My Sleep Doc Pontificates

Since you asked for opinions;

Tim: your doctor sounds like a great salesman (used car), if you follow his advice you should be seeing him at least every 3 months Not to say your doctor doesn't really know what he's talking about, just that he doesn't know based upon what you posted.

I've had 4-5 autopaps and several cpaps, some that recorded some that didn't. I've always checked the delivery pressure on my machines using a simple and very accurate manometer. Unlike your car tire pressure gage a manometer is very accurate. On your particular Remstar Pro2 machine, you indicated it only provided "compliance" details, what your doctor doesn't/didn't know is that machine is capable of delivering full sleep data just like an autopap does. If you search here for some of Jerry's reports you'll see that machine delivers full detailed data even without Derek's software (using only the EncorePro reports). If you understand how the machine generates the data for these reports you'd know the data seen is pretty accurate as it comes from the decision tree of the algorithm that triggers the machine to respond or not respond. Do these machines miss events? Sure they can miss events, but so can a person sitting at a desk half asleep titrating you. The way I look at it, a little bit of data is better than no data at all. If you want to see if your doctors changes to therapy are the right choices, just do a EncorePro report. If your doctor makes a change your sleep should improve and that would be seen on the reports. We've seen it here all the time, if you increase pressure by 1cm, it can make your condition much worse. Without the software you wouldn't know that and neither would your doctor.

Bill: Looking at your reports, it would seem you could possibly benefit from an increase to your low pressure of 5cm? I say that only because during those runs your pulse rate increases indicating possible heart oscillations corresponding to the times your oxygen levels drop (and the SDB runs shown on the EncorePro reports). If that were my case, I would increase that bottom pressure to like 7cm and see if things didn't improve. I bet they would improve just going to 6cm.

Snoredog wrote:Bill: Looking at your reports, it would seem you could possibly benefit from an increase to your low pressure of 5cm? I say that only because during those runs your pulse rate increases indicating possible heart oscillations corresponding to the times your oxygen levels drop (and the SDB runs shown on the EncorePro reports). If that were my case, I would increase that bottom pressure to like 7cm and see if things didn't improve. I bet they would improve just going to 6cm.

I'm trying to get there Snoredog. I was running it at 4 cm! Thing at the moment though is aerophagia. I haven't heard anyone post of having worse aerophagia than I get. I'm attributing it to the Lower Esophageal Sphincter and hoping that things continue to slowly get better as they have since I started taking Protonix for GERD. What I find now though is that, even with the APAP only spending a moderate amount of time at high pressure, on bad nights I still get pretty pumped up. . And raising the minimum pressure just makes things that much worse.

I can afford to give things a little time. Surgical options aren't really all that good or pleasant. After six months though . . ., other options are open.

Regards,
Bill

Moogy:

Thanks for the link to those articles.

As far as the data goes, we are not automobiles or machines. We all operate within ranges.

The data that is collected from xPAP machines is as close as the technology will allow us to get.

Are you better off with the data than without? If you got to ask - then stay ignorant.
Is it perfect? NO, Still evolving.
Is there a subjective component to sleep - you betcha.
How do you feel?
Will a 1 cm change make a lot of difference - probably not but it can.
Is your titration right on? Possibly not.
Will your needs change- probably.

Can I read as well as my DR - Yes.
Are APAP's being substituted for Sleep study titrations - yes.
DOes the medical community have confidence in APAP - yes.
Does the Med community have confidence in the data - yes.

Should you? IT's your therapy - you'll get out of it what you put into it.
If you don't do anything - I think we'd all be ok with that.

Invest your time into reading this forum - go back and read, read, read. Then, draw your own conclusion.

Some things are just, common sense.

Either you got it or you don't.

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CPAPopedia Keywords Contained In This Post (Click For Definition): Titration, APAP

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CPAPopedia Keywords Contained In This Post (Click For Definition): Titration, APAP

Sleepless, I've sent you a PM, because I think I still have a source for the respironics software.

Also, my arguments for software. I have a Remstar Auto, and live very far away from a DME or sleep doctor so it's not feasible to go to them for advice.

Recently I switched masks, from the Nasalaire to the Aura. My software showed me that with the Aura I spent more time at a higher pressure. So I adjusted my machine accordingly.

Now, that wouldn't apply to a straight cpap machine. But you could tweak your pressure up or down and compare your numbers to see which pressure appeared to be the best for you. Especially if you've changed masks or lost weight, etc.

I'm on board with the software now (not that anyone cares poor me.) Just took me a while to get there. It's my analytic nature (helps me in my job) but can mess up my social interactions. Peeps think I'm questioning their word, when I really just need info to help make up my mind. My friends and family are used to it, strangers not so much.

Regards.

Tim

Ya done good, Tim.

Way to go TIm.

In the end you'll be closer to a solution that's BEST for you.

Best,

Tom

Welcome to the forum, Tim.

Best wishes,

Den