NewBe

if they prescribed your pressure at the "worst case scenario", wouldn't you end up with a lot more pressure than you'd need for 99.9999% of the rest of your life?

Good point, Wulfman. I agree 100%.

That was one of my primary reasons for wanting an auto machine. To my mind, it is a way to run my own little titration study any time I want--in my bedroom after a normal day of doing what I normally do. It isn't nearly as good as a real titration, of course, in some ways. But I think the auto's pressures get pretty close.

I was prescribed 16/12. My auto's 95 centile mark is around 12/8 or 13/9 when I sleep on my side in my bed. To my way of thinknig, that demonstrates the important validity of the points you make.

Certainly the doc-recommendation/diag-study/titration/doc-interpretation (ie, guess!) is an imperfect system everywhere, not just at GatorMan's clinic. Getting another study sleeping on his side might be great. But his needs will still change night-to-night and hour-to-hour as far as how much pressure he actually needs. And that's true however he sleeps and wherever he goes for his study.

The pressures tried by our techs and prescribed by our doctors are an educated guess, at best. (And I think some docs add a few cm to the techie's results "just to be sure.") So I choose to add my own not-so-educated guess to how the machine I sleep with every night performs.

Wait, I think I've just repeated a bunch of things I've learned from reading your posts, Wulfman!

One other point that may be relevant to GatorMan's question:

I asked my sleep doc, whom I respect deeply, if I should sleep the way I normally do at home when I got titrated. His answer was that his preference was that I sleep as closely as possible to the way I slept during the diagnostic study "so that he could compare apples to apples" when comparing the titration night to the diagnosis night. Maybe I don't agree completely with that approach, but I respect it. So I went along with it.

Hope that is helpful.

jnk

jnk wrote:

if they prescribed your pressure at the "worst case scenario", wouldn't you end up with a lot more pressure than you'd need for 99.9999% of the rest of your life?

Good point, Wulfman. I agree 100%.

That was one of my primary reasons for wanting an auto machine. To my mind, it is a way to run my own little titration study any time I want--in my bedroom after a normal day of doing what I normally do. It isn't nearly as good as a real titration, of course, in some ways. But I think the auto's pressures get pretty close.

I was prescribed 16/12. My auto's 95 centile mark is around 12/8 or 13/9 when I sleep on my side in my bed. To my way of thinknig, that demonstrates the important validity of the points you make.

Certainly the doc-recommendation/diag-study/titration/doc-interpretation (ie, guess!) is an imperfect system everywhere, not just at GatorMan's clinic. Getting another study sleeping on his side might be great. But his needs will still change night-to-night and hour-to-hour as far as how much pressure he actually needs. And that's true however he sleeps and wherever he goes for his study.

The pressures tried by our techs and prescribed by our doctors are an educated guess, at best. (And I think some docs add a few cm to the techie's results "just to be sure.") So I choose to add my own not-so-educated guess to how the machine I sleep with every night performs.

Wait, I think I've just repeated a bunch of things I've learned from reading your posts, Wulfman!

One other point that may be relevant to GatorMan's question:

I asked my sleep doc, whom I respect deeply, if I should sleep the way I normally do at home when I got titrated. His answer was that his preference was that I sleep as closely as possible to the way I slept during the diagnostic study "so that he could compare apples to apples" when comparing the titration night to the diagnosis night. Maybe I don't agree completely with that approach, but I respect it. So I went along with it.

Hope that is helpful.

jnk

Well, if you slept in the sleep study like you do in your own bed, then THAT would still be an "apples to apples" comparison.

I just think it's asinine to (try to) MAKE a person sleep in a position that is not the way they normally sleep.
The ONLY time I can actually sleep on my back is in my comfy recliner.....don't ask me why......"magic dust"? But, put me in bed on my back and there ain't no way......I'll be staring at the ceiling all night. Back in 1992, I had my appendix out (long before CPAP therapy) and had to TRY to sleep on my back....the two nights I was in there were probably some of the worst I've ever spent in bed.

