Ive changed my mind on auto-titrating devices

General Discussion on any topic relating to CPAP and/or Sleep Apnea.
User avatar
ALF
Posts: 51
Joined: Tue Jun 17, 2014 12:10 am
Location: Seattle

Re: Ive changed my mind on auto-titrating devices

Post by ALF » Thu Feb 04, 2016 3:14 pm

You can always set an auto machine to a single pressure, but you can't set a fixed pressure machine to variable pressure. Given that, these days, auto machines are not much more expensive than fixed machines, why would you prevent yourself from having a choice? Worse case scenario is that you only use an APAP on fixed pressure, and you spent maybe $150 more than you needed to.

_________________
Machine: PR System One REMStar 60 Series Auto CPAP Machine
Mask: AirFit™ P10 Nasal Pillow CPAP Mask with Headgear
Additional Comments: PR System One REMStar 60 Series Auto CPAP Machine, SleepyHead and Sleep Mapper software
"I love sleep. My life has the tendency to fall apart when I'm awake, you know?"
- Ernest Hemingway

User avatar
palerider
Posts: 32300
Joined: Wed Dec 16, 2009 5:43 pm
Location: Dallas(ish).

Re: Ive changed my mind on auto-titrating devices

Post by palerider » Thu Feb 04, 2016 3:15 pm

MrGrumpy wrote:I told you man, stay out of my posts.

palerider wrote:
MrGrumpy wrote:No, Im talking from the perspective of purely clinical effectiveness.I think a single set pressure, as long as that pressure is your 95th percentile (or 90th for Phillips machines) is the best pressure for most as long as they can tolerate that pressure. Why? Because it destroys most if not all the obstructions, unless you gain weight or you change over time.
*shakes head*

_________________
Mask: Bleep DreamPort CPAP Mask Solution
Additional Comments: S9 VPAP Auto
Get OSCAR

Accounts to put on the foe list: dataq1, clownbell, gearchange, lynninnj, mper!?, DreamDiver, Geer1, almostadoctor, sleepgeek, ajack, stom, mogy, D.H., They often post misleading, timewasting stuff.

User avatar
palerider
Posts: 32300
Joined: Wed Dec 16, 2009 5:43 pm
Location: Dallas(ish).

Re: Ive changed my mind on auto-titrating devices

Post by palerider » Thu Feb 04, 2016 3:16 pm

Gasper62 wrote:I'll throw my APAP away immediately ! What were all those learned engineers thinking ? (also shakes head )
you sir, are a wise man.

_________________
Mask: Bleep DreamPort CPAP Mask Solution
Additional Comments: S9 VPAP Auto
Get OSCAR

Accounts to put on the foe list: dataq1, clownbell, gearchange, lynninnj, mper!?, DreamDiver, Geer1, almostadoctor, sleepgeek, ajack, stom, mogy, D.H., They often post misleading, timewasting stuff.

User avatar
chunkyfrog
Posts: 34377
Joined: Mon Jul 12, 2010 5:10 pm
Location: Nebraska--I am sworn to keep the secret of this paradise.

Re: Ive changed my mind on auto-titrating devices

Post by chunkyfrog » Thu Feb 04, 2016 3:40 pm

I know how to set my apap to straight cpap, one pressure only. Easy, peasy!
I already know how it feels. My first machine was an S9 Elite.
For nine months, I was nightly inflated at 14 cm. when I only needed 11.something.
I do NOT miss the balloon frog mode!
I have found my ideal pressure range, and will only change it if the data says I need to.
Since I have TWO (2) machines in one, I have the best of both worlds. Life is good.

_________________
Mask: AirFit™ P10 For Her Nasal Pillow CPAP Mask with Headgear
Additional Comments: Airsense 10 Autoset for Her

User avatar
palerider
Posts: 32300
Joined: Wed Dec 16, 2009 5:43 pm
Location: Dallas(ish).

