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New on Bipap ASV, have a few questions
#81
RE: New on Bipap ASV, have a few questions
Well the ST has definitely been a bust so far, not only it doesn't seem to treat anything, it's also giving me aerophagia even with low pressures of 9-6.

   

Honestly it seems the APAP was actually the machine I did best on 
I had the best AHI with settings around 8-14 .... although I had problems with aerophagia.
was doing ok with pressures like 7-1 (AHI around 6), so it was a trade off between AHI and aerophagia.

The ST has been useless so far.

While the ASV didn't get me great AHI, it was the only one that managed to treat all the CA/OA while not giving me aerophagia (tons of those hypopneas though which I don't know what to do about)

Anyway, I'll wait some more, but I think i already have the data to show my Dr that the Bipap ST is definitely not the solution.

-----
First Last Days AHI FL Machine Pressure Relief Mode Pressure Settings
Oct 7 2019 Oct 7 2019 1 16.28 0 BiPAP AVAPS (1030X110) None ASV (Fixed EPAP) EPAP 6.0 PS 340282346638528859811704183484516925440.0--340282346638528859811704183484516925440.0 (cmH2O)
Oct 6 2019 Oct 6 2019 1 15.62 0 BiPAP AVAPS (1030X110) None ASV (Fixed EPAP) EPAP 5.0 PS 340282346638528859811704183484516925440.0--340282346638528859811704183484516925440.0 (cmH2O)
Oct 3 2019 Oct 4 2019 2 17.46 0 BiPAP AVAPS (1030X110) None ASV (Fixed EPAP) EPAP 6.0 PS 340282346638528859811704183484516925440.0--340282346638528859811704183484516925440.0 (cmH2O)
Oct 2 2019 Oct 2 2019 1 12.86 0.24 BiPAP autoSV Advanced (900X110) None ASV (Variable EPAP) Min EPAP 6.0 Max IPAP 29.0 PS 5.0-23.0 (cmH2O)
Sep 30 2019 Sep 30 2019 1 9.82 0.26 BiPAP autoSV Advanced (900X110) None ASV (Variable EPAP) Min EPAP 4.0 Max IPAP 29.0 PS 5.0-23.0 (cmH2O)
Sep 29 2019 Sep 29 2019 1 11.84 0 BiPAP autoSV Advanced (900X110) None ASV (Variable EPAP) Min EPAP 5.0 Max IPAP 29.0 PS 7.0-23.0 (cmH2O)
Sep 28 2019 Sep 28 2019 1 9.31 0.35 BiPAP autoSV Advanced (900X110) None ASV (Variable EPAP) Min EPAP 4.0 Max IPAP 29.0 PS 6.0-23.0 (cmH2O)
Sep 27 2019 Sep 27 2019 1 7.53 0 BiPAP autoSV Advanced (900X110) None ASV (Variable EPAP) Min EPAP 4.0 Max IPAP 29.0 PS 6.0-23.5 (cmH2O)
Sep 25 2019 Sep 26 2019 2 10.19 0.08 BiPAP autoSV Advanced (900X110) None ASV (Variable EPAP) Min EPAP 5.0 Max IPAP 16.0 PS 3.0-10.0 (cmH2O)
Sep 24 2019 Sep 24 2019 1 17.57 0.36 BiPAP autoSV Advanced (900X110) None ASV (Variable EPAP) Min EPAP 5.0 Max IPAP 30.0 PS 4.0-10.0 (cmH2O)
Sep 23 2019 Sep 23 2019 1 15.85 0.4 BiPAP autoSV Advanced (900X110) None ASV (Variable EPAP) Min EPAP 5.0 Max IPAP 20.0 PS 3.0-15.0 (cmH2O)
Sep 22 2019 Sep 22 2019 1 12.18 0.12 BiPAP autoSV Advanced (900X110) None ASV (Variable EPAP) Min EPAP 6.0 Max IPAP 12.0 PS 0.0-6.0 (cmH2O)
Sep 21 2019 Sep 21 2019 1 15.09 0.16 BiPAP autoSV Advanced (900X110) None ASV (Variable EPAP) Min EPAP 6.0 Max IPAP 9.0 PS 3.0-3.0 (cmH2O)
Sep 20 2019 Sep 20 2019 1 12.83 0 BiPAP autoSV Advanced (900X110) None ASV (Variable EPAP) Min EPAP 5.0 Max IPAP 9.0 PS 3.0-4.0 (cmH2O)
