Ive changed my mind on auto-titrating devices

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jonny515
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Re: Ive changed my mind on auto-titrating devices

Post by jonny515 » Fri Feb 05, 2016 9:52 pm

I have a range right now. I didn't sleep long enough (or deeply enough) for them to figure out what a steady pressure would be. I'm very happy they (without any fight) prescribed APAP. I would not ever sleep in a sleep lab, they could bring me back a hundred times (well no they couldn't), but the results wouldn't be different.

If a steady pressure works you can set that on a APAP too. I don't know what's bad about them.

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Re: Ive changed my mind on auto-titrating devices

Post by palerider » Fri Feb 05, 2016 10:04 pm

jonny515 wrote:I have a range right now. I didn't sleep long enough (or deeply enough) for them to figure out what a steady pressure would be. I'm very happy they (without any fight) prescribed APAP. I would not ever sleep in a sleep lab, they could bring me back a hundred times (well no they couldn't), but the results wouldn't be different.
it's probably set to the default 4-20 settings, so you'll need to watch the data, and tune the machine for your needs, raising the min pressure as you start seeing what the machine is heading towards at night. there's plenty of people here that can help you with it

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Re: Ive changed my mind on auto-titrating devices

Post by Gasper62 » Fri Feb 05, 2016 10:06 pm

MrGrumpy wrote:I'm not saying autopaps and autobipaps are not good. They have their uses. Lord Ive been relying on one for almost three years now, without it, I'd be under no therapy.

But my therapy under APAP sucks. Its better than nothing, but not a huge amount much more. And thats part of my point. To wipe these apneas and hypopneas and RERAs and stuff out before they even hit, your pressure setting needs to be set at a level that prevents them from even happening. That was the original premise for CPAP therapy, an "air splint" for the airway.

In all my years of using these machines since 2007, I did relatively OK when pressures were set high enough to wipe out events. But try to rely on an auto-titrating device to feel well? Ive been doing that for almost three years now and I can tell you, IT DONT WORK. Sure my AHIs are generally low. Sure my downloads look good with the low AHI and all. Resmed designed it that way with their software and algorhythm.

Bottom line is many of you have been sucked into the "gear creep" mentality. I admit I got suckered into it myself for many years. Many of you are just gear heads and enjoy tinkering around with your stuff. Doesnt mean your any healthier, probably means your LESS HEALTHY.

The people who do well are the ones who are using generally straight CPAP pressures or old style bipap with one inhale and one exhale pressure. And are compliant and use a proper mask. Those are the people who get better, start exercising and either are able to keep their jobs or go back to work. Many of the rest of you, just tinker around forever, are addicted to the technology part of this CPAP thing and sit on your ass too much.
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Well gee whiz ! If you know so damned much....why in God's name haven't you switched your apap to operate in cpap mode. Quit all yer cryin', yer acting a tw@t. What's next ? You gonna' tell everybody here what vehicle they need to drive to make you happy ? How about a big cup of STFU ?!?

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jonny515
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Re: Ive changed my mind on auto-titrating devices

Post by jonny515 » Fri Feb 05, 2016 10:15 pm

Nope, thanks for responding. But it is set for 6-10. I think your comments still apply though.
(I did actually sleep but I did not go into REM). I have yet to sleep with the CPAP on, but I did download Sleepyhead.

palerider wrote:
jonny515 wrote:I have a range right now. I didn't sleep long enough (or deeply enough) for them to figure out what a steady pressure would be. I'm very happy they (without any fight) prescribed APAP. I would not ever sleep in a sleep lab, they could bring me back a hundred times (well no they couldn't), but the results wouldn't be different.
it's probably set to the default 4-20 settings, so you'll need to watch the data, and tune the machine for your needs, raising the min pressure as you start seeing what the machine is heading towards at night. there's plenty of people here that can help you with it

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palerider
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Re: Ive changed my mind on auto-titrating devices

Post by palerider » Fri Feb 05, 2016 10:48 pm

jonny515 wrote:Nope, thanks for responding. But it is set for 6-10. I think your comments still apply though.
(I did actually sleep but I did not go into REM). I have yet to sleep with the CPAP on, but I did download Sleepyhead.
6-10 is likely a better starting point that 4-20, but without looking at the data, you won't know if 6, or even 10, is enough

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jonny515
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Re: Ive changed my mind on auto-titrating devices

Post by jonny515 » Fri Feb 05, 2016 11:24 pm

I have yet to fall asleep with the CPAP on, seems like Sleepyhead wouldn't provide anything useful at this point. The machine comes up with figures but they seem rather strange (AHIs range from .4 to 7 for instance).
palerider wrote:
jonny515 wrote:Nope, thanks for responding. But it is set for 6-10. I think your comments still apply though.
(I did actually sleep but I did not go into REM). I have yet to sleep with the CPAP on, but I did download Sleepyhead.
6-10 is likely a better starting point that 4-20, but without looking at the data, you won't know if 6, or even 10, is enough

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Re: Ive changed my mind on auto-titrating devices

Post by palerider » Sat Feb 06, 2016 12:11 am

jonny515 wrote:I have yet to fall asleep with the CPAP on, seems like Sleepyhead wouldn't provide anything useful at this point. The machine comes up with figures but they seem rather strange (AHIs range from .4 to 7 for instance).
Ah, I misinterpreted your "I actually did sleep" to mean "with the machine" not "during my test"... my bad.

keep at it, maybe you can fall asleep with it this weekend

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jonny515
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Re: Ive changed my mind on auto-titrating devices

Post by jonny515 » Sat Feb 06, 2016 11:38 am

Yep, you are right this time. I sometimes forget to write things like nouns and verbs.
I know figured out a problem with the machine settings and am going to try looking at my data via Sleepyhead. Thinking that I am starting to fall asleep and then have an episode and wake up. If that is the case not sure how I am ever falling asleep.

palerider wrote:
jonny515 wrote:I have yet to fall asleep with the CPAP on, seems like Sleepyhead wouldn't provide anything useful at this point. The machine comes up with figures but they seem rather strange (AHIs range from .4 to 7 for instance).
Ah, I misinterpreted your "I actually did sleep" to mean "with the machine" not "during my test"... my bad.

keep at it, maybe you can fall asleep with it this weekend

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archangle
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Re: Ive changed my mind on auto-titrating devices

Post by archangle » Sat Feb 06, 2016 4:23 pm

Why APAP?

