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Re: Increase in AHI
Posted: Mon Jan 13, 2020 9:37 am
by Jonty
Hi Pugsy,
yes - i always go to bed on my side - i then often wake on my back
I have managed to bypass the lock
- changed the min starting pressure to 6 for now - and see how i do with that
Re: Increase in AHI
Posted: Mon Jan 13, 2020 9:51 am
by almostadoctor
I hear a lot of people talk about changing minimum rates on auto machines on this board. Is there something I'm missing? I've studied ResMed "auto" algorithms and the minimum rate is meaningless as long as the maximum rate is within a therapeutic range. This is because the "auto" function studies each cycle of the flow curve, and looks for apneic "mouse bites" in the top of the inspiration. Whenever it sees these, it raises the base pressure (notwithstanding the expiration relief) until the inspiration cycle is full.
Thus, the minimum rate you set shouldn't affect apnea events. I believe it is there specifically to establish a comfortable baseline while you fall asleep. As soon as you fall asleep and your throat is likely to start obstructing, it raises the base pressure to one that prevents the airway obstruction.
So if you raise the minimum, all this will do is make it more difficult to fall asleep.
Does anyone have any specific information to the contrary?
Re: Increase in AHI
Posted: Mon Jan 13, 2020 9:55 am
by LSAT
Go back and study some more...You are wrong.
Re: Increase in AHI
Posted: Mon Jan 13, 2020 10:04 am
by Dog Slobber
almostadoctor wrote: ↑Mon Jan 13, 2020 9:51 am
I hear a lot of people talk about changing minimum rates on auto machines on this board. Is there something I'm missing? I've studied ResMed "auto" algorithms and the minimum rate is meaningless as long as the maximum rate is within a therapeutic range. This is because the "auto" function studies each cycle of the flow curve, and looks for apneic "mouse bites" in the top of the inspiration. Whenever it sees these, it raises the base pressure (notwithstanding the expiration relief) until the inspiration cycle is full.
Thus, the minimum rate you set shouldn't affect apnea events. I believe it is there specifically to establish a comfortable baseline while you fall asleep. As soon as you fall asleep and your throat is likely to start obstructing, it raises the base pressure to one that prevents the airway obstruction.
So if you raise the minimum, all this will do is make it more difficult to fall asleep.
Does anyone have any specific information to the contrary?
Why don't you start your own topic to discuss this, instead of hijacking other peoples topics?
Re: Increase in AHI
Posted: Mon Jan 13, 2020 10:06 am
by jimbud
almostadoctor wrote: ↑Mon Jan 13, 2020 9:51 am
Does anyone have any specific information to the contrary?
Actual experience using these machines.
JPB
Re: Increase in AHI
Posted: Mon Jan 13, 2020 10:15 am
by Pugsy
almostadoctor wrote: ↑Mon Jan 13, 2020 9:51 am
Does anyone have any specific information to the contrary?
Yep.
The need to increase the minimum is to give the machine a better head start to get to where it needs to be in a timely manner in which to prevent the airway from collapsing in the first place.
Not try to fix something after it has already happened.
It does it's best work by preventing the collapse to start with....Prevention is the name of the game
We all know (or should know) that the machine doesn't do a damn thing while an apnea event is actually happening. It sits there and twiddles its little thumbs until the airway is open and the person is breathing freely.
It also can't go from 4 cm to 12 cm (if that is needed) in the blink of an eye. It takes a few minutes to get to where it might need to be and all the while it is traveling upwards the airway can be closing off...and the machine even stops traveling upwards while the airway is blocked....so you can have a lot of events actually happen while the machine is deciding what it wants to do.
The starting minimum of 4 ish...works well if someone might only need 8 ish pressures to hold the airway open.
Doesn't work out so great if someone needs higher pressures (like in the teens) and the machine simply takes too long to get there.
Auto adjusting is great but sometimes we have to help it work to its best potential with some help with the starting point.
If auto mode set to 4 to 20 worked so great then we wouldn't need titration studies or anything like that...we could just give everyone an apap and leave it at the factory defaults (the 4 to 20) and never worry about anything....but in real life it simply doesn't work out that way.
You need to do a lot more studying up on how the auto modes work, what they were designed for and the limitations that come with auto mode as well as real life experience messing with theories. It's never black and white.
Not to mention the response time of different brands and the different algorithms each brand might be using.
You've got a lot to learn.
And as for people here dissing doctors...they wouldn't be here if their doctors or medical care team had done a good job in the first place. They don't have much faith in doctors because their doctors haven't earned it.
Respect is earned...pure and simple. It's not a given.
If doctors did their job well....there would be no need for a forum like this.
And yes...please start your own learning topic about all this stuff instead of hijacking other threads if you want to continue the discussion and name calling.
