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Another Milestone, Thankfully!
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AshSF Offline

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Machine: PRS1 D560TS
Mask Type: Nasal pillows
Mask Make & Model: ResMed P10, Bkup: Airfit F10 & Quattro Air
Humidifier: PRS1 60 series with Heated Tube
CPAP Pressure: 8 - 8 w/ Aflex 3
CPAP Software: SleepyHead

Other Comments: Using APAP mode with fixed pressure

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Post: #11
RE: Another Milestone, Thankfully!
(08-06-2015 09:54 PM)TyroneShoes Wrote:  
(08-06-2015 05:28 PM)parkerdt Wrote:  Thanks! I still have a few concerns to discuss with the Doctor - but to my surprise, I have a 30 minute appointment! So hopefully he can read my card and suggest any tweaks that would help. I'm really curious as to why he prefers fixed pressure, also, even though he prescribed an auto machine. Wink
1) The industry is lethargic. We've had auto for some time, but there is a legacy mind-set that a fixed pressure is still best, which has no real argument to support it that I have been able to find.

2) Auto-CPAP is a threat to the lucrative PSG industry. Its a disrupter. It might mean that the relevance of a PSG is lowered significantly.

For a sleep doc to give in and admit to auto being a better solution is to allow the APAP onto the slippery slope that makes the PSG
I used to think this way but not any more. Agreed that PSG labs just want to make money and charge a lot and most of them don't do a good job.

But:
1) There are clinical studies out there that show that a significant percentage of people have microarousals on varying pressure of the APAP. I have experienced it myself. Since a high percentage of people have titrated pressures less than 12, they can tolerate fixed pressure with little difficulty.

2) often times, your AHI comes into treated range at a lower pressure than the optimal titrated pressure. You need a bit higher pressure to keep O2 levels high and to NOT have any microarousals in the process. The only way to find it out is via an EEG and you can only get that in a lab currently.

3) If an APAP algorithm just fixes the AHI and doesn't fix microarousals and O2, it will still leave the patient 'tired' in the morning.

4) the previous 3 points are only for plain vanilla OSA. What happens o more complex cases. You need a PSG for that.

Some day, we will have reliable EEG that we can buy for cheap. With a wrist pulse ox, EEG and APAP, people can titrate their optimal pressure at home.

I did a home sleep study, got an APAP on 4-20. It took me 4 months and multiple hours of reading, experimentation and analysis to get to a 'rested' feeling. I wonder if a PSG would have been a better use of my time and money than this.

My 2 cents. BTW, I am not a RT, doc or any investor in any PSG lab Smile.

Started APAP 4-20, Closed range to 7.5-14, then straight 8.0 w/ Aflex 3
RDI always below 1. But sleep much much better at straight pressure.
Started on F10, Tried Quattro Air successfully. Finally settled on P10.
08-07-2015 10:25 AM
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parkerdt Offline

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Machine: ResMed A10 AutoSet
Mask Type: Other
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Other Comments: I alternate between WISP and fabric Nuance - like both!

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Post: #12
RE: Another Milestone, Thankfully!
Intersting takes in the last 2 replies.

My Doctor did take the full 30 mins with me, and he had in hand the data from my machine and the ResScan reports. I'm averaging an AHI of 2.74 over my entire first 90 days. Last 30 days my AHI average is 1.98. Much better than the 67 at my sleep study, obviously. And he was pleased with the numbers. Was interested in the fact I had SleepyHead and ResScan, and asked what I saw that concerned me! Asked him about the few Centrals I have and he said not to worry, too low to be of concern. And he said machine reporting of RERA is inaccurate at best, that it takes an EEG to really measure RERA properly, and the machines are essentially guessing.

As to the Auto machine and fixed pressure, he pointed out the microarousals that affect some people. Told me I could try it if I wanted to, and asked if I had tried any other settings. I told him I was using EPR of 2 - no pressure relief was used in my titration. He said no problem, and good for you for trying different things. Suggested I try 1 and 3 as well for a few nights each and find the most comfortable setting. Even asked about my experience with my DME, and if I were satisfied with them. He said the difference in cost of an Auto machine made it worth providing routinely, rather than having to change out a machine if auto was needed in the future.

Lastly he wanted to know if my wife was also sleeping better! May have been a throw-away question, but I was impressed he asked it.

All in all I was impressed by his thoroughness, preparedness, and willingness to answer all my questions and explain those that needed explaining. So I really cannot complain at all. I return in 6 months, and if all is well, will go to being followed annually.

Dave
(This post was last modified: 08-07-2015 04:24 PM by parkerdt.)
08-07-2015 03:41 PM
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DariaVader Offline
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Machine: Resmed S9 AutoSet
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Post: #13
RE: Another Milestone, Thankfully!
good doctors are a good find! keep that one Smile

هههههه هههههه هههههه هههههه هههههه هههههه هههههه هههههه هههههه هههههه هههههه هههههه هههههه هههههه
Tongue Suck Technique for prevention of mouth breathing:
  • Place your tongue behind your front teeth on the roof of your mouth
  • let your tongue fill the space between the upper molars
  • gently suck to form a light vacuum
Practising during the day can help you to keep it at night

هههههه هههههه هههههه هههههه هههههه هههههه هههههه هههههه هههههه هههههه هههههه هههههه هههههه هههههه
08-07-2015 04:45 PM
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parkerdt Offline

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Posts: 256
Joined: May 2015

Machine: ResMed A10 AutoSet
Mask Type: Other
Mask Make & Model: WISP, Nuance
Humidifier: Climate Hose and included humidifier
CPAP Pressure: 9
CPAP Software: SleepyHead

Other Comments: I alternate between WISP and fabric Nuance - like both!

Sex: Male
Location: Mebane, NC

Post: #14
RE: Another Milestone, Thankfully!
Agreed!

(08-07-2015 04:45 PM)DariaVader Wrote:  good doctors are a good find! keep that one Smile
08-07-2015 05:09 PM
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