self titrating an ASV

TASmart · Post by **TASmart** » Sat May 13, 2017 1:04 pm

It doesn't. The treads moved into a discussion of the relative value of at home vrs in lab sleep studies. Sometimes thread do that. It is, after all, the internet. Sorry for my part in the drift.

palerider · Post by **palerider** » Sat May 13, 2017 2:17 pm

TASmart wrote:From Sleep, a peer reviewed journal, which concluded just what my analysis of the population cost of type of testing:

Sleep. 2011 Jun 1

'nuff said.

when you're looking for studies to support your point, you should consider how ancient some of them are, and factor in the progress that's been made since they were published, not to mention conducted.

in other words, home sleep tests ain't what they were 7+ years ago.

TASmart · Post by **TASmart** » Sat May 13, 2017 2:25 pm

palerider wrote:
TASmart wrote:From Sleep, a peer reviewed journal, which concluded just what my analysis of the population cost of type of testing:

Sleep. 2011 Jun 1
'nuff said.

when you're looking for studies to support your point, you should consider how ancient some of them are, and factor in the progress that's been made since they were published, not to mention conducted.

in other words, home sleep tests ain't what they were 7+ years ago.

Got anything more current?

palerider · Post by **palerider** » Sat May 13, 2017 2:51 pm

TASmart wrote:
palerider wrote:
TASmart wrote:From Sleep, a peer reviewed journal, which concluded just what my analysis of the population cost of type of testing:

Sleep. 2011 Jun 1
'nuff said.

when you're looking for studies to support your point, you should consider how ancient some of them are, and factor in the progress that's been made since they were published, not to mention conducted.

in other words, home sleep tests ain't what they were 7+ years ago.
Got anything more current?

you're the one that's basing your theory on old information, information that doesn't take into account the technological advances that have been made in the last few years with respect to more modern home testing appliances.

so I'll ask you.... "got anything more current"?

TASmart · Post by **TASmart** » Sat May 13, 2017 2:59 pm

palerider wrote:
TASmart wrote:
palerider wrote:
TASmart wrote:From Sleep, a peer reviewed journal, which concluded just what my analysis of the population cost of type of testing:

Sleep. 2011 Jun 1
'nuff said.

when you're looking for studies to support your point, you should consider how ancient some of them are, and factor in the progress that's been made since they were published, not to mention conducted.

in other words, home sleep tests ain't what they were 7+ years ago.
Got anything more current?
you're the one that's basing your theory on old information, information that doesn't take into account the technological advances that have been made in the last few years with respect to more modern home testing appliances.

so I'll ask you.... "got anything more current"?

In other word, you got nothing but your opinion.

palerider · Post by **palerider** » Sat May 13, 2017 3:14 pm

TASmart wrote:
palerider wrote: you're the one that's basing your theory on old information, information that doesn't take into account the technological advances that have been made in the last few years with respect to more modern home testing appliances.

so I'll ask you.... "got anything more current"?
In other word, you got nothing but your opinion.

in *the same words* you're basing your theories on old information. if you wish to do that, you're welcome to do so, it's no skin off my nose.

however, if you think that I'm going to spend *my time* doing research for you, for free... you're sadly mistaken.

if you want to have less specious theories, then YOU should do the research, YOU should investigate the capabilities of modern home tests, YOU should look for more recent studies and papers on the subject.

as it is, you've put forth something that, in terms of the march of technology, is ancient history. if you're happy with that, then great.

TASmart · Post by **TASmart** » Sat May 13, 2017 4:47 pm

palerider wrote:
TASmart wrote:
palerider wrote: you're the one that's basing your theory on old information, information that doesn't take into account the technological advances that have been made in the last few years with respect to more modern home testing appliances.

so I'll ask you.... "got anything more current"?
In other word, you got nothing but your opinion.
in *the same words* you're basing your theories on old information. if you wish to do that, you're welcome to do so, it's no skin off my nose.

however, if you think that I'm going to spend *my time* doing research for you, for free... you're sadly mistaken.

if you want to have less specious theories, then YOU should do the research, YOU should investigate the capabilities of modern home tests, YOU should look for more recent studies and papers on the subject.

as it is, you've put forth something that, in terms of the march of technology, is ancient history. if you're happy with that, then great.