A person can use almost any data-recording machine (and preferably software) to monitor their therapy......CPAPs, APAPs or Bi-PAPs/Bilevels. I have nothing against Autos (I have three).....as long as people recognize how to use them to get their best therapy. I've gotten the impression (from the PMs I've received) that too many times the readers of these forums get "Auto envy". They see how many people have Autos in their profiles and think "I just HAVE to have an Auto". In reality there are lots of us who HAVE Autos but use them in single-pressure mode (CPAP). We've been able to determine which settings work best for us.

I'm another example of the mis-titrated/prescribed patients, but I got a data-capable CPAP and software and took control of my own therapy from "day one".


Den

You're exactly right, Wulfman. His "apples" and my "apples" aren't quite the same.

Excellent important point on autos not being necessary for self-titrating. At the time of my getting my machine, I didn't quite understand that, or I might not have been so insistant on what machine I wanted. Now I see that data is much more important than convenience. Thanks for nicely tempering my words above.

I do think some doctors and techs try to make sure they get high numbers (is that where the phrase "doctoring the numbers" comes from?) during the studies to make sure people's insurance will cover their equipment, too. The docs and techs know they are operating in the real world. Still, you get no argument from me that it helps the doctors' and techs' wallets more than their patients. But that's an industry-wide problem.

Also, it is my opinion (that and $5 will get you a coffee at Starbucks) that the technology in the autos, all brands, is a little, uh, "new." If someone is doing well with what they've got, the smart thing might be to wait a few years before jumping on the auto bandwagon. Maybe all the machines will get smarter, better, and less expensive as time goes on and more people get diagnosed and treated. Despite ResMed's apparent business model. Aren't the machines basically backwards vacuum-cleaners with a circuit board, anyway?

jnk

jnk wrote:You're exactly right, Wulfman. His "apples" and my "apples" aren't quite the same.

Excellent important point on autos not being necessary for self-titrating. At the time of my getting my machine, I didn't quite understand that, or I might not have been so insistant on what machine I wanted. Now I see that data is much more important than convenience. Thanks for nicely tempering my words above.

I do think some doctors and techs try to make sure they get high numbers (is that where the phrase "doctoring the numbers" comes from?) during the studies to make sure people's insurance will cover their equipment, too. The docs and techs know they are operating in the real world. Still, you get no argument from me that it helps the doctors' and techs' wallets more than their patients. But that's an industry-wide problem.

Also, it is my opinion (that and $5 will get you a coffee at Starbucks) that the technology in the autos, all brands, is a little, uh, "new." If someone is doing well with what they've got, the smart thing might be to wait a few years before jumping on the auto bandwagon. Maybe all the machines will get smarter, better, and less expensive as time goes on and more people get diagnosed and treated. Despite ResMed's apparent business model. Aren't the machines basically backwards vacuum-cleaners with a circuit board, anyway?

jnk

Yep. Even a "Golden Delicious" and a "Red Delicious" taste differently despite their color.

True. Dr. Colin Sullivan supposedly created his first CPAP machine from a vacuum cleaner motor.


Den (glad to have missed out on those early years of CPAP)

GumbyCT wrote:

gasp wrote:

GumbyCT wrote:Gator....Man - I don't care how many times the phone rang, I don't believe it would cause YOU to hold your breath - do YOU?
.....

LOL I love your reasoning. Sounds like a professor I had once : )))

Well if anything it likely reduced the number of events he did have. Ya think?

LOL True!

BTW a little OT How's it going as a new headrest user?

rested gal wrote:You're absolutely right, jnk.

Besides the on-target points you wrote about why people are encouraged to sleep "supine" (on their back) as much as possible for both diagnostics and titration, I can think of another "worst case scenario" reason for that.

Even if a person truly NEVER sleeps on his/her back at home, it's always possible (heaven forbid!) that the person might someday end up having to spend a lot of time on their back in a hospital. Best to at least know what cpap pressure takes care of "worst case" scenario, whether that's the pressure a person chooses to use, or even needs to use, at home.

You are such a wonderful out-of-the-box thinker! I would have never thought of a ride in an ambulance, unconscious, or hurt badly.