Poster child for Auto Audjusting pressures

Yes, testing in general....so that people could see a potential problem and have an idea what they would offer and why?
Just educational posting. Some people learn best by example and that includes me. If I see results it makes it a lot easier.

-SWS wrote:I didn't realize you were testing the message board at-large. Rather I thought you were testing the treatment modality. Sorry.

No problem...you raised just the very point that I wanted people to see and think about.

Pugsy wrote:I want you (collective you and not you singled out) to be able to think for yourself. We never know how long any one of us is going to be in a position to take up the slack if something was to happen to me or anyone else here on the forum.

It has always been my number one goal to educate so that a person can think for themselves and not for me to spoon feed what to do. I want people to understand the whys and whats of what we do and not "heck, I will do this because so and so said to"
No one learns when we spoon feed stuff.
This is why I often write long explanations as to why I would suggest so and so or do so and so if it were me.

Ah crap....no one said there was going be a test today. I brought my pencil, Give me something to write on

Pugsy wrote: No problem...you raised just the very point that I wanted people to see and think about.

Well you couldn't have picked a better BiLevel point to highlight IMO.

Pugsy wrote:I want you (collective you and not you singled out) to be able to think for yourself. We never know how long any one of us is going to be in a position to take up the slack if something was to happen to me or anyone else here on the forum.

Is anyone else wondering...

kaiasgram wrote: Is anyone else wondering...

Wondering "is Pugsy planning on going anywhere" ?
Nope, not at all...despite what a few of our favorite grumpies might secretly wish.

I would just prefer to help people to learn to walk on their own two feet and not have to rely on someone to hold them up all the time. I am here to lean on sure....but would really rather someone learn how to understand their own reports and be confident in their knowledge that they do something because they have figured it out and not because someone else said so.

Pugsy wrote:

kaiasgram wrote: Is anyone else wondering...

Wondering "is Pugsy planning on going anywhere" ?
Nope, not at all...despite what a few of our favorite grumpies might secretly wish.

I would just prefer to help people to learn to walk on their own two feet and not have to rely on someone to hold them up all the time. I am here to lean on sure....but would really rather someone learn how to understand their own reports and be confident in their knowledge that they do something because they have figured it out and not because someone else said so.

Give a man a fish and he eats for a day.
Teach a man to fish and he eats for a lifetime.

Go Pugsy!

NotLazyJustTired wrote: Give a man a fish and he eats for a day.
Teach a man to fish and he eats for a lifetime.

Exactly my thoughts.
I love helping but I love it even more when someone says that they learned something and are able to get a grasp on things themselves.


Oh...BTW anyone who saw my original post and maybe had a different idea that was different from my thoughts...speak up...remember this is my situation and doesn't mean that everyone else is going to be like me.
There are situations where an alternative is just as workable.
We all learn from brain storming different ideas.

NotLazyJustTired wrote:

Pugsy wrote:

kaiasgram wrote: Is anyone else wondering...

.I would just prefer to help people to learn to walk on their own two feet and not have to rely on someone to hold them up all the time. I am here to lean on sure....but would really rather someone learn how to understand their own reports and be confident in their knowledge that they do something because they have figured it out and not because someone else said so.

Uh,Oh! I think she's talking about me! :wink But I think I'm almost there!!

I like this version:

“Give a man a fish and he will eat for a day. Teach him how to fish, and he will sit in a boat and drink beer all day. ”

― George Carlin


Den

.

DoriC wrote:

NotLazyJustTired wrote:

Pugsy wrote:

kaiasgram wrote: Is anyone else wondering...

.I would just prefer to help people to learn to walk on their own two feet and not have to rely on someone to hold them up all the time. I am here to lean on sure....but would really rather someone learn how to understand their own reports and be confident in their knowledge that they do something because they have figured it out and not because someone else said so.

Uh,Oh! I think she's talking about me! :wink But I think I'm almost there!!

Dori, you're so cute!
Pugsy, it's more than fair to ask us to stand on our own two feet when we can. AND, I'm glad you're not going anywhere any time soon.

I have a question-How can you tell from looking at your data that you are in REM stage sleep.

Also just to clarify if you are not having CA or OA's but are having hypoapnea's then you raise your IPAP pressure. If it is the reverse you raise you EPAP. Correct or did I read that wrong?

My pressure is set at 20 and I'm having no OA's or CA' s. My AHI monthly average right now is .07 with both sleepyhead and with Encore. All events are hypoapneas. Think I can risk lowering the pressure down to like 19?

DoriC wrote:
Uh,Oh! I think she's talking about me! :wink But I think I'm almost there!!

Don't kid yourself. You already know the answer when you ask me a question. You just want to make sure.

tqpannie wrote:I have a question-How can you tell from looking at your data that you are in REM stage sleep.

