CPAP Basics - 2 - Dial Wingin'

General Discussion on any topic relating to CPAP and/or Sleep Apnea.
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Drowsy Dancer
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Re: CPAP Basics - 2 - Dial Wingin'

Post by Drowsy Dancer » Sat May 04, 2013 9:10 am

This is a little cryptic. Did you mean to put this in one of the other topics, or reminding us that one area for potential DWing is changing the Resistance Control on on PR S1?
mollete wrote:Respironics Mask Resistance Settings

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Which, in turn, will give you the correct pressure:

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mollete
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Re: CPAP Basics - 2 - Dial Wingin'

Post by mollete » Sat May 04, 2013 1:36 pm

Well, I had to put it somewhere, and not all DWing is DWing.

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mollete
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Re: CPAP Basics - 2 - Dial Wingin'

Post by mollete » Mon May 20, 2013 5:23 am

Periodically, the subject of Enhanced Expiratory Rebreathing Space (EERS) to address Positive Airway Pressure Treatment-Associated Respiratory Instability (PAPT-ARI) crops up as a potential modality to avoid CompSAS. Coincidently, there happens to be a article explaining EERS:

Treatment of Positive Airway Pressure Treatment-Associated Respiratory Instability with Enhanced Expiratory Rebreathing Space (EERS)

Certainly, let me preface this by saying that this is the most un-DWingable modality out there. You'd need a $1500 - $16,000 device to have a snowball's chance of doing this with any degree of scientific basis, and guessing wrong could result in untoward side effects ranging from throbbing headache to (if someone has an elevated pCO2 from COPD, Overlap Syndrome, chronic opiate usage, or compensated respiratory acidosis from other causes)(at least theoretically) waking up dead (certainly2, I don't believe anyone would want to be part of a study that figures out the mortality rate of DWing EERS in hypercapnics).

However, it may have some value to consider those candidates who may want to pursue this modality with their physician.

A few random thoughts:
  • As suggested by the authors, this is an alternative to ASV. If you are not having success with ASV, perhaps the real question to ask is "Do I even have PAPT-ARI?"
  • In the case of our current EERS Explorer (EERSE), if it is suggested that the respiratory events are post-arousal, then EERS is inappropriate. The arousals need to be corrected, not the breathing events (those arousals would be termed "Spontaneous Arousals". If they were Respiratory Effort-Related Arousals, they would (should?) be called exactly that - RERAs).
  • EERS does not fix Bad Sleep. See Sleep Effect in above article.
  • The EERS effect is instantaneously lost during inadvertent leaks.
  • There's a whole school of thought that says CompSAS resolves spontaneously with appropriate conventional treatment in ~ a month.

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Denial Dave
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Re: CPAP Basics - 2 - Dial Wingin'

Post by Denial Dave » Mon May 20, 2013 8:14 am

I may be way off base on this, but it seems like there is a tendancy to promote dial winging.

New folks come on here having used the machine and mask for less than 2 weeks and folks are eager to suggest that they change pressures. New folks rarely include any other medical issues that they may have when posting about problems.

2 weeks of use is barely enough time to figure out if you have the right mask let alone know if the pressures prescribed are correct.

just my humble opinion.... foe me all you want



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mollete
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Re: CPAP Basics - 2 - Dial Wingin'

Post by mollete » Tue May 21, 2013 5:35 am

Denial Dave wrote:...it seems like there is a tendancy to promote dial winging.
Yeah, probably.

However, "IMHO" DWiing is extremely inefficient and results in losing a lot of patients along the way (the Fail To Comply Heap O'Folks)(along with all the aforementioned reasons).

DWing will usually fail to account for CompSAS (15% of SBD)(and since CPAP Forums tend to attract people with issues, it may be significantly higher than that) and SWJ (trying to fix sleep events when you're not really asleep). Consequently, the DWing Process may takes weeks to never.

OTOH, there have been some outstanding successes when blunders were discovered (and perhaps that may be the underlying message here. The HST initiative has resulted in a lot of patients being given Full Throttle APAPs with a card that says GFL. I mean, wasn't the appearance of AutoIQ a mode that would actually encourage that?)

Ultimately, patients can take this KB and be able to ask the important questions of their HCPs and get positive results (TBL).

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AN EASIER INTERP OF CLINICAL GUIDELINE RE TITRATION

Post by tedburnsIII » Thu Jun 25, 2015 2:53 pm

Just found this document, which is an easy interpretation of the Clinical Guidelines. Invite your attention to page 4:
http://www.aastweb.org/Resources/Guidel ... ummary.pdf

I think Denial Dave makes a valid point. I happen to accord considerable weight to a properly performed lab titration to obtain an optimal pressure that
covers all bases.
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Setting: APAP, 10.5-14cm
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