CPAP VS APAP

Yep. This is a great forum. It's free too. What does that have to do with anything? (you have quite a few Straw man arguments) This is where the question was asked, so this is where I answered it.

Don't disregard it if you makes you feel good. I don't want to take something meaningful away from you. I'm just trying to help educate people on this forum that the respiratory data isn't accurate on the "data capable" PAPs. So there is no need to worry from night to night about some of the changes that are seen. Large trends upwards are something to consult your doctor about.

I'm assuming that's a joke about the "cuz I read it on the internet".

The three Board Certified Sleep Docs I work with and I all feel they are not accurate. We are backing this up now with a long term efficacy study. It's not done yet, but it's clear that compared to an all night PSG with Full EEG (so you know they're asleep) and oximetry, APAP respiratory data isn't accurate at all. If they were 100% accurate, insurance providers would use them exclusively because it would be much more cost effective. It's not, so they don't. Why would you know who I am? Everyone on this board is anonymous. By the way, none of them use CPAP, so does that mean they don't know what they're talking about?

Sleeping in a sleep lab every night would be impractical. If you like fake data ,that is really just a shiny penny to make the PAP unit more technologically attractive, then use it by all means. Again, just trying to help educate. We used to use blood letting to cure people....but hey, it was the best we had!

Guilty about what? "Hey, I have this important information for you, but HA HA....not going to tell you where to find more." Maybe I'll just have one 17 hour video that has everything...then no need for the Titles and Credits frames!

That, my friend, was in the introduction. "Hi, my name is Jason and I'm a Registered Polysomnographic Technologist." I thought mentioning my zodiac sign and college statistics might be a little off topic and so I cut that out. Make your own video and edit it the way you see fit.

Yes, I refer them to cpaptalk. I still do, but one of the shortcomings is that it is primarily just users don't know some of the important key parts of treatment, masks, ways to get the most out of their PAP treatment. I also referred them to CPAP Auction before it closed down so they could have access to less expensive equipment. Problems don't get solved unless there is communication from everyone, professionals and users. Your attitude is odd.

I don't consider this forum to be competition at all. I consider it an ally in educating PAP users. If either of us charged money, then we would be considered competitors. From what I can tell, the goal is the same. I just don't see many professionals in the Sleep Medicine field here to help clarify and provide additional insight.

You're right, I guess I advertised for YouTube, a subsidiary of Google.

I should stick with that? That's rude.

So the cure for cancer is probably out there, but you recommend they spend more time with their family? My apologies for not having two versions of every video, one for people like you who...are like you, and another for people who just want to get a better night's sleep.

Enough. You clearly don't like what my opinion is. Keep looking at your data every morning. It can be like your morning cup of coffee.

*****To answer the original post, don't worry about the short term changes you see on your data, it's really not the most valid information. If you see back to back respiratory events or a huge spike in respiratory activity manifest over a long period of time then that is when you need to let your doctor know. Seeing several "open airway apneas" or Central Apneas, then that can possibly be periodic breathing or Cheyne-Stokes. You would require different treatment entirely and that is also something that you would want to take to your doctor. The video was just to illustrate how easy the APAPs can be fooled and how long it really takes for them to respond to an obstructed airway.

TheLankyLefty wrote:*****To answer the original post, don't worry about the short term changes you see on your data, it's really not the most valid information. If you see back to back respiratory events or a huge spike in respiratory activity manifest over a long period of time then that is when you need to let your doctor know. Seeing several "open airway apneas" or Central Apneas, then that can possibly be periodic breathing or Cheyne-Stokes. You would require different treatment entirely and that is also something that you would want to take to your doctor. The video was just to illustrate how easy the APAPs can be fooled and how long it really takes for them to respond to an obstructed airway.

In case you're not aware that is not news here.

The (protocol) Conventional Wisdom (CW) here at this forum, (would that be like a Standing Order for you), is to set your pressures to 2cm below and 2 cm above the titrated pressure when the RRT from the DME left the machine set to 4-20cm. Perhaps you can teach your colleagues, that would be a tremendous help. IF you indeed want to help.

Also, To leave any changes for at least one week to look for trends BEFORE making any more changes.

But it's hard to find trends without the software which you don't recommend yahoos like us to have, right? After all we could just look at the "Average" numbers on the display, right?

So we do recommend the user use the software designed for that machine. But now you are saying these machines are useless and so is the data they produce? And you are on the leading edge of a group that will study and prove that?

