Message for Avi

rested gal · Post by **rested gal** » Sun May 01, 2011 1:42 pm

"Splinting" works for me.

avi123 wrote:Good morning. Can anyone tell if the flow chart that I got this morning resembles a Central Sleep Apnea or a Complex Sleep Apnea Syndrome?

Dunno about that one tiny little section of the night you picked out, but the overall results indices for the entire night look like Obstructive Sleep Apnea to me, with a low enough "central apnea" index that the centrals probably don't really matter. A good many of your centrals could be completely benign...normal for what might be happening in your sleep at that moment. Post arousal centrals following a few big "recovery" breaths after an obstructive apnea or hypopnea has subsided, for example.

avi123 wrote:AHI & AI - Events/hr

Apnea index: 8.9 AHI: 13.1 Obstructive: 5.7
Central: 3.1 Unknown: 0.0 Hypopnea index: 4.2

If it were me, I'd completely stop thinking about trying to "avoid centrals" and work on setting the minimum pressure high enough to try to prevent the Obstructive Apneas and Hypopneas. While doing that, I wouldn't give the "Central index" more than a passing glance -- a glance just long enough to see that the Central index didn't get above 5.0. As long as the Central index was below 5.0 I wouldn't worry about it at all. Not at all. I wouldn't worry if the Central index hit 4.0 or 4.9. As long as the Central index stayed below 5.0 while I fiddled with the pressure settings to try to get the Obstructive index down, I'd be satisfied. I'd want to get the Obstructive Index down.

But that's just how I'd go about it. You'd do well to check with your doctor about what, if anything, you should try. You and your doctor know more about your general health than I do.

avi123 · Post by **avi123** » Sun May 01, 2011 3:53 pm

rested gal wrote:"Splinting" works for me.

avi123 wrote:Good morning. Can anyone tell if the flow chart that I got this morning resembles a Central Sleep Apnea or a Complex Sleep Apnea Syndrome?
Dunno about that one tiny little section of the night you picked out, but the overall results indices for the entire night look like Obstructive Sleep Apnea to me, with a low enough "central apnea" index that the centrals probably don't really matter. A good many of your centrals could be completely benign...normal for what might be happening in your sleep at that moment. Post arousal centrals following a few big "recovery" breaths after an obstructive apnea or hypopnea has subsided, for example.

avi123 wrote:AHI & AI - Events/hr

Apnea index: 8.9 AHI: 13.1 Obstructive: 5.7
Central: 3.1 Unknown: 0.0 Hypopnea index: 4.2

If it were me, I'd completely stop thinking about trying to "avoid centrals" and work on setting the minimum pressure high enough to try to prevent the Obstructive Apneas and Hypopneas. While doing that, I wouldn't give the "Central index" more than a passing glance -- a glance just long enough to see that the Central index didn't get above 5.0. As long as the Central index was below 5.0 I wouldn't worry about it at all. Not at all. 4.9. As long I wouldn't worry if the Central index hit 4.0 or as the Central index stayed below 5.0 while I fiddled with the pressure settings to try to get the Obstructive index down, I'd be satisfied. I'd want to get the Obstructive Index down.

But that's just how I'd go about it. You'd do well to check with your doctor about what, if anything, you should try. You and your doctor know more about your general health than I do.

RG, thanks, given my results so far, whereby I have titrated up to 9.6 cm without seeing the AHIs showing a down trend, how high a pressure would you titrate to if it was you?

If I get my S9 Autoset and set it at 8 cm to 12 cm with EPR = 2, wouldn't it go up to 12 cm, if needed, to treat OAs, snore, and other limitations, but not higher?

SleepingUgly · Post by **SleepingUgly** » Sun May 01, 2011 7:35 pm

I splint my wrists and stent my airway.

ozij · Post by **ozij** » Sun May 01, 2011 7:58 pm

avi123 wrote:If I get my S9 Autoset and set it at 8 cm to 12 cm with EPR = 2, wouldn't it go up to 12 cm if needed to treat OIs, snore, and other limitations?

