Sleep Apnea-Stick with your Prescription!

I tend to frequent many of the respiratory related forums, probably because I’m a Respiratory Therapist. I don’t do it because it’s exciting, that’s for sure.
I have read on many occasions about patients changing their own pressure beyond the prescribed settings. This particular person did it for her husband who was complaining he “wasn’t getting enough air”. When they went to the doctor and told him of the change of pressure, he wasn’t happy. The physician proceeded to tell them of the extreme danger and that messing with pressures could cause and that it could even lead to death.
Well, this person wrote how the doctor over-reacted and that he had “his God complex” going on.
People, people, people, I’m not some AMA poster child by any stretch of the imagination but in this case the physician was right!
Sleep Medicine is a very new field. As such, researchers are always finding new things such as Complex Sleep Apnea. Complex Sleep Apnea is characterized by increased central apneas with increasing pressures. There are, I’m sure, many, many people on CPAP with Complex Sleep Apnea that is undiagnosed. I have seen sleep studies where the diagnostic portion showed an Apnea/Hypopnia Index of 18, then CPAP was applied and before the sleep lab reached a theraputic CPAP level the central apnea index had reached 80 and the oxygen saturation had dropped to less than 85%.
Sleep studies have also shown that a small portion of patients develop cardiac arrythmias when CPAP pressure is increased. Most arrythmias are not dangerous but some can be life threatening. The physician in these cases weighs all the evidence from the sleep study and prescribes the option that is safe, first, while being theraputic.
When you consider the complications that can and do arise with CPAP therapy, I wonder who really has the “God complex”? The physician with all the medical evidence or the patient who wants to change a prescription based on a feeling?

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