I won't allow helping threads to be derailed by name calling crap. Annoys the hell out of me and no one wants to annoy me because I can do something about it. Fair warning.
Re: Increase in AHI
Posted: Mon Jan 13, 2020 10:19 am
by Jonty
almostadoctor wrote: ↑Mon Jan 13, 2020 9:51 am
I hear a lot of people talk about changing minimum rates on auto machines on this board. Is there something I'm missing? I've studied ResMed "auto" algorithms and the minimum rate is meaningless as long as the maximum rate is within a therapeutic range. This is because the "auto" function studies each cycle of the flow curve, and looks for apneic "mouse bites" in the top of the inspiration. Whenever it sees these, it raises the base pressure (notwithstanding the expiration relief) until the inspiration cycle is full.
Thus, the minimum rate you set shouldn't affect apnea events. I believe it is there specifically to establish a comfortable baseline while you fall asleep. As soon as you fall asleep and your throat is likely to start obstructing, it raises the base pressure to one that prevents the airway obstruction.
So if you raise the minimum, all this will do is make it more difficult to fall asleep.
Does anyone have any specific information to the contrary?
I can only go off what i have been told / by people who have much more knowledge and experience than i do - so therefore based on that i will/ have increased my start pressure to 6 - if i have issues i will reduce it again - so no loss
hopefully this will help all round
Re: Increase in AHI
Posted: Mon Jan 13, 2020 10:29 am
by Pugsy
It's quite common for people to need more pressure (and sometimes a LOT more) when they are on their backs compared to on their side.
I suspect you will need more than 6 minimum to deal with the supine events. It's a good start though. You might get lucky.
You could try to stay on your side more but that's easier said than done for a lot of people. It is an option though.
There's a lot going on with you when you see the machine nearly maxing out trying to prevent the OAs....there are all those centrals/CAs that are troublesome. They very well could just be post arousal centrals because of all the OAs happening and disturbing your sleep.
For that reason I still would want to see the OAs reduced first and then worry about the centrals later if they are still numerous.
So I agree more minimum pressure is needed to deal with the supine related pressure needs...how much more is yet to be determined but I wouldn't be surprised to see that it needs to be even higher.
Re: Increase in AHI
Posted: Mon Jan 13, 2020 10:47 am
by almostadoctor
Dog Slobber wrote: ↑Mon Jan 13, 2020 10:04 am
almostadoctor wrote: ↑Mon Jan 13, 2020 9:51 am
I hear a lot of people talk about changing minimum rates on auto machines on this board. Is there something I'm missing? I've studied ResMed "auto" algorithms and the minimum rate is meaningless as long as the maximum rate is within a therapeutic range. This is because the "auto" function studies each cycle of the flow curve, and looks for apneic "mouse bites" in the top of the inspiration. Whenever it sees these, it raises the base pressure (notwithstanding the expiration relief) until the inspiration cycle is full.
Thus, the minimum rate you set shouldn't affect apnea events. I believe it is there specifically to establish a comfortable baseline while you fall asleep. As soon as you fall asleep and your throat is likely to start obstructing, it raises the base pressure to one that prevents the airway obstruction.
So if you raise the minimum, all this will do is make it more difficult to fall asleep.
Does anyone have any specific information to the contrary?
Why don't you start your own topic to discuss this, instead of hijacking other peoples topics?
I'm not "hijacking" this topic. It's completely on topic.
And to answer your question, I'm posting it because people on this topic are advocating tampering with machines in ways that can be harmful to people's health.
Re: Increase in AHI
Posted: Mon Jan 13, 2020 10:51 am
by Dog Slobber
almostadoctor wrote: ↑Mon Jan 13, 2020 10:47 am
I'm not "hijacking" this topic. It's completely on topic.
And to answer your question, I'm posting it because people on this topic are advocating tampering with machines in ways that can be harmful to people's health.
Yes you are, you are taking the discussion away from the OPs therapy and towards configuring machines.
If you truly want to discuss your points, like I said and re-enforced by the forums moderator, create another topic. I have data and graphs that support the position of modifying the minimum. But I'm not going to use this persons therapy topic to discuss it.
Re: Increase in AHI
Posted: Mon Jan 13, 2020 10:55 am
by Pugsy
almostadoctor wrote: ↑Mon Jan 13, 2020 10:47 am
And to answer your question, I'm posting it because people on this topic are advocating tampering with machines in ways that can be harmful to people's health.
You are detracting from the OP's issues...that's hijacking. Causing discord and crap talk which further takes the thread sideways.
You get to state your opinion....the others get to state their opinion....OP gets to choose whose opinion that they like the best.
Arguing about whose opinion is correct takes the thread sideways.
I get to decide what to do about it when threads start going sideways...I try real hard to keep them from going completely off the track.
