Ready to go postal

I guess that maybe the discussion should be how we as uneducated, non-medical professionals, train those educated, medical professionals who maybe attend a couple of classes regarding OSA and think they know it all--after all they have MD, PhD or RT after their name. While it may be true that they know more medical aspects of treatment, unless they take part in the therapy (use xPAP) they have no idea what it is like to don a mask/nasal pillows and hook yourself up to a machine to sleep.

I am sure that they have good intentions but not the best education when it comes to OSA. As is the case with so many other things,

We the Willing
Led by the Unknowing
Are doing the Impossible
For the Ungrateful.

We have done So Much
With So Little
For So Long
We are now Qualified
To do Anything
With Nothing.


Maybe the moderators need to consider adding medical professional education to the Wisdom section of the website.

GumbyCT wrote:May I ask - what is the reason for the in home titration? And then the reason to re-re-repeat it?

I guess I'll neva no.

It it my guess that we are doing the at home titration for a month because me numbers are still too high. The reason for the clinical titration is that "it is more accurate" than the at home and I will be monitored for the entire night.

BTW,the last two nights on APAP have these results (from the display on the machine):

Pressure: 10.2 and 10.4;
Leak: .02 both nights;
AHI:19 and 36;
AI: 3.7 and 11.1; and
HI: 15.3 and 24.9.

Do we see a pattern developing here that the doctors are ignoring?

tvmangum wrote:It it my guess that we are doing the at home titration for a month because me numbers are still too high. The reason for the clinical titration is that "it is more accurate" than the at home and I will be monitored for the entire night.

BTW,the last two nights on APAP have these results (from the display on the machine):

Pressure: 10.2 and 10.4;
Leak: .02 both nights;
AHI:19 and 36;
AI: 3.7 and 11.1; and
HI: 15.3 and 24.9.

Do we see a pattern developing here that the doctors are ignoring?

Yep! The Auto is apparently working for you as it was designed.

Either your doctors are ignorant of the A10 algorithm or the DME is......or BOTH. They probably think "an Auto is an Auto" and we have/sell ResMed brand machines.....so they're "better".


Den

tvmangum wrote:It it my guess that we are doing the at home titration for a month because me numbers are still too high.

How 'high' are we talking?

Wulfman wrote: Yep! The Auto is apparently working for you as it was designed.

Either your doctors are ignorant of the A10 algorithm or the DME is......or BOTH. They probably think "an Auto is an Auto" and we have/sell ResMed brand machines.....so they're "better".Den

Since most people use an avg.10cm or above,
remind me why these are such good machines???

carbonman wrote: Since most people use an avg.10cm or above,
remind me why these are such good machines???

CM, check out Laura's (Rested Gal) post at 1:26am today on the first page here. I understood the whole deal for the first time ever, after reading that.

carbonman wrote:

Wulfman wrote: Yep! The Auto is apparently working for you as it was designed.

Either your doctors are ignorant of the A10 algorithm or the DME is......or BOTH. They probably think "an Auto is an Auto" and we have/sell ResMed brand machines.....so they're "better".Den

Since most people use an avg.10cm or above,
remind me why these are such good machines???

Not ME!
I'm sure there are some diehard ResMed Auto lovers that will jump in here to tell you, though.....

Den

lktnky (guest) wrote:THANKS RG!

How can I tell if I snore?
I download the night's data every morning, but only use the data card and do not want to buy ResLink.
Can I tell if I snore just by looking at the data?

I may be completely wrong about this, but I think that even though ResMed autopaps do take snores into consideration for responding (with more pressure) they don't mark "snores" on their software reports. If that's so, then you won't see "snores" marked at all on your data with, or without, the ResLink module. There's no snore data produced at all, as I understand it, but I might be mistaken about that.

Perhaps someone who is using the ResScan software can tell you if there is any snore data to be seen. I was using their Autoscan software with the older S7 machines. Not the S8 machine you have, or the ResScan software you're using. I've used an S8 Vantage autopap, but didn't bother to try to use software with it, since I'm not crazy about the way ResMed software displays data anyway. The data I looked at in the ResMed's LCD window in the mornings was sufficient for me.

plr66 wrote: CM, check out Laura's (Rested Gal) post at 1:26am today on the first page here. I understood the whole deal for the first time ever, after reading that.

I did read it.
Thanks! RG.

I live at 12.5-17cm.
If I understand it correctly, this machine would do nothing for me.

Please correct me it this is not the case.

carbonman wrote:Since most people use an avg.10cm or above,
remind me why these are such good machines???

Hold that thought - there is an internet hottie who is a Resmed psycho fanatic who I am sure will be along to tell us bc of some birthmark on my.... oh never mind.

Just do it...GO Postal. Sounds like someone needs it.

rested gal wrote:

lktnky (guest) wrote:THANKS RG!

