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The other point that RG gets at regarding exactly how much IPAP and EPAP is really needed drives the current philosophical split in sleep medicine regarding best methods for BiLevel titration.

I think those in the Rappaport corner look at statistical data across the patient population and observe: "There are way too many patients who actually require CPAP-equivalent pressures during EPAP to make that 'Lesser-EPAP-Pressure' method of BiLevel titration a best standard medical practice".

Yet there are equally wise proponents in the other corner looking at patients and efficacy on a case by case basis who probably observe: "Most patients coming through our sleep labs get by just fine with lower EPAP pressures when we titrate them and carefully monitor their respiration."

Is the glass of water half empty or half full regarding how patients as a whole fare with those lower EPAP pressures? For any given patient the beneficial EPAP pressure might turn out CPAP equivalent or much lower than CPAP equivalent (it all depends on where in expiration or inspiration those heavy obstructions manifest for any given patient). Based on what Titrator mentioned, it sure sounds to me as if most patients get by okay with lower EPAP pressures. Yet I'm sure some patients require CPAP equivalent pressures, and those are the exceptions Rappaport uncomfortably focuses on as an empirically driven research scientist. Yet his philosophical opponents are probably viewing the issue more as case-by-case sleep practitioners.

Thanks, SWS. Good points summing up the distinction between studying "sleep" as a whole and studying "sleep" in individual patients. I will admire the empirical research scientists. At the same time I'd hope to fall into the hands of a case-by-case driven practitioner!

rested gal wrote: At the same time I'd hope to fall into the hands of a case-by-case driven practitioner!

Amen to that! I'll choose the comfort-driven customized approach any day as well!

rested gal wrote: I will admire the empirical research scientists. At the same time I'd hope to fall into the hands of a case-by-case driven practitioner!

If one were cynical (and of course I'm not ) one might comment that the former tend to be motivated by the publication of papers & books that the latter don't have time to read

LDuyer wrote: ... I suspect the technology will improve faster than the understanding of the science. But what do I know?

I just read the following yesterday:

It seems that automatic CPAP is another example where technologic advances exceed clinical knowledge (23) because current automatic CPAP devices with selectable settings provide the physician with a sophisticated tool whose clinical effectiveness is still unknown.

Response of Automatic Continuous Positive Airway Pressure Devices to Different Sleep Breathing Patterns
in American Journal of Respiratory and Critical Care Medicine Vol 166. pp. 469-473,

So it seems like you do know...
O.

ozij wrote: So it seems like you do know...
O.

Gosh, thanks for that!
Maybe my prediction powers are better than I thought they were!

Hmmm.... what shall I predict next?

Thanks for the vote of confidence.



Linda