Cult Of Lanky... Make APAP Go Away

[vandownbytheriver]

I guess I got my priesthood! Send tithes to 'c/o van down by the river'.

https://www.youtube.com/watch?v=C-QnPVEpmmo

Obviously he surfs here and searches on terms 'Lanky' 'Lefty' 'Jason'. Can't say I blame him, this stuff is his life... dare I say he 'lives and breathes' CPAP?

I guess it's time for DogSlobber to post that SHQ link of a properly titrated APAP chart... the gauntlet has been flung. I guess he requested a video?

[Pugsy]

No.....don't go there and start another pissing contest.

Pissing contests will get you banned at worst and at best get a thread locked.

You've been warned.

If Jason wants to start posting stuff here he is welcome to explain his reasoning behind whatever he says.
He let his forum die. I used to moderate over there as well as here. It's not your job in life to convert everyone to your or Jason's way of thinking. Contrary to what you might think....you don't know all of what you think you know.
And here is another news flash...Jason doesn't know everything there is to know either.

I repeat....don't even start the cpap vs apap pissing contest here.
I will nip it in the bud.

Go over to the apneaboard forum instead if you must.

We have had this same pissing contest for years and it always gets ugly and I am not in the mood for that ugly again.
I will remove pissing contests...and fairly quickly.

Everyone here knows I give one warning only...and this one is yours.

[vandownbytheriver]

No.....don't go there and start another pissing contest.
We have had this same pissing contest for years and it always gets ugly and I am not in the mood for that ugly again.
I will remove pissing contests...and fairly quickly.
Everyone here knows I give one warning only...and this one is yours.

What else is there to do? Discuss CPAP issues? But some are off-limits, like synthetic oil in a motorcycle forum? Synth oil won that battle long ago, regardless of the bans (fight me!).

Discuss tap vs distilled? Resmed vs Philips? (ouch!) AS10 vs AS11? Full-face vs nasal vs pillows? To humidify or not to humidify? Oscar vs SleepHQ? Why is APAP off-limits?

You said Jason could come here and say what he wants. I suppose that includes the topic you just made off-limits? How do we resolve this? Only Jason can discuss his methods and reasoning? And we can't reply, or agree, or disagree?

You say he doesn't know everything... I don't know everything... *you* don't know everything. How else will we find it out? How else? Every day I see people put on wide-open APAP machines and they're suffering. What helps? Narrowing the range. Why doesn't a wide range help everyone? Anyone? And why can't we discuss this here?

Jason makes his points plainly. Do you have arguments against them? Post them here! This is the place for this. I think we can all see why I chose the 'cult of Lanky' trope... one side is making cogent points and the other is shouting them down. Why does your finger have to be on the scale, Pugsy? Have you no humor? Why is it like this? Why are you so angry?

[Pugsy]

Pugsy? Have you no humor? Why is it like this? Why are you so angry?

OMG you have no idea do you?

SuperSleeper kicked you off his forum??? Doesn't surprise me one bit. Some people think I am a hard ass....I pale in comparison to SS.

If you keep trying to start pissing contests and generally being an asshole annoyance....that can happen here as well.
I certainly have received numerous requests privately that I should just do that. Contrary to what you may think about yourself.....you aren't on people's Christmas card list here. Now their shit list....you probably claim the top spot on that list. Wonder how well you would fare if I did a poll asking members to vote on banning you or not.

And this is why I don't want another "cpap vs apap" pissing contest war here....all it does is create another pissing contest which is disruptive to the forum. Especially when someone comes here and pretty much puts all sorts of words in my and blatantly admits to wanting to start a fight so he can argue to his heart's content.

BTW you might want to quit putting words in my mouth. I am tired of it and I am almost to the point where I will be taking action when you do that.
Also ...shit like this....totally uncalled for.

Why does your finger have to be on the scale, Pugsy

My finger gets to be on the scale because the forum owners like my finger and that's that. They asked me to take on this thankless job. I didn't lobby for it. You obviously weren't here back when the forum didn't have moderation and members were leaving here left and right because of the pissing contests and general atmosphere and subsequently the forum owners decided we needed a hands on moderator.

