescriptions use a starting pressure of 4 or 5 cm for patient comfort. The majority of patients I have worked with over the years find anything more than that too uncomfortable. For other patients, higher pressures are more comfortable. My low pressure is currently set to 6 cm because I have the same problem you describe. I feel like I'm not getting enough air at lower pressures. For patients who experience this, most physicians and home care companies will work with you to adjust settings to prevent the feelings of "air hunger" you describe.

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[-] Verne7 +0 points · about 1 year ago

So, when I asked my sleep doctor not to give me a pressure too low, because I slept fine in the hospital with a regular cpap which only has one pressure, the doctor's reason would be .... that she is an example of a doctor that doesn't listen to her patient...? (to say it politely) From what you say, there was really no reason for her not to follow my request other than being difficult. Doctors are so childish sometimes when I question them.

Not to be too critical really, but how many years is "over the years", because from what I hear the apap is fairly new. That would mean the "low" pressure setting is also a new thing... right?

And, from what I read here (which of course is only a sample mainly, of the people trying to solve problems), many people are being starved for oxygen. And, the bad thing is that many people will stop using the device, as I mentioned that I felt like doing. Wouldn't it be better to prescribe a setting high enough that it wouldn't do this. Since we are being force to have a sleep doctor prescribe the settings and might take a month or two before they review the issue. I mean if you set it a bit high for those it makes uncomfortable, they are simply getting more air, and are not being suffocated as are the people where the pressure is too low.

And, the final part is we must not only pay for another doctor visit to get this insanity resolved, but we also must make another visit to the DME... This should be resolved on the first visit to the DME, by testing to see what pressure IS comfortable to the patient. Not simply by the doctor "guessing" at the correct low setting. At least as long as unreliable doctors have us by the short-hairs, where we are required to get a prescription for the treatment machines.

After adjusting my own apap the Airsense 10, I see the complexities and realize something must be done, but the bit about being forced to have a "prescription" to get the machine is idiotic.

Not trying to attack you DanM, just the process itself, which is far from being even close to adequate.

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[-] Verne7 +1 point · about 1 year ago

Sorry for the rant DanM. You did not deserve it. Thank you for your reply. I do value your advice.

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[-] DanM +0 points · about 1 year ago Sleep Enthusiast

Hi Verne7. No need to apologize! The experience of receiving proper treatment for sleep disorders can be frustrating, and I fully understand your point of view. I do agree that providers should spend more time with patients when dispensing equipment so that the patient can wear the device during setup, make sure they feel comfortable and are getting enough air, and have plenty of time to ask questions. My comment about working with patients over the years was meant to apply to several treatment types. CPAP, APAP and BiPAP can all be set to start at various pressure levels, but the most common are the 4 and 5 cm I mentioned. It certainly does not mean that is enough pressure for every patient, as it was not enough for me. Part of the reason MyApnea.Org exists is to give voice to patients like you and to hopefully learn about things we need to spend more time researching to help improve the treatment experience. Thanks for sharing!

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[-] wiredgeorge +1 point · about 1 year ago Sleep Enthusiast

I am guessing you had a bad night Verne? I think Dan is one of the best sources of reason and he is conservative in his answers. I think the reason the numbers on your machine as set the way they are is because that is what experienced medical professionals saw working in your sleep study. The initial pressure of 6? Does your Airsense 10 have a ramp function displayed in APAP mode? I use BIPAP and mine has a ramp function. This starts at a low pressure and increases over a user selected period of time. My ramp time was initially 20 minutes and I quickly found that unnecessary as I don't stay awake for even 5 after I turn the machine on.

As Dan said, this is done for max patient comfort and the number obviously can't be determined by a single sleep study. The sleep doc has no way of knowing how quickly you will fall asleep or how quickly, at night, you will get used to the higher pressure. In my case, I quickly turned the ramp from 20 minutes to OFF. Found that the highest pressure (mine is 25) was a bit overwhelming so turned the ramp to 5 minutes and left it there. I suspect I don't even need a ramp time now but leave it there as it doesn't make a lot of difference. My ramp starts at 4 I believe and I have to place my hand over the exhale holes on my mask to see if it is working. It isn't real comfortable at this low pressure but my machine starts at like 4 to 7 (goes from 4 to 7 exhale / inhale) and that could be turned up some but it doesn't bother me much anymore.

Hang in there and just realize that any sleep doc that will make a follow up is probably VERY busy because he is talking to patients. My sleep doc (I don't know his/her name) never talked to me or communicated with me in any way. Seems like that should be part of the process but it wasn't so hang in there and self educate and keep in mind that folks who take the time to give sane advice on this forum, at least the ones with bona fide medical experience, are going to be conservative in their answers. If you are not getting the answers you need in a timely fashion, your insurance company is being paid to make sure you are so give them a call and see if they can intercede and get you the answers you need to make sleep comfortable.

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