Flow limitation advise

Wulfman... · Post by **Wulfman...** » Fri Jul 15, 2016 6:57 pm

An excerpt from ONE source:

AutoCPAP
The aim of AutoCPAP is to adjust the pressure in response to respiratory events without adjustment to artifacts caused by
leak or other factors. AutoCPAP from different companies and different models by the same company have varying definitions of events, responses to obstructive events, and protocols for decreasing the pressure once the breathing stabilizes. These variations are important to understand for appropriate clinical care as they affect the patient’s tolerance of the devices and the clinical efficacy.12–14 If a patient enters REM sleep or changes position, the degree of obstruction may suddenly increase and by the time the device is able to adjust to the needed pressure the patient may have had desaturations or arousals. This is why most studies reporting the equivalence of AutoCPAP to in-lab titration recommend changing the EPAP minimum to the pressure the device is at or below 90–95% of the time.2,15 In our experience, many patients left on AutoCPAP 4–20 are undertreated and may present with awakenings a couple hours into sleep, residual symptoms, or difficulty tolerating PAP. Some patients are sensitive to the pressure changes, so if patients are not doing well with AutoCPAP, fixed CPAP should be tried.

Den

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palerider · Post by **palerider** » Fri Jul 15, 2016 7:13 pm

Wulfman... wrote:An excerpt from ONE source:

some patients hate the color pink... so? I can cut and paste (or make up) things too... aren't you the one that demands *reliable* sources when arguing your points?

ah, nevermind, I just realized that one of the things you love to repeat:

Wulfman... wrote:Doing the same thing over and over and expecting different results is supposed to be the definition of "insanity".

is you subtly reminding people of the futility of trying to get you to understand an opposing viewpoint.

here's your stick back, go on beating your dead horse

Wulfman... · Post by **Wulfman...** » Fri Jul 15, 2016 7:27 pm

palerider wrote:
Wulfman... wrote:An excerpt from ONE source:
some patients hate the color pink... so? I can cut and paste (or make up) things too... aren't you the one that demands *reliable* sources when arguing your points?

ah, nevermind, I just realized that one of the things you love to repeat:
Wulfman... wrote:Doing the same thing over and over and expecting different results is supposed to be the definition of "insanity".
is you subtly reminding people of the futility of trying to get you to understand an opposing viewpoint.

here's your stick back, go on beating your dead horse

Yep!

I first posted it back here:

viewtopic.php?f=1&t=111984&p=1075788&hi ... 5#p1075788

That's the discussion we had about differences in machine responses to events.

Then you claimed to have found it, too. WOOOOOO!!!

Den

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palerider · Post by **palerider** » Fri Jul 15, 2016 8:25 pm

Wulfman... wrote:Then you claimed to have found it, too. WOOOOOO!!!

no, I highlighted the chart of different machine algorithms.

my point still stands, you keep saying "pressure changes knock you out of deeper sleep".... without *any* evidence that that is what is happening.

Wulfman... · Post by **Wulfman...** » Fri Jul 15, 2016 9:45 pm

palerider wrote:
Wulfman... wrote:Then you claimed to have found it, too. WOOOOOO!!!
no, I highlighted the chart of different machine algorithms.

my point still stands, you keep saying "pressure changes knock you out of deeper sleep".... without *any* evidence that that is what is happening.

I believe the terms I've frequently used is "needed sleep stages".........some deeper and some REM.
A person's breathing can change in various sleep stages. These potential changes may be interpreted as a need to increase pressures. If that happens and the user is adversely affected by pressure changes, they may be bumped out of those needed sleep stages and into lighter stages.

Here's one that shows some differences in breathing during various sleep stages.

http://journals.plos.org/plosone/articl ... 151530.PDF

I've never said it's an "absolute". All I've done is recommend that if the user is having difficulty with feeling rested with ranges of pressures, to TRY a straight pressure to see if it may make a difference.

Den

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palerider · Post by **palerider** » Fri Jul 15, 2016 10:00 pm

Wulfman... wrote:can... may... may

uh.. huh.

Wulfman... wrote:Here's one that shows some differences in breathing during various sleep stages.

Thanks for pointing out the differing conditions that can, may, might, need differing pressures something that people keep trying to get you to acknowledge.

it's like you're doing my work for me

Wulfman... · Post by **Wulfman...** » Fri Jul 15, 2016 10:22 pm

palerider wrote:
Wulfman... wrote:can... may... may
uh.. huh.

Wulfman... wrote:Here's one that shows some differences in breathing during various sleep stages.
Thanks for pointing out the differing conditions that can, may, might, need differing pressures something that people keep trying to get you to acknowledge.

it's like you're doing my work for me

For SOME people "yes" and some people "no".

It's painfully apparent YOU don't get it!!!