And last news flash for you...it wasn't so much the cpap vs apap thing that got my dander up here....it was the way you presented it in the first place. You advertised for an argument. You did it on purpose.
And now you got what you want but not in a manner that you like. Tough shit.

BTW...I often tell people to try fixed pressures or even extremely tight ranges and/or even try both and let them see what seems to help them the best. I got no problem with advising someone to try fixed pressures. I just have a problem with people speaking in absolutes which you do ad nauseam. There are no absolutes when it comes to cpap/apap/whatever pap therapy.....way too many variables involved.

Another news flash...there are currently 2 other forum members who have moderator status. I am not the only one.
They prefer to remain anonymous just so they don't have to take this shit from people like you.

Have a nice day.

[Pugsy]

To all the other forum members...
Vanwhatshisname has started this thread. Feel free to tell him your thoughts about his thoughts but just don't get sucked into the pissing contest he wants to start about cpap vs apap. It's not our job here at the forum to decide which is the "best" therapy for all human kind. We aren't going to "prove" anything by arguing cpap vs apap but it will thoroughly disrupt the forum with the ensuing pissing contest arguments.

Do you all want another biker bar forum again?

There will NOT be another pissing contest about cpap vs apap. Go back and read all the old posts about this discussion if you desire to be a part of another fight about it. Don't post though. Don't resurrect old threads with more arguments. If you do I will delete such posts promptly.

Finally.....I know that I am not on everyone's Christmas card list as well. Sigh....it comes with the territory but it's not like we had a massive list of people wanting the job and the 2 others now that have the job want to avoid the limelight. Pretty sad state of affairs don't you think?
All of the 3 of us (moderators) were recruited....we didn't volunteer or seek the position.

[Dog Slobber]

Jason makes his points plainly. Do you have arguments against them? Post them here! This is the place for this. I think we can all see why I chose the 'cult of Lanky' trope... one side is making cogent points and the other is shouting them down.

This is not the first time that you have asked people to respond to Lanky's claims.

Prove him wrong!

The video explains his reasoning, attack it! Don't be lazy.

You asked for people to respond to his points, and I did, no "shouting down", no "ad homonym". And how did you respond. You completely ignored my response. Of course you replied to every other responder. So please, don't take the position that people are unwilling post arguments against his points.

I'll repost:

Prove him wrong!

Sure:

• He states he typically needs a pressure of 12cm (on his side). He then did his "experiment" on his back, where he claims he typically needs more pressure. He then configures APAP mode to a minimum of 8cm. At least 4 centimeters less than he knows he needs.
  It is commonly understood that in Auto mode, the minimum pressure needs to be close to your typical pressure needs.
• He demonstrates a complete lack of understanding of Soft Mode and for For Her mode. Making the claim that Soft Response is basically, For Her mode, but with out the For Her label so dudes would use it. This is wrong. Yes, the default for For Her mode is Soft Mode, but there are other differences in the For Her algorithm. Specifically, For Her mode will not increase the pressure beyond 12cm because of apneas. He is conducting and "experiment" where he states his needs pressure probably at 13cm and he's using an algorithm that has some limitations that can cap it at 12cm.
• He introduced a major change to his sleep ritual, not using the v-com. Something that he has stated multiple times is important to good quality sleep. But, didn't give time for his body to adjust.
• He did one night on each setting. This demonstrates a complete ignorance of sample size and variability of sleep from night to night.
• He demonstrates ignorance of the ResMed algorithm. It is well understood, that the algorithm alwqays attempts to return to minimum. (the exception potetntialy being the For Her algorithm, which can establish a new baseline minimum.
• His ignorance of the For Her algorithm is irresponsible, given it's been available since the S9 for Her and is well documented in the Clinician manual.
• His ignorance of the Standard/Soft response and deducing that; it is just For Her in disguise, is also ignorant and well documented in the clinician manuals.
• Where is his video on a properly configured APAP? Almost always when somebody asks for therapy configuration, they are advised to increase the minimum. Jason, absolutely should not be unaware of this.

But, I'm guessing you're not really interested in anyone proving him wrong.

I guess it's time for DogSlobber to post that SHQ link of a properly titrated APAP chart... the gauntlet has been flung.

