APAP adjustments

palerider wrote: ↑

Tue Apr 28, 2020 6:57 am

...
NO, that's not what it means *at all*.
https://adventures-in-hosehead-land.blo ... de-to.html
It means that for the entire night, pressure was at, or below 9cm.

It could have been at anything below the night for 94% of the time, and only been at 9 for a few minutes,
95% number is nothing but a statistic, like max pressure with any brief spikes dis-regarded, like how the olympics would throw out the top judges score (and bottom) and only count the middle ones.
...
You really shouldn't many *any* adjustments based on any of the statistical numbers, you should make adjustments based on what the pressure curves look like.

Thanks palerider!

I'm terribly imprecise. Apologies!

At the end there, it sounds to me like you're saying this is more of an art than a science. When you treat using the pressure curves in the lab, I'm curious if you use an algorithm to sort it or just eye it. If you are using an algorithm to determine preferred pressure settings, then it would be more of a science.

Chris

Chris..

I remember making that statement somewhere..... about feeling like the machine was breathing for me. It was too much minimum pressure. I lowered it last night from 7 to 6.5, much better, I'll leave it there for a few days. My AHI was 6.7. The flex setting is at 3, for me is comfortable.

Palerider said, not trying to demean here.... but be educated.

You really shouldn't many *any* adjustments based on any of the statistical numbers, you should make adjustments based on what the pressure curves look like.

pressure curves and leak rate.... what needs to be considered to adjust minimum pressure?

milboltnut wrote: ↑

Tue Apr 28, 2020 8:58 am

Chris..

I remember making that statement somewhere..... about feeling like the machine was breathing for me. It was too much minimum pressure. I lowered it last night from 7 to 6.5, much better, I'll leave it there for a few days. My AHI was 6.7. The flex setting is at 3, for me is comfortable.

Palerider said, not trying to demean here.... but be educated.

You really shouldn't many *any* adjustments based on any of the statistical numbers, you should make adjustments based on what the pressure curves look like.

pressure curves and leak rate.... what needs to be considered to adjust minimum pressure?

Not sure I'm helping here, milbotnut. I think I'm going to step back for a bit.

Chris

you don't agree?

or i should jusy tweek minimum pressures

DreamDiver wrote: ↑

Tue Apr 28, 2020 8:40 am

You say Flex is not trying to rush breathing. If you're asleep while it's happening, and your subconscious interprets the ...

If you're asleep, you will never know. Your "subconscious" doesn't control your breathing while you're asleep, your blood chemistry does.

DreamDiver wrote: ↑

Tue Apr 28, 2020 8:40 am

The effect is evident regardless of what the machine is trying to do, eh? For some like me, flex algorithms make you feel like you're running a marathon all night. I used to wake up feeling like I'd been doing crunches all night. Unfortunately it did nothing for my abs. I ended up hating the machine because you couldn't get exhale relief without an obnoxious Flex algorithm. Unfortunately, I'm not a fan of PR for so many reasons.

And for many others, it does not matter, don't cast your own experiences onto others. I'm not a fan of Philips Respironics either, but not because of *flex, that never bothered me.

DreamDiver wrote: ↑

Tue Apr 28, 2020 8:40 am

What would be interesting is getting a machine that would combine the best of both worlds. When someone is about to have a flaggable pressure-worthy event, use the PR flex style algorithm to entice the autonomic system to breathe a little better,

Unfortunately, nobody has invented a psychic machine, which is why every single machine *reacts*.

No matter what you want to think, *flex doesn't have the effect on unconscious breathing, if it did, you would see high RRs on the charts of everyone using it,and you don't.

DreamDiver wrote: ↑

Tue Apr 28, 2020 8:40 am

but then when things get more stable, smoothly switch back to standard ResMed EPR algorithm. Pressure-worthy events that occur after that small change would raise the pressure as usual. Now it starts to sound a little like some of the more expensive machines...

Chris

No, it doesn't.

DreamDiver wrote: ↑

Tue Apr 28, 2020 8:51 am

palerider wrote: ↑

Tue Apr 28, 2020 6:57 am

...
NO, that's not what it means *at all*.
https://adventures-in-hosehead-land.blo ... de-to.html
It means that for the entire night, pressure was at, or below 9cm.

It could have been at anything below the night for 94% of the time, and only been at 9 for a few minutes,
95% number is nothing but a statistic, like max pressure with any brief spikes dis-regarded, like how the olympics would throw out the top judges score (and bottom) and only count the middle ones.
...
You really shouldn't many *any* adjustments based on any of the statistical numbers, you should make adjustments based on what the pressure curves look like.

Thanks palerider!

