UARS: A Critical Link to Optimizing PAP Therapy Results

DreamStalker wrote:......he is fixated/programmed on some "establishment" out to get everyone ........:

Hmmm?

Will check out Dr. K's site today

I did that yest and looked at the videos. Very useful especially his personal details bit.

Ms Piggy wrote:
from RG
Dr. Krakow's points have also included that "feeling good" is relative to how one felt before. If flow limitations remained after titration, perhaps one could feel even better if those were addressed.

I set my machine back to auto mode but with a very narrow range (8.5-9.0) so it would show flow limitations. (It only shows them in auto mode). I did have a number of flow limitations. I'm not assuming my machine is catching all UARS-type events when it scores a flow limitation. At least that's how i'm interpreting what I read here. When my range was wider before, I started getting a few centrals at pressures of 10 or greater, so I backed the pressure off. My AHI is generally 1.0 or less at a pressure of 9.0. I do have a doctor who has been working with me on this, but he's a GP, not a specialist.

I'm wondering if my sleep could be better. It's much better than it was, of course. I would describe this as moving from brain fog where I absolutely could not think in the late afternoon or evening. I'm thinking a lot better, but my brain is still not great. I've had some times when it was, but mostly it's not quite there.

This has been a valuable thread. Thanks, Dr. Krakow for the great perspective, and thanks RG and others for the helpful discussion of bi-level machines. I think I'm understanding them better than I used to. Not sure if a bilevel would work for me, but that would be the purpose of the re-titration, no?

Plus, I have a family member awaiting his sleep study. I'm sure he has very severe apnea, given his wife's description of his sleep. My guess is that he may be a likely candidate for a bilevel machine because of the severity of the problem. I'm hoping they will do a good job with his study. I'm going to discuss the bi-level machines with him so he understands and gets a good machine that he can track his own data. He's very interested in doing so.

Rested Gal, thanks to all the info you provided, I think I finally figure out how the EPAP setting in bilevels work.

Problem: My titrated pressure is 16. Tech guy fixes my pressure at 16 with a straight CPAP. But I couldn't breathe at 16. I need to lower it to 10 to breathe. How am I going to do this?

Solution: I get a bilevel . but how a bilevel's gonna help me? I'm still stuck between a rock and a hard place: I need to set my EPAP at 10 to breathe; But if I go with 10, all apnea hell starts to break loose since I need at least 16 to suppress them.

So the mystery thus far is how a bilevel set at 16 EPAP could let me breathe at 10, 6 lower than my minimum, but still surpress my apnea just like my old CPAP setting at 16?

It's really no magic. Just simple physics. Picture me and my bilevel blowing into a baloon which needs 16 cmH2O to stay inflated. To keep the baloon stays inflated, the bilevel can blow 16 all by itself or the bilevel can blow at only 10 while I supply the other 6 to keep the total at 16.

Same thing happens with the EPAP setting. It sets at 16 but the machine actually blows at only 10. My own exhaling provide the other 6. That way I can breathe comfortably against 10 and still maintain a total 16 to suppress the apnea.

Please reckon that is only general concept as dictated by physical law. I'll leave it to other experts/luminaries in the forum to give the verdict on this.

if he goes into the study demanding a bipap machine without qualifying for one per his insurance guidelines it will do no good. IF he's normalized on CPAP, what would be the need for a BiLevel machine?

Anonymous wrote:Rested Gal, thanks to all the info you provided, I think I finally figure out how the EPAP setting in bilevels work.

Problem: My titrated pressure is 16. Tech guy fixes my pressure at 16 with a straight CPAP. But I couldn't breathe at 16. I need to lower it to 10 to breathe. How am I going to do this?

Solution: I get a bilevel . but how a bilevel's gonna help me? I'm still stuck between a rock and a hard place: I need to set my EPAP at 10 to breathe; But if I go with 10, all apnea hell starts to break loose since I need at least 16 to suppress them.

So the mystery thus far is how a bilevel set at 16 EPAP could let me breathe at 10, 6 lower than my minimum, but still surpress my apnea just like my old CPAP setting at 16?

It's really no magic. Just simple physics. Picture me and my bilevel blowing into a baloon which needs 16 cmH2O to stay inflated. To keep the baloon stays inflated, the bilevel can blow 16 all by itself or the bilevel can blow at only 10 while I supply the other 6 to keep the total at 16.

Same thing happens with the EPAP setting. It sets at 16 but the machine actually blows at only 10. My own exhaling provide the other 6. That way I can breathe comfortably against 10 and still maintain a total 16 to suppress the apnea.

Please reckon that is only general concept as dictated by physical law. I'll leave it to other experts/luminaries in the forum to give the verdict on this.