If Lanky wants to comment in this topic, I would be more than happy to post my charts here.

I am also willing to respond to the problems in his latest post, should he care to respond here. But as demonstrated above, responding to you is a complete waste of time.

[robysue1]

No.....don't go there and start another pissing contest.
We have had this same pissing contest for years and it always gets ugly and I am not in the mood for that ugly again.
I will remove pissing contests...and fairly quickly.
Everyone here knows I give one warning only...and this one is yours.

What else is there to do? Discuss CPAP issues? But some are off-limits, like synthetic oil in a motorcycle forum? Synth oil won that battle long ago, regardless of the bans (fight me!).

Vandownbytheriver,

You started this thread with a needlessly inflammatory subject title.

Many of us here have a certain respect for some of the things that Left says, but disagree substantially with his claims that straight CPAP is best for everyone. We disagree because our own personal experience argues otherwise.

Pugsy is right to warn you that she's not going to tolerate you intentionally starting pissing contests.

Discuss tap vs distilled? Resmed vs Philips? (ouch!) AS10 vs AS11? Full-face vs nasal vs pillows? To humidify or not to humidify? Oscar vs SleepHQ? Why is APAP off-limits?

You're fine to advocate that in your experience straight CPAP is better. But when you start preaching that all the rest of us don't know diddly-squat about what we are talking about---in spite of our own years of experience dealing with xPAP therapy in our own beds, then that's a problem.

For what it's worth, there have been times when Pugsy or I or others have suggested to a newbie that trying straight CPAP might be worthwhile---particularly when there is some actual evidence in the wave-flow that pressure increases may be causing arousals. Or when a person is dealing with aerophagia problems combined with what looks like runaway pressure increases that are being caused by flow limitations that might not even be related to OSA.

As for your other list of topics:

If someone intentionally started a thread intended to create a flame war between Resmed and PR machines, Pugsy might well jump in with the same warning. (Although right now, with the whole PR recall and the way it's been handled? I don't think you'll have a whole lot of people saying that everyone should insist on a PR machine because they're superior---particularly since PR is no longer selling new xPAP machines in the US market.)

Full-face vs nasal vs pillows masks? I've never seen anybody here post saying that everybody needs to use a FFM. Or a nasal mask. Or a pillows mask. I have seen lots of people telling newbies that the Respiratory Therapist who told them that the RT sets everyone up with a mask of type X because of fill in the reason likely doesn't know what they are talking about. I've seen lots of posts suggesting a user with mask struggles be open to trying many different kinds of masks. I've seen pillows users (like myself) tell folks that since they know they mouth breathe, they really ought to consider trying a FFM, particularly if they don't want to mouth tape. And I've seen some FFM users tell folks that if they don't know whether they're mouth breathing, then trying a nasal or pillows mask might be worth while if tolerating the FFM is an issue.

Humidity? Lots of comments telling folks that it takes experimentation to figure out the correct level of humidification for their particular nose. Pugsy and I both use maximum humidification, but we are constantly telling newbies that too much humidity can trigger nasal congestion as easily as not enough humidity can. And that when nasal congestion is an issue, it's always worth experimenting for a night or two with less (or no) humidification to find out if your nose happens to be one that likes things on the drier side.

I don't see many arguments on OSCAR vs SleepHQ, although I do see comments about telling folks there's no need to pay for the "higher" level of SleepHQ. The paid subscription just doesn't seem to have any worthwhile benefits for most of us over here. But we really do appreciate the public links to SleepHQ data even when we ourselves don't use SleepHQ ourselves.

As for distilled water vs. bottled water vs. tap water: Most of those posts are really what I call "reassurance" posts---i.e. reassuring a newbie that if their only alternative for a night or two is bottled or tap water that things will be "ok"---that it's not going to create substantial harm to either their machine or their body as long as the water is potable.

And again: APAP vs. CPAP is not "off limits". What is off limits is starting a pissing contest by claiming that everybody would be so much better off if we just used straight CPAP.

It's fine to post that in your experience you find that you do best using straight CPAP. And it's even fine to give us details about why you know that in the sense of what you yourself may have had to deal with while you were using APAP. But posting a thread with the title "Make APAP go Away" invites a flame war.

