Poster child for Auto Audjusting pressures

For those of you who don't know my story.
I had the titration sleep study from Hell. I didn't meet criteria during the diagnostic sleep study due to never hitting REM sleep until later in the night when there wasn't enough time to do the titration as a split night.
Criteria was 15 events per hour.
So I had to come back for the titration study. It was a nightmare and only got a grand total of 156 minutes of sleep with only 6 minutes in REM sleep. So I came out of the titration with RX of 8 cm.
It worked great when I wasn't in REM sleep but I didn't get much REM and I guess during that 6 minutes I was in my "don't need much pressure" REM sleep.
At home with my machine 8 cm gave me an AHI of around 10.0 or so...felt like total crap.
It was obviously REM sleep related because I had periods of time with nothing going on at all and periods of time where I had some really ugly clusters of OAs.

I ended up with 10 minimum so that the machine could get to where it needed quickly enough to do a good job and sometimes I saw around 18 cm or so being needed especially in the wee hours of the night where we typically have more REM.
Armed with my reports when I went back for my 90 day follow up with the doctor's PA that I was seeing...she totally agreed with what I came up with and gave me the official "blessing" to use APAP mode with 10 min and 20 max...not that I really needed it
Long term...my 90% pressure was around 13 cm...but a couple times a week I would see 17 or 18 90% pressures.. Just some nights I need more pressure than other nights.

For any of you who are thinking supine sleeping was the culprit. I experimented for a month with using a wall to keep me off my back. I went to sleep in one position on my side and woke up in same position. I had it fixed so I couldn't move at all.
I still saw the sometimes much higher pressure needs even if I was totally on my side all night long.
That's how I came up with the conclusion that supine sleeping didn't impact pressure needs. That leaves REM sleep as sole culprit.

Pugsy wrote:For any of you who are thinking supine sleeping was the culprit. I experimented for a month with using a wall to keep me off my back. I went to sleep in one position on my side and woke up in same position. I had it fixed so I couldn't move at all.
I still saw the sometimes much higher pressure needs even if I was totally on my side all night long.
That's how I came up with the conclusion that supine sleeping didn't impact pressure needs. That leaves REM sleep as sole culprit.

Thanks for sharing Pugsy! This is interesting and seems logical. I thought supine impacted, but thinking more about it I am simply more comfortable in supine vs. side sleeping and therefore probably get into - and spend more time in - REM sleep. Cool stuff!

In my opinion Pugsy has been experimenting too much with different kinds of machines. Since she does not require an ASV machine, she could have done well with an S9 Autoset machine and use the APRs. If instead of jumping from machine to machine she would have spent the time on fine calibrating the S9Autoset then I take a guess that she would have done better treatment- wise, long ago. However, the real test of adequate treatment is feeling in- shape during daytimes.

avi123 wrote:In my opinion Pugsy has been experimenting too much with different kinds of machines. Since she does not require an ASV machine, she could have done well with an S9 Autoset machine and use the APRs. If instead of jumping from machine to machine she would have spent the time on fine calibrating the S9Autoset then I take a guess that she would have done better treatment wise, long ago.

Your comment would make sense if Pugsy was using an ASV machine, but she isn't (none of her machine's are ASV machnes).

She pretty much uses one machine (the S9). Sometimes she switches to the equivalent Respironics machine, but it's also an Auto BiPap. (I think she prefers ResMed's EPR over AFlex for the most part.)

All three machines are BiPap machines, the newest just not being an Auto.

Most of us think it's a good idea to have a backup machine.

So sorry, can't "buy" your argument on this one.

I continue my point, from my above post, that even if you find a machine mode that shows zero events during the night then it does not guarantee that you are optimizing your treatment. My following one year results show very few events during sleep but this " adequate treatment" does not take away my RESes (Residual Excessive Sleepiness) during the a. m. parts of the days. It seems to me that those underlying medical conditions that caused my Sleep Disorder Breathing, in the first place, continue unabated. And they are those that need be treated vigorously as well.




All the values in above one year Stats are MEDIANS of the daily values.

BTW, it took me almost a year to arrive at a machine's set-up that treats ALL events. There are no more events left over any more.
If I had started fooling around, eight months ago, with the S9 BiLevel Auto, for which I have an Rx, I am convinced that I would not have reached this zero event stage, by now.