Den

.

palerider · Post by **palerider** » Fri Jul 15, 2016 10:48 pm

Wulfman... wrote:It's painfully apparent YOU don't get it!!!

oh, I get "it", and if you actually *acted* like you proclaim:

Wulfman... wrote:All I've done is recommend that if the user is having difficulty with feeling rested with ranges of pressures, to TRY a straight pressure to see if it may make a difference.

instead of what you normally do, which is to immediately tell people that their problem *IS* pressure changes... not "might be" not "that they could TRY straight pressure as an alternative.... no, you declare that you've divined what their problem *IS* and then prescribe a remedy...

if you actually acted like you claim above, then I'd not feel the need to constantly point out that you're talking out your ass on that subject.

it'd be a lot simpler if you actually acted the way you claim you do. stop treating it like a popularity contest, adding up the people you claim to have helped to prop up your side of things , and focus on finding out what an *INDIVIDUAL* has wrong, and what the best thing *FOR THEM* is.

mrkdilkington2 · Post by **mrkdilkington2** » Sat Jul 16, 2016 2:15 am

OP it sounds like you have UARS like I did. Despite constant attempts to optimize my cpap therapy, my sleep remained fragmented and I was WAY more tired and fatigued during the day/early night than a healthy and fit male in their 20's ought to be. The only thing that works for me was double jaw surgery aka maxillomandibular advancement. I just had the procedure done a week ago and I'm already breathing and sleeping better.

ChicagoGranny · Post by **ChicagoGranny** » Sat Jul 16, 2016 6:24 am

mrkdilkington2 wrote:OP it sounds like you have UARS like I did.

The old I-have-UARS-so-you-must-have-UARS approach.

And thrown in for free, the old I-had-MMA-surgery-so-you-need-MMA-surgery approach.

ChicagoGranny · Post by **ChicagoGranny** » Sat Jul 16, 2016 6:29 am

Sylvia54 wrote: Last night I went over the comments again and set the machine at 8/12. Felt somewhat unrefreshed early this morning but feeling better as the day goes on, more clear-headed. So glad now that I questioned the sleep Dr's prescription of 7/7 and got it changed. Followup with clinic APRN helped somewhat and then I got good advice here to increase starting pressure by alittle when I'd put it back to 7/11. Sleep was still fragmented but I'd also cut back the clonazepam to only 0.25 mg., still got close to 6 hrs total. Hope it's not just a fluke. No LL or PB events last night, AHI down to 2.69. Also with being awake off and on during the night and I've noticed that period of time increases the AHI reading on the machine, so it's probably lower than 2.69. I'll have to give my RT some credit too for memorizing that "range is better than fixed pressure". I have gotten quality help and encouragement from the DME admin assistant who has sleep apnea herself and uses cpap.

Sylvia, It's good that you have taken control of the process and are making some progress in optimizing your CPAP therapy. While you are doing that, it would be good to check your status on these basics:

- Practice good sleep hygiene (Google it and read several sources)
- Eat a good diet
- Have a regular, moderate exercise program
- Try to avoid daytime naps
- Practice total abstinence of caffeine including sources like chocolate (sigh)
- Review all medicines, vitamins and supplements you are taking to make sure none are interfering with sleep
- Use the bedroom for sleeping (and sex) only, and make sure the bedroom and bed are comfortable.
- Learn to appropriately handle emotional stress in your life
- Use CPAP software, such as the free SleepyHead, to make sure your therapy is optimized
- If you still don't feel or sleep well, make sure you have regular medical checkups to confirm there are no other medical problems

CG

Good luck!

mrkdilkington2 · Post by **mrkdilkington2** » Sat Jul 16, 2016 7:04 am

ChicagoGranny wrote:
mrkdilkington2 wrote:OP it sounds like you have UARS like I did.
The old I-have-UARS-so-you-must-have-UARS approach.

And thrown in for free, the old I-had-MMA-surgery-so-you-need-MMA-surgery approach.

It's certainly worth having a consultation with an orthognathic surgeon to see if he/she would benefit from the procedure by running imaging tests and finding out whether or not they are a candidate.

ChicagoGranny · Post by **ChicagoGranny** » Sat Jul 16, 2016 7:19 am

mrkdilkington2 wrote:It's certainly worth having a consultation with an orthognathic surgeon to see if he/she would benefit from the procedure by running imaging tests and finding out whether or not they are a candidate.

If you recommend this for Sylvia, why not recommend it for everyone diagnosed with OSA?

mrkdilkington2 · Post by **mrkdilkington2** » Sat Jul 16, 2016 8:06 am

ChicagoGranny wrote:
mrkdilkington2 wrote:It's certainly worth having a consultation with an orthognathic surgeon to see if he/she would benefit from the procedure by running imaging tests and finding out whether or not they are a candidate.
If you recommend this for Sylvia, why not recommend it for everyone diagnosed with OSA?

I do recommend it for anyone in the 20 to 55 age group (upper limit is debatable) that has been diagnosed with OSA (I was diagnosed as mild), struggles to find relief from their symptoms with cpap (mine were fatigue and fragmented sleep), and is a candidate for the procedure according to their surgeon. I just happened to recommend it to OP because last year I was also in search of a way to help my cpap therapy reduce my flow limitations. Specifically, I had a significant amount of custom-event based flow limitations in SleepyHead and abnormal waveforms that responded very poorly to pressure increases in terms of the two symptoms I spoke of before. I also had an anterior open-bite so I needed jaw surgery anyways, but this may not be the case for others.

ChicagoGranny · Post by **ChicagoGranny** » Sat Jul 16, 2016 8:14 am

Dilkington, I agree with much of what you have said, especially for the younger (20 - 45) portion of the segment you mention.

Regarding Syvlia, at this point we don't know her age. And, she is in the beginning stage of using and optimizing her CPAP therapy. I am hopeful that she will soon reach a very good CPAP therapy.

If you care to, starting another thread about your experience with MMA would be appreciated.

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