You said Jason could come here and say what he wants. I suppose that includes the topic you just made off-limits? How do we resolve this? Only Jason can discuss his methods and reasoning? And we can't reply, or agree, or disagree?

If Jason wants to post his reasoning here, he's welcome to do it. However, he has to not engage in a pissing contest with people who politely tell him that in their own experience in sleeping with xPAP, they have found that they do much better using APAP because they have fewer problems caused by sleeping at a relatively higher pressure all night long.

For example: I was originally titrated at 9cm of pressure in an in-lab titration study. That recommendation of 9cm was based on a whopping 17 minutes of data recorded at the very end of a pretty awful night's sleep. I started out on straight CPAP at 9cm. And by three days into therapy I was dealing with extremely painful aerophagia and a burgeoning case of CPAP-induced insomnia. It took switching me from CPAP to APAP to bi-level to Auto-bi-level to bring the aerophagia under control so I could sleep for more than 50-70 minutes at a stretch. It took another two years of very difficult CBT-I combined with judicious use of prescription sleeping pills to bring the insomnia under control. So based on my own experiences I know that straight CPAP is not going to work as well for me as VAuto does, regardless of Lanky Left's take on things.

You say he doesn't know everything... I don't know everything... *you* don't know everything. How else will we find it out? How else?

It's the difference between saying, "Switching to straight CPAP might help" and saying "You need to switch to straight CPAP because everyone does lousy on APAP. Trust me, switching to straight CPAP will fix your problems. Trust me, I know what I'm saying."

To many of us, many of Lanky Left's statements come across as the second rather than the first.

Every day I see people put on wide-open APAP machines and they're suffering. What helps? Narrowing the range. Why doesn't a wide range help everyone? Anyone? And why can't we discuss this here?

Nobody here has ever been an advocate of leaving APAPs running wide open (4-20cm) specifically because of what you state: Every day we see people who the RTs have set up with "wide open" APAPs in misery.

The question is why has it become so common to set up a newbie with an APAP set to 4-20cm? Well, that goes back to cutting the costs of health care: It's much less expensive to set up a new xPAP user with an APAP running 4-20cm than it is to have them come in for an in-lab sleep titration that may still not get the setting perfect. The idea (which is often ignored) is that the newbie won't be running in 4-20cm mode forever, but rather that someone will actually look at the data after a week or two and then use the data to tighten the range appropriately.

Newbies in trouble with APAPs running at 4-20cm often complain about not being able to breathe at 4cm. That's an easy enough fix--just bump the min pressure up to 6 or 7cm or where ever "breathing" become easier to do. That of course begs the question: Why even have machines that run as low as 4cm in the first place? Well there are a few newbies (like I was) who cannot exhale comfortably at 6 or 7cm of pressure. Being able to start with the pressure at 4cm was important to me when I was still on APAP---it allowed me to more comfortably exhale while attempting to get to sleep.

As for how to "tighten" the APAP range based on data: There's a significant agreement on this board that the minimum pressure needs to be set high enough to control most of the apnea. There's some real disagreement on whether it's "ok" or "desirable" to just leave the top pressure set at 20cm (with the rationale being the machine won't increase pressure beyond what's needed) or to cap it as some point (because there are certain somewhat uncommon situations where the pressure may in fact be increased unnecessarily, usually caused by "flow limitations" that are not really part of OSA in that they don't get any better as the pressure is increased.)

Jason makes his points plainly.

What I've seen from Jason (Lanky Left) is mostly "Trust me, I know what I'm saying." rather than coherent arguments about why everyone should be on straight CPAP. Look at your own title to this thread: You want to make APAP "go away"--as in you want to simply deny the personal experience of many of us on the board who have found that APAP works for us better than straight CPAP does.

Do you have arguments against them? Post them here! This is the place for this. I think we can all see why I chose the 'cult of Lanky' trope... one side is making cogent points and the other is shouting them down. Why does your finger have to be on the scale, Pugsy? Have you no humor? Why is it like this? Why are you so angry?

I haven't seen you make any cogent points in this thread beyond "Jason says ....."

