Wide vs. Narrow Pressure Ranges (APAP)

Dog Slobber wrote: ↑

Mon Jul 18, 2022 11:15 am

This discussion between Tec5 and DogSlobber all centers around the assertion (by Chunkyfrog) that cpap " machine cannot possibly react quickly enough " .

If it were true that Cpap machines cannot react quickly, one would expect that some medical researcher somewhere would have studied that.
It is also reasonable to suggest that the manufacturers of Cpap equipment would have used that claim as a marketing tool.

So, is there any evidence that Cpap machines are slow to react. I've offered an example of reaction time to a Flow Limitation that is unencumbered by other factors. It seems to me that a 3 second reaction time is pretty darn good. DogSlobber suggests that the reaction to the FL is -6 seconds, again pretty darn good. (Tec5 can argue that reacting before the event is neigh impossible- but that's a different discussion.

Regardless of whose position you would take ( +3 or -6 seconds) both are quick enough reaction times.

The burden (if there is one ) is on those that claim that Cpap machines cannot react quickly.

dataq1 wrote: ↑

Mon Jul 18, 2022 3:12 pm

DogSlobber suggests that the reaction to the FL is -6 seconds, again pretty darn good. (Tec5 can argue that reacting before the event is neigh impossible- but that's a different discussion.

Regardless of whose position you would take ( +3 or -6 seconds) both are quick enough reaction times.

Please point out where I made the claim that the pressure was increased before the flow limitations occurred. In fact I've denied making any claim of the sort, multiple times.

Stop lying.

At 3:39 on 7-17-22 Dog Slobber stated: "measured pressure begins to increase at 05:09:46"

In that same post Dogslobber displays the FL graph that indicates the FL began at 05:09:52

05:09:46 - 05:09:52 is negative six seconds ( - 00:00:06)

As in six seconds BEFORE the FL; as in six seconds in advance of the FL.

viewtopic/t184709/Wide-vs-Narrow-Pressu ... l#p1416038

dataq1 wrote: ↑

Mon Jul 18, 2022 5:35 pm

At 3:39 on 7-17-22 Dog Slobber stated: "measured pressure begins to increase at 05:09:46"

In that same post Dogslobber displays the FL graph that indicates the FL began at 05:09:52

05:09:46 - 05:09:52 is negative six seconds ( - 00:00:06)

As in six seconds BEFORE the FL; as in six seconds in advance of the FL.

viewtopic/t184709/Wide-vs-Narrow-Pressu ... l#p1416038

Yes, and it's you who then interpreted that as a reaction to the FL of -6 seconds.

dataq1 wrote: ↑

Mon Jul 18, 2022 3:12 pm

DogSlobber suggests that the reaction to the FL is -6 seconds

I also made it clear that it was the value as measured by the machine.

I never said or suggested that it was a reaction to an event that happened 6 seconds later. That is absurd, and if you had a grain of ethics you would retract that I said or even suggested as much.

Dog Slobber wrote: ↑

Mon Jul 18, 2022 6:35 pm

That is absurd

For sure that's one thing that we can agree on; it is absurd to adhere to a position that the machine's reaction (increasing the turbine speed to bump up the pressure) was a result of an event that that had not yet been detected. The only alternative plausible explanation for that scenario would be that the Oscar graphs are out of sync.

However, I've told, and showed you that the period prior to FL bump at 05:09:52 was quiet, there was nothing else going on, no FLs, no apneas, no hypopneas, no snores, no leaks.

From the graphs, it appears that the ONLY thing that was observed was a FL bump at 05:09:52.
Earlier you had suggested " there could have been FLs measured at 0.2, or 0.1 or 0.05. Large enough to trigger a pressure increase, but not large enough to be represented on a trace at that level of granularity." So I increased the resolution of the FL graph to demonstrate that the FL was on a steady course of zero FLs.

Admittedly, this is just one example of where the pressure was increased, in an apparent reaction to the FL bump, in a prompt fashion (whether that promptness is 3 seconds or -6 seconds).
Fortunately, it is an example that is devoid of confounding events. It shows the machine's capability to react quickly.

So, I question the validity of the notion that these machines are incapable of reacting quickly, that's all.

I will not engage you in a personal attack battle, despite your efforts to provoke a flaming war.

dataq1 wrote: ↑

Mon Jul 18, 2022 8:58 pm

For sure that's one thing that we can agree on; it is absurd to adhere to a position that the machine's reaction (increasing the turbine speed to bump up the pressure) was a result of an event that that had not yet been detected.

Yes, and that's one of the reasons why I never said it reacted to flow limitations that hadn't happened yet.

Why did you say that I did?

dataq1 wrote: ↑

Mon Jul 18, 2022 8:58 pm

The only alternative plausible explanation for that scenario would be that the Oscar graphs are out of sync.