Sep 19 2019 Sep 19 2019 1 8.21 0.35 BiPAP autoSV Advanced (900X110) None ASV (Variable EPAP) Min EPAP 6.0 Max IPAP 6.0 PS 0.0-0.0 (cmH2O)
Sep 18 2019 Sep 18 2019 1 22.43 0 BiPAP autoSV Advanced (900X110) None ASV (Variable EPAP) Min EPAP 4.0 Max IPAP 6.0 PS 0.0-0.0 (cmH2O)
Sep 17 2019 Sep 17 2019 1 5.32 0.13 Auto CPAP (500X110) None APAP (Variable) Min 8 Max 12 (cmH2O)
Sep 16 2019 Sep 16 2019 1 8.06 0.34 Auto CPAP (500X110) None APAP (Variable) Min 8 Max 12.5 (cmH2O)
Jun 25 2019 Sep 15 2019 56 7.01 0.24 Auto CPAP (500X110) None APAP (Variable) Min 8 Max 14 (cmH2O)
Jun 24 2019 Jun 24 2019 1 8.65 0 Auto CPAP (500X110) None APAP (Variable) Min 10 Max 15 (cmH2O)
Jun 20 2019 Jun 23 2019 4 6.04 0.08 Auto CPAP (500X110) None APAP (Variable) Min 8 Max 15 (cmH2O)
Jun 19 2019 Jun 19 2019 1 7.35 0.14 Auto CPAP (500X110) None APAP (Variable) Min 7 Max 16 (cmH2O)
Jun 17 2019 Jun 18 2019 2 6.93 0.19 Auto CPAP (500X110) None APAP (Variable) Min 11.5 Max 14 (cmH2O)
Jun 15 2019 Jun 16 2019 2 7.91 0 Auto CPAP (500X110) None APAP (Variable) Min 11 Max 13.5 (cmH2O)
Jun 14 2019 Jun 14 2019 1 6.12 0.37 Auto CPAP (500X110) None APAP (Variable) Min 10 Max 10 (cmH2O)
Jun 13 2019 Jun 13 2019 1 5.58 0.31 Auto CPAP (500X110) None APAP (Variable) Min 11 Max 13 (cmH2O)
Jun 9 2019 Jun 12 2019 4 3.05 0.08 Auto CPAP (500X110) None APAP (Variable) Min 10 Max 13 (cmH2O)
May 17 2019 Jun 8 2019 22 3.68 0.09 Auto CPAP (500X110) None APAP (Variable) Min 11 Max 14 (cmH2O)
May 16 2019 May 16 2019 1 6.58 0 Auto CPAP (500X110) None APAP (Variable) Min 13 Max 14.5 (cmH2O)
May 2 2019 May 15 2019 14 3.81 0.08 Auto CPAP (500X110) None APAP (Variable) Min 12 Max 13.5 (cmH2O)
May 1 2019 May 1 2019 1 3.19 0 Auto CPAP (500X110) None APAP (Variable) Min 12 Max 15 (cmH2O)
Apr 30 2019 Apr 30 2019 1 5.83 0 Auto CPAP (500X110) None APAP (Variable) Min 11 Max 14 (cmH2O)
Apr 29 2019 Apr 29 2019 1 3.63 0.12 Auto CPAP (500X110) None APAP (Variable) Min 12 Max 15 (cmH2O)
Mar 25 2019 Apr 28 2019 34 9.24 0.2 Auto CPAP (500X110) None APAP (Variable) Min 7 Max 15 (cmH2O)
Nov 28 2018 Mar 24 2019 111 7.42 0.21 Auto CPAP (500X110) None APAP (Variable) Min 7 Max 11 (cmH2O)
Nov 27 2018 Nov 27 2018 1 16.06 0.24 Auto CPAP (500X110) None APAP (Variable) Min 11 Max 13 (cmH2O)
Nov 25 2018 Nov 26 2018 2 10.28 0.1 Auto CPAP (500X110) None APAP (Variable) Min 10 Max 12 (cmH2O)
Nov 20 2018 Nov 24 2018 5 8.58 0.23 Auto CPAP (500X110) None APAP (Variable) Min 10 Max 13 (cmH2O)
Nov 19 2018 Nov 19 2018 1 14.45 0.28 Auto CPAP (500X110) None APAP (Variable) Min 6 Max 12 (cmH2O)
Nov 18 2018 Nov 18 2018 1 16.96 0.29 Auto CPAP (500X110) None APAP (Variable) Min 7.5 Max 11 (cmH2O)
Nov 17 2018 Nov 17 2018 1 13.51 0 Auto CPAP (500X110) None APAP (Variable) Min 8 Max 11 (cmH2O)
Nov 16 2018 Nov 16 2018 1 11.71 0.3 Auto CPAP (500X110) None APAP (Variable) Min 7 Max 11 (cmH2O)
Nov 8 2018 Nov 15 2018 7 19.71 0.06 Auto CPAP (500X110) None APAP (Variable) Min 7 Max 20 (cmH2O)
Nov 1 2018 Nov 7 2018 6 21.3 0.31 Auto CPAP (500X110) None APAP (Variable) Min 5 Max 20 (cmH2O)
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#82
RE: New on Bipap ASV, have a few questions
"The ST has been useless so far.