AVI123 I've come to the conclusion that you do not like anything that Pugsy does.

It's not just Pugsy. Anything any female says frequently gets a similar response from him. I'm surprised he even saw it as most of us women end up on his foe list.

squid13 wrote:AVI123 I've come to the conclusion that you do not like anything that Pugsy does.

I have known that for the last 2 years. But gosh, his 2 years of struggling makes him so much more qualified than a mere woman who has been doing this for 4 years now..
If I said the sun rose in the East and set in the West he would argue with me. He hates women...especially women who don't take any crap from him or god forbid...who might actually have some common sense which some grumpy old men seem to be lacking.
He used to tell people that APAPs would kill you. Yep..he did that.
He is not worth my effort now unless he is spouting off garbage to a newbie that might hurt someone. He doesn't even understand the difference between the bilevel machines that I use and an ASV bilevel machine. What I use is really nothing more than a machine with larger options for exhale relief. Yes, sometimes used for CSA when minor tweaking of pressures allows for the centrals to subside but also simply used for exhale relief. World of difference between these "plain" bilevels and the ASV bilevels with backup rates and burst of pressure to kick start the breathing.

My whole point to this thread is to show that sometimes auto adjusting pressures work great but if for some reason an auto adjusting machine isn't feasible or if auto adjusting pressures seem to create more problems than they fix then it is still possible to obtain quite acceptable therapy. Yeah, I make a good argument for always using auto adjusting pressures since they don't bother me BUT there are some advantages to fixed pressures and even I can obtain quite acceptable therapy with fixed pressures with just a bit of tweaking.

Now I don't go chasing AHI 0.0...never have. I don't go chasing a perfect 0.0 leak either. I have had both and didn't feel one whit different from a less than "perfect" night. Trying to obtain either creates more issues with sleep quality than a few minor blips will cause in problems for me. I could wear a chin strap like a vise and/or seal my lips shut but I know for sure that doing so causes me more awakenings than a little leak does.

Oh, BTW...2 years ago I made a suggestion which he blew off as to how to optimize his therapy back when his AHI was double digit and guess what...it was pretty much what he stumbled on with 2 years of struggling because he was too bull headed to even think that a woman might have a decent idea from her little pea sized brain. He refused to listen to me back.
He never challenges a man...only women...and I wasn't the only one. I just happen to be the biggest thorn in his side because I am still here and I think he realizes that he isn't going to get rid of me.

Though if someone wants to do EXACTLY what he does and wear the EXACT same mask and chin strap...he will tell you that is the BEST way to do anything because that is HIS way and his way is always superior.
That's how come he always sticks his "perfect" reports in someone else's thread (like here) when it really has no bearing on the discussion. He likes to be the center of attention I guess.
Nasal pillow masks are for girls and real men don't wear something meant for women. Yep...he said that.
For some reason he has a problem with women...it's okay for us to use an inferior (by his thoughts) mask but not a man.
I never saw him advise a woman to use a "real" mask. Just men.

Mainly I now consider the source and just move on. He isn't worth my effort anymore. He doesn't want to learn or listen.
Now if one of you guys came up with the same thoughts as mine he would likely deem those worthy.

Grumpy old man..

.....now I see where some of Pugsy's comments came from in my Thread!

I signed in--that's much better
(can't see the comments of the resident gynophobe)

squid13 wrote:AVI123 I've come to the conclusion that you do not like anything that Pugsy does.

Look what you have created!

And you who suffers, like me from Peripheral Neuropathy, have not even related to my above post that having zero events left on graphs, even day after day, does not mean much with regards to achieving an "adequate treatment". And you sure know it yourself. Besides, I have not written that I don't like anything that Pugsy does which is not correct. I do like Pugsy trimming the hair in her husband's nostrils and ears, for example.

avi123 wrote:

squid13 wrote:AVI123 I've come to the conclusion that you do not like anything that Pugsy does.

Look what you have created!

I have not written that I don't like anything that Pugsy does which is not correct. I do like Pugsy trimming the hair in her husband's nostrils and ears, for example.

Okay, I think I have finally figured out why Avi is such a jerk and woman hater. He tried to convince some woman that it was her duty to trim HIS nose hairs and she shoved those scissors up as far as they would go and punctured his brain.....