If you believe that the graphs are out of sync, then why are you claiming I believe that
Actually there are other explanations as well. I stated as much, but all you care about is lying about me saying something I never said.

dataq1 wrote: ↑

Mon Jul 18, 2022 8:58 pm

However, I've told, and showed you that the period prior to FL bump at 05:09:52 was quiet, there was nothing else going on, no FLs, no apneas, no hypopneas, no snores, no leaks.

You never showed that there was no snores.

And after you demonstrated that there were no events, did I dispute it. No, I didn't. I even took the position that if they were out of sync, the likely inaccurate time was the flow limitations.

Here's a pressure increase that occurred in June. The machine measured the pressure increase started at about 5:58

There is zero activity before the increase, no FLs, no Hypopneas, no Snores, No OAs.

There is an OA about 14 minutes after.

Since there was no activity before, are you alleging that the pressure increase never happened until the OA at about 6:13?

And me stating that the pressure increase started at 5:58. Am I stating that the machine is reacting to an event in -14 minutes.

No.

But, yet that's what you and Tec5 did in this thread.

Yeah...and it's giving me a massive headache. Everything has gone to hell and another pissing contest has popped up.
I am of the opinion that original topic and discussion has lost any educational value and it's a hair away from getting locked.
He said, you said, he lied, you lied...that's all I see here. Nothing useful at all.

To all participants....knock it off please. You are disrupting the forum with the infighting.

This is the only warning...further comments about comments meant to disparage someone else and take original topic off the rails ...will be dealt with swiftly and you won't like what I do.

Time to move on folks and go fight about something else. You beat this dead horse to death one too many times.

No...no one is discussing any technical aspects at this point in this "discussion"...each person's point has been made multiple times and there simply isn't a 100% known for sure answer as to what happened when the machine in question increased the pressure. SOMETHING HAPPENED but whatever it was...it can't be seen on what we have available to look at.
What is so hard about understanding that fact...accepting it and moving on???? Move on folks.

Move on...call up ResMed and ask them....go look up the ResMed auto algorithm patent in detail....ask your doctor....quit the comments about comments...in other words STFU.

Questions are being asked that there are no answers to...move on. Fighting is going on that leaves a bad taste in other peoples mouths.

ResMed never meant the detailed data that we CAN see to be the answer to all the world's problems or questions...or in this case how the auto adjusting algorithm works in very minute detail. Ever think that maybe we don't see everything on the reports we can get????
It was never meant to be looked at when examining under the microscope like this.

Repeatedly asking or stating the same thing over and over again....that's spammy and highly annoying and will be dealt with as all spam is dealt with.

You haven't got an answer to your question because no one here knows the answer.
Move on....go to another forum and ask your questions and see if someone there knows an answer or wants to hazard a guess.
All the rest of us see is the he said she said he lied and I am calling you out on it....because that's all anyone can talk about when there are no answers available to a question.

The back and forth between you guys and DS...that stops right now....all of you...shut up...drop it...move on.

Some people just won't shut up.....even after I asked nicely.

This thread is now locked and you guys and gals can take your discussion private if you want to continue it...or go ask your question at another forum.

Don't go starting a new topic to continue the whining....it won't last.
Don't go pulling the passive/aggressive BS either. I see right through it.

Move on.

My inbox is full of complaints about this thread....causing me extra work and we all know how I feel about extra work.

Find something else to "talk" about or STFU.

Thank you all for lessening my work load and cooling off the temperatures here.

Give me a bit of time and I will clean up this thread and remove the remarks that were fanning the flame war and pissing contest....then I will unlock the thread. I will be seriously editing this thread.....it's either that or I just remove it.

When I do...the first "he said, she said" I see and bitching....will result in the entire thread being removed.
So be careful what you say.

Won't be tonight....I have other stuff to do.

Thread is now unlocked.
I removed the bickering between some people that were IMHO not helpful at all in this thread.
If you don't see your posts...I felt non helpful and intended to just be a thorn in someone's side.
Don't agree??? Tough.

Don't anyone go down the he said road. If the question can't be answered then just don't say anything if you don't have documented proof of your response. Don't go making comments about other people's comments either.

If you don't listen to me...expect your posts to be removed or edited.
All this bickering and infighting is just giving the overall forum a nasty look and I won't have it.

To Tec5....stay out of it. Your response(s) is what got the thread locked in the first place. You aren't being helpful at all.
Move on to something else to try to start a fire and disrupt things.

To everyone....there is no need to point out that so and so is being an asshole....we all can see it for ourselves and make our own determinations. All it does is promote a flame war and another pissing contest and derail threads.

To Dataq1....your question has been asked and I admit not really answered to your satisfaction....probably because there is no answer that will satisfy you. Unless someone new comes along with a new idea...move on...I doubt you will ever get an answer that will satisfy you.
Don't go try to explain things again, again and again....we all know it and see it.
Wait patiently for someone other than DS or Tec5 to offer an idea or not offer an idea because no one can answer your question. Accept the fact that you may not get an answer.