Yes, it may go up to 12 if it doesn't get rid of all those inidcators of obstruction.

I am impressed at the dramatic residual snoring in your overall data - have you seen any difference in the snore data in all your pressure trials - I know there's no index, but is there any visual difference in the charts?

Have you considered involving an ENT - as was suggested in the post titration report?

I find nasal rinses very helpful --- you can find information about that here: http://www.neilmed.com/usa/directions.php
I mix my own solution: 1/4 teaspoon kitchent salt - that's the rough kind, with no additive, used for Koshering meat - and 1/8 teaspoon baking soda in the squeeze bottle. I warm the water in a glass in the microwave.

avi123 · Post by **avi123** » Sun May 01, 2011 8:35 pm

ozij · Post by **ozij** » Sun May 01, 2011 9:33 pm

avi123 wrote: In such a case the stent would be a metal spring at about 3/4" in dia and placed inside the throat . Initially the stent is collapsed to a smaller size and inserted into the throat with an elongated forcep where you let it open up to expand and keep the airway open for the night. If you get used to it then you'll could give up the CPAP. Think about it.

I find that an extremely cruel comment made to one of the nicest, kindest persons on this site.
Have you, for one minute considered how this might feel in your own throat Avi? Does it not make you cringe and gag when you put yourself in Dori's place?

DoriC · Post by **DoriC** » Sun May 01, 2011 10:03 pm

Avi, you have made some pretty strange and rude comments here but you have been treated very fairly in spite of that, but I do think it should be you who is embarrassed and ashamed by suggesting I undergo the cruel and painful procedure you describe. I'm hoping you're a nicer person than the one you portray here and if you ever get your therapy under control and enjoy better sleep, we might see evidence of that. For the moment I will find it easy to simply ignore you.

rested gal · Post by **rested gal** » Sun May 01, 2011 11:42 pm

avi123 wrote:RG, thanks, given my results so far, how high a pressure would you titrate to, if it was you?

I don't know. I know what works for me, but I don't know what would be best for you. That would be a good question to ask your sleep doctor.

avi123 · Post by **avi123** » Mon May 02, 2011 7:11 am

Hi, I came up with the stent idea for CPAP treatment by intuition. I made a mistake mentioning it next to a poster's name. Apparently it was misunderstood. So I am going to delete that post and transfer the content to my own post. Sorry if any one took it to heart.

IMO, distending the upper airway could be done with a stent similarly to the way stents are used in heart's clogged coronary arteries. In such a case the stent would be a metal spring at about 3/4" in dia, coated with Silicone, and placed inside the throat . Initially the stent is collapsed to a smaller size and inserted into the throat by forceps led by an inflated small balloon, where it is let to expand and keep the airway open for the night. To pull it out in the morning, there is a thin plastic wire coming out from the mouth. Pulling this string collapses the stent back to its smaller size. If I could get used to it then I could give up the CPAP.

The system as I described above is presently used instead of doing TURPS (transurethral prostate surgery) quite successfully.

See here:

http://en.wikipedia.org/wiki/Stent

and here

http://www.americanmedicalsystems.com/m ... stric.html

Engineers and gadgeteers, where are you?

rested gal · Post by **rested gal** » Mon May 02, 2011 9:20 am

All night long would be a long time to not be able to swallow saliva.

SleepingUgly · Post by **SleepingUgly** » Mon May 02, 2011 11:48 am

In Avi's defense, I don't think he meant any harm to Dori. He has a tendency to insert odd, esoteric, tangential ideas into his posts, and I don't think this was a case of anything other than that.

Sure hate to defend the one person on the planet who's ever called me a "bully" but on the upside, since he foed me, he won't see that I'm defending him.

DoriC · Post by **DoriC** » Mon May 02, 2011 5:45 pm

SU, Believe me, he did me no harm at all, I know some of his comments are "out there", but he just lit my fuse at the wrong time! And my hat's off to you for defending someone who called you a bully and foed you! You've set some high standards!

rested gal · Post by **rested gal** » Mon May 02, 2011 5:51 pm

SleepingUgly wrote:In Avi's defense, I don't think he meant any harm to Dori.