I am good with that.

TASmart · Post by **TASmart** » Sat May 13, 2017 8:57 pm

From the AAST 2015:

An overview of recent study findings
A study was conducted that sought to compare the functional outcomes and CPAP adherence in patients with suspected OSA by comparing how PSG results compared to HSAT results.
While the authors found that HSAT is as effective in detecting OSA as a traditional PSG test, the study looked at a limited scope of study participants who were almost exclusively middle-aged obese men from two Veterans Health Administration (VA) facilities. However, in another study with a more diverse patient participant group, researchers found more evidence that using a HSAT for diagnosis and treatment of OSA was not inferior to an in laboratory PSG method in regard to CPAP adherence, titration pressures, time to treatment, and functional outcomes.
But which option is more cost effective in the long run? A study finds in favor of PSG
According to this study, in the long run, a full-night PSG is more cost-effective than a split-night and HSAT testing due to “superior diagnostic accuracy” and limiting of false-positive and false-negative studies that result in unnecessary therapies or untreated cardiovascular risk.
More areas of concern for sleep technologists
An Incomplete Measurement: As of today, current HSAT methods do not measure everything that a PSG can. PSG can accurately monitor sleep, blood oxygen levels, respiratory effort and airflow, limb movements, heart rate and body position. However, HSAT can not measure the Respiratory Disturbance Index (RDI), meaning that subtle breathing irregularities are often missed. Furthermore, it has been found that mild to moderate sleep disordered breathing is sometimes missed using home sleep apnea testing.
Patient Errors: HSAT requires a patient to correctly place equipment on themselves. This equipment can be moved during sleep, or be placed incorrectly, which leads to faulty results or no results, meaning significant disorders can be missed.
In addition, patients often err when estimating when they went to sleep, and how long they slept in total. In a sleep center, professionals monitoring the patient can ensure the correct placement of equipment, ongoing integrity of the recording, and the correct measurement of important variables. HSAT does not tell us whether the patient was sleep or what stages of sleep occurred, which is important to assess.

palerider · Post by **palerider** » Sat May 13, 2017 10:53 pm

TASmart wrote:From the AAST 2015:

An overview of recent study findings
A study was conducted that sought to compare the functional outcomes and CPAP adherence in patients with suspected OSA by comparing how PSG results compared to HSAT results.
While the authors found that HSAT is as effective in detecting OSA as a traditional PSG test, the study looked at a limited scope of study participants who were almost exclusively middle-aged obese men from two Veterans Health Administration (VA) facilities. However, in another study with a more diverse patient participant group, researchers found more evidence that using a HSAT for diagnosis and treatment of OSA was not inferior to an in laboratory PSG method in regard to CPAP adherence, titration pressures, time to treatment, and functional outcomes.
But which option is more cost effective in the long run? A study finds in favor of PSG
According to this study, in the long run, a full-night PSG is more cost-effective than a split-night and HSAT testing due to “superior diagnostic accuracy” and limiting of false-positive and false-negative studies that result in unnecessary therapies or untreated cardiovascular risk.
More areas of concern for sleep technologists
An Incomplete Measurement: As of today, current HSAT methods do not measure everything that a PSG can. PSG can accurately monitor sleep, blood oxygen levels, respiratory effort and airflow, limb movements, heart rate and body position. However, HSAT can not measure the Respiratory Disturbance Index (RDI), meaning that subtle breathing irregularities are often missed. Furthermore, it has been found that mild to moderate sleep disordered breathing is sometimes missed using home sleep apnea testing.
Patient Errors: HSAT requires a patient to correctly place equipment on themselves. This equipment can be moved during sleep, or be placed incorrectly, which leads to faulty results or no results, meaning significant disorders can be missed.
In addition, patients often err when estimating when they went to sleep, and how long they slept in total. In a sleep center, professionals monitoring the patient can ensure the correct placement of equipment, ongoing integrity of the recording, and the correct measurement of important variables. HSAT does not tell us whether the patient was sleep or what stages of sleep occurred, which is important to assess.

