Flow limitation advise

palerider wrote:

tan wrote:

palerider wrote:some folks here think that slowly changing pressures during the night are a big bugaboo...

they can be IF such higher pressures cause loss of proper seal. If not, then I rather think, it ain't a big deal

the rants against the evils of auto machines aren't about leaks caused by high pressures, which, really, are a separate issue, the assertion is that the slowly changing pressures, over the course of minutes, somehow jolts everybody out of their 'deep sleep stages' and into lighter ones. (I've never seen anybody proposing this actually produce anything resembling evidence of this, or indeed, an understanding of actual sleep stages and what they do, and how the brain cycles between them.)

It's terrible when your brain turns on you.

Your remarks are totally absurd and ridiculous!
Even if the evidence was presented to you (which it has been many times and is readily find-able), you wouldn't/won't accept it.
Apparently personal experiences don't count, either........ Lots of them here on the forum.
If APAPs (or auto Bi-levels, etc.) were so effective, why not just leave them in their wide-open ranges?
MAYBE because not everyone sleeps or breathes the same.

You need to do some reading and accept that not all users are the same or respond the same to various types of therapy.
By the way, that's why some use CPAP, some use Bi-Level and the variations and some use ASV machines. We're all different, we all respond differently to different therapy and many need different types of therapy.


Den

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Wulfman... wrote:If APAPs (or auto Bi-levels, etc.) were so effective, why not just leave them in their wide-open ranges?

Every time I begin to think you know how APAP works, you post something that shows you don't.

You should know the answer to your question. APAP algorithms do not respond fast enough to get from 4 cm to a high pressure in time to prevent apneas. Maybe those sleep disturbances you are constantly worried about are apneas instead of pressure changes?

avi123 wrote:Cross your fingers because if you're a real UARSnik,


According to this article in the Chest website from 2011 authored by the followings:

Olukayode Ogunrinde, MD; Herbert J. Yue, MD; and Christian Guilleminault, MD, BiolD

Dr. Ogunrinde is Clinical Fellow, Department of Sleep Medicine, Stanford University; Dr. Yue is Clinical Fellow, Department of Sleep Medicine, Stanford University; and Dr. Guilleminault is Professor, Division of Sleep Medicine, Stanford University Medical School, Redwood City, California.

Drs. Ogunrinde, Yue, and Guilleminault have disclosed no significant relationships with the companies/organizations whose products or services may be discussed within this chapter.



Over the past few years, numerous articles have been published that have increased our understanding of the features of upper airway resistance syndrome (UARS). UARS has been previously described as a distinct clinical syndrome, although there is ongoing controversy and some consider it to be part of a spectrum of sleep-disordered breathing that includes primary snoring, obstructive hypopnea syndrome (OHS), and obstructive sleep apnea syndrome (OSAS). However, patients with UARS present with different polysomnographic abnormalities and do not meet generally accepted criteria for either apneas or hypopneas. The lack of education about UARS in the medical community has allowed these patients to go undiagnosed and untreated. Increased research into UARS will help us to identify the optimal treatment for these patients, as well as to educate clinicians about this relatively under-recognized population.
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The optimal treatment for patients with UARS is not currently known. Continuous positive airway pressure (CPAP) has been quite useful in the treatment of sleep-disordered breathing and there are some notable positive results in CPAP treatment of UARS Among those patients who have been treated, typically with CPAP therapy, many have experienced symptomatic improvement. The current fund of knowledge regarding UARS has been growing, and we are beginning to understand the underlying pathophysiology.

Avi123; Are you trying to rain on my parade or what, lol. So do you have UARS yourself or know of anyone else on here whose been diagnosed with UARS by a sleep doctor? I've read that some sleep clinics don't recognize UARS. While meeting with my sleep doc after the first sleep study, I started to show him an article on UARS. He quickly waved it off and held up a printout of my apnea events that showed the intermittent spikes of severe apnea. And he says; no you have sleep apnea.

It's true that I had the orthodontic treatment for crowded teeth (small lower jaw), wore braces for about 3 yrs as a teenager. Dr. Steven Parker, who wrote "Sleep Interrupted", thinks this sets people up for UARS. Receding jaw from the missing teeth narrows the airway I think? Mine is caused by tongue obstruction. But then I've also read that many older women develop sleep apnea from lack of hormones and there's common complaints of interrupted sleep and insomnia in many older women. Hormones support the tongue and throat muscles.

I've come across two other women on this site who suspect they have UARS, one was diagnosed and prescribed cpap by an ENT doctor after sleep clinic did not recognize a problem. The other was self diagnosed and somehow got ahold of a cpap machine on her own. Both had similar orthodontic work as I did. But the difference between me and them is that I have slept normally most of my life, until four years ago. I've had periods of insomnia before but most likely from hormone imbalance because a short light course of HRT always made a difference. The other two women needed sleep aids for a number of years while they were younger.

I did come across an internet article (don't recall how recent) that said cpap is the best option available for treating UARS.

