Dr. Krakow, salesman extraordinaire? UPDATED

gvz wrote:And to my old friend, the luthier:

And the leader of the band.

Damn, gvz, your post clean stopped me in my tracks.

gvz wrote:Miss ya.

The same.

ignorant1 wrote: Again, there is no "Big Secret". In fact, Dr. K speaks at seminars and has tried to get others to listen to what he may have to contribute. But far too many sleep centers and practitioners are stuck in the mud with a “if it ain’t broke, don’t fix it” mentality; i.e., if the AHI is good, who cares about all those pesky “residual” arousals. We got paid, let the DME monitor compliance (only) so they get paid, and NEXT IN LINE PLEASE!

Wow.

Out of the mouths of babes (and ignorants) and all that.


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ignorant1 wrote:Yes, there are numerous factors, such as you mentioned, that come into play. (And I agree with you about the greater LA basin needing to be deep-sixed!) The fact that ABQ is 5,000 feet higher than LA is significant; one thing being due to differences in how blood gasses like CO2 are blown off. (IIRC) So right away we have the issue of respiratory drive & Centrals to debate about. You will be happy to know that in my case, there are no piles of undisclosed medications to foul the data. Just one med (thyroid), and nothing else. No alcohol, no caffeine, no OTC meds, no crazy supplements, nothing.

Double Wow.

Wow², even. (Wow squared)

Excellent post, ignorant1.

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And to Dave:

How about doing what I did just a few hours ago?

Pick up the phone and call the dude.

Then, give me an email (or a call), and when I'm out your way, we'll have a beer, talk about the soxx, etc.

.

SleepingUgly wrote:I just need an ASV to borrow for this experiment.

So how's the experiment coming?

Which ASV did you get/are planning to use? This decision would obviously be very significant in that only one of the four ASVs has the algorithmic ability to achieve Lowest Effective OA Treatment Pressure, and at least theoretically have a better shot at reducing overall MAP and therefore aerophagia.

And yet, as previously suggested, I don't believe that it is driving pressure per se that is the issue-- rather, it's avoiding a milieu that encourages phagia-ing (unnecessarily high pressures, square waveforms, failure to move to bilevel after CPAP intolerance, etc. that contribute to Arousal-Wake).

Consequently, in this case, that would seem to make ASV a "comfort measure", and an expensive one at that.

SleepingUgly wrote:I just need an ASV to borrow for this experiment.

You can borrow mine. Brand new. Still in it's original packing.

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SleepingUgly wrote:I could even be blinded.

Now we're talking!

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SleepingUgly wrote:My husband can blindfold me

WTF? Husband? JC, this wasn't part of our deal, Sue!

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SleepingUgly wrote:this will be like a cross between an S & M film and a serious, high-tech research study!

A dressed in Black Leather SDB wet-dream to be premiered on Dieter's Sprokets. Touch my Monkey! Touch him!

As long as I own all world-wide rights, in all media, currently available now or yet to be invented, in perpetuity, (all profit-participants to be paid pari passu with all other participants).

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FROM THE SUBLIME TO DOWN THE LIME:

deltadave wrote:Consequently, in this case, that would seem to make ASV a "comfort measure", and an expensive one at that.

A quick question, double D.

I vaguely remember (and my apologies if I'm wrong) that you've written that you're the best sleeper you know.

Imagine two diagnostic sleep studies, on separate nights, with you as the sleep subject, hooked up to one of K's rooms-fer-rent, with his crack staff ah' eyeballin' y'all' at 5000+ feets.

During the previous 24 hours before each study, you are locked in a room and your routine is exactly replicated moment for moment, so that each day is like Ground Hog Day: every moment of day one matches every moment of day two.

Then the sleep studies are conducted.

Against all odds, both studies are impossibly, precisely identical, breath for breath, each waveform perfectly sinusoidal, like it was a machine that was breathing, not a human being.

Yet, during the day that follows each study, your mood, affect, alertness, etc. etc. couldn't be more different.

As a clinician, how would you manage such a case?

