All Sleep Professionals Should be “Tased”

Todzo · Post by **Todzo** » Mon Apr 01, 2013 2:53 pm

Apparently some police officers are tasered during training (see: https://www.youtube.com/watch?v=AUquJQ_OgeE ).

Yet the people who manage our care often have never been “under the mask”!

I have come to believe that the breathing instability induced by the xPAP pressure is the main reason for the extremely high xPAP drop out rate. I also know that hypocapnic central apneas (a severe example of breathing instability) are induce by increasing the cm/H2O pressure (see: http://www.ncbi.nlm.nih.gov/pubmed/19940101 ) and I think that I read elsewhere that most healthy body weight people central by 20 cm/H2O.

So lets make it a training requirement for sleep professionals that they sleep with a CPAP for one night set at 20 cm/H2O if BMI is less than 30 increasing a cm/H2O per BMI point above that.

At least it would help to increase understanding of the breathing stability issues we often encounter during CPAP therapy.

cosmo · Post by **cosmo** » Mon Apr 01, 2013 2:55 pm

No tasing. That is cruel.

A punch in the guts will suffice for me.

Boyce · Post by **Boyce** » Mon Apr 01, 2013 2:58 pm

Would not choking them during sleep be more appropriate?

Todzo · Post by **Todzo** » Mon Apr 01, 2013 2:59 pm

cosmo wrote:No tasing. That is cruel.

A punch in the guts will suffice for me.

I am a little concerned that exposing someone to that many hypocapnic events might cause them harm - then I thought - they let us go through them all the time - and - it does seem more than fair.

chunkyfrog · Post by **chunkyfrog** » Mon Apr 01, 2013 3:00 pm

I have a really dense pillow; maybe that will work.

Todzo · Post by **Todzo** » Mon Apr 01, 2013 3:02 pm

chunkyfrog wrote:I have a really dense pillow; maybe that will work.

I think I am sensing some frustration here!@#$%^%$$&**((

BlackSpinner · Post by **BlackSpinner** » Mon Apr 01, 2013 3:03 pm

It won't help. The twit who "helped" me originally was a user. I think employment with a DME causes brain damage.

Todzo · Post by **Todzo** » Mon Apr 01, 2013 3:10 pm

BlackSpinner wrote:It won't help. The twit who "helped" me originally was a user. I think employment with a DME causes brain damage.

DMEs seem to avoid pressure

Sir NoddinOff · Post by **Sir NoddinOff** » Mon Apr 01, 2013 5:26 pm

Todzo wrote: I have come to believe that the breathing instability induced by the xPAP pressure is the main reason for the extremely high xPAP drop out rate. I also know that hypocapnic central apneas (a severe example of breathing instability) are induce by increasing the cm/H2O pressure (see: http://www.ncbi.nlm.nih.gov/pubmed/19940101 ) and I think that I read elsewhere that most healthy body weight people central by 20

Earlier this year I was pretty harsh with you on this topic, demanding proof etc. Hey, it's my job, it's what I do best! Anyway, to satisfy myself that Philips-Respironics auto algorithm was helping me, I did some testing over the past seven days. I shut off the auto CPAP mode in the clinicians menu and am now running straight CPAP at 7.5cmH2O.

RESULTS: Initially, I have noticed a 20% lower overall AHI, plus a reduction in Flow Limitations or REPAs, plus half my normal amount of periodic breathing, which is all good. On the down side, sometimes I feel suffocated by the lower therapy pressure. ie. not enough air. BTW, my auto settings were 8-12. I also noticed a modest improvement is my quality and quantity sleep. Being cautious (one week does not represent a real sample!), I'd say it's still too early to draw conclusive results (therefore no screen grabss yet), however I grudging admit you may be on to something. I'll keep you all updated as more data accumulates.

Todzo · Post by **Todzo** » Mon Apr 01, 2013 7:38 pm

Sir NoddinOff wrote:
Todzo wrote: I have come to believe that the breathing instability induced by the xPAP pressure is the main reason for the extremely high xPAP drop out rate. I also know that hypocapnic central apneas (a severe example of breathing instability) are induce by increasing the cm/H2O pressure (see: http://www.ncbi.nlm.nih.gov/pubmed/19940101 ) and I think that I read elsewhere that most healthy body weight people central by 20
Earlier this year I was pretty harsh with you on this topic, demanding proof etc. Hey, it's my job, it's what I do best!