Re: Ive changed my mind on auto-titrating devices

Post by palerider » Thu Feb 04, 2016 3:58 pm

chunkyfrog wrote:I know how to set my apap to straight cpap, one pressure only. Easy, peasy!
I already know how it feels. My first machine was an S9 Elite.
For nine months, I was nightly inflated at 14 cm. when I only needed 11.something.
I do NOT miss the balloon frog mode!
I have found my ideal pressure range, and will only change it if the data says I need to.
Since I have TWO (2) machines in one, I have the best of both worlds. Life is good.
when this thread first went up, one of the wise ones here on the forum PM'd me this tidbit:
ILiveUnderABridge wrote:Plus, you are keeping one factor the same...pressure. If YOU CHANGE, say you gain or lose weight or you start drinking booze at night or taking a lot of benzos, its gonna reflect in your AHI for a set pressure. For that, you go back to your sleep doc, say, damn, look at my shitty AHI and I dont feel so hot anymore. My sleep is deteriorating as well. Sleep doc says, "lets re-titrate you for this twenty pound weight gain or weight loss." DONE. And you have a new pressure.

and said that was one of the best arguments FOR an apap that they'd seen in quite a while.

I think I have to agree...

_________________
Mask: Bleep DreamPort CPAP Mask Solution
Additional Comments: S9 VPAP Auto
Get OSCAR

Accounts to put on the foe list: dataq1, clownbell, gearchange, lynninnj, mper!?, DreamDiver, Geer1, almostadoctor, sleepgeek, ajack, stom, mogy, D.H., They often post misleading, timewasting stuff.

MrGrumpy
Posts: 412
Joined: Fri Mar 21, 2008 12:12 am
Location: North Carolina

Re: Ive changed my mind on auto-titrating devices

Post by MrGrumpy » Thu Feb 04, 2016 4:39 pm

You get my point. What you are saying. If you use a set pressure that is high enough, it zaps everything. And you dont have to do this up and down all night long APAP stuff.

That being said, I admit to owning four AutoPaps and Ive owned more than four in the past. But I want to go back to being a "single set pressure kind of guy."

ClayL wrote:When I was last due for a new machine I asked my sleep doc about an auto CPAP. He said he usually had good results with fixed pressure and didn't think it was necessary but he did prescribe an auto but asked me to use it in auto mode for a month and then switch to fixed for a month and send him the Sleepyhead results. In my case there was almost no difference between the two but the auto was slightly better so I left it in auto mode. A couple of years later my AHI was often somewhat higher than before. The machine seemed like it was lagging too far behind the apneas so I set it to fixed mode and the AHI got consistently better. It has been a couple of years and I have left it in the fixed mode - AHI is still good - 1.89 average for the last 12 months.
Id be dead by now if I didn't use my CPAP gear every night.

User avatar
Gasper62
Posts: 982
Joined: Tue Mar 10, 2015 1:22 pm
Location: Central Maryland

Re: Ive changed my mind on auto-titrating devices

Post by Gasper62 » Thu Feb 04, 2016 5:58 pm

Can I interest ya in an extremely low-mileage horse and buggy rig ?

User avatar
chunkyfrog
Posts: 34377
Joined: Mon Jul 12, 2010 5:10 pm
Location: Nebraska--I am sworn to keep the secret of this paradise.

Re: Ive changed my mind on auto-titrating devices

Post by chunkyfrog » Thu Feb 04, 2016 6:15 pm

My apnea is easily treated--by ME! I only need to see my sleep doc in order to keep Medicare happy.
I prefer not to take his attention away from patients who are actually NEED his help.

_________________
Mask: AirFit™ P10 For Her Nasal Pillow CPAP Mask with Headgear
Additional Comments: Airsense 10 Autoset for Her

Janknitz
Posts: 8410
Joined: Sat Mar 20, 2010 1:05 pm
Location: Northern California

Re: Ive changed my mind on auto-titrating devices

Post by Janknitz » Fri Feb 05, 2016 4:10 pm

There are indeed many people who will do fine at a fixed pressure. An APAP can be set at a fixed pressure, no problem there.

