Question on Pressure - Updated Info.

[Velbor]

With the major contributors repeating what has been said many times in many posts, I feel as though I have the right to do the same.

Therefore, repeating what I have said before, while the "official" ResMed verbiage regarding the A10 algorithm is undisputedly correct and authoritative, that does not alone necessarily make it accessible and unambiguous.

Indeed, the repeated "need" for (without disputing the utility of) these discussions provides strong evidence that accurate statements are not necessarily easily understood statements.

Key religious documents (e.g. the Bible, the Qur'an) provide the best examples of this fact. Political statements (a few of which may indeed be true) are not necessarily clear. Knowledgable commentary (even conflicting commentary) is often helpful in bringing out the nuance of the meaning.

ResMed's statements are clear to me. They are clearly not very clear to others. ResMed stated them the way they did, either because they are very smart and wise and clever, or because they are less concerned with clarity than with other goals, or because they don't know any better. THIS choice is unclear to me. Velbor

[dsm]

With the major contributors repeating what has been said many times in many posts, I feel as though I have the right to do the same.

Therefore, repeating what I have said before, while the "official" ResMed verbiage regarding the A10 algorithm is undisputedly correct and authoritative, that does not alone necessarily make it accessible and unambiguous.

Indeed, the repeated "need" for (without disputing the utility of) these discussions provides strong evidence that accurate statements are not necessarily easily understood statements.

Key religious documents (e.g. the Bible, the Qur'an) provide the best examples of this fact. Political statements (a few of which may indeed be true) are not necessarily clear. Knowledgable commentary (even conflicting commentary) is often helpful in bringing out the nuance of the meaning.

ResMed's statements are clear to me. They are clearly not very clear to others. ResMed stated them the way they did, either because they are very smart and wise and clever, or because they are less concerned with clarity than with other goals, or because they don't know any better. THIS choice is unclear to me. Velbor

Velbor,

The Resmed A10 comment was 1st made over 10 years ago as part of an extended interview but in terms of effective therapy it is meaningless. But because of the way it was worded it was picked up out of context by people who found it was a great scare tactic & has been used repeatedly just for that effect. Sometimes the person propagating it has not understood what it really means in relation to effective therapy, but there are many who know only too well that used in isolation, it is a great statement to scare newcomers (just as DoriC stated and to the effect that DoriC stated).

DSM

[DoriC]

I agree with a previous post, they should set up newbies on CPAP only until an ideal pressure is found.

Phil

That was the advice I was given early on repeatedly by a respected "pro" here when we were having mask, leak, pressure issues on auto. I would say "only until an ideal pressure is found and maybe permenantly". We would have saved ourselves alot of grief but I was determined to use all the fancy features of this auto machine I fought so hard to get. Hubby is doing pretty well on Cpap=12, but if I can't help myself and MUST experiment, it's only in a very narrow range and we still come back to straight cpap. Of course, it's different for everyone. Phil, keep us updated, it will be helpful. Dori

[DoriC]

Indeed, the repeated "need" for (without disputing the utility of) these discussions provides strong evidence that accurate statements are not necessarily easily understood statements.

Velbor

Velbor, that's why it's taken 4 pages to get to your statement. I couldn't have said it better myself. Dori

[-SWS]

My views about this topic are identical to ozij's.

This is a tough topic apparently filled with faaaaar more social challenge than technical challenge:
1) Resmed will not directly respond to apneas above 10 cm, and
2) Resmed will effectively prevent apneas above 10 cm in most cases.

So what's so technically complex about the above two sentences? I don't plan on changing my views or words about technically-easy sentence one or technically-easy sentence two one iota. So please get over it. Resmed apparently doesn't plan on changing highly basic technical truths either.

Yes, there are yet other posters here who love to cite technically-easy sentence one while omitting technically-easy sentence two. That's not where the technical confusion comes in guys. That's where the social chaos enters the picture. Just like ozij, I have repeatedly stressed both of those technically easy concepts. And like ozij, I have cited balancing white papers supporting technically-easy sentence two.

