Are Most People on Auto?

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elsueno wrote: ↑

Fri Feb 19, 2021 2:37 am

(Pugsy, sometimes I make my text larger than usual because my retinas are a bit messed up [9 eye surgeries including 4 retinal surgeries]. That way I can proofread before I post. Usually, I simply compose my stuff in a word processor and post using the default size. But sometimes, when I type things in directly, I forget to put the font back to normal size before I post. Or it seems ok to just leave it bigger. My mistake, I’ll try not to do that ever again at your site. As for the bolding/italicizing of parts of the text, well, in the world, some people like bold or italics in places for emphasis, especially if they are skimming content. But clearly, YMMV, I mean YMMV, so again, I’ll try not to do that if I ever post here again.)

Okay...you compose in large text because you need to...I can understand that. The problem is I have got a large number of complaints about it and that is because in the past we did have some trolls who did it just to yank chains so people sort of get irritated easily about it. You would have just had to been here and "enjoyed" it to understand the reaction.

In the future if you compose in large text and forget to change things back....don't worry about it as I can fix it so it won't annoy the others so much. I have already done that with some of your posts....but all I did was change the font size...I never messed with color or bold or italics.

It is quite acceptable to use "bold" or "italics" or even a small increase in font or isolated color change to accentuate a word or collection of words...so that's not a problem. It's when we have massive large text and weird colors all over the place that it gets under people's skin and they get testy.

It is fine to have discussions about "hot" topics but it would have been probably better to start your own thread instead of hijacking someone else's thread....that's sort of forum etiquette around here. Even though I know you are essentially sort of only wanting to further the discussion that the OP started...she didn't go there...it's her thread and forum etiquette is we don't hijack other people's threads unless maybe the OP either wants it to go there or they got all they needed and it's not important. We have a lot of threads go off track....more than threads than stay on topic if truth be known but in general if the person started the topic/thread and is still currently involved....we try to stay on topic. This here....man... it's a gray line and part what makes my job here not an easy job. It's not always black and white.

The fixed vs auto adjusting discussion has been around since the beginning of auto adjusting algorithms. You can find old and new stuff documenting both sides of that coin all over the internet....if anyone looks hard enough they can find someone somewhere who writes something that justifies a person's own personal opinion. It is what it is and it all boils down to personal opinion of whomever is doing the writing or the research or whatever.

You seem to think that AHI of 0.0 means your therapy is the best it can be and thus more advantageous to someone's overall health and since you use fixed pressures that is it is healthier overall to get those results and your overall health is very important to you.
If it were that critical don't you think maybe that line in the sand for diagnosing and treating might be a lot lower than the AHI of 5???
There are many reasons to not use this 0.0 AHI as a goal or proof of anything....

My opinion ....and that's all it is...my opinion, is sleep itself is my primary goal because without good sleep none of this matters.
I can get an AHI of 0.0 and sleep horribly from other reasons outside apnea...and I still feel like total crap but it's not my machine settings or anything related to the therapy. We all know that without good sleep everything goes to hell in terms of our physical and mental health and how we feel. IMHO...I think that a lot of people expect the cpap/apap/whatever machine to fix all their problems and have unrealistic expectations of what minor setting difference can do to fix all their problems....these machines fix airway related problems ONLY. They don't/can't fix problems with sleep that are unrelated to the airway. Having an AHI of 0.0 just means they didn't have enough airway related events happen, that met criteria for a flag, show up. Doesn't mean they slept good though and sure as hell doesn't mean they felt the good numbers.

We do seem to be a numbers oriented society though in terms of evaluating anything to prove that we are doing well.
We seem to have a problem factoring in subjective feelings though. AHI of 0.0 doesn't mean squat if we don't sleep well and there is a mile long list of reason why we don't sleep well that are all totally unrelated to the airway/apnea issue.

You do come across as thinking that the fixed pressure way of doing things is the "right" way to do it...you may not have intended that to happen but that's what came across and you used your own AHI of 0.0 report to "prove" it.

I don't have the time or desire to go finding documentation that you seem to need to "prove" anything to you because I already understand that there are no absolutes with cpap therapy (that old YMMV sticker). I am not going to do your homework for you. I learned a long time ago that most research and documentation is a bit jaded by the people doing the research or writing the papers using past research...they cherry pick data points to validate where their initial thoughts might be. They cherry pick data points to prove their own goals or personal opinions.