Wulfman... wrote:Your remarks are totally absurd and ridiculous!

lookin in the mirror again, Den?

Wulfman... wrote:Even if the evidence was presented to you (which it has been many times and is readily find-able), you wouldn't/won't accept it.
Apparently personal experiences don't count, either........ Lots of them here on the forum.

there are *lots* of subjective tales on the forum, yes, there are many, there are also many tales of people that have gotten all sorts of diseases, and conditions "because of cpap", there are many reports of things happening that you yourself have corrected, just because someone *believes* something doesn't make it true, or accurate.

show me some objective data, something to back up your suppositions about sleep stages and pressure changes. Produce some pressure traces and sleep stage traces, and SHOW that your ASSUMPTION has basis in fact, not just "your feelings".

Wulfman... wrote:If APAPs (or auto Bi-levels, etc.) were so effective, why not just leave them in their wide-open ranges?

now, who's being "totally absurd and ridiculous!"? you know as well as I do that an apap needs to be tuned to an individuals needs to be most effective.

Wulfman... wrote:MAYBE because not everyone sleeps or breathes the same.

You need to do some reading and accept that not all users are the same or respond the same to various types of therapy.
By the way, that's why some use CPAP, some use Bi-Level and the variations and some use ASV machines. We're all different, we all respond differently to different therapy and many need different types of therapy.

well, I know that YOU will never respond rationally when someone challenges your suppositions...

bilevel and asv machines, btw, don't fit very well with your "pressure changes are horrible" THEORY. in case you hadn't noticed.

Sylvia54 wrote:

avi123 wrote:Cross your fingers

Avi123; Are you trying to rain on my parade or what,

it's best to just put avi123 on the foe list, he rambles and interjects irrelevant crap all the time, I can't remember the last time that I saw something useful from him.

palerider wrote:it's best to just put avi123 on the foe list, he rambles and interjects irrelevant crap all the time, I can't remember the last time that I saw something useful from him.

+1

Sylvia, Avi doesn't deserve a reply. I am concerned he is in early-stage dementia.

palerider wrote:

Wulfman... wrote:Your remarks are totally absurd and ridiculous!

lookin in the mirror again, Den?

Wulfman... wrote:Even if the evidence was presented to you (which it has been many times and is readily find-able), you wouldn't/won't accept it.
Apparently personal experiences don't count, either........ Lots of them here on the forum.

there are *lots* of subjective tales on the forum, yes, there are many, there are also many tales of people that have gotten all sorts of diseases, and conditions "because of cpap", there are many reports of things happening that you yourself have corrected, just because someone *believes* something doesn't make it true, or accurate.

show me some objective data, something to back up your suppositions about sleep stages and pressure changes. Produce some pressure traces and sleep stage traces, and SHOW that your ASSUMPTION has basis in fact, not just "your feelings".

Wulfman... wrote:If APAPs (or auto Bi-levels, etc.) were so effective, why not just leave them in their wide-open ranges?

now, who's being "totally absurd and ridiculous!"? you know as well as I do that an apap needs to be tuned to an individuals needs to be most effective.

Wulfman... wrote:MAYBE because not everyone sleeps or breathes the same.

You need to do some reading and accept that not all users are the same or respond the same to various types of therapy.
By the way, that's why some use CPAP, some use Bi-Level and the variations and some use ASV machines. We're all different, we all respond differently to different therapy and many need different types of therapy.

well, I know that YOU will never respond rationally when someone challenges your suppositions...

bilevel and asv machines, btw, don't fit very well with your "pressure changes are horrible" THEORY. in case you hadn't noticed.

Do your own research. I have.

I've never said that "pressure changes are horrible". They work for some people, but for others who are using ranges of pressures and never seem to feel rested, TRYING straight pressure should be an option.

And, virtually EVERYTHING with regard to this therapy is "subjective" in that each of us is different, we require different therapy and different pressures, humidity, exhale relief (if any) and on and on.


Den

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And.........

If a single (moderate/effective) pressure was sufficient to reduce AHIs and other indexes to practically nothing, why would you NEED a range if there were virtually no events to chase or subdue/prevent?

Or........... (along with that)

If the person did not have the breathing events that triggered pressure increases to fend off apneas, the pressure changes would not occur and the apneas would occur without attempted intervention/prevention.


Den

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Wulfman... wrote:Do your own research. I have.

ok, so, nothing to back up your theory, got it.

Wulfman... wrote:I've never said that "pressure changes are horrible". They work for some people, but for others who are using ranges of pressures and never seem to feel rested, TRYING straight pressure should be an option.

you're *constantly* jumping in with your assumptions and stating "it's clear to me that your problems are caused by pressure changes. long before any other data is brought forth, like the guy you proclaimed that on, come to find out he'd been having the wakenings problem for some time *on straight pressure* and had PLMD and other physical issues that needed remediation.