Today?

In 2020?

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That's it for tonight's radio X, folks (Z!...Z...Z...z...z), Tonight, in my dreams, I'm going to lake vostok, lay down on the 15 million year-old ice and do some remote dreamin'.

chow 4 now,

roc

.

deltadave wrote:

SleepingUgly wrote:I just need an ASV to borrow for this experiment.

So how's the experiment coming?

Which ASV did you get/are planning to use? This decision would obviously be very significant in that only one of the four ASVs has the algorithmic ability to achieve Lowest Effective OA Treatment Pressure, and at least theoretically have a better shot at reducing overall MAP and therefore aerophagia.

And yet, as previously suggested, I don't believe that it is driving pressure per se that is the issue-- rather, it's avoiding a milieu that encourages phagia-ing (unnecessarily high pressures, square waveforms, failure to move to bilevel after CPAP intolerance, etc. that contribute to Arousal-Wake).

Consequently, in this case, that would seem to make ASV a "comfort measure", and an expensive one at that.

Well, no one has offered to lend me an ASV so far (until Rocklin' just did). Which ASV would achieve Lowest Effective OA Treatment Pressure? Do you think it has a better shot of reducing overall MAP and therefore aerophagia than my S9 VPAP?

I've had 3 nights in a row at the same setting. Got aerophagia the first night, not the second, yes the third. This pressure doesn't even approach what I need. I'm using Easy-Breathe.

deltadave wrote:Consequently, in this case, that would seem to make ASV a "comfort measure", and an expensive one at that.

True in my opinion as well. ASV is monetarily expensive regardless of WHICH sleep problem it happens to singularly address: central dysregulation or sleep deterioration (based in intolerance/discomfort of less-expensive machines).

Either of those conditions in excess can be deleterious. When/if ASV happens to treat either of those problems better than other platforms, then I'd guess a cost-comparison for people like ignorant1 converts from: a) comparing monetary cost of the machines, to b) also comparing quality-of-life (QOL) costs/benefits of ASV---versus those of less-effective CPAP/BiLevel/APAP.

Rhetorically: How many people buy expensive mattresses when a less-comfortable and less-expensive mattress is made for the same purpose? Are those comparatively expensive mattresses frivilous purchases? Was ASV a frivilous purchase for ignorant1? If ASV happened to work for SU would it be a frivilous purchase?

-SWS wrote:Rhetorically: How many people buy expensive mattresses when a less-comfortable and less-expensive mattress is made for the same purpose? Are those comparatively expensive mattresses frivilous purchases? Was ASV a frivilous purchase for ignorant1? If ASV happened to work for SU would it be a frivilous purchase?

Word.

To which we might add, referring to the opening post of this thread:

If all underlying sleep issues were solved by a trip to Maimonides, would that be a frivolous purchase?

And while we're at it:

Has ignorant1's search for the Truth led him to discovery of "The Big Secret", but having done so, his brain has exploded a la Lt. "Doc" Ostrow after screwing with the Krell brain-buster?

And:

Has the NM Sleep Family ordered a "hit" on ignorant1, and his sudden disappearance is a result of his entry into the Witness Protection Program (insert Law and Order "doink-doink" sound clip here)?

Or:

Has ignorant1 been Raptured (insert Law and Order doink-doink sound clip here too)(I like the Law and Order doink-doink sound clip)?

Questions of the universe...

deltadave wrote:

-SWS wrote:Rhetorically: How many people buy expensive mattresses when a less-comfortable and less-expensive mattress is made for the same purpose? Are those comparatively expensive mattresses frivilous purchases? Was ASV a frivilous purchase for ignorant1? If ASV happened to work for SU would it be a frivilous purchase?

Word.

Thanks. I'm going to try FireFox. It underlines those nasty misspelllings in red.

LOL!!