As good an explanation as any because there's no doubt he's not right in the head.

avi123 wrote:Look what you have created!

And you who suffers, like me from Peripheral Neuropathy

Hey my numb feet has nothing to do with my appnea. My neuropathy is taken care of with Metanx and I wear sweat socks to bed everynight and my feet never interrupted my sleep. My AHI is below 2 and quite a few nights below 1 and my leak line is zero. I feel good in the morning and that's all that counts. I don't chase zero cause that can drive you nuts trying to accomplish that. To me how I feel is what counts. PS What have I created?

Madalot wrote:

avi123 wrote:

squid13 wrote:AVI123 I've come to the conclusion that you do not like anything that Pugsy does.

Look what you have created!

I have not written that I don't like anything that Pugsy does which is not correct. I do like Pugsy trimming the hair in her husband's nostrils and ears, for example.

Okay, I think I have finally figured out why Avi is such a jerk and woman hater. He tried to convince some woman that it was her duty to trim HIS nose hairs and she shoved those scissors up as far as they would go and punctured his brain.....

As good an explanation as any because there's no doubt he's not right in the head.

Now THAT was good! I really laughed out loud... for which I thank you, Madalot!

Kenwood wrote:.....now I see where some of Pugsy's comments came from in my Thread!

Partly but not entirely. It's something that has been on my mind recently and finally decided to act upon it and do a bit of education in the process. Just got lucky with the one report that showed the clusters so figured I would take the time to do a bit of in service.

Not everyone can get an auto adjusting machine for whatever reasons. DME is maybe a jerk and doctor not helpful and not deep enough pockets to go the out of pocket route. Also some people really don't necessarily deal with auto adjusting pressures as easily as others. Maybe the range the machine wants to go to in an effort to kill some snores takes a person in to aerophagia territory and the aerophagia is much worse than letting a couple of snores of flow limitations slide that might not even grow up to be a full fledged event. Maybe they are sensitive to the variations in pressure and again chasing a snore that may not grow up to be worth chasing might create more of a sleep disruption than the snore would cause.

I know several people who feel more rested on cpap mode than they do in apap mode.

You never know...you might not do well with an auto adjusting machine chasing those snores of yours...heck for all I know they may not even be the kind of snores that the machine will try to kill. If insurance picks up the tab that's one thing but if it doesn't...that's a mighty pricey experiment out of pocket.

Another point I wanted to make is that sometimes we have to compromise. Pick our most important battles to fight and devote our energy to those battles instead of spreading our energy out trying to fight battles that we have little chance of winning. Like the one I face.....is tonight going to be a night where my machine wants to go really high or not?
I have no way of knowing what the future holds so I do the best I can with the information I have and the tools at my disposal.
I can be perfectly happy with a fixed pressure...cpap or bilevel. I might trade off a rare cluster if I did but unless there are a lot of them every night (which I already know isn't common for me) I could do quite well with fixed pressures.
That's why I went ahead and bought the 660 PR S1 from Mark. I was curious about the heated hose feature more than I was worried about the lack of auto adjusting pressures. I already knew what to expect and what I was going to need to do.
For me it really wasn't an issue. Even if I could afford to order the 760 I can't..no RX..and I can't afford it anyway.

Now that the 760 has a PS min and a PS max...that means I can have my desired 4 cm PS instead of starting out the night at 2 cm default and have it roam around...it will be perfect and that was really the only reason I preferred the S9 VPAP Auto..that and the ClimateLine. Just a silly little preference that only matters while awake which is maybe 5 minutes as it never takes me long to go to sleep. One of these days I will spot a killer deal on a 760 on craigslist nearby.

So it wasn't just you that prompted this thread but your situation got me to thinking.
I don't want people to think that just because they don't have a machine that has auto adjusting ability means that they can't have the "best" therapy. It can be done..might take just a bit of time and a little tweaking but it can be done.
I don't always have the prettiest of reports even in auto adjusting mode...sometimes I probably need a little higher EPAP to start with but those times are rare and I really don't feel horrible with a not so pretty report so it just isn't that big of a deal.

Number one goal in my book...again like I say often...good quality sleep. If I don't have that then it doesn't matter how perfect the reports are.