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SWS,

Lets make that a very flexible plastic bottle & lets fit a vacuum pump in through the bottom

DSM

-SWS wrote: <snip>

Let's look at that cork-theory on two bases: 1) static pressure, and 2) increasing pressure. The cork theory loses credence on all counts of static pressure since fixed pressure prescriptions anywhere between 4 or 5cm and 30 cm do not exacerbate this problem--rather they tend to fix the problem. Let's look at the transient pressure case. ASV treats cases of mixed and complex apnea, both having obstructive components. Obstructive apneic stenting exclusively via EEP does not always occur. On a regular basis across the patient population, the ASV very quickly cycles a PS increase no less than 3 cm (often plenty more). When this happens in the midst of even complete obstruction, we do not incur a cork or even super-cork problem---as strange or charmed as it may sound in physics. Very Happy
<snip>

SWS,

I am sure we both agree and understand that an ASV machine's added PS is not there to clear OSA events but to stabilize irregular breathing such as C-S. An ASV machine *doesn't try to clear an OSA block* other than with an adequate EEP.

There is no machine I know of that seriously tries to clear an in-flight OSA block where there is no air flow but only effort by the sleeper's lungs.

Bill's post yesterday had a reference to the reactive nature of Auto CPAP machines to OSA blocks. It seems to me to be a common sense point.

There is not doubt in my mind that the only effective way to keep an OSA event at bay is by effective splinting of the airway in advance.

If the splinting CMS is inadequate and a block occurs it *has* to go its natural course and the sleeper's body & brain react - CO2 level triggers an arousal - sleeper moves & the block clears.

No Auto is going to effectively clear an individual block once a 'full-on' block is underway. No ASV is effectively going to clear such a block, & it is unlikely that any Bilevel even if timed & with a large ipap/epap gap & switching between epap & ipap, no matter what rate, is going to clear such a block. None of their algorithms are designed nor expected to do so other than by misinformed users.

The normal Auto cpap at the commencement of a detected block *will* be instructed to slowly raise pressure in the hope the new splinting pressure will prevent subsequent blocks *not* because it is in *any* way trying to clear the current block, if that procedure fails to prevent more airway blocks - within a small window of time - the machine will repeat as per algorithm. The target is a splinting pressure that is high enough to overcome the current pattern of OSA events.

Also, the Auto is monitoring pre-cursor events (snoring, flow lims, hypops etc: ) and will use that data too to raise pressure so as to increase the splinting of the airway. So, in theory an Auto is always anticipating the dreaded 'block' but as all our collective nightly data proves, doesn't always succeed.

So in summary, I am in no way convinced that piling pressure on is going to do anything good when a full-on block is in effect & believe the designers know this too


DSM

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

Boy am I glad that I asked which machine to get.

Needsdecaf wrote:Boy am I glad that I asked which machine to get.

Have ya been able to reach a conclusion?

-SWS wrote:Let's look at that cork-theory on two bases: 1) static pressure, and 2) increasing pressure. The cork theory loses credence on all counts of static pressure since fixed pressure prescriptions anywhere between 4 or 5cm and 30 cm do not exacerbate this problem--rather they tend to fix the problem.

DSM's insistance on revisiting the "cork-theory" has gotten me thinking ( ... at least I call it thought, but whatever ... ). Back when I first got an air-blowing machine, I learned real quick that I couldn't wear a full-face mask. When the auto-algorithm increased pressure, my AHI quickly increased as well. I assumed this to be caused by pressure under the mask pushing my jaw back, thereby exacerbating my apnea. That made sense to me, due to my proclivity toward TMJ problems (identified by a dentist years earlier, BTW).

The folks who use full-face masks (FFM) don't have this problem. The folks here who use full-face masks recommend them highly. Does that mean everyone should use a full-face mask? Does that mean the problem I experienced with pressure increases causing increased apnea wasn't real? Nope, only means that full-face masks work well for those they work well for.

Same thing with CPAP therapy ... CPAP therapy works well for those it works well for. We've had a few folks wander into this forum who couldn't tolerate it. Doesn't seem to make much sense to those of us who benefit from CPAP therapy.

What about the folks who have persistent apneas which are never resolved by CPAP therapy. I could point to numerous postings to illustrate this. Sure, lots of folks get their AHI's down below 1.0, but just as many have consistently high residual AHI's. If they're not caused by centrals what else could they be caused by? Corks, maybe? Maybe some similar physiological mechanism?

