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Wulfman... wrote:Now YOU'RE criticizing/arguing with Pugsy.

have you been delusional long? I get the impression it's fairly recent.

palerider wrote:

Wulfman... wrote:

Pugsy wrote: A possible solution would be to keep an ASV machine at the higher altitude address for use there.

My apologies for not quoting the WHOLE post, but I think it already has been and should be easy enough to find.

you're the rabid nutjob that insists on complete posts.

you're quite right, Pugsy did mention an asv as a possible solution *TO THE CENTRALS*.

doesn't have anything to do with your bad advice, and typical trying to cloud the water afterwards.

We don't even know for sure whether they're TRUE Centrals or other possibilities.
We don't know (at this point) whether more pressure causes more of them or diminishes them.

"Central Sleep Apneas" and "Pressure-Induced Centrals" are not necessarily the same thing, either.
If your "range of pressures" and "get a bigger hammer" philosophies work, there should be no problem. Right?
If they're identified as Centrals, the machine shouldn't be increasing pressures and will subsequently decrease pressures.
We wouldn't know for sure unless we see an actual report. (and then we still may not know)

Try using the "Rule of Holes".........if you're in one, stop digging.


Den

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palerider wrote: you should include the mask pressure trace for that example. that shows the asv in action.

You know I turn that damn thing off because I don't like it.
If I feel up to it later I might redo the screen shot.
Right now I am pissed because I totally FU'd the wave form from the 560 (even though it was uneventful) and had to deactivate that patient in Encore Pro.
Dumb ass that I am.

I am tired. Have a headache. Cpap.com didn't call me like they were supposed to (at least yet anyway) and I stayed home all day waiting for the call when I wanted to go shopping...
I need to go feed the horses and do some chores and take a breather.

And go get some cheese to go with my whine.

Wulfman... wrote:We don't even know for sure whether they're TRUE Centrals or other possibilities.

thus spake the parrot. "TRUE Centrals Bakawk!" do you know what the term "TRUE Centrals" means?

what I will easily agree on is "we don't know", which makes your:

Wulfman... wrote:You need to jack up your pressures till you get your numbers down.

ill advised at best and possibly detrimental.

Wulfman... wrote:We don't know (at this point) whether more pressure causes more of them or diminishes them.

please parrot out some reputable information go support your apparent theory that more pressure can help central apnea.

Wulfman... wrote:Try using the "Rule of Holes".........if you're in one, stop digging.

I'm waiting, but you seem to have switched from the shovel to a backhoe.

Pugsy wrote:

palerider wrote: you should include the mask pressure trace for that example. that shows the asv in action.

You know I turn that damn thing off because I don't like it.
If I feel up to it later I might redo the screen shot.

I know but in the case of an ASV, the mask pressure trace *does* clearly show the actions of the machine, with the higher pressure breaths easily visible to help understand what the machine is doing.

Pugsy wrote:And go get some cheese to go with my whine.

or, if you've got some, a glass of your most excellent home made irish cream.

now I'll sit back and wait for den to try and twist this into an argument

palerider wrote:I know but in the case of an ASV, the mask pressure trace *does* clearly show the actions of the machine, with the higher pressure breaths easily visible to help understand what the machine is doing.

Yeah...I know, I know...so I did it for you and anyone interested in what it looks like for real.
Interesting that it's multiple little bursts.. thanks for making me really look at it...I think.
See image below

I haven't made any Irish Creme in a long time...sure which I had some...I think I do have a bottled White Russian hiding in the fridge though....it's calling my name.

Pugsy wrote:

palerider wrote:I know but in the case of an ASV, the mask pressure trace *does* clearly show the actions of the machine, with the higher pressure breaths easily visible to help understand what the machine is doing.

Yeah...I know, I know...so I did it for you and anyone interested in what it looks like for real.
Interesting that it's multiple little bursts.. thanks for making me really look at it...I think.

yes, you can see it attempting to ventilate you, which in this case, it can't because it's an obstructive, and as soon as you start breathing on your own it pops back to normal PS.

I don't expect Den to look at this and actually *learn* anything, but others who wonder how things work may.