I'm terribly imprecise. Apologies!

Not so much "imprecise" as plain wrong,and that's a problem when it misleads newbies.

DreamDiver wrote: ↑

Tue Apr 28, 2020 8:51 am

At the end there, it sounds to me like you're saying this is more of an art than a science. When you treat using the pressure curves in the lab, I'm curious if you use an algorithm to sort it or just eye it. If you are using an algorithm to determine preferred pressure settings, then it would be more of a science.

Chris

I'm saying that people that don't know what they're doing with pressure settings try to use some statistic to try and summarize an entire night, and that leads to poor results.

It isn't that simple.

Look at the nights pressure curve, see how the pressure behaved, does it look jagged? Does the pressure repeatedly spike up when it drops down to some point? If so, the min pressure is too low, and needs to be raised above that point where there are repeated events.

milboltnut wrote: ↑

Tue Apr 28, 2020 8:58 am

pressure curves and leak rate.... what needs to be considered to adjust minimum pressure?

Leak has nothing to do with it.

Palerider

min pressure is too low, and needs to be raised above that point where there are repeated events.

Thanks for the info it's greatly appreciated....

palerider wrote: ↑

Tue Apr 28, 2020 10:27 am

If you're asleep, you will never know. Your "subconscious" doesn't control your breathing while you're asleep, your blood chemistry does.

Your blood chemistry doesn't control your when you draw breath. Your nervous system does -- either consciously or otherwise -- via cues from blood chemistry. Potayto potahto.

palerider wrote: ↑

Tue Apr 28, 2020 10:27 am

And for many others, it does not matter, don't cast your own experiences onto others. I'm not a fan of Philips Respironics either, but not because of *flex, that never bothered me.

PR has poorly designed machines. We both said it. Pot calling the kettle black.

palerider wrote: ↑

Tue Apr 28, 2020 10:27 am

Unfortunately, nobody has invented a psychic machine, which is why every single machine *reacts*.

No psychic machines necessary. Artificial Intelligence and Neural Networking are the next evolution in CPAP tech. It's entirely possible a neural network could learn to anticipate a patient's each and every next event and adjust minimally to reduce or prevent the event. The problem lies in making it so the AI adjustments are limited to safe parameters and can be intentionally tweaked or turned off by the clinician or patient. Apparently there are already machines that do something like this, such as ASV.

ResMed wrote:ASV mode. The clinically published ASV algorithm constantly learns the patient’s unique respiratory rate and delivers pressure matched to patients’ breathing, adapting dynamically to their changing needs."

palerider wrote: ↑

Tue Apr 28, 2020 10:27 am

No matter what you want to think, *flex doesn't have the effect on unconscious breathing, if it did, you would see high RRs on the charts of everyone using it,and you don't.

Regardless of the wording I'm using -- my body reacts in a way that is beyond my conscious control when I'm asleep that causes my breathing to race when subjected the Flex algorithms. When I turned it off, the body aches and cramps stopped. Period. You don't forget that kind of muscle cramping or soreness or the lack of it when you cease using Flex. Instead of telling me how pathetically wrong I am, how about using whatever terminology you prefer to educate and clarify what you know I'm trying to say? And how about in a way that doesn't intentionally rub people's fur the wrong way?

palerider wrote: ↑

Tue Apr 28, 2020 10:27 am

No, it doesn't.

No, ASV is not AI. It only keeps a record of what's happened recently and forgets it all seconds later. But it's a first step.

palerider,

I am all about clarification and making things understood. I am willing to learn. I'm not willing to be pilloried because you slept poorly or ate a bad krumpet this morning.

I'm not sure why you're riding me so hard. If you prefer, please put me on foe. I actually enjoy your comments when you're not burning people in effigy. You're extremely well-versed in this subject, but most of us are still trying to learn. Some of us are still in the walking dead stage. Civility is a good thing. Compassion is even better. Please acquire a measure of each that will grant you some serenity and others peace.

Chris

Chris.....

Your blood chemistry doesn't control your when you draw breath. Your nervous system does -- either consciously or otherwise

They would call that, CA.... something about Co2 concentration... during that time? I think I remember the Pulmonary Dr... telling me the machine takes over?

Correct me if I'm wrong

milboltnut wrote: ↑

Tue Apr 28, 2020 11:32 am

Chris.....
They would call that, CA.... something about Co2 concentration... during that time? I think I remember the Pulmonary Dr... telling me the machine takes over?

Correct me if I'm wrong

It's been a while since I took the biology courses that covered this. Like you, I'm a little fuzzy on the details. Perhaps palerider will kindly elaborate.