Either that or call up ResMed or take your need for 100% proof of anything to another forum.
Sometimes you just don't get what you want because your wants are unrealistic.

And please....everyone...no comments or whatever about my comments here.
Comments about comments....will be promptly removed as soon as I see them.
You will stay strictly on topic or your replies will be removed...and in case anyone has forgotten the topic is wide vs narrow pressure range with a side question about dataq1 seeing the pressure increase when no one can see why it increased.
Impossible to answer that question because we don't have access to what drives the auto adjusting algorithm in minute detail.

Move on unless you want to stay strictly on topic and provide real helpful answers with proper documentation.

Pugsy wrote: ↑

Wed Jul 20, 2022 7:17 am

To Dataq1....your question has been asked and I admit not really answered to your satisfaction....probably because there is no answer that will satisfy you. Unless someone new comes along with a new idea...move on...I doubt you will ever get an answer that will satisfy you.

Respectfully, it seems that there is a misunderstanding on what I was driving at. I do not have a question about WHY there is a slow response to a Flow Limitation, if true that question can only be satisfactorily answered by Resmed.

The issue I raise is DOES the machine respond slowly. If it does respond slowly, that should be evident to folks who look carefully at their OSCAR graphs, particularly under those conditions when there are no other confounding activities to cloud the timeliness of a pressure response.

I apologize if I wasn't sufficiently clear. My focus was on the "does it" rather than the "why does it".

Meanwhile I have finally gotten the paper that ElusiveSleep cited " Randomized short-term trial of High-span versus low-span APAP for treating sleep Apnea" and in the process of reading it carefully.

palerider wrote: ↑

Fri Jul 15, 2022 7:15 pm

The important thing is not this "range" it's the MINIMUM PRESSSURE that matters.

For most people. the max pressure, as long as it's high enough for your possible needs DOES NOT MATTER.

chunkyfrog wrote: ↑

Fri Jul 15, 2022 9:41 pm

I agree with Palerider, because with an unrealistically low starting pressure, (4 or 5)
the machine cannot possibly react quickly enough to prevent most apneas.
Many pappers need at least an 8 to give the machine a good starting point.

Perhaps a paraphrase of what chunkyfrog wrote will help:

When the pressure is too low, the machine cannot prevent apneas from happening. it will raise the pressure a bit after an obstructive event. When the next obstructive event happens it will raise the pressure again. And when things settle down it may eventually drop down to lower pressure that may let another obstructive event happen.
And so on.
If the minimal pressure is too low, more obstructive events happen. Note the text I highlighted in color: after the pressure drops, the machine monitors for recurring events. We don't want them to recur.

https://www.resmed.com/en-us/healthcare-professional/products-and-support/innovation-technology/ wrote: AutoSet™ algorithm
ResMed’s renowned and clinically proven AutoSet algorithm – one of the most clinically published algorithms in the field of sleep-disordered breathing – continually monitors each patient’s unique breathing pattern on a breath-by-breath basis, making automatic adjustments for comfortable therapy throughout the night.

When AutoSet detects an event, it doesn’t just apply a fixed pressure response, but instead assesses the severity of each event – whether it’s flow limitation, snoring or apnea – before determining and delivering the ideal, lowest pressure solution. After breathing stabilizes, AutoSet gradually decreases the pressure, while continuously monitoring for recurring events. Through it all, patients remain comfortable, receiving the pressure that’s right for them, at any given time – no more, no less.

And, because research shows that women with OSA experience more upper airway resistance and flow limitation, 1 we’ve designed a special AutoSet for Her algorithm that offers a more sensitive response. It also provides more subtle changes in pressure to minimize disturbance, and automatically adjusts the minimum pressure if multiple apneas occur below a certain threshold.

According to the above description, it's only the AutoSet for Her that "automatically adjusts the minimum pressure if multiple apneas occur below a certain threshold".

ozij wrote: ↑

Wed Jul 20, 2022 10:39 am

According to the above description, it's only the AutoSet for Her that "automatically adjusts the minimum pressure if multiple apneas occur below a certain threshold".

Yep...the for her autoset mode will create a new minimum pressure if criteria is met for the rest of the session anyway.
It's limited in what it will create but I have seen it happen myself when I used the for Her auto mode.
page 6 and 7 of the manual explains it
https://www.respshop.com/manuals/ResMed ... %20her.pdf

I actually think this is a good feature for a lot of people. Wish the other auto mode would do it.

Pugsy wrote: ↑

Wed Jul 20, 2022 10:49 am

I actually think this is a good feature for a lot of people. Wish the other auto mode would do it.

They only though of it later....

And thanks for the link - excellent info!