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Re: Optimum pressure caveats, indeed!!

Posted by SGS on February 12, 2003 at 14:09:08:

In Reply to: Re: Optimum pressure caveats, indeed!! posted by BigGuy on February 12, 2003 at 07:56:06:

CPAP doesn't do these things you note in pt 2&3 as far as I know.

OSA obstructions are immediately caused by collapse of the airway dilators. CPAP splints open this collapsible airway allowing you to breath unimpeded by a blockage. CPAP doesn't breath for you (this is called mechanical ventilation -in out in out etc). You still have to breath for yourself on CPAP- your diaphragm is not going to get 'lazy' (afterall you have been breathing your shole life- also people with OSA tend to have very strong breathing muscles from years of stuggling against/overcoming the upper airway blocakge). CPAP doesn't really force air into your lungs either- it overcomes the pressure imbalance in the upper airway.

CPAP doesn't induce desaturations unless the pressure is high enough to start bringing about central apnoeas. OSA brings about the desaturations. If the pressure is set properly and you don't have leaks etc then you should not have desaturations on CPAP.

One of the problems with CPAP titration is that the night-to-night pressure requirements can change in some people. They also change in response to sleeping position and sleep stage. On any given night and at any part of the night it is possible that a properly manually titrated pressure may be too low (or too high) due to sleeping position, sleep stage or just random variation. AutoCPAP machines aim to get around some of these problems- but the machines are not always as good as the manufacturers claim they are- and they are certainly not as good as a trained sleep tech in a sleep lab. I sincerly hope one day that they will but we're not there yet.

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