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Snoredog wrote: At the same time we cannot assume they are resistant apneas, Vocal Cord Dysfunction or Asthma related episodes either.

I agree that assumptions cannot be made toward any etiology. It's just plain difficult to differentiate any of the above based on a single APAP data channel.

Snoredog wrote:Like I said, you have a 50-50 chance on getting it right, I prefer to error on the safe side.

A 50-50 chance implies an empirically-based probability. So what, then, is that 50-50 probability based on? Since current epidemiology doesn't offer any empirically established prevalence rates with which to establish statistical likelihoods, absolutely no one can assign 50-50 probabilities to anything in this equation (especially in light of etiological discoveries that will very likely continue in the method or process execution of sleep science itself).

Snoredog wrote: If resistant apneas were the case, then higher pressure should have resolved the clusters

No. What makes an apnea resistant is that it does not resolve with pressure. And either a central or obstructive apnea can be pressure resistant (with central apneas sometimes being pressure aggravated as well). But the idea of those apneas being thought of as "resistant" is simply because they cannot be accurately differentiated by Respironics or anyone on this message board, and they do not readily resolve with pressure either.

With that said, turning pressure down experimentally is not at all a bad idea at times. That trial-and-error process has, unfortunately, proven to be necessary on this message again and again. Observing presumable phenotypes via pressure patterns is one thing (albeit a risky proposition on a message board at best), but diagnostically attributing specific etiologies is something altogether different that absolutely no one here can do via a message board. ...Not even the keen dog who snores mightily among us. .

-SWS wrote:

Snoredog wrote: At the same time we cannot assume they are resistant apneas, Vocal Cord Dysfunction or Asthma related episodes either.

I agree that assumptions cannot be made toward any etiology. It's just plain difficult to differentiate any of the above based on a single APAP data channel.

Snoredog wrote:Like I said, you have a 50-50 chance on getting it right, I prefer to error on the safe side.

A 50-50 chance implies an empirically-based probability. So what, then, is that 50-50 probability based on? Since current epidemiology doesn't offer any empirically established prevalence rates with which to establish statistical likelihoods, absolutely no one can assign 50-50 probabilities to anything in this equation (especially in light of etiological discoveries that will very likely continue in the method or process execution of sleep science itself).

Snoredog wrote: If resistant apneas were the case, then higher pressure should have resolved the clusters

No. What makes an apnea resistant is that it does not resolve with pressure. And either a central or obstructive apnea can be pressure resistant (with central apneas sometimes being pressure aggravated as well). But the idea of those apneas being thought of as "resistant" is simply because they cannot be accurately differentiated by Respironics or anyone on this message board, and they do not readily resolve with pressure either.

With that said, turning pressure down experimentally is not at all a bad idea at times. That trial-and-error process has, unfortunately, proven to be necessary on this message again and again. Observing presumable phenotypes via pressure patterns is one thing (albeit a risky proposition on a message board at best), but diagnostically attributing specific etiologies is something altogether different that absolutely no one here can do via a message board. ...Not even the keen dog who snores mightily among us. .

Snoredog wrote:I didn't diagnose anything, I suggested the machine was misreading the events reported and what to do to resolve it, my solution worked, your suggestion didn't so explain it away if you want.

I think the appropriate thing to do would be to have it as a setting on the supplier menu. Increase pressure to resolve unresponsive apneas, or decrease pressure to resolve unresponsive apneas. Then, people that have centrals can turn it to decrease and people that only have OSA can turn it to increase.

Of course there's not a chance that it would be set correctly in the majority of cases, but if the default were increase, then it wouldn't change current behavior of the machines at all in general.

Wouldn't a 50-50 chance be correct if 50% of apneas were obstructive & 50% were central, generally? Like you have a 50-50 chance of head or tails on the flip of a coin. No one has a 50-50 chance of having obstructive versus central apneas; most have a much higher chance of having obstructive apneas and any apneas scored by their machine are most likely to be obstructive. Considering Carla's original PSG & titration showed no centrals, even at pressures up to 13, its a pretty small chance that she would have them now and that her autoPAP would also mislabel them.

christinequilts wrote:Wouldn't a 50-50 chance be correct if 50% of apneas were obstructive & 50% were central, generally? Like you have a 50-50 chance of head or tails on the flip of a coin. No one has a 50-50 chance of having obstructive versus central apneas; most have a much higher chance of having obstructive apneas and any apneas scored by their machine are most likely to be obstructive.

Agreed. Accurate probability assessments toward anything in this equation can only be based on statistical epidemiology (which, as I understand, is not yet well established in this young branch of medicine). So is there a 50-50 chance of central events happening? As you correctly point out, Christine, current epidemiological estimates within the field of sleep science attribute much greater probability to obstructive events. So can there be a 50-50 chance that lowering pressure is the best course of action? Again, an empirically-formulated body of data/conclusions is simply not available to us for purposes of formulating probability bases. And for the specific case at hand, an exact probability-basis of pressure response is most definitely unknown (especially in light of missing physiologic and other background information----but also in light of the fact that Carla just may be affecting several physiologic factors simultaneously besides pressure).

My sincere apologies to Snoredog who was not handing out diagnoses after all. But a reminder to all of us, and especially to myself, that we really must be extremely careful about handing out medical certainties and absolutes on this message board. I for one truly enjoy reading suggestions like, "Consider the possibility of central apneas, based on the following reasoning..." or "I really think you and your doctor need to consider acid reflux as a possibility". But in my heart of hearts, I honestly do not think it is a good idea for any patients to hear absolute statements on a message board like "You clearly have a central apnea issue" or perhaps even "You most certainly suffer from acid reflux disease". As patients who help other patients, we really should tread this inordinately complex path of information and interrelated analyses very carefully. I honestly think this particular analytic path is fraught with more scientific uncertainties and medical unknowns than today's scientists and doctors would ever readily dispose---at least not with any similar degree of analytical ease that routinely happens on message boards.

I hope I have not offended anyone here with my own views regarding this topic. My sincere apologies to any readers whom I might have offended along the way. On this holiday I offer my heartfelt best wishes to all who read this thread----and especially to my insightful friend Snoredog, who I hope I have not offended. HAPPY HOLIDAY TO ALL!!! .