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Can a higher pressure actually increase CAs?
#31
I was just saying that his wide open pressure could account for the tick he was describing that he didn't like. As well as Bipap being recommended for higher pressures. Also that the Bipap might help with that tick as well. The CA's I was leaving to the better informed, but I didn't think they had to do with recommending a Bipap either.
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#32
(11-25-2014, 08:50 PM)Galactus Wrote: VPAP/BIPAP is also an issue for compliance based on pressure settings as well.

Keep in mind you list in your profile 5-20 pressure and that will have a lot to do with the changing pressures and what you are describing. Narrowing the pressures might help you.
Thanks, snd thanks also for reminding me. I changed the pressure to straight 8 a little while back, and today I changed it in my profile.

FWIW, I think the "tic" I was describing diminished at 8-14, and now that I am at straight 8 I have not noticed it.

Regardless, I think a more sophisticated algorithm for EPR timing is something that should be considered.

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#33
(11-26-2014, 03:44 PM)TyroneShoes Wrote: Regardless, I think a more sophisticated algorithm for EPR timing is something that should be considered.

Those algorithms can be found in bi-level machines. ResMed VPAP and Respironics BiPAP are examples, and the mosre sophisitcated versions are ASV machines.

As I was saying, the BiPAP has a feature called Bi-Flex that starts to lower the pressure when the flow rate slows near the end of an inhalation.

My VPAP Auto has settings something like that, too, called triggering and cycling. I've never adjusted mine. I just kept them at the defaults because I don't really understand how they work, or I should say, I don't understand how adjusting them could help me. I find that my VPAP makes very comfortable transitions between inhale and exhale. The BiPAP, on the other hand, was a bit kludgy as I could feel it transition between three distinct pressure levels when Bi-Flex is set to its maximum value of 3.

Some people believe that to change your Autoset to a VPAP all you'd need to do is make changes to the machine's software. Something that no one seems to know how to do. Which makes sense because if indeed it is possible to do it, they would guard it as a secret. The same is likely true of the Respironics machines.
Sleepster
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INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED AS MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEB SITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
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#34
I think only an expert can make an informed decision on what might be the right machine in some cases; for some cases the clues are obvious, but for some cases they are not, and will likely rely on expert parsing of the sleep study.

The book Outliers defines "expert" as someone concentrating for 10,000 hours in a particular discipline, and if that is the bar, that would mean an ENT who treats 1 out of every 20 patients for sleep issues would have to see patients 40 hours a week for 50 weeks a year for 100 years to become expert. Math does not lie. 100 years. Someone who only sees patients with sleep issues needs only 5 years to become expert. And things change; some of what was learned by the expert over 5 years ago may no longer apply all that much.

So, especially if you have complex SA, maybe an ENT just won't cut it if he has no primary training in sleep medicine. Sort of like hiring a security guard to run Homeland Security. This is exactly why I found a seasoned neurologist with a fellowship in sleep medicine for my sleep doc.
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#35
(11-26-2014, 08:53 PM)TyroneShoes Wrote: The book Outliers defines "expert" as someone concentrating for 10,000 hours in a particular discipline,

One journalist with no particular academic credentials doesn't really speak with a lot of authority on the proper definition of the word "expert."

The amount of time needed to become an "expert" varies widely depending on the discipline.
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#36
What you are not aware of, in terms of medicine, is that there is a continual education going on for each physician - we are required to in order to maintain our license. It is now increasingly difficult to fall behind in knowledge and technique in our field. What is true, however, is that the fields have narrowed immensely, and so an ENT/ORL may not be the ideal choice as a consultant on a SA case - however, he would be, after the GP, a good place to start, to ascertain if there is anything functionally wrong in the throat or nasal region. Once that has been eliminated as a problem or a cause, the next step is a sleep specialist, who may default to a neurologist should the problem be CA, or may not, as most have neurological training as well. And the thing is, the narrower the speciality, the more one sees "it all" in a short time. There are only so many ways for things to go wrong (or right) in a given part of the body....
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#37
Upon re-reading the thread... LOTS of good advice here.

I'd like to throw another viewpoint in, for a definition for an expert:

The 10,000 hour definition corresponds to requirements for a licensed skilled tradesman. And when I finally wrote my exam and transitioned from apprentice to journeyman electrician... I finally understood how little I really knew Grin

Similar experiences when I started getting into IT... that continue to this day.

Note: As a consumer/user/patient/etc. there's also a responsibility for you to try and be informed enough to recognize true expertise... and respect it and the work that goes into maintaining current knowledge.

On the flip side, to help me keep it all in perspective, my older brother taught me the following:

"An Expert is someone who can tell you tomorrow why the prognostication made yesterday did not work out today." Dielaughing

[Don't call me an Expert...]Dont-know
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#38
(11-27-2014, 12:00 PM)rjberube Wrote: "An Expert is someone who can tell you tomorrow why the prognostication made yesterday did not work out today." Dielaughing

Pricelesss!!
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#39
I think it's a mischaracterization of Malcolm Gladwells' 10 000 hours to call it the definition of an expert. In his book Outliers he states that it's one of three attributes that characterizes every one of the type of outliers he discusses in that section of the book.

Some experts are called upon to do the Monday morning quarterbacking demanded when things go wrong, but others are called upon up front to actually get things done.

When I need an expert electrician for either of those things, I don't call a plumber. Smile

The 10 000 hours does get mentioned a lot and seems to have gained some acceptance as a claim for the amount of experience needed to become a true expert. Doing something for 40 hours a week, 50 weeks a year, for 5 years will get you there. But everyone who works in a field that requires expertise knows that there can be a big difference between someone with 5 years of experience and someone with 20 years of experience.

Another thing to consider is that some people with 20 years of experience simply have one year of experience repeated 20 times! Dielaughing

Sleepster
Apnea Board Moderator
www.ApneaBoard.com


INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED AS MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEB SITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
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#40
(11-27-2014, 12:59 PM)Sleepster Wrote: Another thing to consider is that some people with 20 years of experience simply have one year of experience repeated 20 times! Dielaughing

OMG!!! So true... And sadly, they're often the most insecure as a result.

My wife worked in a teaching hospital, in the medical education area, and would see firsthand the results of the truism [which applies in almost every field]: "There's always someone who is last in the graduating class..." Laugh-a-lot

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