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Another Milestone, Thankfully!
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.

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.

PRS1 Auto & Dreamstation Auto w/ P10 and straight pressure of 7cm. 
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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.

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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
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RE: Another Milestone, Thankfully!

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

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