I do regret not getting you all those citations. While I have spent hundreds of hours in the medical literature my race to find the answers kept me from organizing that literature, as well, winter is not a productive time for me. I hope to get better organization of my sources, and more sources, established and in use this summer.

My understanding of all of this developed from deep need. I deal with Post Traumatic Stress (PTS) on top of severe Obstructive Sleep Apnea (OSA) with Extreme Hypoxia (AHI=52; SpO2 nadir 55%). Due to the PTS I sometimes experience “unstable breathing” during daytime awake hours. I learned that I could control those awake times using eucapnic breathing techniques (pulse oximeter guided). In doing so the changes that carbon dioxide level has in my body were directly demonstrated to me on a daily if not hourly - indeed minute by minute basis.

The hugh part that stress plays in CPAP induced unstable breathing was demonstrated to me this winter. The previous winter my pressure was 15 cm/H2O. Running at 8 cm/H2O this winter I hoped that the threshold where unstable breathing would occur due to CPAP pressure would be higher than 8 in spite of the added PTS stress due to the approach of the anniversary of the event that brought PTS into my life. When symptoms did occur and I was able to trace them to changes in my flow waveform (they did not show up as respiratory events scored by my machine) I did what had worked last winter[1] and was a much happier camper this winter than I was last winter likely due to better health from better treatment.

Sir NoddinOff wrote: Anyway, to satisfy myself that Philips-Respironics auto algorithm was helping me, I did some testing over the past seven days. I shut off the auto CPAP mode in the clinicians menu and am now running straight CPAP at 7.5cmH2O.

RESULTS: Initially, I have noticed a 20% lower overall AHI, plus a reduction in Flow Limitations or REPAs, plus half my normal amount of periodic breathing, which is all good. On the down side, sometimes I feel suffocated by the lower therapy pressure. ie. not enough air. BTW, my auto settings were 8-12. I also noticed a modest improvement is my quality and quantity sleep. Being cautious (one week does not represent a real sample!), I'd say it's still too early to draw conclusive results (therefore no screen grabss yet), however I grudging admit you may be on to something. I'll keep you all updated as more data accumulates.

One of the things I quickly learned from my striving for eucapnic breathing is that a stuffy nose is one of the first signs that I am breathing too much. One of the things I am very much looking forward to this summer that I experienced last summer for the first time in decades is the smell of the flowers growing all around me.

I have done one short trial with Auto-PAP – I breathed too much – started to snore – it raised pressure. It would not work for me.

XPAP, as a technology, has a very very long way to go indeed!!

Have a great week!

Todzo

[1]: Gilmartin G, McGeehan B, Vigneault K, Daly RW, Manento M, Weiss JW, Thomas RJ.
Treatment of positive airway pressure treatment-associated respiratory instability with enhanced expiratory rebreathing space (EERS).
Source: J Clin Sleep Med. 2010 Dec 15;6(6):529-38. Division of Pulmonary, Critical Care and Sleep Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA.
Link: http://www.ncbi.nlm.nih.gov/pubmed/21206741

Dog Tired · Post by **Dog Tired** » Sat Apr 06, 2013 6:09 am

Tasing could be quite appropriate for some... Or even an electric cattle prod, judiciously applied.

On the other hand, there are probably a number of patients who could be equally deserving...

sleepstar · Post by **sleepstar** » Sat Apr 06, 2013 6:32 am

It's unfortunate that some have had bad experiences with sleep professionals... We aren't all bad though I promise

Sheriff Buford · Post by **Sheriff Buford** » Sat Apr 06, 2013 6:35 am

I got the taser... everyone line up....
Todzo... start bringing in the DME's...

Seriously, the taser provides officers with an additional weapon to take a violent (notice I said violent) suspect down as opposed to the "old days" where our options were limited and the outcomes may be undesirable (getting good at the verbal political correctness, eh?). I was tased, to the objection of my younger officers because of my health (not good looks.... ). They thought it would kill me. I showed them youngsters thing or two. Go up against a drunk (or high) 300 lb. smelly cowboy... pissed off and lookin' for a fight and the taser becomes your best friend.

Sheriff

49er · Post by **49er** » Sat Apr 06, 2013 6:44 am

Sheriff Buford wrote:I got the taser... everyone line up....
Todzo... start bringing in the DME's...

Sheriff,

Since you are in Texas, you need to round up PandaTx's as a start. Make sure you film it and it goes out on youtube.

49er

All Sleep Professionals Should be “Tased”

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