Here are my OSCAR results

[Fejsbukpejdz]

Here are first three images I have sent her, next three I will post in next post

[Fejsbukpejdz]

Here are the last three images I have sent her

[khauser]

Most of us are English speakers and typically bad at other languages. Google translate suggests the top grasping is pressure support and the bottom is flow, but I've never seen pressure graphed like that...

[Fejsbukpejdz]

Most of us are English speakers and typically bad at other languages. Google translate suggests the top grasping is pressure support and the bottom is flow, but I've never seen pressure graphed like that...

sorry... Here I translated it from German to English

I forgot to translate but all the stuff she has is in German

[Fejsbukpejdz]

Most of us are English speakers and typically bad at other languages. Google translate suggests the top grasping is pressure support and the bottom is flow, but I've never seen pressure graphed like that...

Now you can see what I did with his breathing so far...

This is as far as this machine can get me.

This machine is simply not meant to deal with what he has.

We reduced AHI to just below 1.

What was optimal is not to blow the higher pressure as machine was trying to do earlier on its own. It will result in leaks and also it will not solve the flow limitation issue.

In fact, slightly enhancing his breathing with higher pressure, liftes his snoring and expanded his airways and it should be a slight pressure that should not go over 8.

From 4 to 8 he it works.

Now that does not address the>>>> flow limitations DIRECTLY, which still persist and in fact, still cause arousal that eventually wake him up.

However it does solve a hugeeeee other things around it that acompanied it.

So the solution was to expand his airways with slight pressure, then let him ride the FLEX function as MUCH AS it can.

FLEX is meant as a comfort function, not as a therapy option. For this crap Airsense 10 would be good, it would sense it better and give it what it has.

Now that is also not ideal.

Ideal is AirCurve 10 VAuto because it is meant to address this issue.

So AHI got down below 1. I think it can go to 0.

I am confident, with proper breath to breath pressure support, flow limitaitons would be lifted, fixing deficit in tidial volume and getting rid of arousals once his O2 dips.

[Fejsbukpejdz]

I must say that in positional apnea or chin tucking or upper airway resistance especially if it is caused by shape of the oral, nasal cavities, size of tonsils or uvula or the soft palate...

The pressure increase can't do c**p there... Maybe a little bit.

What should be done is just slightly elevate the pressure so it's airways in general get expanded a little bit and then let the patient ride the flex function... which is pressure support in its essence but meant for comfort. Not as nearly as much as he needs.

I tried from min 4 to min 9, and min 7.5 was ideal in his case. Max should be set to 8 and completely ignore what machine wants to do once it sees something is wrong. At least on the Dreamstation. now AirCurve 10 VAuto would be another thing.

Ideal is proper Bilevel with breath to breath pressure support or it depends what the cause is, surgery.

Surgery in other cases are simply stupid and most likely have worse outcomes than standard cpap therapy.

There are surgeries for soft tissues... There I'd be skeptic... Whatever is hard to touch and causes a barrier. It can be cut 100%. I am 100% convinced of this! No need for clinical trial in this case. What is hard and is a barrier, it can be reshaped, moved and cut. But I assume such cases are rare and it is questionable if even in this case it is one of those components.

A proper otolaryngologist should know what to do. But .... doctors just don't think these days.

They trust computers not their eyes.

I told 15 specialists 40 days ago what his diagnosis is. They ridiculed me for saying it, they did not gave him diagnosis. I counted his breath with my stopwatch, watched his thorax, questioned stuff... Measured his breath with a microphone trying to figure out if its Cheyne Stokes but realize it is not because I'd expect gradual increase in his breathing. Yet they were specialists, have huge clinics, get huge salaries and yet they dismissed it. They gave us this dissmissive look. I got the machine on my own without a perscription. They gave him antidepressants and one said, just yesterday, despite seeing his AHI improve "he could try benzos" which I was afraid many would say. I assumed it is obstruction of some sort because I saw his chest jerking trying to inhale, but I could not calm my mind until Julie told me to shut up about centrals.