But what I have a problem with is sticking everyone with fixed pressure machine not because it's necessarily the best thing, but because it's CHEAPER for the DME to provide--it has nothing to do with what is important to the patient. Flexibility is limited with a CPAP, where an APAP gives you options.

With a fixed CPAP, if you want to tweak the effectiveness of the setting, you can do shot in the dark pressure changes, or pay for a sleep study. An APAP setting allows you to see exactly what's happening and what pressure settings might be best. Then you can go right back to the old or new fixed pressure.

I'm not one to say everyone needs an APAP setting, but I believe that everyone needs an APAP OPTION--in case the titration was off, in case of weight loss or gain or change in medical condition, in case of time bringing changes to the anatomy and physiology of the sleeper.
What you need to know before you meet your DME http://tinyurl.com/2arffqx
Taming the Mirage Quattro http://tinyurl.com/2ft3lh8
Swift FX Fitting Guide http://tinyurl.com/22ur9ts
Don't Pay that Upcharge! http://tinyurl.com/2ck48rm

User avatar
palerider
Posts: 32300
Joined: Wed Dec 16, 2009 5:43 pm
Location: Dallas(ish).

Re: Ive changed my mind on auto-titrating devices

Post by palerider » Fri Feb 05, 2016 4:32 pm

Janknitz wrote:With a fixed CPAP, if you want to tweak the effectiveness of the setting, you can do shot in the dark pressure changes, or pay for a sleep study..
in all fairness, it's not much more difficult to tweak pressures with full data fixed CPAP, you have to take it slower, and experiment a little more, but it's quite possible.

the downside is that it won't adjust to your changing needs, so you need to monitor your data more closely to keep getting good treatment.

_________________
Mask: Bleep DreamPort CPAP Mask Solution
Additional Comments: S9 VPAP Auto
Get OSCAR

Accounts to put on the foe list: dataq1, clownbell, gearchange, lynninnj, mper!?, DreamDiver, Geer1, almostadoctor, sleepgeek, ajack, stom, mogy, D.H., They often post misleading, timewasting stuff.

Janknitz
Posts: 8410
Joined: Sat Mar 20, 2010 1:05 pm
Location: Northern California

Re: Ive changed my mind on auto-titrating devices

Post by Janknitz » Fri Feb 05, 2016 6:18 pm

Well, even the APAP doesn't really "adjust to your changing needs" unless you have it set wide open. Once you have a pressure range dialed in, particularly a narrow pressure range, it won't increase or decrease beyond that range unless you see the need and change the settings. But it's a lot easier to use the data on an APAP to get a good idea of where the settings need to be.

Example: I was having issues sleeping but my numbers looked really good. AHI was less than 2 each night. But by printing out the pressure graph we could see that I was topping out the maximum set pressure most of the night. We raised the ceiling a little and all was well. That would not have shown up with a fixed pressure.

What I might have done, given the same circumstances but using the machine in CPAP mode is to do a week or so with an APAP pressure range to see what's going on. Then the pressure change to a new fixed pressure might have been more of an educated guess. The APAP does not have to be set wide open 4-20 to do this, either. A range around the set pressure (say 2 cm H20 in either direction) would have been informative.
What you need to know before you meet your DME http://tinyurl.com/2arffqx
Taming the Mirage Quattro http://tinyurl.com/2ft3lh8
Swift FX Fitting Guide http://tinyurl.com/22ur9ts
Don't Pay that Upcharge! http://tinyurl.com/2ck48rm

User avatar
palerider
Posts: 32300
Joined: Wed Dec 16, 2009 5:43 pm
Location: Dallas(ish).