Chris

DreamDiver wrote: ↑

Tue Apr 28, 2020 11:23 am

palerider wrote: ↑

Tue Apr 28, 2020 10:27 am

If you're asleep, you will never know. Your "subconscious" doesn't control your breathing while you're asleep, your blood chemistry does.

Your blood chemistry doesn't control your when you draw breath. Your nervous system does -- either consciously or otherwise -- via cues from blood chemistry. Potayto potahto.

Medical science begs to differ, feel free to stay ignorant though, if it pleases you.

DreamDiver wrote: ↑

Tue Apr 28, 2020 11:23 am

Pot calling the kettle black.

You don't seem to know what that saying means.

DreamDiver wrote: ↑

Tue Apr 28, 2020 11:23 am

palerider wrote: ↑

Tue Apr 28, 2020 10:27 am

Unfortunately, nobody has invented a psychic machine, which is why every single machine *reacts*.

No psychic machines necessary. Artificial Intelligence and Neural Networking blah blah blah

Once again, you don't understand.

ASV machines don't *learn* anything, no matter what marketing wank you find, they *react* to reductions in tidal volume as a central apnea sufferer starts to become hypocapnic and their respiratory drive decreases.

Talking about something that "may" happen in the future has no relevance in the here and now.

palerider wrote: ↑

Tue Apr 28, 2020 10:27 am

No matter what you want to think, *flex doesn't have the effect on unconscious breathing, if it did, you would see high RRs on the charts of everyone using it,and you don't.

Regardless of the wording I'm using -- my body reacts in a way that is beyond my conscious control when I'm asleep that causes my breathing to race when subjected the Flex algorithms. [/quote]
Oh? Where's your Oscar reports showing this elevated RR while asleep? I'm interested.

DreamDiver wrote: ↑

Tue Apr 28, 2020 11:23 am

palerider wrote: ↑

Tue Apr 28, 2020 10:27 am

No, it doesn't.

No, ASV is not AI. It only keeps a record of what's happened recently and forgets it all seconds later. But it's a first step.

It would be nice if there were machines that would *learn* and auto adjust, but there are no such things on the market, ASVs need to be adjusted to people's needs for optimal performance, just like all machines.

DreamDiver wrote: ↑

Tue Apr 28, 2020 11:23 am

palerider,

I am all about clarification and making things understood. I am willing to learn. I'm not willing to be pilloried because you slept poorly or ate a bad krumpet this morning.

I'm not sure why you're riding me so hard. If you prefer, please put me on foe. I actually enjoy your comments when you're not burning people in effigy. You're extremely well-versed in this subject, but most of us are still trying to learn. Civility is a good thing. Please acquire a measure that will grant you some serenity and others peace.

Chris

Simple, you're posting *wrong* and misleading information, and the needs to be corrected.

If you're "trying to learn", then by all means, do so, but stop talking about things you don't understand.

You mentioned the for list, feel free to use it.

milboltnut wrote: ↑

Tue Apr 28, 2020 11:32 am

Chris.....

Your blood chemistry doesn't control your when you draw breath. Your nervous system does -- either consciously or otherwise

They would call that, CA.... something about Co2 concentration... during that time? I think I remember the Pulmonary Dr... telling me the machine takes over?

Co2 makes the blood more acidic, which leads to acidosis if not blown off by respiration. So as the co2 level of the blood increases, your respiratory drive increases.

If your co2 level is low, your respiratory drive decreases, to the point of your body not feeling the need to breathe, until your co2 goes back up.... And if that lasts for 10 seconds or longer... Central apnea.

For instance, if you take a number of deep breaths, and then hold your breath, you feel no urge to breathe for a while, then it becomes uncontrollable, and you *have* to gasp for breath.

Many people think that's because of low oxygen, but if you wear a oximeter, you most likely not notice any drop in your SpO2... It's the co2 buildup.

palerider wrote: ↑

Tue Apr 28, 2020 11:54 am

Simple, you're posting *wrong* and misleading information, and the needs to be corrected.

If you're "trying to learn", then by all means, do so, but stop talking about things you don't understand.

You mentioned the for list, feel free to use it.

Negative reinforcement is a poor educational device.
People respond better to positive reinforcement.
They learn better and they react better.

Continuing to use negative reinforcement in light of the knowledge that positive reinforcement is a better educational tool is not a logical behavior.

You make people feel bad about themselves. It's obvious you don't care. Are you here to help people or do you simply enjoy making people feel bad?

Chris

Since this is my thread, I guess I can go off topic.

Would you say, Palerider, that blood chemistry transferring brain impulses to the lungs, is likened unto electrolytes transferring voltage, from one plate to another.. positive to negative, in a car battery?