Why don't you fill out your profile and tell us what machine you have. Is it data capable? If so, do you have the software?
If you can monitor your therapy, try lowering your pressure to where you CAN stand it and then work up. If you have/had an APAP, the pressure would probably climb up there during the night, anyway.

Who knows.....you could be like me and find that a lower pressure actually works better than what you were prescribed. At least you'd be getting more pressure than you were getting pre-treatment.

Den

[quote="Anonymous"]Rested Gal, thanks to all the info you provided, I think I finally figure out how the EPAP setting in bilevels work.

Problem: My titrated pressure is 16. Tech guy fixes my pressure at 16 with a straight CPAP. But I couldn't breathe at 16. I need to lower it to 10 to breathe. How am I going to do this?

Solution: I get a bilevel . but how a bilevel's gonna help me? I'm still stuck between a rock and a hard place: I need to set my EPAP at 10 to breathe; But if I go with 10, all apnea hell starts to break loose since I need at least 16 to suppress them.

So the mystery thus far is how a bilevel set at 16 EPAP could let me breathe at 10, 6 lower than my minimum, but still surpress my apnea just like my old CPAP setting at 16?

It's really no magic. Just simple physics. Picture me and my bilevel blowing into a baloon which needs 16 cmH2O to stay inflated. To keep the baloon stays inflated, the bilevel can blow 16 all by itself or the bilevel can blow at only 10 while I supply the other 6 to keep the total at 16.

Same thing happens with the EPAP setting. It sets at 16 but the machine actually blows at only 10. My own exhaling provide the other 6. That way I can breathe comfortably against 10 and still maintain a total 16 to suppress the apnea.

Please reckon that is only general concept as dictated by physical law. I'll leave it to other experts/luminaries in the forum to give the verdict on this.

A possible mechanism for less pressure on exhalation.
Inhalation is when negative pressures occur in the airway causing it to collapse inward. Exhale---pinch your nostrils closed and keep your lips sealed---now try to inhale. You can feel the inward pull at your cheeks and back of your throat. Those are the forces that lead to collapse. When you exhale that doesn't happen. Normally we do not breathe out against pressure. It would take pressure sensors to coordinate appropriate pressures for the respiratory cycle--just when the pressure needs to increase/decrease and how much the pressure needs to be. To me--I want a machine that more closely follows the respiratory cycle. I don't believe it is really just comfort.
Look at the idea is that feelings of discomfort are simply personal. I think they are tied to neurophysiological responses and interactions between respiratory cycle pressures and the brain. The brain depends on a normal oxygen supply and if the brain thinks anything is interfering with oxygen supply--it responds with some level of discomfort that prods us to take action for survival. Some of us may be able to ignore what we intellectually determine is minor discomfort or that there is no threat and we coast along on a low level of adrenalin. I'm not sure that is necessarily what is best for our bodies. So in the end--to me--BiPAP is not just for comfort--it supports more normal physiological functioning.
khvn, you don't want people to be brainwashed/conned by bilevel proponents---I don't want people to be brainwashed or ridiculed by CPAP proponents. We each know our bodies best-better than any physician can. If we listen to our bodies/minds and don't ignore signals just because someone (maybe even most doctors) think BiPAP is "unnecessary" or is more expensive; we'll have better treatment.

thanks to all the info you provided, I think I finally figure out how the EPAP setting in bilevels work....(your specifics)....but how a bilevel's gonna help me?

Are you are trying to understand this-or do you not agree. I'm not sure if you have or have not figured it out. You use the "YahBut" statement a couple times; that to me indicates an unwillingness to look at something from a different perspective.

And since then it looks like a lot of people are learning more about BiPAPs (including myself) and you have helped keep this thread going-Thank you.

rooster wrote:

DreamStalker wrote:......he is fixated/programmed on some "establishment" out to get everyone ........:

Hmmm?

Start another thread if you want Mr. ... this one is too informative to derail.

krousseau wrote:A possible mechanism for less pressure on exhalation.
Inhalation is when negative pressures occur in the airway causing it to collapse inward. Exhale---pinch your nostrils closed and keep your lips sealed---now try to inhale. You can feel the inward pull at your cheeks and back of your throat. Those are the forces that lead to collapse. When you exhale that doesn't happen. Normally we do not breathe out against pressure. It would take pressure sensors to coordinate appropriate pressures for the respiratory cycle--just when the pressure needs to increase/decrease and how much the pressure needs to be. To me--I want a machine that more closely follows the respiratory cycle. I don't believe it is really just comfort.
Look at the idea is that feelings of discomfort are simply personal. I think they are tied to neurophysiological responses and interactions between respiratory cycle pressures and the brain. The brain depends on a normal oxygen supply and if the brain thinks anything is interfering with oxygen supply--it responds with some level of discomfort that prods us to take action for survival. Some of us may be able to ignore what we intellectually determine is minor discomfort or that there is no threat and we coast along on a low level of adrenalin. I'm not sure that is necessarily what is best for our bodies. So in the end--to me--BiPAP is not just for comfort--it supports more normal physiological functioning.
khvn, you don't want people to be brainwashed/conned by bilevel proponents---I don't want people to be brainwashed or ridiculed by CPAP proponents. We each know our bodies best-better than any physician can. If we listen to our bodies/minds and don't ignore signals just because someone (maybe even most doctors) think BiPAP is "unnecessary" or is more expensive; we'll have better treatment.