Anyway, food for thought.

I'll respond to your transient case, after you 'splain all the acronyms, -SWS ...

Regards,
Bill

Needsdecaf wrote:Boy am I glad that I asked which machine to get.

rotfl!

As long as you don't habitually chew on corks or pop whole eggs into your mouth, just about any machine will be ok.

Ok, sorry to drag this thread off topic but just got done speaking to my DME now.

THey are saying that since the Dr. didn't order an auto machine, they won't order one without the scrip saying as such.

They wanted to give me REMStar Plus. I told them I wanted a Pro, no less. They switched it out so now I have a REMStar Pro with HH on order.

Should I bother with fighting for the Auto? My titration is only 8. And I've never had full time therapy before. Just go with the flow and see what happens?

Should I have really bothered getting the Pro over the plus?

Thanks.

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CPAPopedia Keywords Contained In This Post (Click For Definition): Titration, DME, auto

Needsdecaf wrote:Ok, sorry to drag this thread off topic but just got done speaking to my DME now.

THey are saying that since the Dr. didn't order an auto machine, they won't order one without the scrip saying as such.

They wanted to give me REMStar Plus. I told them I wanted a Pro, no less. They switched it out so now I have a REMStar Pro with HH on order.

Should I bother with fighting for the Auto? My titration is only 8. And I've never had full time therapy before. Just go with the flow and see what happens?

Should I have really bothered getting the Pro over the plus?

Thanks.

Categorically:

NO.

YES!

Den

Needsdecaf wrote:Should I bother with fighting for the Auto? My titration is only 8.

No, you have no important reason to fight for an auto.

Needsdecaf wrote:Should I have really bothered getting the Pro over the plus?

Yes! Pro gives full data. Plus does not.

Ya done good!!!!

Needsdecaf wrote: I've never had full time therapy before. Just go with the flow and see what happens?

I'd get the Encore Viewer software and the necessary card reader to monitor how things go, and help you decide if you want to tweak the pressure later.

Most excellent folks, thanks for the heads up. I didn't feel like fighting for the Auto if I didn't need to.

Will get the software so that I can graph all the fun data. Do you need to get a card reader or is there a wire to plug directly into the machine that also works (I have a laptop, this would not be inconvenient).

BTW, no comments on my "go with the flow" line?

Thanks, I feel relieved, really do. Machine should be delivered on Friday. Not sure when I can set up with the RT, but I will call back and see.

Yay!

Needsdecaf wrote:Should I bother with fighting for the Auto? My titration is only 8. And I've never had full time therapy before. Just go with the flow and see what happens?

Should I have really bothered getting the Pro over the plus?

I agree with Wulfman. You should get the Pro over the Plus. I'm having problems with my threapy and because I have the Plus, I am doing the "shot in the dark" method of trying to correct it because the Plus has no data to tell me what's wrong

Next time I see the doc, I'm pushing for a machine specific perscription so I won't have to fight with either the DME or the insurance (one of my co-workers went though this and it was what she had to do)

Yes, you'll need the card reader.

Somewhere down the road if/when you want to get a backup machine and have the extra money, then you may want to consider an Auto......that's the way I did it, but then found out I really didn't NEED an Auto......straight pressure worked best for me.

Den

What is the latest version of the software? From what I see for sale online it's 1.0?

I thought that someone had said a while back it's 1.8.....

Needsdecaf wrote:What is the latest version of the software? From what I see for sale online it's 1.0?

I thought that someone had said a while back it's 1.8.....

1.8 is referring to Encore Pro software...the one for DMEs and doctors. It's been out for years.

1.0 is referring to Encore Viewer software ... the one Respironics recently created for users. It just came out last fall.

Both give exactly the same detailed data presented in the same graphs and charts.

Encore Viewer is what we can readily buy.

rested gal wrote:

Needsdecaf wrote:What is the latest version of the software? From what I see for sale online it's 1.0?

I thought that someone had said a while back it's 1.8.....

1.8 is referring to Encore Pro software...the one for DMEs and doctors. It's been out for years.

1.0 is referring to Encore Viewer software ... the one Respironics recently created for users. It just came out last fall.

Both give exactly the same detailed data presented in the same graphs and charts.

Encore Viewer is what we can readily buy.

Gotcha. So Encore Viewer will work fine. Very good and thanks always!