How can I tell if I snore?
I download the night's data every morning, but only use the data card and do not want to buy ResLink.
Can I tell if I snore just by looking at the data?

I may be completely wrong about this, but I think that even though ResMed autopaps do take snores into consideration for responding (with more pressure) they don't mark "snores" on their software reports. If that's so, then you won't see "snores" marked at all on your data with, or without, the ResLink module. There's no snore data produced at all, as I understand it, but I might be mistaken about that.

Perhaps someone who is using the ResScan software can tell you if there is any snore data to be seen. I was using their Autoscan software with the older S7 machines. Not the S8 machine you have, or the ResScan software you're using. I've used an S8 Vantage autopap, but didn't bother to try to use software with it, since I'm not crazy about the way ResMed software displays data anyway. The data I looked at in the ResMed's LCD window in the mornings was sufficient for me.

I had always heard this, too, so I got curious about this (snore details), and went to the ResScan 3.7 Clinical Guide. I finally found references to it in the Index pointing to page 33.

Detailed data is gathered by the flow generator and stored in internal memory. It can be copied
from there to a data card, or retrieved directly for display in ResScan. The information classed
as detailed data is about treatment parameters such as pressure and leak.
The data displayed in the Detailed tab will depend on the flow generator used. Traces displayed
may include:
• Pressure (cm H2O or hPa)—can include: Mean, Inspiratory, Expiratory (cm H2O or hPa can
be set in Tools > Options > Graphs)
• Flow (L/min or L/sec—can be set in Tools > Options > Graphs)
• AutoSet Pressure (cm H2O or hPa)
• Leak (L/min or L/sec)
• Apnea or Hypopnea events
• AHI and AI (Events/hr)
• Flattening (flat to round)
• Snore (quiet to loud)
• Minute Ventilation (L/min) and Target Ventilation
• Respiratory Rate (breaths/min)
• Tidal Volume (L/min).
Note: To change the units and range for Leak and to customize vertical range for parameters,
see “Options Dialog” on page 44.
If there is no data in a section of the graph, the flow generator was not being used at that time.
If the oximeter falls off or fails to make contact with the patient at any stage, the Pulse Rate and
SpO2 traces will be empty or will show a zero reading.

On page 34 there is pictured some options for "Selecting traces". There's a "menu" where Snores can be checked.

Since I'm not a ResMed machine user, I don't know if this is a new feature or not.


Den

GumbyCT wrote: Just do it...GO Postal. Sounds like someone needs it.

or for an alternate, less intrusive action....

GET MAD!

I want you to say,
"I'm a human being!"
"My life has value!"

...and get up, go the window and YELL,

"I'M MAD AS HELL, and I'M NOT GOING TO TAKE IT ANYMORE!"

carbonman wrote:Since most people use an avg.10cm or above,
remind me why these are such good machines???

Recall that most people's apneas are cleared by the time 10 cm is encountered. They are cleared as either: 1) completely addressed at that 10 cm point, or 2) partially addressed and sagging a bit at that same 10 cm point.

That first case above is easy to understand. But the second case is admittedly counterintuitive to many of us. Anyway, an apnea that needs a full 14 cm to clear is most often not going to be read by any APAP machine as an apnea at 10, 11, 12, or 13 cm. Rather, that 14 cm apnea is going to be read like a sagging partial event (snore and/or FL) at those pressures that Resmed can and will gladly raise pressure toward getting the patient out of "apnea territory".

carbonman wrote:I live at 12.5-17cm.
If I understand it correctly, this machine would do nothing for me.

It really depends on: 1) how many full closures rather than under-addressed sags you still have after 10 cm, and 2) whether you are lacking adequate flow-limitation ("wave flattening") and/or snore signs above 10 cm. There are many people who live at that pressure range you described who do quite well with the Resmed A10 algorithm.

With that said, A10 may not be a good algorithm for you, and it is very clearly not a great wide-open algorithm for tvmangum. As it turns out, no APAP algorithm may suit tvmangum. He may be better off with that fixed-pressure approach that seemed to be working beautifully.

Thanks, Den, for looking that up...about snores being reported with ResScan. I'm glad to know that, now.

carbonman wrote: I live at 12.5-17cm.
If I understand it correctly, this machine would do nothing for me.

Please correct me it this is not the case.

If you mean you have your Respironics machine set for minimum pressure 12.5 and maximum pressure 17, then setting a ResMed machine for that same range would quite likely treat you just as well as your Respironics machine does, imho.

The A10 algorithm used by ResMed autopaps is misunderstood too often, imho, as meaning that if a person was prescribed more than 10 cm from a sleep study, OR has set their minimum pressure for more than 10 cm, then a ResMed autopap is out of the running completely. I don't think that's so.