My opinions:
  • Any CPAP is a tool. The quality of the results depends on the skill of the operator (whoever's managing the settings) more than the quality of the tool, although the quality of the tool does matter.
  • An APAP can do everything the CPAP does.
  • If the minimum pressure is too low, it may be uncomfortable for the patient, leaks may be a problem, and the patient may suffer from apnea or flow problems until the machine adjusts upwards.
  • The minimum pressure should usually be set somewhere near the therapeutic pressure.
  • Allowing the pressure to drop below the maximum pressure the patient needs has some advantages. Less aerophagia, ear problems, mask leaks, mouth leaks, patient comfort, pressure induced central apnea, etc.
  • Pressure changes may be uncomfortable for some patients and may cause difficulty adjusting the mask.
  • There is an art of compromise in terms of setting the minimum pressure. A competent operator would tailor the setting to what works best for the patient.
  • If the auto machine adjust the pressure up too high, it may cause problems. It may simply "run away". Even if the patient "needs it," it may cause discomfort, leaks, gas, ear problems, etc.
  • A competent operator will will tailor this setting too.
  • Seeing what pressure range the APAP wants to use gives useful information about what pressure the patients "needs," and gives some clues about the severity of the patient's apnea in his real sleep environment.
Summary:
  • APAP has advantages for many patients
  • Used properly, there is no disadvantage to the patient. The APAP can be set to a small pressure range, or even set to manual CPAP.
  • Wide open 4-20 auto is rarely the right way to use the device.
I think of the modern data capable APAP machine as being like a well made cordless drill/driver with a torque limiter. Unfortunately, most of the medical mafia just uses it as a hammer.

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Re: Ive changed my mind on auto-titrating devices

Post by zoocrewphoto » Mon Feb 08, 2016 3:33 am

I have two huge benefits from using an apap range. I need a lot more pressure when I sleep on my back. Most of the night, my pressure stays within 11-13, but I will usually have a few spikes to 15, and on rare nights, it gets close to 17. I would NOT want to spend the whole night at 15 or 17.

The second reason is a really goo bonus for me. As the pressure starts going up, I now roll back onto my side. So, while using cpap, I barely sleep on my bank. Before cpap, I spent a lot more time on my back. If I were to look at the numbers without considering the context, I would assume that 13 would be high enough to prevent most events. But, if I were to actually sleep with a straight 13 pressure, I would probably roll onto my back and stay there for long periods of time. That would result in a lot of events. I can't afford to throw away that 13-17 range. I may not need it that long each night, but I do need it.

I also find that my pressure change if I take a muscle relaxer, if I have a cold, if I am dealing with asthma attacks, etc. There are times when I need more pressure, and I don't have to worry about it since I know my range can handle it. The only pressure adjustment I need to make is when I have a bad cough. I need to raise my minimum to 13 so that a coughing spasm doesn't cause me to rip off my mask.

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Re: Ive changed my mind on auto-titrating devices

Post by chunkyfrog » Mon Feb 08, 2016 6:02 am

On straight 14 cm. pressure, I would inflate like a Whoopie cushion, minus the giggles.
9.2-13 eliminates that lovely experience.

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Re: Ive changed my mind on auto-titrating devices

Post by Sheriff Buford » Mon Feb 08, 2016 8:15 am

archangle wrote: Used properly, there is no disadvantage to the patient.
I humbly disagree. There's not many people that feel the same using straight cpap vs autopap. Second, I think the reason (as I have stated before) is the amount of time a autopap takes to respond to an event can be the culprit. Short as it is... your are clearly experiencing an event, waiting for the machine to respond. During this time you are experiencing minimum therapy without the needed pressure to deal with the event.

Sheriff

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Re: Ive changed my mind on auto-titrating devices

Post by chunkyfrog » Mon Feb 08, 2016 9:50 am

Sheriff; I would consider "using properly" as switching to cpap mode when needed.
(As you did). The advantage of the apap machine is a choice of modes.
Unfortunately, the manufacturers do not see fit to provide a proper manual to the patient.

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Re: Ive changed my mind on auto-titrating devices

Post by Oltremare » Mon Feb 08, 2016 10:08 am

I am a dilettante and I don't know what is best between CPAP and Auto-CPAP. I can only say that with my AIRSENSE 10 autoset I am fine. I tried one day to set it as CPAP, but I did not have a good sleep! With the advice of many friends in the forum (Pugsy where are you?), I have achieved a great setting and my AHI is always less than 1. EPR is wonderful and I hope everything will be so for a long time.

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Sheriff Buford
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Re: Ive changed my mind on auto-titrating devices

Post by Sheriff Buford » Mon Feb 08, 2016 11:33 am

Agreed... there are folks that feel much better in one mode rather than the other mode.

I thought this discussion may pull Pugsy out. Maybe...

Sheriff