Most here prefer an auto machine because it is like having 2 machines in one as it can be set to straight cpap when auto is not needed. But can be changed to auto without the expense of changing out machines if it turns that they have been titrated to the wrong pressure(s) because they have only had 2-4 hours of (documented) sleep in a lab. OR if it turns out they have positional or sleep stage events and need an auto.

TheLankyLefty wrote:one for people like you who...are like you

You can make money with that "original quote".

Gumby, what is with the personal attacks?

You know I'm not an RRT...right? RPSGT and RRT and under completely different scopes of practice.

When did I say not to have software?

When did I say that the machines are useless? APAPs are great for just the reasons you laid out. It adjust to the individual pressure needs with regards to supine and nonsupine sleep, and REM vs. NREM.

You may know about the settings of 4-20 being poor settings, but many doctors and patients don't. The machines aren't useless. Again, just the respiratory data that they produce is largely useless. Haven't I written that before? It's like you're set on arguing something that wasn't even said.

GumbyCT wrote:The (protocol) Conventional Wisdom (CW) here at this forum, (would that be like a Standing Order for you), is to set your pressures to 2cm below and 2 cm above the titrated pressure when the RRT from the DME left the machine set to 4-20cm. Perhaps you can teach your colleagues, that would be a tremendous help. IF you indeed want to help.

Trying to help is exactly what I am doing. This is where you, the user, need someone in the business to shed light on the subject because you don't know what you're talking about. I can educate the doctors, but how many are really checking out YouTube videos or looking at this forum. Maybe two in the last year? So instead we need to target the patients who will in turn go to their doctors with this information.

RRT puts the patient on 4-20 because that's what the doctor ordered. RRT doesn't want to lose their job and they have hundreds of patients, so they set it up and move on. They could educate the doctor, but they don't because they don't give a flying fig. So we educate the patient and hopefully this reaches the before getting their APAP.

"Doctor, why am I on 4-20cmH20, shouldn't those pressures be closer to my optimal pressures for NREM and REM?".
Doctor: "Oh....yeah....we can do that." Writes personalized prescription for APAP.

In a perfect world the doctor would already know that. Sounds like you have a good doctor. You assume all others do. Why you have some bender about RRT's I don't know. Did one kill your family? RPSGTs and RRTs notoriously don't get along because they don't overlap into sleep at all. Just the equipment side. But you already knew that, didn't you. More conventional wisdom. Yes, you knew it, but many new users don't.

So my apologies for you having to read something that you already know, but I promise you there are new users that didn't know. Think like a new user or you become one of the jerks that assumes everyone knows everything.

[sarcasm=] I have more original quotes, but God forbid I PROMOTE those. [/sarcasm]

TheLankyLefty wrote:[sarcasm=] I have more original quotes, but God forbid I PROMOTE those. [/sarcasm]

Yea here is another ....

TheLankyLefty wrote:Gumby, what is with the personal attacks?

You know I'm not an RRT...right? RPSGT and RRT and under completely different scopes of practice.

So show me where you felt attacked?

GumbyCT wrote:Of course not. It's just the way it comes across. So your idea is for us to disregard the ONLY nitely info we have available cuz you say to?

GumbyCT wrote:MY sleep doc said it is 100% accurate or she wouldn't use it. She is a doc, I/we don't have a clue who you are.

TheLankyLefty wrote:And you should spend more time with your family, instead of trying to steal visitors from the competitions website and forum.

GumbyCT wrote:The (protocol) Conventional Wisdom (CW) here at this forum, (would that be like a Standing Order for you)

GumbyCT wrote:But it's hard to find trends without the software which you don't recommend yahoos like us to have, right? After all we could just look at the "Average" numbers on the display, right?

....just to name a few.

Why you feel the need to attack my position (and me personally) is beyond me. The irony is that large text at the bottom of your signature is very similar to my presentation title "Who's driving this bus? Be your own advocate."

The reason why patients won't have access to the software is because that is giving them control. Now here is where many people throw their hands up and say it's all about money. The doctor and the DME makes no money on this. If they did they would be much more eager to do it. DME employees don't often jump at the chance to download data.

The reason it's not given to patients is because it gives them control of their pressure settings. These settings are very fine on most patients. There is usually a window of around 4cmH20 that is optimal, in many more it's much less. If a patient can change this easily then they move it too low and RERAs and Hypopneas manifest, too high and Central start. Each damaging in its own right.

PAP therapy is a prescription. Giving out the software is akin to giving every pain management patient an Rx pad so they can write their own Vidodin prescriptions. No, it's not some ploy by "big business." The truth of that is that ResMed and Respironics would LOVE to sell everyone the software. But then why do I have a feeling people would complain that they are being charged for it?