While the ASV didn't get me great AHI, it was the only one that managed to treat all the CA/OA while not giving me aerophagia (tons of those hypopneas though which I don't know what to do about)"

I'd convey this to the doc, if he or she cares about getting good results for you. Making your complaints and observations heard will need to be the priority and this message needs brought out loud and clear.

When I knew by evidence that I needed an ASV, I made someone look at the data. I asked why I wasn't on ASV because of the centrals.

If it were me, I'd highlight the results were best on the ASV. We can work on the hypopnea as soon as you get it. Further, I'd make getting the ResMed my goal also.
Dave

OSCAR
Standard OSCAR Chart Order
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Dealing With A DME
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INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEBSITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
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#83
RE: New on Bipap ASV, have a few questions
Again, I am new to these topics so look to others and of course most of all your Doc as the voice of authority. 
 
I am not yet sure the ST/AVAPS/AVAPS-AE won’t work for you and am not convinced an ResMed 10 ASV will.
 
In my inexperience I just get the feeling that access to control of settings like Rise Time and Trigger sensitivities are going to important and this is where the ASV algorithm claims no strength and is in fact weaker than the all other advanced ResMed and Phillips Resp machines.   
 
One example:
 IF in this chart like at 02:30:29, 02:30:37 and 02:36:42 where there is a little pop over the zero line and a delay to the next breath is from "failed inspiration" attempts …  
 
http://www.apneaboard.com/forums/attachment.php?aid=15814
 
Then the ResMed Aircurve 10 ASV (with very few setting configuration options) is the least likely of all the popular advanced xPAP machines to help.     
 
All of the other advanced ResMed machines and other advanced Dreamstations and the Dreamstation you have now give you access to settings like Trigger Sensitivity, Rise Time, and sometimes additional settings that let you better shape the flows.  
 
 
 
/////////// 
 
Regarding "aerophagia even with low pressures of 9-6."
 
There are threads here were people write about learning how to fight back to disrupt/reset the ASV algorithm when they are getting too much air.  
 
I would not give up on the AVAPS machine yet.  If you swap it for an ASV without working through some of these you may be shooting yourself in the foot because the Dreamstation AVAPS has the settings to help sort this out and the ResMed Aircurve 10 ASV DOES NOT  
 
A widely used ventilation strategy (that I think I often see in my ResMed ASV) is something like:
- 15+Breaths Per Min (I have seen mention of 15-20, 18, 16-22, etc. BPM)
- 'Lower tidal volumes' so that minute ventilation is 6 mL/kg of 'ideal body weight' or 'predicted body weight'
- An inverse I:E ratio, increasingly inverse as BPM increases, to avoid "Alveolar overdistension likely causes lung injury and that total lung inflation volume may be .... risk of aerophagia ... barotrama, volutrama ... and also to allow adequate time for expiration to complete.”  
 