Me...I tell people that their mileage might vary and simply offer the option of trying something else to see if it helps or not because I know that they may or may not be the "norm". I let them do their own research because their own research is probably the best for THEM. Doesn't matter if it is better for me or you or joe blow next door.
Doesn't matter if the option is fixed vs auto adjusting pressures or using exhale relief or not using exhale relief or even the mask that they prefer. One man's treasure is another man's trash kind of thing.

So I won't debate you because I already accept the YMMV thing for everyone. I don't really care what mode someone uses or what mask they use or if they sleep standing on their head.
I don't think that fixed is simply better way of doing things...it sure isn't for me but I do recognize that it might be better for SOME people and that's fine.

My job here isn't to tell someone the "best" way or the "best" anything ....my job here is to try to help them optimize and be successful with whatever option or way of doing anything THEY decided they want to try.

Very well said pugsy.
You are the best.

JPB

I have been on APAP for a long time. More recently my main machine broke so I had to use my backup machine that only does straight CPAP. I actually feel better on it so when my new main machine arrived I kept the straight pressure. I wake up less in the middle of the night with straight pressure and my AHI numbers are fine with the straight CPAP pressure as well. I would try both and see how you feel with each.

Joel

For the most part, when I see people compare Fixed pressure vs Auto, and believe Fixed is performing better, they are comparing Fixed against a misconfigured or non-optimized Auto. And almost always, it's because the minimum pressure is too low.

• Not getting any triggers such as Hypopneas or Flow Limitations (on Auto) before experiencing complete obstructive events. Increase your minimum.
• Getting more Obstructive events on Auto than Fixed. Increase your minimum.
• You *believe* you are being disturbed by too much pressure, limit your maximum.

Auto mode, with the minimum set to what you would Fixed mode to be, will treat obstructive events identically to fixed, and be in a position to potentially prevent events that fixed can't.

Dog Slobber wrote: ↑

Fri Feb 19, 2021 11:49 am

For the most part, when I see people compare Fixed pressure vs Auto, and believe Fixed is performing better, they are comparing Fixed against a misconfigured or non-optimized Auto. And almost always, it's because the minimum pressure is too low.

Very true and often because the very people who we trust to prescribe these settings don't really understand how the machine responds and how the minimum is actually a critical setting. They think it is more of a plug and play situation and it simply isn't because they don't understand the response time limitations for auto mode especially when they just leave the settings at factory default and wonder why it doesn't do a good job preventing anything.
And then the people blame the pressure changes for disturbing sleep when there's a real good chance that the apnea event(s) not prevented well were the cause of the problems sleeping.

Pressure changes using auto mode don't happen very fast at all....several minutes to go both up and down. If someone is using any sort of exhale relief the pressure changes a lot more with exhale relief and much faster...yet we sleep through that just fine.
But we have a problem sleeping through a 2 cm change that takes place over 4 minutes????? Sorry but it just doesn't jive to me unless the more pressure causes a leak which in turn causes a wake up.

Happens all the time though...the machine increases the pressure in an effort to prevent impending airway collapses it senses is happening but it doesn't prevent because too long of a response time...the events happen anyway...wake ups happen and the pressure change gets the blame for the wake ups when it was the events themselves that caused the wake ups.

Hell...if all we needed to do was prevent all events...dispense a machine set to 20 cm fixed for everyone and it will pretty much kill the bulk of all obstructive events. No need for follow up because 20 cm should hold the airway open for the bulk of the people all night long. Never mind the problems that could come from using a fixed higher pressure all night that could be prevented by using less pressure for part of the night. I can just see the bitching now....Some people think it is impossible to exhale against 6 cm...just try 20 cm and see how much fun it is. It's like the Richter scale...The higher you go the multiples of worse it gets.

A person can get just as good of results using auto mode if they do like DS has said...use an optimal minimum pressure for the bulk of the night and let the machine auto adjust for the outlier stuff...like in my case my REM pressure needs which are substantial.
I sure as hell don't relish using 15 or 16 cm all night long just to deal with the 20% of the time I am in REM and might need so much pressure.