You see: I'm a firm believer that xPAP therapy is highly personal and what works well for person A can be a disaster for person B. And vice versa: What works well for person B can be a disaster for person A. My problem with Jason is that he seems to be far too inflexible in his own beliefs that APAP is bad for everybody. And that he's not particularly interested in really listening to folks like me who found straight CPAP a disaster.

Your personal experiences with straight CPAP are worth hearing about. I do think some people do in fact do better with fixed CPAP pressure. And you seem to be one of those people who does better on fixed CPAP. So rather than telling us "Jason says ...", why don't you tell us about your personal experiences: Can you actually tell us of your own personal experience with APAP? Specifically what problems that you were experiencing were fixed by switching to straight CPAP? Specifically how did you determine what straight CPAP pressure to use? If I can better understand the problems you struggled with on APAP, and how switching them to straight CPAP fixed those problems, I'll be better able to identify a person who might be experiencing that same set of problems. But you should also take the time to really listen to those of us who say that APAP works better for us as well as those of us who believe that setting people up with an APAP (than can always be set to run as a straight CPAP) is better for everybody than being set up with a CPAP that cannot be switched to APAP mode if/when it becomes clear that the person is not doing well with straight CPAP.

[robysue1]

You asked for people to respond to his points, and I did, no "shouting down", no "ad homonym". And how did you respond. You completely ignored my response. Of course you replied to every other responder. So please, don't take the position that people are unwilling post arguments against his points.

I'll repost:

Prove him wrong!

Sure:

• He states he typically needs a pressure of 12cm (on his side). He then did his "experiment" on his back, where he claims he typically needs more pressure. He then configures APAP mode to a minimum of 8cm. At least 4 centimeters less than he knows he needs.
  It is commonly understood that in Auto mode, the minimum pressure needs to be close to your typical pressure needs.
• He demonstrates a complete lack of understanding of Soft Mode and for For Her mode. Making the claim that Soft Response is basically, For Her mode, but with out the For Her label so dudes would use it. This is wrong. Yes, the default for For Her mode is Soft Mode, but there are other differences in the For Her algorithm. Specifically, For Her mode will not increase the pressure beyond 12cm because of apneas. He is conducting and "experiment" where he states his needs pressure probably at 13cm and he's using an algorithm that has some limitations that can cap it at 12cm.
• He introduced a major change to his sleep ritual, not using the v-com. Something that he has stated multiple times is important to good quality sleep. But, didn't give time for his body to adjust.
• He did one night on each setting. This demonstrates a complete ignorance of sample size and variability of sleep from night to night.
• He demonstrates ignorance of the ResMed algorithm. It is well understood, that the algorithm alwqays attempts to return to minimum. (the exception potetntialy being the For Her algorithm, which can establish a new baseline minimum.
• His ignorance of the For Her algorithm is irresponsible, given it's been available since the S9 for Her and is well documented in the Clinician manual.
• His ignorance of the Standard/Soft response and deducing that; it is just For Her in disguise, is also ignorant and well documented in the clinician manuals.
• Where is his video on a properly configured APAP? Almost always when somebody asks for therapy configuration, they are advised to increase the minimum. Jason, absolutely should not be unaware of this.

But, I'm guessing you're not really interested in anyone proving him wrong.

Thank you Dog Slobber for taking the time to watch the video (I don't have that kind of time) and respond quite civilly to why Lanky's arguments are illogical and in some cases mathematically invalid. Also thank you for taking the time to point out Lanky's real ignorance of how the algorithms work, particularly since the information about the differences in the algorithms is well documented and not difficult to find.

[Dog Slobber]

Thank you Dog Slobber for taking the time to watch the video (I don't have that kind of time) and respond quite civilly to why Lanky's arguments are illogical and in some cases mathematically invalid. Also thank you for taking the time to point out Lanky's real ignorance of how the algorithms work, particularly since the information about the differences in the algorithms is well documented and not difficult to find.

Your welcome, and yes, I absolutely agree with the points you made.

I do want to clarify. The points I presented, are not from the most recent video linked to in the this forum. They are from a previous video. I only reposted them here, to re-enforce that Vandownbytheriver, has a habit of challenging people to respond, and then completely ignoring those who do.