I didn't think he did, either.

SleepingUgly wrote:He has a tendency to insert odd, esoteric, tangential ideas into his posts, and I don't think this was a case of anything other than that.

That was exactly my impression, too.

SleepingUgly wrote:Sure hate to defend the one person on the planet who's ever called me a "bully" but on the upside, since he foed me, he won't see that I'm defending him.

He will now.

SleepingUgly · Post by **SleepingUgly** » Mon May 02, 2011 6:03 pm

rested gal wrote:
SleepingUgly wrote:In Avi's defense, I don't think he meant any harm to Dori.
I didn't think he did, either.

SleepingUgly wrote:He has a tendency to insert odd, esoteric, tangential ideas into his posts, and I don't think this was a case of anything other than that.
That was exactly my impression, too.

SleepingUgly wrote:Sure hate to defend the one person on the planet who's ever called me a "bully" but on the upside, since he foed me, he won't see that I'm defending him.
He will now.

Now he's going to foe me all over again for calling his ideas "odd"!

avi123 · Post by **avi123** » Tue May 03, 2011 7:43 am

Hi, I don't know why was I treated by ozi in such a threatening way (aggressive tone)? Is ozi a moderator here?

Check the posts below.

As to SU, she used a four letter word on me when I mentioned to her that her new (at the time) Avatar was [probably] an infringement of trademarks.

BTW, so far I have gained no new practical knowledge in this thread. It's just rehashing the same literature.

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ozij wrote:
avi123 wrote:BTW, you have a grammar mistake when you write: "Continuous Positive Air Pressure is there to stend your airway and keep it from collapsing" . IMO, the word is STENT and not STEND.
Thank you for correcting my typo. You were quite correct, the word I mistyped should be "stent" and the sentnce should read:
Continuous Positive Air Pressure is there to stent your airway and keep it from collapsing. It never "blasts through" an apnea.

I wrote:No cpap - fixed or auto - will "open" an apnea. Continuous Positive Air Pressure is there to stent your airway and keep it from collapsing, but if it collapses, it collapses. With proper pressure, in garden variety OSA, most obstructive apneas will be prevented - or perhaps be shorter, but none are "opened".

You are also mistaken in assuming the Autoset will "drop the pressure" if it encounters a central apnea. It will do no such thing. After an apnea it considers obstructive, an Autoset will raise the pressure. After a central apnea it will simply not make any changes.

You have got many flow limitations - these are going to drive the Autoset's pressure up -- in an attempt to get rid of them. The Autoset is very responsive to flow limitations.

What do your snores look like on the ResScan charts?

in response avi123 wrote: Reply:

Hi, reading the report by Resmed engineers which you gave a link to a couple of months ago, they wrote that the S9 Autoset will drop the pressure (to below 10 cm) if the FOT detects an open airway.

I wrote:One of us misread, misunderstood or misremembered what they read.

If you point to my specific post and quote the paragraph in the report that supports your position, one of us may learn from their mistake.

Until you do so, I maintain my position: The ResMed Autoset algorithm does not reduce pressure in response to an apnea it identifies as central.

Instead of pointing to the report avi123 wrote: Before I reply:

Please clarify this:
<snip>
If I set the S9 Autoset at 8 cm low and 12 cm hi, what will it do if it encounters Obstructive Apnea vs. Central Apnea?

One of us misread, misunderstood or misremembered what they read.

If you point to my specific post and quote the paragraph in the report that supports your position, one of us may learn from their mistake.

Until you do so, I maintain my position: The ResMed Autoset algorithm does not reduce pressure in response to an apnea it identifies as central.

In order for this discussion to be a learning experience for me, you, or anyone else who happens to read this thread, we have to be on same page in the same paragraph of the ResMed engineers report that you refer to.

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