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Fixed vs auto pressure ?
#21
(07-13-2015, 05:30 PM)BIGELI Wrote: Having been under treatment for sleep apnea for over 8 years I feel the number one indicator of successful therapy is HOW LONG TO YOU SLEEP on the average night. My breathing stopped enough times throughout the night that I was given a pacemaker when in reality I needed treatment for apnea. Thats to the good advise I got from this 'board' I sleep with my machine on auto 9 to14. Getting 7 hours or so sleep each night. The lower the pressure you can find success with the less leaks you'll have and sinus trouble. At least that as been my experience.

Hi BIGELI,
Happy to hear that your therapy is working for you, and I agree about getting enough sleep.
When I look back to 1 year ago, I wasn't getting more than 2 to 3 hours of sleep a night. I was pretty much a zombie every day, don't know how I survived. Now I get an average of 7 to 8 hour a night. Still can't believe it sometimes.

So I say to anyone out there, give CPAP a chance to work, it does get better. Smile
#22
(07-13-2015, 05:50 PM)OpalRose Wrote: Now with all that said, I have nothing against using a straight pressure if that's what works best for you. As Retired_Guy says, we are all different. Smile

Nope, Retired_Guy says that he is the same! Rolleyes Big Grin
#23
(07-13-2015, 07:09 PM)PaytonA Wrote:
(07-13-2015, 05:50 PM)OpalRose Wrote: Now with all that said, I have nothing against using a straight pressure if that's what works best for you. As Retired_Guy says, we are all different. Smile

Nope, Retired_Guy says that he is the same! Rolleyes Big Grin


He's the same, we are different Oh-jeez boy, do I miss his posts.


#24
Ted, your continued proof by assertion has been repeated in nearly every thread you have participated in. The AAST Guideline Summary you cite specifically says:
Quote:This guideline does not cover PAP titration in the home, nor the use of servoventilation or autotitrating devices

This limited guideline cannot be used to argue the merits of CPAP rather than APAP. This guideline does not address APAP or auto BPAP, so it cannot be used in an argument of CPAP vs APAP. It is simply a guide for obtaining optimal pressure in CPAP and fixed BPAP. There may be any number of more appropriate references that include auto titrating devices.

Does it not seem advantageous to have a device that continues to monitor OA, H, FL, and RERA and makes adjustments to that according to it's programming, and that reduces pressure when it is not needed?

I think it's great you've found CPAP to be a good solution for yourself, but your argument is based on a logical fallacy.
Quote:tedburnsIII Wrote:
Titration study by definition comes up with one 'cover all' pressure to handle all sleep positions/scenarios adequately.
#25
PSG/titration sleep studies have for 30 years tried to find the "best" pressure for each patient. But that thinking was based on CPAP being CPAP, and before we had APAP. It made a lot of sense then. The technology has improved, and we now do have APAP. But the thinking related to finding a "best" pressure did not improve, and never evolved, and no longer makes much sense at all. Today the "best" pressure is not a fixed pressure anymore, for most patients. The "best" pressure is a range of pressure.

Did the thinking not evolve because the PSG community was just simply ignorant of how technology had changed? Or did it become entrenched because it was a threat to the business model?

Or maybe a little of both?

In either case, one question has a definitive answer. That question is "is this thinking not evolving providing what is the best care for OSA patients?" and that answer is "absolutely not".
#26
Sleeprider-

No fallacy, it is official procedure. And by definition there's only one pressure they can deem as optimal to have uniformity.

I could not care less if a person goes APAP or CPAP. Outside special conditions, the Guidelines are the Guidelines and 'cover all' sleep positions, RERA, OA, Hyp, sats/desats, spontaneous arousals, etc. for the night the titration is performed. If you do your part, it will render a pretty good benchmark.

I don't know why you continually 'bash' the titration guidelines. They must have some Guidelines to achieve standards for achieving therapeutic benefit. It's a great suggested starting pressure for further adjustment and tweaking, according to one's OSA condition, and absent conditions which require ASV, etc.

Simplified explanation of the Guidelines:

http://www.aastweb.org/Resources/Guideli...ummary.pdf

And without referring to my optimal pressure derived from the titration study, I would've been hypoxic at the prescribed auto pressure of 6-15cm for months because apneas and hyps were all but eliminated at the lower pressure or only 1cm higher. I also did not show any REM in the titration until 9cm was achieved.

So, averaging out at 7cm did not do it from a therapeutic perspective notwithstanding consistent AHIs of <1.0 and feeling good, and rested.

