[Pressure] What's the down-side of too high a pressure?

[RonWessels]

In my research on sleep apnea, I've come across all sorts of extra issues faced by people with higher CPAP pressure settings. Things like: discomfort because of the higher pressure, nasal pillows less likely to work, greater chance of mask leakage, etc.

My question is this: aside from "lowering the pressure means that you don't have to deal with the issues of higher pressure", are there any down-sides of having a CPAP pressure that is too high?

To put it another way, imagine that you are completely comfortable with the pressure you are currently using. You then have another sleep study and find out that a lower pressure will now be an effective treatment. What is the down-side of staying at your current (higher) pressure?

By the way, I am not in this situation. The question is pure curiosity.

[Paptillian]

Well there's the obvious one: it takes more power to blow harder Not that electricity is the main concern here...

[zonk]

To put it another way, imagine that you are completely comfortable with the pressure you are currently using. You then have another sleep study and find out that a lower pressure will now be an effective treatment. What is the down-side of staying at your current (higher) pressure?

By the way, I am not in this situation. The question is pure curiosity.

Over treatment and possibility of inducing central sleep apnea
For this reason, I use S9 so don,t have to be on fixed pressure all night also can differentiate between types of apnea and treat accordingly
The trick is to find start pressure that is comfortable and treat run the mill type apnea and have some leeway to go higher if needed

[RonWessels]

Over treatment and possibility of inducing central sleep apnea

Ok, but don't you have the same possibility of inducing central sleep apnea if you actually need the higher pressure to overcome obstructive sleep apnea? In other words, is CSA induced because of high pressures independent of need, or because of excess pressure over and above what is required to keep your airway open? If the latter, how does your brain know what pressure is required to keep your airway open?

[zonk]

I think you,re correct, the same apply on higher pressure too but if the machine don,t score central apnea, there is no way of knowing
Usually people switched to bilevel machines if higher pressure needed and ASV machines for the treatment of central apnea

[jgjones1972]

Everyone is different and I think some people have an easier time with high pressures than others. I run fairly high pressure and I like the pressure. I no longer have any aerophagia and get a 10 or 12 second CA about once a week (which probably isn't even pressure related). The only way I could see higher than necessary pressure as harmful to an otherwise healthy PAPer is if they couldn't shake the hyperventilation or aerophagia.

[archangle]

Ok, but don't you have the same possibility of inducing central sleep apnea if you actually need the higher pressure to overcome obstructive sleep apnea? In other words, is CSA induced because of high pressures independent of need, or because of excess pressure over and above what is required to keep your airway open? If the latter, how does your brain know what pressure is required to keep your airway open?

Pressure induced CSA seems to be independent of OSA. Some people will not be able to use a high enough pressure to fix their OSA because it will cause CSA. Sometimes, you have to find the best compromise.

[archangle]

Some possible disadvantages of higher pressure.

1. Patient discomfort
   
2. Difficulty sleeping
   
3. Aerophagia (gas)
   
4. Increased leaks around mask
   
5. Opening the mouth with nasal masks, causing leaks
   
6. Central apneas and more subtle breathing problems
   
7. Ear popping
   
8. Muscle soreness (usually temporary)
   
9. Difficulty exhaling
   
10. Chipmunk cheeks
    
11. More water usage
    
12. More noise, more air blowing on your arms or your partner
    

[skyler]

Ron, what I found using and AUTO machine was the higher the pressure on ipap, the
more apneas I would have and the pressure would go higher to compensate and it turned into a vicious cycle.
It's good to run through different scenarios that can come up with therapy.

[vsheline]

Some possible disadvantages of higher pressure.

1. Patient discomfort
   
2. Difficulty sleeping
   
3. Aerophagia (gas)
   
4. Increased leaks around mask
   
5. Opening the mouth with nasal masks, causing leaks
   
6. Central apneas and more subtle breathing problems
   
7. Ear popping
   
8. Muscle soreness (usually temporary)
   
9. Difficulty exhaling
   
10. Chipmunk cheeks
    
11. More water usage
    
12. More noise, more air blowing on your arms or your partner
    

Also, a few people experience dizziness or vertigo from high pressure, and so must limit their machines to use pressure too low to fully avoid OSA.

Also, when one is recovering from surgery done on the airway areas, I think one may be told to stop CPAP for about a month, to allow the airway to heal.