Technically, the above two sentences in blue are very basic. Socially, they are difficult for these reasons:
1) Some posters will repeatedly cite the half-truth without the full pair of balancing statements,
2) Other posters will cite the full truth, with additional supporting evidence,
3) Doug has decided statement one shouldn't even be mentioned,
4) Doug uses lots of polite smilies to incriminate and insult the full-truth posters, as if they were actually the posters disseminating half-truths ("word spinners" & underhanded "marketing" motivated individuals)

Quite frankly, how intelligent is it to repeatedly incriminate and insult the truthful posters trained in science when you really have an issue with posters of the half-truth, Doug? That either hints at totally screwed logic or an altogether different motive than purported.

The newcomer-confusion enters the picture only when posters neglect technically-easy sentence two in blue text above. (polite smilies go here)

[dsm]

SWS

If I was arguing my issue before a judge, I'd regard DoriC's testimony as a slam dunk case and slam dunk meaning.

But have it how you will my good friend

Cheers

DSM

[-SWS]

SWS

If I was arguing my issue before a judge, I'd regard DoriC's testimony as a slam dunk case and slam dunk meaning.

But have it how you will my good friend

Cheers

DSM

Courts always prefer full truths over convenient half-truths, Doug. Citing either half-truth is clearly not preferable to some of us.



DoriC, if you'd rather not clarify then please don't. That's okay!

But if you don't mind, perhaps you can help by telling us exactly how/why your views were formed, and then changed, about these highly basic joint concepts:

This is a tough topic apparently filled with faaaaar more social challenge than technical challenge:
1) Resmed will not directly respond to apneas above 10 cm, and
2) Resmed will effectively prevent apneas above 10 cm in most cases.

Any other newcomers care to help by constructively weighing in? I'm utterly confused why those two highly basic statements should be technically confusing to newcomers or veterans.

[dsm]

DoriC, if you'd rather not expound then please don't. That's okay!

But if you don't mind, perhaps you can help by telling us exactly how/why your views were formed, and then changed, about these joint concepts:

This is a tough topic apparently filled with faaaaar more social challenge than technical challenge:
1) Resmed will not directly respond to apneas above 10 cm, and
2) Resmed will effectively prevent apneas above 10 cm in most cases.

Any other newcomers care to help by constructively weighing in?

SWS,

Cmon ! - That does not alter the points made & discussed - now you are trying to subtly badger the witness. DoriC said what she said & it reiterated 100% the case I was making & have made many times before. You are being naughty

DSM

#2 this is like watching a recalcitrant worm dangling on a hook - Steve you are one tough cookie

[-SWS]

Doug, if you think DoriC's statement is a slam-dunk in logic, that's fine. I completely disagree with you. Please try to lay off the psychological underhanded-motivation predictions (marketing, naughty, etc) since you're consistently labeling my own motives incorrectly---not to mention the insulting shadow that casts.

Here's the heart of what DoriC said:

Very few things made any sense to me at the time but something did jump out at me that I thought I understood perfectly. "Resmeds do not respond to apneas over 10cms".

But her statement contains only one of those two highly basic A10 concepts I have highlighted in blue. It would be beneficial to understand exactly why the other basic A10 concept I have highlighted in blue is missing from that initial perception.

I sure hope the answer isn't that we have to lean on opposite half-truths to balance posters leaning on the other half-truths. I would rather figure out a way to clarify the full truth.

These are the two simple truths that newcomers should be able to easily understand IMHO:
1) Resmed will not directly respond to apneas above 10 cm, and
2) Resmed will effectively prevent apneas above 10 cm in most cases.

[mars]

Any other newcomers care to help by constructively weighing in? I'm utterly confused why those two highly basic statements should be technically confusing to newcomers or veterans.

---------------------------------------------------------------------------------------------------------------------------------------------------

Hi

Yes, I would like to respond.