Pugsy wrote:I haven't made any Irish Creme in a long time...sure which I had some...I think I do have a bottled White Russian hiding in the fridge though....it's calling my name.

Brendaaaaaaa come drink meeeeeeee.

palerider wrote: yes, you can see it attempting to ventilate you, which in this case, it can't because it's an obstructive, and as soon as you start breathing on your own it pops back to normal PS.

So...what would it look like if it wasn't obstructive...what does it look like when it's a central being responded to?
Do you have any examples of a for sure central being treated?
I have never had enough centrals for me to be able to tell for sure what I am seeing.

I just drank the White Russian...last one. Damn.

Pugsy wrote:

palerider wrote: yes, you can see it attempting to ventilate you, which in this case, it can't because it's an obstructive, and as soon as you start breathing on your own it pops back to normal PS.

So...what would it look like if it wasn't obstructive...what does it look like when it's a central being responded to?
Do you have any examples of a for sure central being treated?
I have never had enough centrals for me to be able to tell for sure what I am seeing.

I just drank the White Russian...last one. Damn.

Yeah, I'll be waiting to see that, too........


Den

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You all are worrying about AHI changing with alt, I think attitude would be the most important thing to worry about, that's what causes the failure. Jim

If you stay where you live, alt Seldom changes.

makes sense. you can read about people going to the "mile high city" in Colorado and even normal healthy people can have cardiopulmonary issues the first few days.

Pugsy wrote:

palerider wrote: yes, you can see it attempting to ventilate you, which in this case, it can't because it's an obstructive, and as soon as you start breathing on your own it pops back to normal PS.

So...what would it look like if it wasn't obstructive...what does it look like when it's a central being responded to?
Do you have any examples of a for sure central being treated?

here's a good example of a couple centrals that are wiped out:


if you zoom in, you can see where the flow level falters a bit and the PS starts to pick up around 19:01:35, then the increased PS does a good job, this time, of keeping ventilation going till breathing effort resumes around 19:02:08ish.

basically, you see the pressure spikes going above the baseline, and and still see fairly decent respiratory flow. that's a nearly perfectly handled CA.

here's another section, from later in the same night, where things weren't handled as well, and there were drops below the target MV, but, on average, it was doing it's best to fight this spell of CSR.


the MV line is at the bottom, with current target rate(smooth line) and the wavery one (actual) the ASV just tries to keep the MV above that target.

Pugsy wrote:I just drank the White Russian...last one. Damn.

time for an emergency booze run to the store?

Thank you for explaining that central response. I see said the blind man.
When I have time I will take a stroll through my flow rate and see if I see any evidence of a real central being treated. I know I have one every now and then..we all do.

No need for an emergency liquor store run...I don't drink that much anyway and the one White Russian (in a tiny bottle) was enough but if it wasn't...I have other alternatives available.
My latest thing that I like especially when it's hot and I have been outside mowing...Henry's Hard Orange Soda. Tastes just like Orange NeHi from back when I was a kid.
So I have a new six pack of those that I just bought last week.

I don't drink alcohol all that much...the calories are bad for my butt size. I would rather eat them than drink them.

Pugsy wrote:Thank you for explaining that central response. I see said the blind man.
When I have time I will take a stroll through my flow rate and see if I see any evidence of a real central being treated. I know I have one every now and then..we all do.

just look at the dreaded mask pressure trace for places where it spikes up, without a marked apnea event. that's the easiest way to spot 'em. and, that, to me, is why the resmed doesn't flag centrals... from that first pic I posted, it's a central, as are the others... but the patient never experienced lack of airflow for 10 seconds!

Pugsy wrote:No need for an emergency liquor store run...I don't drink that much anyway and the one White Russian (in a tiny bottle) was enough but if it wasn't...I have other alternatives available.
My latest thing that I like especially when it's hot and I have been outside mowing...Henry's Hard Orange Soda. Tastes just like Orange NeHi from back when I was a kid.
So I have a new six pack of those that I just bought last week.

I don't drink alcohol all that much...the calories are bad for my butt size. I would rather eat them than drink them.