First of all history..my own personal history with the AHI of 53 in REM sleep per my sleep study compared to 12 in non REM sleep.
Secondly there is a common pattern to all sleep stages. First REM stage normally starts around 90 minutes or so (maybe a little sooner or a little later) after sleep onset. It doesn't take me long to get to sleep.
Third...nearly 4 years of seeing my reports and seeing a common pattern no matter which type of machine or operation mode I use.

So mainly experience and time and looking at lots of reports. If you go to this link and scroll down to the Physiology section and on the right is a hypnogram of normal sleep stages. http://en.wikipedia.org/wiki/Sleep
Of course it isn't always perfect but this is pretty close to what most of us will go through unless of course we have a lot of fragmented sleep or arousals or awakenings for some reason.. Mess with the cycles too much and we come up short on the amount of deep and REM sleep that the body needs to make good use of the restorative powers of sleep.
These is why the first question I ask someone who is having trouble feeling decent...is your sleep fragmented for any reason?
If a person wakes up 20 or 30 times a night they are going to feel like crap no matter how good the reports look.

tqpannie wrote:Also just to clarify if you are not having CA or OA's but are having hypoapnea's then you raise your IPAP pressure. If it is the reverse you raise you EPAP. Correct or did I read that wrong?

Correct...If I saw a large majority of Hyponea events...I would probably concentrate on IPAP a little closer but I have never had many Hyponeas...it's always been mainly OAs. So I target EPAP first. My IPAP choice is a product of my preferred Pressure support for comfort. Not because I am worried about the IPAP dealing with anything really. Pure comfort.

EPAP for Obstructive apnea zapping
IPAP for Hyponea zapping.

Now if someone has a lot of both...try to fix the OAs first and see how many Hyponeas are left to worry about because there's a good chance that there will be a significant reduction in Hyponeas secondary to better OA control.

tqpannie wrote:My pressure is set at 20 and I'm having no OA's or CA' s. My AHI monthly average right now is .07 with both sleepyhead and with Encore. All events are hypoapneas. Think I can risk lowering the pressure down to like 19?

With an AHI that low...yep, I would think you probably have probably more than 1 cm room to reduce the pressure.
You are probably seeing minimal hyponeas with an AHI less than 1 like you are seeing. What are your current settings on your BiPap? Fixed mode or auto adjusting?

Everyone:
Now you ResMed S9 users....you have EPR available and while it isn't exactly like Pressure Support on a bilevel it works very similarly. The timing isn't quite the same and you are limited to 3 cm difference.
I had always used a Respironics machine until I tried the S9 VPAP Auto that a forum member loaned to me so I could finally know what a ResMed felt like. I played with CPAP mode with EPR of 3....it's close to VPAP fixed bilevel mode with PS of 3.

Respironics users...Flex is nothing like EPR or Pressure support difference. Totally different animal. No where near the amount of reduction straight off the bat with exhale. Flex work with your own breathing rhythm. I liked AFlex and thought CFlex was useless. Just my own personal opinion. I know there are people who view Flex or EPR as training wheels or they don't like it. Hey, that's fine. Whatever floats your boat and works is fine by me.
We are all individuals and we all often have different preferences.
I look at it this way...anything that increases my comfort also stands a good chance to increase my overall sleep quality and like I have said before....sleep quality is pretty much my number one goal. If we have crappy sleep quality the best AHI in the world isn't going to help us feel any better.

Easy to remember put like that:
EPAP for Obstructive apnea zapping
IPAP for Hypopnea zapping.

Does this basically apply with ASV technology ie. machine triggered assisted breathing? I know it's probably a simplification, considering the other parameters of ventilation involved, but bear with me. Simply curious. Thanks, Pugsy for the mention of pressure support... been wondering about that.

Sir NoddinOff wrote:Does this basically apply with ASV technology ie. machine triggered assisted breathing?

SWS or JohnBFisher would likely be a better source of information about ASV stuff.
My ASV understanding is very basic and I am not comfortable with more than just the very basics.
Pressure support has a different function...at least more than my pure comfort function.
That's why I stay out of ASV report discussions....I am on the sideline trying to learn more about it just like most of us here.

Okay, here is my report from last night. I didn't change my settings from 9.5/13.5 last night. We went out of town and didn't get home till late. I had done a lot of sitting so my back was acting up especially. It was late and I just didn't want to fool with a new setting...besides I didn't know just how good of sleep I would get because of the extra back issues.

It wasn't a bad night on paper. Shorter hours than I would really like but sometimes life happens.

Oh...while looking back in Dec 2011 through Feb 2012 when I was using my BiPap Auto in fixed bilevel mode last year I found one night where I was using 8/12 settings...AHI was like 0.58...not much happened. This just goes along with "we don't sleep the same every night"...That was one of the nights if I had been using APAP for some reason I wouldn't have needed the higher pressures that I sometimes need. It wasn't a particularly short night either.

So...we don't always need the same pressure settings every night even in a fixed pressure mode. This is why we need to look at long term patterns when deciding which pressure we might need. Can't go panicking when sometimes things look less than optimal or have a good night followed by a not so good night on paper.