I have read a lot of threads about this A10 business, very confusing early on, a little less confusing as I read more, but clarity is very difficult to find amongst a deluge of technical information.

So...........................

1, I do not really need to bother about any of it, as I have a Sandman Auto, and the discussion does not personally concern me

2. My Ahi, and how I feel, is what the whole business is all about.

I do not remember the 2 sentences put together like they are above before. I am fairly sure I understand the 2 sentences, and I think I had worked that out with all the previous threads and arguements. But what a task.

3. So it is my choice whether or not to read all this technical stuff, and I think all of us are really grateful that some Forum members have this knowledge, and are able to help others.

Finally, I must say that I have discovered that to tell someone something in a receivable way can require a depth of knowledge about that subject that the hearer would never be aware of, and this depth is especially needed if one does not know the hearer.

I will remember those 2 sentences long after I have forgotten most of the other arguements. But they need to be said together - always.

Since joining the Forum I have always considered myself lucky not to have a Resmed or Respironics machine, as it made my understanding of my therapy so much easier.

But keep the technical stuff going, one day I may get an in-depth

cheers

Mars

[dsm]

Doug, if you think DoriC's statement is a slam-dunk in logic, that's fine. I completely disagree with you. Please try to lay off the psychological underhanded-motivation thing (marketing, naughty, etc) since you're consistently getting that utterly wrong where my own motives are concerned. It's insulting to be incorrectly labeled that way again and again.

Here's the heart of what DoriC said:

Very few things made any sense to me at the time but something did jump out at me that I thought I understood perfectly. "Resmeds do not respond to apneas over 10cms".

But her statement contains only one of those two highly basic A10 concepts I have highlighted in blue. It would be beneficial to understand exactly why the other basic A10 concept I have highlighted in blue is missing from that initial perception.

I sure hope the answer isn't that we have to lean on opposite half-truths to balance posters leaning on the other half-truths. I would rather figure out a way to clarify the full truth.

SWS,

No need to divert attention from the discussion - no one is insulting anyone unless it is being feined. DoriC made her point ipso facto.

Dori tells us she went to her supplier & insisted on another brand. Because of her interpretation of the A10 statement. You really are trying to badger her for what she said. But step back & look at the facts of her interpretation as she explained them !.

DSM

PS any of my side comments merely reflect how powerfully you argue your case & that can be irrespective of prior established points. I respect that power, but doesn't mean I agree with the tactics.

[-SWS]

but clarity is very difficult to find amongst a deluge of technical information.

I will remember those 2 sentences long after I have forgotten most of the other arguements. But they need to be said together - always.

Mars, thanks for that. So if I read correctly, a deluge of highly technical information presents a formidable problem to newcomers. That second simple technical statement I have in blue is somehow not coming through as clearly as the first, however.

My other question to any newcomers who care to answer has to do with what degree of bias or "expectation loading" my two statements in blue text might unintentionally impart. If you read my two statements in blue---so that one was never mentioned without the other---would those two statements somehow make you reluctant to rely on that particular algorithm?

I think that may be Doug's worry, and I acknowledge that unfair "expectation loading" or unintentional biasing is a problem, if that's what's actually happening. And if that is what's happening, can I please have some suggestions for a solution about how we can avoid unintentionally imparting psychological bias without leaving part of the truth off? Is that even possible?

My proposed revision for my own future posts:
1) Resmed will not directly respond to frank apneas above 10 cm,
2) Resmed will effectively treat apneas above 10 cm by preventing them.

Confusing? Clarifying? Misleading? Underhanded wording? Truthful?

Thanks in advance.

[Wulfman]

Den

If a majority of people say that when using a Resmed that their AI scores tend to be quite a bit lower than when using a Respironics - who is getting the better therapy ?. To be fair, there are many other considerations but the reason I ask is because that is what people generally report. Very low AI score but very high HI score & I think we can agree that as has been said many times comparing AI & HI between brands is very doubtful.

As posted above, the true measure of how good an Auto is, is if it can pre-empt the OSA events that someone is prone to and can do so to the point where the user feels their therapy works well.