When I tell you to start your own thread...and quit hijacking...I mean it.
If you are having trouble understanding why we give the advice we do....start your own thread with specific questions and do your arguing there.
We aren't going to stop advising changing the settings.....simply not going to happen because it isn't harmful and there are studies done proving that the patients won't hurt themselves doing it.
Re: Increase in AHI
Posted: Mon Jan 13, 2020 10:56 am
by Pugsy
Enough with the sideways chat...including my own. My apologies to the OP.
Any further sideways direction stuff will be removed.
Fair warning and only warning.
Re: Increase in AHI
Posted: Mon Jan 13, 2020 10:57 am
by almostadoctor
Pugsy wrote: ↑Mon Jan 13, 2020 10:15 am
almostadoctor wrote: ↑Mon Jan 13, 2020 9:51 am
Does anyone have any specific information to the contrary?
Yep.
The need to increase the minimum is to give the machine a better head start to get to where it needs to be in a timely manner in which to prevent the airway from collapsing in the first place.
Not try to fix something after it has already happened.
It does it's best work by preventing the collapse to start with....Prevention is the name of the game
We all know (or should know) that the machine doesn't do a damn thing while an apnea event is actually happening. It sits there and twiddles its little thumbs until the airway is open and the person is breathing freely.
It also can't go from 4 cm to 12 cm (if that is needed) in the blink of an eye. It takes a few minutes to get to where it might need to be and all the while it is traveling upwards the airway can be closing off...and the machine even stops traveling upwards while the airway is blocked....so you can have a lot of events actually happen while the machine is deciding what it wants to do.
The starting minimum of 4 ish...works well if someone might only need 8 ish pressures to hold the airway open.
Doesn't work out so great if someone needs higher pressures (like in the teens) and the machine simply takes too long to get there.
Auto adjusting is great but sometimes we have to help it work to its best potential with some help with the starting point.
If auto mode set to 4 to 20 worked so great then we wouldn't need titration studies or anything like that...we could just give everyone an apap and leave it at the factory defaults (the 4 to 20) and never worry about anything....but in real life it simply doesn't work out that way.
You need to do a lot more studying up on how the auto modes work, what they were designed for and the limitations that come with auto mode as well as real life experience messing with theories. It's never black and white.
Not to mention the response time of different brands and the different algorithms each brand might be using.
You've got a lot to learn.
And as for people here dissing doctors...they wouldn't be here if their doctors or medical care team had done a good job in the first place. They don't have much faith in doctors because their doctors haven't earned it.
Respect is earned...pure and simple. It's not a given.
If doctors did their job well....there would be no need for a forum like this.
And yes...please start your own learning topic about all this stuff instead of hijacking other threads if you want to continue the discussion and name calling.
I won't allow helping threads to be derailed by name calling crap. Annoys the hell out of me and no one wants to annoy me because I can do something about it. Fair warning.
You make some good points. But in some of them you're ignoring man-years of scientific research and FDA risk mitigation.
I take issue with you saying I'm name-calling. I have not done that at all. People on this topic have bad-mouthed doctors. You did so above.
If you want your doctor or medical team to do a better job, ask them. Repeatedly. Go to an obudsman in your clinic or medical plan. File a formal grievance. I have had to do all of these, and I get better service. And not just for me but for everyone who comes after me because I have taken the effort to improve the system instead of just complaining.
If you keep advocating hacking machines in ways that may not be FDA approved, you could threaten people's health.
If you want to throw me off this board, and think you can, go ahead. But I'm not the one threatening users, threatening health, and using profanity on this board. You are.
Re: Increase in AHI
Posted: Mon Jan 13, 2020 11:12 am
by Pugsy
almostadoctor wrote: ↑Mon Jan 13, 2020 10:57 am
I take issue with you saying I'm name-calling.
I never said you were the one doing the name calling...did I?
My warning wasn't just for you...it was for some others and they know me and understand....it's not the first time they got the "get back on track" message.
If you don't like it here....go somewhere else but you aren't going to come here and change the way this forum does anything.
Yes...I could stop you from posting but I really don't like doing that. I would rather you just sit back and maybe do more reading and learning and not typing but that probably won't happen.
And as for my profanity....you ain't seen nothing yet and this was the kids version you saw from me.No
The forum owners are really big into free speech here...in all forms.
Start your own thread and you will see the gloves come off.
Now....this is indeed the last discussion about your unhappiness with how we do things here.
If you comment again about anything not related to the OP....it's simply going to be removed...no warning...just poof...gone.
Re: Increase in AHI
Posted: Mon Jan 13, 2020 11:15 am
by LSAT
Hey Almost doc...If the machine you have listed is really the machine you are using..it's a brick..Limited usable data to monitor your therapy. If you are using the CPAP model, no wonder you don't know what is happening.