An inverse I:E ratio would look something .9.  The I:E ratio in the image you just posted above is showing means of Insp:2.7 / Exp:1.9 = I:E ratio of 1.42  
 
The 1.42 number is just is for the session-long means, at each one minute through the session the ratio is likely better or worse than the mean.   So it would not be surprising to hear aerophagia occurs from time to time through the night.  
 
From screenshots of charts showing two mins of Flow Rate the group might be able to help you sort this out and help with when and how to use those settings to see what they will do for you. 
 
You currently have one of the most powerful and capable BiPAP/ventilators known to man.  You might have to spend $10-$20k more to get access to more tools to work with than you have in your hands now.  If the Aircurve 10 ASV does not work awesome with it's hidden default settings your stuck, the ASV is kind of dumb black box.  
 
Why not zoom in and post a few charts with 2 mins of the Flow Rate and other key charts visible and see if the group can help you start to kick this thing in the ….. 
 
WillSleep

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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#84
RE: New on Bipap ASV, have a few questions
Willsleep,

Would you elaborate on the claim of "You might have to spend $10-$20k more to get access to more tools to work with than you have in your hands now." That estimated price for any xPAP equipment sounds a bit high.

Further you go on to say "If the Aircurve 10 ASV does not work awesome with it's hidden default settings your stuck, the ASV is kind of dumb black box." Isn't the ResMed Aircurve 10 ASV what you're using? In my usage, it's not exactly a dumb black box. Mine is smart enough to use 4 pressure related settings to reduce my AHI to less than 1 in most nights. Although a small point, but this ASV is also white to whitish silver in color only.

It's certainly possible that my take on tcolar needing ASV is off the mark, either by a little or a lot. However, you can't throw out random (and misleading at the the least) info disputing my take. I'll take the criticism and arguments if they're based on fact.

Secondarily, is your equipment info on your left bar accurate? It helps to keep that updated so we know at a glance this bit of info.
Dave

OSCAR
Standard OSCAR Chart Order
Mask Primer
Dealing With A DME
Soft Cervical Collar Wiki
INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEBSITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
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#85
RE: New on Bipap ASV, have a few questions
Also just to be clear I don't have a Resdmed, only ever had Phillips products so far.

I'd like to try a Resmed ASV if i get the chance, ASV cleared by OA and CA events without giving me aerophagia.
Was still getting lots of hypopneas, but hoping the Resmed faster/stronger reaction to events could help there.
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#86
RE: New on Bipap ASV, have a few questions
(10-09-2019, 12:18 PM)SarcasticDave94 Wrote: Willsleep,

Would you elaborate ...  

Hi Dave, 

You yes be happy to elaborate. 

Yes, left bar machine info is incorrect.  You got me excited to try the Aircurve 10 ASV so I went out and paid cash for one.  The ASV is the machine I have been using most often.  

I am beat tonight but will answer the questions you left within a day or two.

Happy Snoozing!

WillSleep

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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#87
RE: New on Bipap ASV, have a few questions
(10-09-2019, 12:26 PM)tcolar Wrote: Was still getting lots of hypopneas ... 
Hi tcolar, 
Quick one.. in that last screenshot you posted that had like a AHI of 17 I noticed that it looks like you have EPAP fixed at 6 cmH2O and Pressure Support set to 3 (which would be the same as setting IMAP to a fixed 9).  
This Pressure Support (3) / IMAP (9) setting is even lower than lowest recommended setting to start the titration process.  
Just from a quick look at the configurations from the four best nights in the long list of nights above I think you will have a better night if you increase your minimum Pressure Support to at least (4 or 5 ) / IMAP Min 10 or 11.

Good Night guys.

WillSleep

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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#88
RE: New on Bipap ASV, have a few questions
(10-09-2019, 12:18 PM)SarcasticDave94 Wrote: ...Mine is smart enough to use 4 pressure related settings to reduce my AHI...