Both Resmed and Respironics are proven and successful devices.

The one issue that crops up repeatedly that DOES make a difference for some users, is the different speeds that Resmeds respond to events when compared to how Respironics responds - so this issue is to do with how fast Resmeds respond. The A10 algorithm when under 10 CMs, the further it is below 10 CMs the quicker it will raise pressure when sensing signatures of looming events or when hypopneas / apneas have been scored. The Respironics (as best as I recall from the patent data) works at the same speed of response no matter what the pressure setting & many people have commented that they find the Respironics Autos 'softer'. Some have used the word aggressive to describe the Resmed response. These are people who tend to be in the lower CMs settings (around 6-10).

Cheers

DSM

In my opinion of Autos......ALMOST NOBODY! From the reports I've seen (those posted on the forum and those that have been sent to me personally), the vast majority of XPAP users (especially new users starting out) have no business trying to attempt this therapy with an Auto (IN AUTO MODE). They're disastrous. It becomes a self-perpetuating cycle of snores, leaks and pressure increases......and then this process is repeated during the night till the user finally takes off the mask or starts their machine over.......THEN, they wonder why their Auto isn't working like it should.
First and foremost, new users need to get a mask that works properly for them. When you add in all the complications of an Auto, they don't know if it's the mask or the machine that's failing them.

I get so damned mad when the new users are told that they NEED to get an Auto (as if they won't get effective therapy if they don't). Yes, they're a "versatile" machine, but most people (understatement) don't know their capabilities or limitations. So, the user thinks "Gee, I spent all this extra money for this fancy machine......I need to use it in a range of pressures."

As far as DoriC's husband's therapy goes, the vast majority of his apneas were/are "frank"......and in a range of pressures, his leaks were severe. At a fixed pressure of about 12 or 12.5, he does pretty good.
With a ResMed Auto (in Auto mode with a range of pressures), I believe his therapy would be disastrous.
If DoriC's husband had used a ResMed machine in his sleep study/titration, I doubt that is was an Auto or in Auto mode. It was probably a special machine used for sleep studies.

Any more questions???

Den

[dsm]

Den

As regards your overall comments on Autos, I am with you 100% - Autos are so easily misconfigured (the range left wide open 4-20) by professionals who really don't grasp how they work best.

Largely because of that failure, they have not delivered the promise we all held for them. But much of the motivation for having an Auto was that these were (in the early years) the only machines that offered (if the right model), nightly data. I bought my Remstar Auto for that reason - I mostly ran it in cpap mode.

Now days, many bilevels & cpaps offer the ability to capture & extract detailed nightly data & bilevels have dropped to prices that are affordable & are increasingly being recommended by smarter RTs & doctors.

DSM

[Plowboy]

Ok, I am going to try this again from a novice point of view. The whole intent, as I understand it, is to "splint" my airway open so I can draw breath and not desaturate, cause a big dump of adrenaline into my system, stress my organs and cause general havoc. That being said, If I set my pressure to a specific level in CPAP mode, all I need worry about is being able to handle the constant pressure from a personal "comfort" level, try and drop my AHI to the lowest possible level (snores, leaks and all rectified for the sake of this argument). Once I am comfortable and acclimate, maybe then begin to play with the settings to achieve a more comfortable experience, learning the technical stuff along the way as it applies to my specific equipment.

I equate this discussion with some of the IT gurus I work with, their preferences have nothing to do with the comparative simple functions I need from a computer, I just need it to open excel, word, etc., etc., and don’t really care about processor type, platform, bios settings, etc. As long as the damn thing performs at the simple level I need to do my job, that’s all I care about

Ditto CPAP therapy, if it keeps me around a little longer and improves my quality of life, I don’t really care at this point to fiddle with the damn thing and confuse as well as discourage my compliance. I think the Dr. and the DME should have set mine to CPAP only right now and we could have got into the technical stuff after I was kind of "dialed in".


Phil