things to be aware of about the above quoted article:

"A study was conducted" may 2011
"the study looked at" jul 2012
"According to this study, in the long run" June 2011

also, the article is in the American Association of Sleep Technologists blog... so, perhaps consider the source... it's like research that says that cigarettes are great for your health*

*paid for by the tobacco industry.

TASmart · Post by **TASmart** » Sat May 13, 2017 11:02 pm

This was in reference to the post right above which claimed that AAST said that dual belt home studies were going to replace lab based studies. I have no interest in unsubstantiated opinions.

palerider · Post by **palerider** » Sat May 13, 2017 11:39 pm

TASmart wrote:This was in reference to the post right above which claimed that AAST said that dual belt home studies were going to replace lab based studies. I have no interest in unsubstantiated opinions.

I'm just pointing out to others that you're still basing your opinions on far from state of the art data.

changing your mind isn't on the horizon.

klv329 · Post by **klv329** » Sun May 14, 2017 8:03 am

xxyzx wrote:I recently just had a sleep lab titrate a bipap
it was at TOTAL FAIL
possibly because i cant sleep at the hours the sleep labs want us to

i have central apnea, had it for decades. OSA is new.
doctor wrote Rx for an ASV

now they want me to do another sleep study to titrate the ASV
WTF!
a couple hours sleep in a strange environment is not going to be typical
I think a month sleeping at home and adjusting the ASV if necessary would be more realistic and likely to succeed

Is there any reason not to start at the bipap numbers
and turn on all the automation they blocked on the bipap
and lower some numbers to help avoid CAs

has anyone self titrated an ASV
is there any valid reason not to try that

Or maybe I should forget the whole thing
high enough pressure to help the OSA will cause more CA
so maybe I can't do any better with a machine

all advice sincerely appreciated

Going from APAP to ASV wasn't too much of a problem with the Resmed ASV machine because so much of what it does is automated. For me, Min EPAP is 1 below the minimum APAP pressure that takes care of most OA's, but the Resmed ASV seems to produce decent results with Min EPAP 2-3 below minimum APAP, For Max PS , it takes something around 10 to be effective for me. A Min PS of 1-2 takes care of some Hypopneas. It just takes some testing.

The respironics machine has more settings that you can adjust, including a back up breathing rate, if it helps.

Maybe going from BIPAP/VPAP to Resmed ASV takes more testing?

TASmart · Post by **TASmart** » Sun May 14, 2017 8:22 am

palerider wrote:
TASmart wrote:This was in reference to the post right above which claimed that AAST said that dual belt home studies were going to replace lab based studies. I have no interest in unsubstantiated opinions.
I'm just pointing out to others that you're still basing your opinions on far from state of the art data.

changing your mind isn't on the horizon.

TASmart · Post by **TASmart** » Sun May 14, 2017 10:23 am

xxyzx wrote:
TASmart wrote:This was in reference to the post right above which claimed that AAST said that dual belt home studies were going to replace lab based studies. I have no interest in unsubstantiated opinions.
=========

you quoted some bad study in 2015

they made the claim in 2017

are you saying AAST is just a bunch of quacks

No, I would have to see what they actually said in 2017, and the context it was said in. I recognize that knowledge is cumulative. What we think today is built on the work previously done. But since you did not see fit to actually tell me where the specific study/opinion/whatever came from I have no idea what it constitutes.

TASmart · Post by **TASmart** » Sun May 14, 2017 11:47 am

Done with this thread.

self titrating an ASV

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