I love arguments like this because it forces me to constantly rethink my position, but please keep it on topic.

Here is what was said. Tell me what is wrong with this picture.

TheLankyLefty wrote:When did I say not to have software?

When did I say that the machines are useless? APAPs are great for just the reasons you laid out. It adjust to the individual pressure needs with regards to supine and nonsupine sleep, and REM vs. NREM.

<snip> The machines aren't useless. Again, just the respiratory data that they produce is largely useless. Haven't I written that before? It's like you're set on arguing something that wasn't even said.

So from that you want me to understand that these are very good machine EXCEPT for the data that these very good machines produce is useless.

Or is it - these are very good machine EXCEPT for "the respiratory data that they produce is largely useless". So you are saying the leak data should not be considered respiratory AND is very good data. However comma leak data should not be viewed on the software - ONLY the average numbers that appear on the screen are useful.

Did I get that right?

TheLankyLefty wrote:....just to name a few.

Those are facts, things I've experienced, or me trying to understand YOU.

TheLankyLefty wrote:I love arguments like this because it forces me to constantly rethink my position, but please keep it on topic.

Which is what you were trying to do by playing the pity me card, accusing personal attacks.

And this is where TLL tries to take the topic in another direction. These are BS reasons and rightfully should get their very own topic.
You are aware the pressure can be changed without the software, right?

You are aware there IS software that will NOT change the pressure, right?

So why did you say these things then?

TheLankyLefty wrote: The reason why patients won't have access to the software is because that is giving them control.

That IS BS.

TheLankyLefty wrote:PAP therapy is a prescription. Giving out the software is akin to giving every pain management patient an Rx pad so they can write their own Vidodin prescriptions.

BS - maybe they should give you something to dispense these pills as prescribed?

TheLankyLefty wrote: There is usually a window of around 4cmH20 that is optimal, in many more it's much less. If a patient can change this easily then they move it too low and RERAs and Hypopneas manifest, too high and Central start. Each damaging in its own right.

Did you say that you were sleeping with a cpap 1-2 months each year? You did have a sleep study right? AND have been titrated.

TheLankyLefty wrote:When did I say not to have software?

I take it we will never see a software section on your forum?

Do your best to stay ON Topic please.

So, who's bringing the popcorn?
This troll is really feisty!
Not too smart, though; won't be much of a match.

TheLankyLefty wrote:....just to name a few.

Why you feel the need to attack my position (and me personally) is beyond me. The irony is that large text at the bottom of your signature is very similar to my presentation title "Who's driving this bus? Be your own advocate."

I don't like to ass-u-me so I will say - "WE are NOT talking about the same Advocate". Are we? Nice try.

ad·vo·cate (dv-kt)
tr.v. ad·vo·cat·ed, ad·vo·cat·ing, ad·vo·cates
To speak, plead, or argue in favor of. See Synonyms at support.
n. (-kt, -kt)
1. One that argues for a cause; a supporter or defender: an advocate of civil rights.
2. One that pleads in another's behalf; an intercessor: advocates for abused children and spouses.

Look it's the FREE Dictionary - http://www.thefreedictionary.com/advocate

chunkyfrog wrote:So, who's bringing the popcorn?
This troll is really feisty!
Not too smart, though; won't be much of a match.

I like this one...

TheLankyLefty wrote:Trying to help is exactly what I am doing. This is where you, the user, need someone in the business to shed light on the subject because you don't know what you're talking about.

Now I will get accused of a personal attack.

For me - I am just grateful he didn't go to med-school but then there prob is a reason. Just my thoughts

TheLankyLefty wrote: With data capable machines the problem that I have is that the "data" is by definition not accurate and so it is nothing more than frustrating. With this I am referring to anything involving any respiratory data.

[portion omitted]

I set people up on Auto CPAPs for long term diagnostic treatment use if we need more titration data (so I'm intimately aware of the APAPs capabilities.

First, let me say I applaud anyone who endeavors to educate and help people understand a diagnosis of apnea. Too many doctors set patients up with cpap machines (most of the poor sods getting 'bricks' that only record compliance data) and for many that's it. Everyone gets paid and you have a cpap machine on your nightstand, usually without a good understanding of what it does or how it does it.

I'm curious... your 2 statements above seem contradictory (and I don't mean to be facetious). How can you claim that the data isn't accurate and then say that you set people up on apaps for diagnostic purposes for data collection. If you don't think the data is accurate, what do you use it for?

