Sleeper2, I agree than using an APAP to set lower pressures, and to react to events means that - almost by definition - a consistant AHI of zero will be unachievable on APAP.Heres where the sleep techs stance differs from that of the pt. My #1 goal is an ahi of 0. Not 1.3 or 3.2 or 5.7 but 0
I appreciate your answer, and do believe you care for your patients. Those of us using cpap machines have to live with them every night, compliance and comfort are a major issue under those conditions. A "better job in ultimate titration" in a users terminology means that she gets up in the morning feeling good - and is energetic during the day. Some of us have discovered that for them anything below 3 is fine, above it not so good. We have also had users report using much lower pressures than prescribed, because the mask leaks at the higher pressure woke them up, and they sleep better when the pressure is lower.
It is your - understandable - technical orientation that we take issue with. Sleep is not a technical experience. Perhaps you were taught to aim for 0 events and I believe you that you are good at it. The ahi is easy to use. However, it has been questioned if it is the right measure.THE APNEA-HYPOPNEA INDEX: USEFUL OR USELESS?
After your patient has been sent home on straight pressure, with 0 eventss, the question is still there: Have you - has your clinic ever checked compliance in your patients? Do you have any idea what, in your clinic, distiguishes compliant from non-compliat patients.
When checked objectively, CPAP treatment has notorious compliance results. There is recearch that shows how a little bit more involvment on the professionals' side would make a big difference in compliance. Few of us have recieved that support. It costs too much, it is not easy to measure, though its cost effectiveness in the long run is obvious, since properly treated OSA reduces the expense per patient.
Until recently, with most straight PAP machines, you couldn't even collect valid data on people's compliance - you had to trust self report. This objective data has recently been collected, by data collecting APAPs set to work as CPAPs, and the results show that compliance is higher when the machines are set to work as APAPs. Apparently the price of those occasional events is well worth paying.
Please stay with us - give us your perspective, teach us what you can, and try to understand ours: We have been deprived of natural recuperating sleep. We hook up to those machines in order to sleep well. We spend many many hours, night after night with that equipment. We know quite a lot about what it does to the way we feel. Many of us are frustrated at doctors and technicians who don't take the time to listen to what we tell them. It would be great to have a dialogue with one who listens.
O.