Jason makes some other points in the most recent vidoe that I disagree with, and should he wish to post here, would be more than happy to respond and discuss. But responding to Van, as demonstrated is a waste of time.

[chunkyfrog]

Regardless of one's views, there is absolutely NO "one size fits all".
We are all equal--but NOT the same.
I suffered for my first 9 months of single pressure because of that attitude.
Others suffer because auto is simply not for them.
Universal solutions universally disrespect us all.

[MyIdaho]

Bravo RobySue! Excellent, a thorough and well detailed reply. Your posts are always a worthwhile read. I have learned a great deal from your posts over the years. Thanks for sharing your knowledge and experiences! I nominate you for Education Czar of Cpaptalk!

[colomom]

I guess I got my priesthood! Send tithes to 'c/o van down by the river'.

https://www.youtube.com/watch?v=C-QnPVEpmmo

Obviously he surfs here and searches on terms 'Lanky' 'Lefty' 'Jason'. Can't say I blame him, this stuff is his life... dare I say he 'lives and breathes' CPAP?

I couldn’t make it through much of the video. His constant plugging of his discount code to buy supplies tells me enough about his motivations. That said I guess we have to all pay the bills;)

Your criticism of Pugsy is unfair and a disservice. She is incredibly knowledgeable and strikes the perfect balance needed between free speech and reasonable moderation.
It was many years back that I started my journey into learning about cpap, I was trying to figure out numerous problems with my medically complex son. At that time Jason’s forum had nearly no involvement, Apnea Board had some great knowledgeable people but their over moderatation led to lots of horrible advice going unchallenged. This forum at the time was a real S*** show, while there was good advice to be found it was difficult to find through all the insults and off topic pissing contests.
Pugsy’s moderation has really cleaned it up, somehow she has found a way to strike the perfect balance between free speech and reasonable moderation. For me once Pugsy stepped into the moderator position this forum became a really incredible resource for knowledge.

As far as the argument over fixed pressure, we’re all different but it didn’t work for my son. His fist pulmonologist was a big believer in fixed pressure he had 4 or 5 hospital studies getting the pressure right. At the various fixed pressures they prescribed his O2 was to low so the had to add an O2 bleed. Recently his new Pulmonologist switched him to a wider range of APAP pressures, with that change his O2 has finally hit the golden spot and he was told he no longer needs an O2 bleed!
The moral of the story is we are all different, there is no one answer as to whether or not APAP is best. Some likely do better on CPAP and many do better with APAP, we are all different. A one size fits all supposition is hardly worth debate.

The one thing I know is the mud slinging, personal attacks, and pissing contests only confuse and distract people who come here seeking help.

[Kiralynx]

I guess I got my priesthood! Send tithes to 'c/o van down by the river'.

https://www.youtube.com/watch?v=C-QnPVEpmmo

Obviously he surfs here and searches on terms 'Lanky' 'Lefty' 'Jason'. Can't say I blame him, this stuff is his life... dare I say he 'lives and breathes' CPAP?

I guess it's time for DogSlobber to post that SHQ link of a properly titrated APAP chart... the gauntlet has been flung. I guess he requested a video?

Know what? I don't give a flying fig about your wanting to argue CPAP vs APAP. Some people do best with straight CPAP. Some people do better with APAP. I am uninterested in either because they do not work for me. I need a bilevel.

So I fail to see what the point of the argument is.

""There are nine and sixty ways of constructing tribal lays,
"And every single one of them is right!" "

[prodigyplace]

Regardless of one's views, there is absolutely NO "one size fits all".
We are all equal--but NOT the same.
I suffered for my first 9 months of single pressure because of that attitude.
Others suffer because auto is simply not for them.
Universal solutions universally disrespect us all.

News flash!

Users here are not robots produced from an assembly ,one, all the same, but are discrete individuals whose bodies all respond differently. That is partially why medicine is considered a PRACTICE rather than settled scientific solutions.

[chunkyfrog]

And the nice thing about auto machines is that they can be set to run either way.
But non-auto, being the cheaper one, gives you no choice at all.
Dealers love to sell stuff you can't use. Mo money, bruh!
The DMEs here used to run an xpap "help" group.
After I pointed out to the attendees that apaps can be run either way--
the meetings STOPPED!