Re: Ive changed my mind on auto-titrating devices

Post by palerider » Fri Feb 05, 2016 7:01 pm

Janknitz wrote:Well, even the APAP doesn't really "adjust to your changing needs" unless you have it set wide open. Once you have a pressure range dialed in, particularly a narrow pressure range, it won't increase or decrease beyond that range unless you see the need and change the settings. But it's a lot easier to use the data on an APAP to get a good idea of where the settings need to be.
typically, for me, the top pressure isn't a concern. I get the lower pressure right, and leave the top open. for some people it may be an issue. by leaving plenty of headroom, the machine can go up if your needs change, and won't if you don't need it. some folks like Pugsy, if I remember, only need about 9 for most of the night, but 18+ for her REM stages.

I never recommend "wide open" except for the first night just to see if the person might be one of those rare people that only need 4cm, but after the first night, I focus on the lower pressure, and typically find that once it's in the ballpark, the top pressure is rarely of any concern, for me, because the machine shouldn't ever need to go very far up.

_________________
Mask: Bleep DreamPort CPAP Mask Solution
Additional Comments: S9 VPAP Auto
Get OSCAR

Accounts to put on the foe list: dataq1, clownbell, gearchange, lynninnj, mper!?, DreamDiver, Geer1, almostadoctor, sleepgeek, ajack, stom, mogy, D.H., They often post misleading, timewasting stuff.

MrGrumpy
Posts: 412
Joined: Fri Mar 21, 2008 12:12 am
Location: North Carolina

Re: Ive changed my mind on auto-titrating devices

Post by MrGrumpy » Fri Feb 05, 2016 8:55 pm

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.
Id be dead by now if I didn't use my CPAP gear every night.

MrGrumpy
Posts: 412
Joined: Fri Mar 21, 2008 12:12 am
Location: North Carolina

Re: Ive changed my mind on auto-titrating devices

Post by MrGrumpy » Fri Feb 05, 2016 8:58 pm

How do you know? Youre an idiot. Tweaking a straight CPAP or straight bipap with no objective external data is indeed like shots in the dark. Like I said man, GO AWAY you have never even been to a sleep doc, nor had an actual sleep study before. Your gear is secondhand and not even prescribed.

palerider wrote:
Janknitz wrote:With a fixed CPAP, if you want to tweak the effectiveness of the setting, you can do shot in the dark pressure changes, or pay for a sleep study..
in all fairness, it's not much more difficult to tweak pressures with full data fixed CPAP, you have to take it slower, and experiment a little more, but it's quite possible.

the downside is that it won't adjust to your changing needs, so you need to monitor your data more closely to keep getting good treatment.
Id be dead by now if I didn't use my CPAP gear every night.

User avatar
palerider
Posts: 32300
Joined: Wed Dec 16, 2009 5:43 pm
Location: Dallas(ish).

Re: Ive changed my mind on auto-titrating devices

Post by palerider » Fri Feb 05, 2016 9:27 pm

MrGrumpy wrote:How do you know? Youre an idiot. Tweaking a straight CPAP or straight bipap with no objective external data is indeed like shots in the dark. Like I said man, GO AWAY you have never even been to a sleep doc, nor had an actual sleep study before. Your gear is secondhand and not even prescribed.
it is quite clear that our respective posting history, as well as the number of people we have each helped, speaks volumes.

you have posted nothing of value in your latest incarnation... just lunatic rants.

it is interesting, and possibly telling, a brief perusal of your posts from 2008, and the few brief ones when you popped in to try and unload your overpriced oximeter back in 2014 didn't show this level of lunacy. one has to wonder what has happened to you since then. perhaps you've been sniffing too many mercury fumes in a hobby of making felt hats?

it's also quite clear from your rants that you've got no concept of the idea of taking charge of your own therapy, nor what is needed to optimize it, all you can do is blindly stumble your way to your hated doctors and sleep specialists and beg them to help you, instead of helping yourself.

I'd pity you if you weren't so vile and offensive.

_________________
Mask: Bleep DreamPort CPAP Mask Solution
Additional Comments: S9 VPAP Auto
Get OSCAR

Accounts to put on the foe list: dataq1, clownbell, gearchange, lynninnj, mper!?, DreamDiver, Geer1, almostadoctor, sleepgeek, ajack, stom, mogy, D.H., They often post misleading, timewasting stuff.