ALL autopaps, including ResMed, respond with more pressure to flow limitations. That cannot be stressed often enough, imho. ALL autopaps respond by raising the pressure when they sense "flow limitation" (partial -- not full -- collapse of the airway.) Most people's breathing does show signs of flow becoming limited (as -SWS pointed out) well before the airway would collapse on into full closure.

To try to correct the flow limited breathing, autopaps will keep raising the pressure all the way up to the maximum in the range, if need be. Just like any other brand of autopap, a ResMed autopap would raise the pressure all the way to your max of 17, carbonman, if needed....to try to open the airway if it senses your breathing is becoming "flow limited" due to partial collapse of the airway. Snores are often first sign indicators of a partial collapse starting, so autopaps respond to snores, too.

Responding with more pressure when flow limitations or snores are sensed PREVENTS most apneas from occurring at all.

That's how a ResMed autopap (and any other brand of autopap) treats people, even if the person has set more pressure than 10 cm as their minimum pressure, or has been prescribed more pressure than 10 from their sleep study. The ResMed autopap treats them by doing what every other autopap does, too -- by responding with more pressure (even more than 10) when the least little sign of flow limited breathing is sensed.

With any brand of autopap it's really all about preventation in the first place. Dealing with and eliminating flow limitations is the way all of them go about trying to prevent an apnea from happening, as I understand it.

So -- what happens if a sudden apnea sneaks through despite any brand of autopap's best efforts at preventing that from happening?

ResMed chooses to wait it out. Waits for that odd, random apnea to clear on its own (by the person's brain arousing him/her enough to breathe again.)

Respironics chooses to try three small pressure nudges, to see if the airflow will improve with a SLIGHT bit more pressure. We're not talking full cm jumps with those nudges. We're talking fractions of a cm at a time, and giving it time between each nudge to see what happens. If no improvement is seen after the final nudge, Respironics is not going to try to "treat" that apnea further. It, too, will wait it out at that point, and will even drop the pressure back down to before the nudges started.

There really isn't much difference, imho, between "waiting it out" and "waiting it out after some mild pressure nudges to see what happens." I think it's not very often that a few tentative small pressure nudges will make much difference to an apnea that is already well and truly in place. Either way, that sudden apnea is probably going to just have to run its course, with either of those two major brands of machines. After the person has had an arousal that gets them breathing again, then the autopaps will continue trying to prevent more apneas from happening, by doing what they do best -- continuing to watch for flow limitations and treating those partial closures with more pressure.

I think this next thing is important to keep in mind, if a person has the opportunity to try both brands of autopap and starts looking at the data from each to try to see which one "treats" them better:

If you used both brands of autopap, you would probably see a higher AHI reported by a ResMed machine than from a Respironics machine. But that higher AHI will almost certainly have nothing to do with "ResMed will not increase pressure for an apnea above 10 cm." Nor would it mean that one brand was noticing something the other was missing, or that one was imagining something the other knew was not there. Nor would it mean that one brand was treating you better than the other.

The higher AHI that's likely to be seen from a ResMed machine has to do with the way different manufacturers draw a line in the sand to define when a "flow limitation" is to be called "hypopnea." Your AI (apnea index) is very likely to be reported as the same, or similar, low number from either brand of machine. But the HI (hypopnea index) is very likely to be higher from a ResMed machine, simply because of the different definitions for "hypopnea" that the two manufacturers use. I mentally cut the Hypopna index in half when I use a ResMed machine, if I want to compare my AHI results to the AHI I get from a Respironics machine.

Again, a bottom line: Regardless of the difference in the AHI report (mainly due to the difference in the "HI" part of the AHI) from those two brands of machines for the same person, the effectiveness of the treatment the person has had from either machine when they wake up in the morning, is very likely going to make the person feel the same. Most people (not "all..."most) are likely to feel just as good (or bad) using one machine as the other.

There can be different features built into different manufacturers' autopaps that can make people prefer one over another, or even do better on one over another. I personally find Respironics' A-Flex and C-Flex exhalation features to be more comfortable and "natural breathing feeling" than I do ResMed's EPR. So, when I want to use "autopap" I use my Respironics Auto with A-flex.

I also find Respironics' Bi-Flex feature in their bilevel machine (BiPAP) more comfortable than I do with any of the rise time and Inspiration max/Expiration min "comfort" features in ResMed's bilevel machine (VPAP.) So, when I want to use a "bilevel", I use my Respironics BiPAP Auto with Bi-Flex.

However, anytime I use a ResMed cpap, autopap, or bilevel machine, I've gotten exactly the same "well rested" feeling in the morning that I get from any Respironics machine. I get the same good treatment from any of them. I chalk the higher AHI" from ResMed up to the difference in "HI" definitions...I cut the ResMed HI in half...and I then see the same data results from either brand.

There are people, of course, who will do better on one type (cpap, autopap, bilevel) of machine, or one particular brand of machine, than on others. I'm lucky that any type or brand can treat me equally well.