thanks to all the info you provided, I think I finally figure out how the EPAP setting in bilevels work....(your specifics)....but how a bilevel's gonna help me?

Are you are trying to understand this-or do you not agree. I'm not sure if you have or have not figured it out. You use the "YahBut" statement a couple times; that to me indicates an unwillingness to look at something from a different perspective.

And since then it looks like a lot of people are learning more about BiPAPs (including myself) and you have helped keep this thread going-Thank you.

Very well put krousseau !

krousseau wrote:khvn, you don't want people to be brainwashed/conned by bilevel proponents---I don't want people to be brainwashed or ridiculed by CPAP proponents. We each know our bodies best-better than any physician can. If we listen to our bodies/minds and don't ignore signals just because someone (maybe even most doctors) think BiPAP is "unnecessary" or is more expensive; we'll have better treatment.

krousseau, you really nail it when you say these magic words: "We each know our bodies best-better than any physician can". And I'm not trying to knock down any particular machine. I'm just against the smokes and mirrors due to monetary greed that keep us from getting the best treatment we could.

krousseau wrote: Are you are trying to understand this-or do you not agree. I'm not sure if you have or have not figured it out. You use the "YahBut" statement a couple times; that to me indicates an unwillingness to look at something from a different perspective.

I think I understand the basic mechanic behind bilevels now (thanks to all who contribute to this thread). But that's only a small part in the big picture of OSA treatment. One much more important issue is this: If bilevel is the better tool for OSA treatment then how can we get it, in spite of corporate greed that only wants to give us the cheapest alternative.

I know people, doctors included, are saying bilevels are not for everybody. We all tend to agree with that since it *IS* the conventional thinking. However, if you're willing to look past the obvious, it maybe just another myth to be debunked. But y'all must be tired of all my bickering by now...

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CPAPopedia Keywords Contained In This Post (Click For Definition): bipap, CPAP

I hope to soon know if it a better tool for me-I've adjusted my APAP pressures to reflect the numbers they arrived at during BiPAP titration. I don't usually base any changes on one night's experience; I made an exception to that rule after trying one night of CPAP at a pressure of 15. Now I'm using APAP with a range of 9-15. Will also try 11-15 before I start BiPAP (won't have the BiPAP for about 2 more weeks). The current level of 9-15 does not seem to be eliminating the FLs and still have rest of complaints (fatigue, aerphagia, etc).

Hi Dr.Kraskow and Rested Gal,

Now, as I had requested in the email sent for understanding of the exactly how the cpap/apap on striaght pressure, c-flex, a-flex, EPR, IPAP&EPAP algorithms works has come to live with this discussions. These algorithms are crucial to further undertand for better treatments. Questions,

Q1) Would it be poosible to find the algorithm from the respective cpap designers (a pseudo algorithm will do as we are not requesting for the programming or the hard codes).

Q2) Given that the bipap is the best cpap available for best treatment in sleep apnea. The treatment for hypopnea still need another approach to counter teh problem. This raise my perevious email sent on the dynamic algorithms for better overall treatment in sleep apnea and hypopnes.

Q3) I would say that the dynamic algoritms with the "Fazzy Logic" will come into play in the next level of treatment. This is the open door for yet another new domain for sleep disorder treatment. Are we in the the stage of new frontier? I think so.....

Any comment are welcome.....I am still learning.

Best Regards,
Mckooi

Some might find the following charts helpful with respect to the different Respironics Flex technologies:

CFLEX



AFLEX



BIFLEX

Whoa, look at that EPAP line in the BIFLEX chart! The machine allows pressure to dip below EPAP--which is a no-no since not enough pressure would allow apnea to pop up here. What saves the day must be our own breath that compensates for the pressure loss and pushes the total pressure up to the safety of the EPAP line again.

khvn wrote:Whoa, look at that EPAP line in the BIFLEX chart! The machine allows pressure to dip below EPAP--which is a no-no since not enough pressure would allow apnea to pop up here.

khvn,

You honestly think they would design it to do that if it wasn't safe to do so? You act like the people who design these things are idiots and don't do any testing or have any expertise.

-James