Finally the mind is a powerful tool....that's why placebos actually work for some people. They think it works so it works.
If someone thinks or strongly believes something works better....it probably will. If getting AHI of 0.0 makes a person think like they feel like superman/woman...that's wonderful. I am envious. I wish it were that easy.
The best day I have ever had followed a night with AHI 10.4....to this day I tell people if I could have that feeling every day following a night of 10.4 AHI I would gladly take it.

cpapgirl1318 wrote: ↑

Thu Feb 18, 2021 10:04 am

Hello everyone. Just wondering if most people are on auto pressure (sorry not sure of exact name) with a range or one fixed pressure. Just wondering why somebody may be on one fixed pressure as opposed to a range.

Some people have convinced themselves that having pressure cranked up high enough to stop all their apneas is better than letting a machine handle exceptions and have a lower pressure much of the night.

cpapgirl1318 wrote: ↑

Thu Feb 18, 2021 10:04 am

which seems like such a big change.

It's not. but it'd probably be better to stick with a min pressure of 7.

cpapgirl1318 wrote: ↑

Thu Feb 18, 2021 1:51 pm

Pugsy I literally just sent you a PM! Thanks for your reply. Do you think it’s odd the sleep doc put it down to 5 when my fixed was 7?

Many sleep doctors aren't competent to set pressures, which is why this forum exists.

Pugsy wrote: ↑

Thu Feb 18, 2021 5:02 pm

Hey EL Sueno....lose the fancy bold and huge text.....it's annoying as hell.
[totally justified comments]
Have a nice day.
(also justified)

Did you notice the PS of 8 elmoutho has? yeesh.

cpapgirl1318 wrote: ↑

Thu Feb 18, 2021 11:49 pm

Well the sleep doctor put in the order for the APAP for 5-15 and I was told it will take 48 hours to set it by the DME so I just changed it myself and wow!!! 5 and even 6 does feel like suffocating. So I just set it 7-15 since 7 has been my fixed pressure.

Go you!

palerider wrote: ↑

Fri Feb 19, 2021 8:28 pm

Pugsy wrote: ↑

Thu Feb 18, 2021 5:02 pm

Hey EL Sueno....lose the fancy bold and huge text.....it's annoying as hell.
[totally justified comments]
Have a nice day.
(also justified)

Did you notice the PS of 8 elmoutho has? yeesh.

Yep...sure did. I cringed but he's not asking for help or complaining and in fact is extremely proud of his 0.0.
Maybe there is a medical reason for it...wouldn't be impossible for there to be a need for it.
So I kept my mouth shut....for once. at least about that little tidbit.
If he's happy with his results....far be it for me to say anything....suspect it would fall on deaf ears anyway. I got enough to do as it is...I think Ralph is trying to sneak back in...I got at couple of questionable new account posts sitting in queue I need to decide on.
Ralph is using a VPN so it's harder to spot him at first until he sneaks in and shows his wonderful personality and makes my BP rise.

elsueno wrote: ↑

Fri Feb 19, 2021 2:37 am

OK one more time, my last post on this thread.

Promise? or will you be like so many others who regretfully renege on their promises and keep annoying people who know better.

elsueno wrote: ↑

Fri Feb 19, 2021 2:37 am

If this doesn’t end well, then sayonara, good luck to all. Sincere apologies to the OP for taking this a bit off topic.

then why do it MORE?

elsueno wrote: ↑

Fri Feb 19, 2021 2:37 am

(Pugsy, sometimes I make my text larger than usual because my retinas are a bit messed up

Sorry about your eyeballs, but that's no reason to assault OUR eyeballs. Just make the fonts bigger on your computer and leave us alone.

elsueno wrote: ↑

Fri Feb 19, 2021 2:37 am

more offtopic crap

"I apologize for dragging the thread offtopic but I'm going to do it again because I'm not really sorry or apologizing".

Dog Slobber wrote: ↑

Fri Feb 19, 2021 11:49 am

[*]You *believe* you are being disturbed by too much pressure, limit your maximum.[/list]

Actually, I'd probably suggest "increase the minimum" for that one too, because it means the machine is having to go up too high to try and head off what it should have been configured to take care of anyway

Pugsy wrote: ↑

Fri Feb 19, 2021 8:34 pm

I think Ralph is trying to sneak back in...I got at couple of questionable new account posts sitting in queue I need to decide on.
Ralph is using a VPN so it's harder to spot him at first until he sneaks in and shows his wonderful personality and makes my BP rise.

Good luck with that, we all appreciate (or damn well should for those that are unappreciative jerks) the fact that you're here, at the castle gates, trying to keep out the barbarians.

THANK YOU!

(Now I have this image of Pugsy in armor with a big sword, just looking to skewer someone.)