My 2 cents: do not underestimate the value of the titration study. The medical community doesn't, neither should we as internet CPAP armchair 'Commandos'.





#27
Maybe the guidelines are simply just wrong.
#28
(07-13-2015, 08:02 PM)tedburnsIII Wrote: Sleeprider-

I don't know why you continually 'bash' the titration guidelines. They must have some Guidelines to achieve standards for achieving therapeutic benefit. It's a great suggested starting pressure for further adjustment and tweaking, according to one's OSA condition, and absent conditions which require ASV, etc.

Simplified explanation of the Guidelines:

http://www.aastweb.org/Resources/Guideli...ummary.pdf

And without referring to my optimal pressure derived from the titration study, I would've been hypoxic at the prescribed auto pressure of 6-15cm for months because apneas and hyps were all but eliminated at the lower pressure or only 1cm higher.

No bashing of the guidelines. They are simply limited to non auto-titrating machines, and therefore seem irrelevant in a discussion of auto vs continuous. In addition it is short sighted to think a single lab titration can be valid for the next 5 years, covering changes in health, environment, and many other factors. An auto machine allows the titration to be continuously reconsidered using the sophisticated algorithms programed into the machine based on many of the same criteria that are used in the titration guidelines.

The fallacy is the "repeated proof by assertion" that is a consequence of your repeated use of this guideline as an authoritative article to cover all PAP therapy, and questions posed on the forum. We have seen this same argument cited dozens of times for all kinds of situations where it marginally applies or is essentially off-topic.

This thread was not about your personal titration, but I agree that most individuals using APAP will do better with the minimum pressure to the what a lab would determine to be the 90% pressure, or the 90% pressure determined by using an auto machine to self-titrate. By close, I mean equal or within -2.0 cm of the 90% pressure. A wide-open auto machine (4.0 - 20) is notoriously ineffective. So I think we're in agreement.

APAP simply works better for some people, and studies suggest it improves comfort and compliance. It can also be operated in CPAP mode. So it seems pointless to debate fixed vs auto when one machine can provide both.
#29
(07-13-2015, 08:06 PM)TyroneShoes Wrote: Maybe the guidelines are simply just wrong.

Maybe you are wrong.



#30
(07-13-2015, 08:28 PM)Sleeprider Wrote:
(07-13-2015, 08:02 PM)tedburnsIII Wrote: Sleeprider-

I don't know why you continually 'bash' the titration guidelines. They must have some Guidelines to achieve standards for achieving therapeutic benefit. It's a great suggested starting pressure for further adjustment and tweaking, according to one's OSA condition, and absent conditions which require ASV, etc.

Simplified explanation of the Guidelines:

http://www.aastweb.org/Resources/Guideli...ummary.pdf

And without referring to my optimal pressure derived from the titration study, I would've been hypoxic at the prescribed auto pressure of 6-15cm for months because apneas and hyps were all but eliminated at the lower pressure or only 1cm higher.

No bashing of the guidelines. They are simply limited to non auto-titrating machines, and therefore seem irrelevant in a discussion of auto vs continuous. The fallacy is the "repeated proof by assertion" that is a consequence of the repeated use of this guideline as an authoritative article to cover all PAP therapy.

This thread was not about your personal titration, but I agree that most individuals using APAP will do better with the minimum pressure to the what a lab would determine to be the 90% pressure, or the 90% pressure determined by using an auto machine to self-titrate. By close, I mean equal or within -2.0 cm of the 90% pressure. A wide-open auto machine (4.0 - 20) is notoriously ineffective. So I think we're in agreement.

APAP simply works better for some people, and studies suggest it improves comfort and compliance. It can also be operated in CPAP mode. So it seems pointless to debate fixed vs auto when one machine can provide both.

I am simply saying not to ignore the optimal pressure if one goes APAP. I have read elsewhere that if one starts out -2 as lower pressure and perhaps +3 over the optimum pressure it's a good rule of thumb.

Example: optimum pressure determined to be 8cm.

Try Auto 6-10 or 6-11 cm to start. Try to sleep on side as possible. Check sats with overnight PO if desats are an issue in titration portion of the study.

The Guidelines do not apply to auto-titrating machines solely for the reason that they CAN'T or DON'T recommend an auto pressure range. But APAP prescriptions are made all the time based upon titration results of that solitary pressure. After all, the main difference from CPAP is that pressure is not fixed, but the titrated optimum pressure certainly has relevance in determining the starting APAP pressure ranges.


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