just looking for input:)

[pharmwoman]

my sleep doc noticed ive lost a few pounds the other day and lowered my pressure to 7, from 10--he said it would help with the mouth-breathing--
so the lst 2 nites, what i notice is the machine is much quieter--Im sleeping ok..............but is there anyway the lowered pressure could hurt me??I guess Im just anxious about all this.

[Guest]

is there anyway the lowered pressure could hurt me??

Hurt you? No.



However, if he made this adjustment without seeing any data, he may have reduced the effectiveness of your treatment along with the pressure.

What does your software tell you? Has your AHI increased since he lowered the pressure?

He lowered it 3cms because he noticed you lost a few pounds?! Good grief! And people wonder why we have so little faith in sleep doctors and DMEs.

Is this doctor intentionally setting your APAP as a straight CPAP at a single set pressure?

[pharmwoman]

ok, he said the only thing he can tell from reading the machine is how many hours it is used--he also was responding to my complaints of headaches and the fact that the mask was leaking like crazy no matter what i do--so i have to say the quietness is good, and I always felt 10 was sort of high for me. I really was shocked the other day when he told me he couldnt give me additional data--how am I supposed to figure my progress??

[Guest]

ok, he said the only thing he can tell from reading the machine is how many hours it is used.

I really was shocked the other day when he told me he couldnt give me additional data--how am I supposed to figure my progress??

Oh my god. He's either lying or incompetent. You have the Resmed Vantage Auto which gives complete data, not just compliance. I'd suggest you purchase the software and start monitoring your results. I'd suggest you use your machine in auto mode so it can be set to a range of pressures. I'd suggest you'll be able to see which pressure gives you the lowest AHI and how leaks are affecting your therapy.

I'd suggest your sleep doctor (like the sleep doctors and DMEs of so many others) is worthless and you need to take charge of your own therapy.

[Guest]

Why not purchase the Clinician's Manual for your machine (eBay $6.00).
Then set your machine for 'Auto' 8 - 12 cu/H2O. Next just monitor yourself for a bit..

[Bingo]

Okay, how about we all just take a step back here and try to help this nice poster out without throwing all sorts of accusations around.

In answer to your question - can the lowered pressure HURT you?

Not as such, no. Chances are such a small drop of 3cm will not cause a dramatic change one way or the other in your level of Apneic episodes. There are cases where it COULD, yes. However, your prescribing MD is going to either currently have, or have reviewed this information and is therefore in a pretty good position to make suggestions.

Additionally, let's take a look at a hypothetical example. Say that perhaps at a level of 7cm during your titration you had an AHI of 10. However, when titrated up to 10cm you had an AHI of 1. This is not at all uncommon.

Great, you now get a prescription for 10cm. However, at 10cm, you find yourself unable to tolerate the treatment. You experience constant headaches, the noise level wakes you occasionally, and you finally find a mask you like but due to how you sleep, it leaks like crazy!

So which do you think is better? Basically getting NO treatment from 10cm, or at least getting partial treatment at 7cm? And then maybe after a couple months of being able to accept 7cm we can then start bringing you back up to 10cm!

That sounds like excellent judgement to me, and a great way to start turning someones health around.

Also, in response to the person who immidately started suggesting that her MD was "...either lying or incompetent." and "your sleep doctor (like the sleep doctors and DMEs of so many others) is worthless ..."
It is very easy to make these sorts of accusations while having almost NONE of the available information.

I really, really wish people would stop trying to advance this "all medical professionals are horrrible evil people who want to steal your lunch money" rhetoric by terrifying people who are simply looking for honest answers.

There is a great big picture to be seen out there, if you just stand back a few steps. Honest.

Bingo

[birdiebaby]

I sent you a PM....

Shelley

[ozij]

ok, he said the only thing he can tell from reading the machine is how many hours it is used

Questions for Bingo:

The machine in use is a Resmed S8 Vantage EPR Auto CPAP .

1. Is the doctor's statement correct - is compliance the only data he can get from the machine?

2. Do you consider the following information correct:

Data Includes Usage, Leak AHI, Events and Pressure
Via Cable 365 sessions of summary data, five sessions of detailed data.
ResScan Data Card 180 sessions of summary data, five sessions of detailed data.
Menu Display Some data available via LCD menu

(source: Resmeds Brochure http://resmed.com/Shared/StaticFiles/s8 ... sh-usa.pdf)

3. If it is correct, why does the doctor say something different? I really want to hear your expalnation of that.

4. Does the doctor lack knowledge?

5. Is the doctor lying?

6. Is the doctor knowledgeble, but disrespectful to the patient?

7. Would you like your doctor to treat you like that?


This is not the first time your attention to facts has been somewhat lacking... We (at any rate, I) still remember your recommendation to use the ramp on a Respironics Auto because you didn't notice it was an auto. I believe the following statement, from you own post is very pertinent: It is very easy to make these sorts of accusations while having almost NONE of the available information

It is you, accusing forum members, and disregarding some very important facts. The people here look at the details, and know them.

There is a great big picture to be seen out there, if you just stand back a few steps. Honest

Honest? Or is that a typical, rhetorical way of disregarding facts.

If you want us to take you seriously, its about time you related to facts.

Any comments about Margie's story, by the way? Are these events part of the great big picture you're looking at? Because, you know, these are part of the great big picture we see, day in and day out.

Thank you

O.