Wulfman... wrote:And, virtually EVERYTHING with regard to this therapy is "subjective" in that each of us is different, we require different therapy and different pressures, humidity, exhale relief (if any) and on and on.

sub·jec·tive səbˈjektiv/
adjective
1. based on or influenced by personal feelings, tastes, or opinions

ob·jec·tive əbˈjektiv/
adjective
1. (of a person or their judgment) not influenced by personal feelings or opinions in considering and representing facts.

so, no, "virtually EVERYTHING" is *not* subjective.

Wulfman... wrote:If a single (moderate/effective) pressure was sufficient to reduce AHIs and other indexes to practically nothing, why would you NEED a range if there were virtually no events to chase or subdue/prevent?

You are demonstrating your limited lack of knowledge about the benefits of APAP.

There is a basic and fundamental answer to your question. A pressure range allows the patient to use a lower, more comfortable pressure at times when a lower pressure will adequately treat his condition without tying him in to a higher pressure that is only needed at certain times.

Examples include people who do well at lower pressures when they sleep on their stomach or sides, and people who do well at lower pressures when they are in non-REM sleep. The higher pressure kicks in respectively when back sleeping and when in REM.

Your idea to run at a higher pressure all night long may well be more disturbing to sleep than the slow changes in pressure of an APAP.

ChicagoGranny wrote:

Wulfman... wrote:If a single (moderate/effective) pressure was sufficient to reduce AHIs and other indexes to practically nothing, why would you NEED a range if there were virtually no events to chase or subdue/prevent?

You are demonstrating your limited lack of knowledge about the benefits of APAP.

There is a basic and fundamental answer to your question. A pressure range allows the patient to use a lower, more comfortable pressure at times when a lower pressure will adequately treat his condition without tying him in to a higher pressure that is only needed at certain times.

Examples include people who do well at lower pressures when they sleep on their stomach or sides, and people who do well at lower pressures when they are in non-REM sleep. The higher pressure kicks in respectively when back sleeping and when in REM.

Your idea to run at a higher pressure all night long may well be more disturbing to sleep than the slow changes in pressure of an APAP.

And that would demonstrate that you don't understand how APAPs work (in ranges of pressures).
If the events that signal pressure changes (increases) aren't present, the apneas/hypopneas aren't going to be headed off. There was an exchange just within the last few days where some folks said (there's that "subjective" thing again) they don't experience higher events when sleeping in the supine position. Their REM events were the primary reason for needing extra pressure. But, you would still need preceding events (flow limitations, snores or hypopneas) to trigger pressure increases. If those don't occur, the events are going to take place without pressure responses.
And, if these people can sleep at HIGHER pressures some of the night, why not ALL of the night? How "low" is "low" for sleeping the rest of the night? (Oops, there's that "subjective" thing again)

Not everyone has the "textbook" breathing events that the APAPs are programmed for (algorithms).

Isn't this why we advocate for people getting the most versatile and data-capable machines in the category they need?

I think I've come to the conclusion that I'M more "flexible" about this therapy than some of you are.


Den

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Wulfman... wrote:If the person did not have the breathing events that triggered pressure increases to fend off apneas, the pressure changes would not occur and the apneas would occur without attempted intervention/prevention.

apneas cause pressure increases too, as you'd know, if you did something besides dismissing the technology.

Wulfman... wrote:And that would demonstrate that you don't understand how APAPs work (in ranges of pressures).

Wulfman... wrote:I think I've come to the conclusion that I'M more "flexible" about this therapy than some of you are.

excellent, Den, don't let reality cloud your 'thinking'.

palerider wrote:

Wulfman... wrote:If the person did not have the breathing events that triggered pressure increases to fend off apneas, the pressure changes would not occur and the apneas would occur without attempted intervention/prevention.

apneas cause pressure increases too, as you'd know, if you did something besides dismissing the technology.

WOOOOOOOO!!!

The preferable way is to PREVENT them.
And, if the pressure isn't too low and the breathing patterns fit the algorithm, then the machine responses will prevent them.


Den

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Wulfman... wrote:

palerider wrote:

Wulfman... wrote:If the person did not have the breathing events that triggered pressure increases to fend off apneas, the pressure changes would not occur and the apneas would occur without attempted intervention/prevention.

apneas cause pressure increases too, as you'd know, if you did something besides dismissing the technology.

WOOOOOOOO!!!

The preferable way is to PREVENT them.
And, if the pressure isn't too low and the breathing patterns fit the algorithm, then the machine responses will prevent them.

well, duh. but since the 'seeing into the future' module hasn't been quite perfected, then people can have better pressures throughout the night, and have an apena or two here and there as pressure needs increase...

or they can do it then DEN way, and crank up the pressure to PREVENT all apneas... thus increasing discomfort, mask leaks, aerophagia, and other side effect of high pressure.... but, hey, "The preferable way is to PREVENT them." comfort be damned, good sleep be damned.

let's see how far you get convincing pugsy she needs to stay at 18+cm *all night long* to deal with her REM cycles, instead of the 8 or 9 she needs the rest of the night.

I'll get the popcorn and watch, you have fun.