While thinking about the word, "Word" -- as a greeting (and/or as "agreement" with what had just been said) -- I knew what it meant, but went a'googlin' anyway. Hard to find "Word" as a greeting until you come across an urban slang dictionary:

http://www.urbandictionary.com/define.php?term=word

1. Word
1) well said
2)said in a agreement
3) can be used as a greeting, hey whats up
1..and 2...Yo u goin to that rocks tanite....word
3) word up

Words are fun. Sometimes frivilous fun. And more often frivolous fun.

rested gal wrote: Words are fun. Sometimes frivilous fun. And more often frivolous fun.

Word.



P.S. Or FireFox... or perceptive friends.

Sorry for the delayed response. I come back after a few days, and geez… I had to go buy some hip-waders to get through all the muck.

BUT – I am very pleased to see another highly esteemed & knowledgeable poster entering this discussion. SWS has succinctly summarized this entire issue. Bravo. His post merits re-reading – again & again until it fully sinks in:

SWS wrote:
…ASV is monetarily expensive regardless of WHICH sleep problem it happens to singularly address: central dysregulation or sleep deterioration (based in intolerance/discomfort of less-expensive machines).

Either of those conditions in excess can be deleterious. When/if ASV happens to treat either of those problems better than other platforms, then I'd guess a cost-comparison for people like ignorant1 converts from: a) comparing monetary cost of the machines, to b) also comparing quality-of-life (QOL) costs/benefits of ASV---versus those of less-effective CPAP/BiLevel/APAP.

Deltadave wrote:
…only one of the four ASVs has the algorithmic ability to achieve Lowest Effective OA Treatment Pressure…

The suspense is making me hold my breath! (And that’s really pissing off my ASV.) Which machine are you speaking of? Inquiring minds want to know!

Deltadave wrote:
…a Pressure Profile of a night on the ASV.
AND
BTW, what are your current settings?

No problem - I’ve got 6 months worth of ASV data. Current settings: I’ll PM you.

AND...

Re: the posting by “Sleepy Blimp” – Sorry to hear of your plight. We don’t know anything else about this phantom poster, but if this is an honest portrayal of someone’s experience, it further proves the point that (like xPAP) ASV is NOT a panacea for all ills. However, ASV DOES provide tremendous help to those that are able to benefit from it.

Rocklin: You poor old bastard you! Your meds need to be adjusted. The split schizoid personalities are still emergent as evidenced by the alternating accents – German at times, and then Hillbilly. What sort of self-respecting Russian would allow this to recur? как вам не стыдно!

Deltadave wrote:
Has ignorant1's search for the Truth led him to discovery of "The Big Secret", but having done so, his brain has exploded…

and SWS wrote:
Rhetorically: How many people buy expensive mattresses when a less-comfortable and less-expensive mattress is made for the same purpose? Are those comparatively expensive mattresses frivilous purchases?

No, actually my brain didn’t explode. But it has melted into a highly viscous (or semi-gelatinous) goo that slowly dribbles out of my ear at night. (I’m a side sleeper.) I attribute this state of affairs to years & years of hypoxic events, but the biggest annoyance is how this has ruined my $70,000 Vividus mattress. http://www.luxurylaunches.com/other_stu ... ensive.php (For now, I had to have my servants pull an old Duxiana out of one of the guest cottages.)

And on that note, I’ve gotta run… I’m scheduled for a good old-fashioned rapturing later today!

-SWS wrote:

deltadave wrote:

-SWS wrote:Rhetorically: How many people buy expensive mattresses when a less-comfortable and less-expensive mattress is made for the same purpose? Are those comparatively expensive mattresses frivilous purchases? Was ASV a frivilous purchase for ignorant1? If ASV happened to work for SU would it be a frivilous purchase?

Word.

Thanks. I'm going to try FireFox. It underlines those nasty misspelllings in red.

Word?

ignorant1 wrote:Current settings: I’ll PM you.

I knew it!

THAT'S the Big Secret!

deltadave wrote: Has ignorant1 been Raptured?

I figure a smidgen of helium will do the trick.

Helium titrated by ASV, natch.

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Now there's a thought.

Will Iggy insist on bringing his beloved ASV to the Pearly Gates?

doink-doink.

nah.