[Bingo]

Heh. I'll give it a go. I'm sorry if you feel the need to get personal with this. I was simply giving a different side to an issue.

What the heck though, I'll answer your questions:

1) "1. Is the doctor's statement correct - is compliance the only data he can get from the machine? "

I haven't the foggiest. I do not use that machine, so I wouldn't be in a position to answer that!

2) Do you consider the following information correct etc etc

See the answer to #1.

HOWEVER - and this is H-U-G-E:
What I meant by not going off the persons MD yet was that YOU (meaning, the collective you reading this post, no one in particular) have NO idea what context the initial statement about what could be read. How do you know that what he wasn't saying was 'The only information available here is the hours in use'. Heck, the initial poster never answered your question regarding why it was set in straight CPAP mode - it's very possible she MAYBE even chose the incorrect machine when setting up her profile.

THAT is what I meant about not having all the information and waiting a moment beore grabbing torches and pitchforks. Do you have ANY idea if what he initially said was also followed by, 'However, I'd really like for you to call me when you get home so I can walk you through finding out other information'. I'm certainly not saying it did, but it's just another example of the sorts of things that DO get forgotten in these matters.

3, 4, 5, 6 - all answered in #1 and 2 above.

7) Another question that simply can't be easily answered. However, IF my doctor was able to rationally look at information and make a judgement such as 'If I put you on full therapy now, you will not be comfortable using it so I am going to start you on partial treatment to at least get you something' then YES, I very much would want my doctor to treat me that way. It shows sensible judgement and compassion beyond just looking at numbers.

Please, understand - ALL I am trying to do is get people to stop for just a moment before throwing people to the wolves. Look at the big picture. It's astounding how often ALL PEOPLE, myself included, can let our anger blind us to simlpe facts. A wonderful example of this is the old saying about how you can have 10 great meals at a restaurant, but the only one everyone hears about is the 1 that had a hair in it.

Bingo - who apparently lacks attention and relation to facts too. Wow!

[Wulfman]

Excellent, Ozij.

Ponderings:
I've been trying to figure out why the doctor turned a mask leak problem into a prescribed pressure issue. A pressure of 10 cm. shouldn't be a problem for that mask unless it's the wrong size or improperly adjusted. Also, if it's a full-face (as pictured: FlexiFit HC431 Full Face Mask) mask, I'm not sure why there would be a problem with mouth-breathing......
Some things just don't add up here......starting with the doctor.

Den

[Guest]

I really, really wish people would stop trying to advance this "all medical professionals are horrrible evil people who want to steal your lunch money" rhetoric by terrifying people who are simply looking for honest answers.

and honest answers they are given:

Oh my god. He's either lying or incompetent. You have the Resmed Vantage Auto which gives complete data, not just compliance. I'd suggest you purchase the software and start monitoring your results. I'd suggest you use your machine in auto mode so it can be set to a range of pressures. I'd suggest you'll be able to see which pressure gives you the lowest AHI and how leaks are affecting your therapy.

I'd suggest your sleep doctor (like the sleep doctors and DMEs of so many others) is worthless and you need to take charge of your own therapy.

BTW Bingo, I didn't say, "all medical professionals are horrible evil people." You came up with that one all on your own.

[pharmwoman]

original poster here--

I came to the doc specifically because I was having headaches intermittently, and the maks situation had brought me to tears--the fisher paykel FF mask all of a sudden was leaking like crazy, and the noise of the machine was relly bugging me--so I asked my doc if i could use my breeze again but was concerned about the mouth breathing. That, combined with my weight loss of about 5 lbs(im a small person) led him to suggest lowering the pressure and going back to the breeze.
My hubby works for a DME and he says they only monitor compliance--he said my machine , which is the REMSTAR plus with C-flex can only monitor compliance.---so with all that being said, what do you guys think??:)
and thanks everyone;)

[pharmwoman]

ok i updated my profile to show the correct machine and mask--so could i do any additional monitoring on this unit?? thanks guys;0)

[Wulfman]

original poster here--

I came to the doc specifically because I was having headaches intermittently, and the maks situation had brought me to tears--the fisher paykel FF mask all of a sudden was leaking like crazy, and the noise of the machine was relly bugging me--so I asked my doc if i could use my breeze again but was concerned about the mouth breathing. That, combined with my weight loss of about 5 lbs(im a small person) led him to suggest lowering the pressure and going back to the breeze.
My hubby works for a DME and he says they only monitor compliance--he said my machine , which is the REMSTAR plus with C-flex can only monitor compliance.---so with all that being said, what do you guys think??:)
and thanks everyone;)

Your husband is correct in that regard (compliance information).....you have no real way to monitor your therapy other than by how you "feel".
Mouth-breathing may be mouth-leaking......which could account for your headaches in that your therapy is not working properly. IF you're leaking air out of your mouth at night, you need to solve that problem either with taping, the polident pads or something along those lines.
I still think the leaking with the FF mask is either a size or adjustment issue.

Best wishes,

Den

[neversleeps]

ok i updated my profile to show the correct machine and mask--so could i do any additional monitoring on this unit?? thanks guys;0)

Remstar Plus? Not the Resmed Vantage Auto you originally had pictured? Well, thats a pretty big difference and makes my answer different:

Your doctor is not lying or incompetent. You can only get compliance from the Remstar Plus. If you want event data you have to tell your doctor you want to upgrade to the Remstar Pro 2 or the Remstar Auto.

(previously not logged in and appeared as "Guest".)