(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.
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