It tried and I failed many times... But I tried. When I failed I tried to learn and you guys helped me so much I cried after Julie told me how to start. I remain forever thankful. I am so
pissed at our hospitals doctors and "Fachärzte".

I showed a video to an internest and he said "I don't see a breathing pause there" :S

SO... I don't trust an otolaryngologist unless I talked to him for 30 minutes and listen to what he thinks.

[Dog Slobber]

Given the time frame of when you've moved the pressure to 8, lack of graphs above 8, and your propensity to continuously micro-manage and continuously make adjustments, despite being told to set his therapy, leave it alone and look for trends, I don't think you should be managing his therapy.

[Fejsbukpejdz]

With all due respect for helping me, you're wrong.

Higher pressures do not help. He is not a regular apnea patient. He is young, in his 20s, skinny kid with flow limitation.

I set the minimum to 6 and maximum to 20 in the end it ends up the same as this one with 8 and 20.

Now I never had sleep apnea but I can assume that AHI of 4.03 and 0.99 makes a HUGE difference.

Now if you take ANYoNE, ANYONE here who has AHI below 0.99 and tell them you will do something and it will be above 4 and then let them go on for months on that, you will see the reponse you will get. That is when I meant, get under patients skin. Put yourself in their shoes.

The graps here are where machine starts increasing the pressure. IT does not help all. And it makes sense why it does not help.

Now, you call it micromanaging. 4.03 is really close to the 5 limit and is 4 times higher than 0.99.

But I want to ask you why leave someone on that for months to wait the dumb sleep study and suffer if you can figure out that machine is doing something wrong?
Why do I have to watch that for 150 nights and why should he live through 150 nights of that, if you give this machine a run and it is doing something completely wrong?

If I can have someone run for months on AHI of 4.03 OR 0.99, I don't give a damn if the appointment is in 4 months.

Lower airpressure does him better and it does so for a reason. He visually breaths better. His stats are 4 times better. His flow limitation is even better. He does not have those extreme narrowings which end up in obstructives. He himself today said "I felt like reborn". Today he smiled through half of the day and went to gym. He said " I didn't get such sleep in years".

His heart is good, his MRI just today came out fine, his lungs xray was good, glomerular filtration rate is perfect, liver values ideal.

Why should I be afraid to lower his pressure if it does him good?

I do not thing AHI from 4 to 0.99 is micro managing.

The anatomy of the upper airways and flow limitations are the crucial behind why higher pressure is not maybe the smartest solution here.

[Dog Slobber]

Show me the graphs where you left him on minimum 8 for a few days?
Show me the graphs where you left him on minimum 8.5 for a few days?
Show me the graphs where you left him on minimum 9 for a few days?

OSCAR has a great Statistics page that shows a history of machine settings changes and AHI.

Why don't you post it.

You are completely disregarding the volatility and variables we encounter night to night. This is especially true with new CPAP users who have a lot of arousals and their breathing patterns show it. You are cherry picking odd breathing patterns where you didn't know whether he was asleep or awake and diagnosing he needs surgery from it.

Two weeks ago you had no clue what these machines did. You where told to set a min pressure, you thought that min meant minutes and then you ran the thing for 5 minutes. You then wanted to know what to do next.

Fast forward to now, and in the two week period you're now an expert. You pick and choose what advise your going to follow, believe yourself to have sufficient expertise to make videos to teach people how to run these machines. You've determined his machine should be upgraded to BiLevel and you'd prep him for surgery tomorrow, if you could find a doctor who'd believe your lunatic rantings.

You're dangerous.

[Julie]

Sad.

You're now doing the same thing re flow rates as you did re centrals before... do you want help, or just validation of your own theories?

There is no such thing as a 'regular' apnea patient. Certainly there are probably more patients who are older, heavier, etc... but it's thought now that apnea may be the reason for weight gain, not the other way around, and so many younger patients are now being seen because of their narrow airway secondary to jaw anatomy, and other issues. Do not play games with your brother's health because you are trying to show what you know - all 3 or whatever weeks of it! What you are doing is not right and you need to stop and listen for a change.