As an apap user who looks at my data regularly, this seeming contradiction struck me.

RandyJ wrote:this seeming contradiction struck me.

I thought there were many contradictions thru out been then he thinks it's a personal attack if you ask about those contradictions .

As for this one...

TheLankyLefty wrote:Trying to help is exactly what I am doing. This is where you, the user, need someone in the business to shed light on the subject because you don't know what you're talking about.

It makes me wonder - how has cpaptalk managed without for so long? Someone to shine the light on what they want you to see.

EDIT: Now it's time for me to go create some useless data that my doc won't look at - even at my next annual appt.

Geez....just more personal attacks in back to back then pause.....back posts.

I have worked in several research and for profit sleep disorders centers in the last 12 years. Most of them overlap greatly.

Yes, I am an advocate for patients. I want (not just PAP users) all patients with sleep disorders to know as much as possible so that they know all the risks and benefits of all forms of treatment. I want them to understand that there are several mask available, and that the one that are given by a DME may not be in their best interests. I want them to know that all sleep labs and doctors and technicians aren't created equal. The system is broken. I help the sleep disorders patient by giving them an insiders look at they system and how to get the most out of whatever therapy they decide is best for them once they have all the facts.

Sounds like I'm an advocate for teaching people to be their own advocate.

So with regards to data capable whether it's CPAP or APAP. The respiratory data is very flawed and so very unreliable. Respiratory data includes apnea, hypopneas, open airway apneas (centrals), vibratory snore, and airflow reduction. Yes, all of it is poo. When you are finally asleep, the APAP will react to you very well. I have no problem with that. The problem I have is that the "AHI" it reports to the user isn't helpful when checked daily. Even when checked daily the AHI is an average for the night. This still isn't helpful. If you have software to check where it occurred during the night you still don't know if you're asleep.

This is why I say that with regards to Respiratory data, it is better to go by how you feel in the morning. Memory and concentration good? Feel rested? Feel the need to nap? Sore throat? Bed partner complaining of snoring again? If all is good, then why is the data important? Right, because you said that it's the best we have. That's not good enough.

Leak data is very valuable. Leak calculation is very accurate in data capable machines. Seeing it graphically is very helpful. It's not realistic though for the reasons I mentioned above. That's the reason whether you think it's BS or not.

I know people know how to change the PAP prescriptions themselves. People are also able to get Vicodin when they don't have a prescription for it. I don't see the point. If they find out how to do it, then the risks are on them. They've made a conscious choice. If you just give away the directions on how to do it, then it's on them. Sniff sniff sniff....then you smell a lawsuit when they develop a pneumothorax. (look it up, it's in the same dictionary you referred me to)

One last thing that bothers me about your position. That it is "conventional wisdom" how APAPs are supposed to be set. With patients who are newly diagnosed and new to the sleep disorders arena, there is no such as conventional wisdom. Some people don't even know what apnea is, or how to put on their mask, or how to start their PAP unit.

Your attitude that everyone knows everything is damaging. It prevents people from feeling comfortable in asking the questions that need to be asked so that they too can get a better nights sleep.

I realize that you are an APAP user. You have tons of experience with it while asleep. I have about 8 years of experience with it while awake.

I think this topic has been thoroughly exhausted. Now we just need Jerry Springers "Final Thoughts"

TheLankyLefty wrote: I want them to know that all sleep labs and doctors and technicians aren't created equal. The system is broken. I help the sleep disorders patient by giving them an insiders look at they system and how to get the most out of whatever therapy they decide is best for them once they have all the facts.

I think everyone is good at something. I think the best way YOU can help is to tell everyone where you know they can get a sleep study done properly and score correctly then guide them to a DME who won't sell them a brick. THAT would be a help.

obtw - show me where I said -

TheLankyLefty wrote:that everyone knows everything

That IS why we come here silly - to learn.

Time out. I need to go find my hip waders. The BS is getting awfully deep.

Thank goodness I didn't go by "how I felt in the morning" some 2 plus years ago. The machine would have been long ago sold. Jeeezzzz.

I am a medical professional (or was until I retired) and I can't believe what I am reading here. I am speechless and those that know me will understand that is a tall order for me.

Gumby, I've got your back here. Just couldn't stand it anymore. This guy sounds like the yahoo that told me it was against a Federal law for patients to have the software and this was back when ResMed and Respironics openly sold their software to patients.

Another person to put on my foe list so I don't waste my time reading their comments.