A clarification:

The 4 pressure related settings I'm referring to are the 4 pressure settings that can be manually adjusted with this ASV. EPAP Min and Max and then PS Min and Max are these 4 pressure settings. IPAP is machine set by the algorithm.
Dave

OSCAR
Standard OSCAR Chart Order
Mask Primer
Dealing With A DME
Soft Cervical Collar Wiki
INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEBSITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
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#89
RE: New on Bipap ASV, have a few questions
Hi Dave, a few quick replies.  

(10-09-2019, 12:18 PM)SarcasticDave94 Wrote: Willsleep,

Would you elaborate ..

Yes but first, In no way was I criticizing you.  I am immensely thankful for all the help you given others across over 3000 posts in this forum.  THANK YOU!!   Keep it Rolling!      



(10-09-2019, 12:18 PM)SarcasticDave94 Wrote: Willsleep,

Would you elaborate on the claim of "You might have to spend $10-$20k more to get access to more tools to work with than you have in your hands now." That estimated price for any xPAP equipment sounds a bit high.

Sure, easy.  In terms of professional grade ventilator algorithms and controls capability the Astral 150 is about the closest product in the ResMed line to Phillips AVAPS tcolar has in his hands right now. The AVAPS has a powerful toolkit to work with to better understand and design a resolution for therapy.

https://www.resmed.com/us/dam/documents/products/machine/astral-series/fact-sheet/1019228_astral_confident_care_fs_amer_eng.pdf

https://www.resmed.com/us/dam/documents/...er_eng.pdf

To get access to "more" you would need to move up to purchasing hospital ER / ICU grade ventilators https://www.google.com/search?&oq=GE+Dat...ventilator  

 

(10-09-2019, 12:18 PM)SarcasticDave94 Wrote: Willsleep,

Would you elaborate on ...  "If the Aircurve 10 ASV does not work awesome with it's hidden default settings your stuck, the ASV is kind of dumb black box." 

Sure.  I tried to answer this higher in that exact same post.  The black box statement was just the last sentence in a post-wide theme.  
   
From that post.
"In my inexperience I just get the feeling that access to control of settings like Rise Time and Trigger sensitivities are going to important and this is where the ASV algorithm claims no strength and is in fact weaker than the all other advanced ResMed and Phillips Resp machines.   
 
~like in this example.. the ResMed Aircurve 10 ASV (with very few setting configuration options) is the least likely of all the popular advanced xPAP machines to help.     
 
All of the other advanced ResMed machines, other advanced Dreamstations and the Dreamstation you have now give you access to settings like Trigger Sensitivity, Rise Time, and sometimes additional settings that let you better shape the flows.  
 

If the Aircurve 10 ASV does not work awesome with it's hidden default settings your stuck, the ASV is kind of dumb black box."  
 

All of the specific examples I identified in the two pretty thoughtfully worked out posts above point to instances of therapy needs areas where you need access to settings like Tigger Sensitivity, Rise Time, TiControl, & Cycle Sensitivity to address.  ASV does not give you any access to these settings, in regard to these parameters, "the ASV is a dumb black box".  

              

///////////////////////////////////

This is not a slam on ResMed, or the ResMed ASV.  I am pro ResMed, Phillips and everyone else who is contributing to address these therapy needs.   

A solution from the ResMed family:   From all I have seen the VAUTO, ST-A and ASTRAL 150 provide access to the settings mentioned above.    ResMed's marketing literature proposes that each of the advanced BiPAPs are the best answer for a different patient need.
ASV ResMed proposes the ASV as the best solution for CAs, but we know it has broader roles as often a big improvement over general use of the lessor CPAPs and BiPAPs.  The ASV just does not provide any visibility to the control settings mentioned above.  

VAUTO ResMed proposes the AirCurve 10 VAUTO as solution for people who higher pressures than are friendly in fixed CPAP and the fixed BiPAPs, but the VAUTO provides access to some of the settings I mentioned above and I would expect the VAUTO to be a massive improvement over the DreamStation APAP tcolar started with.  

ST-A ResMed proposes the AirCurve 10 ST-A (with iVAPS) as the product they have designed to best address the examples I raised above.

Astral 150 The Astral 150 adds auto-EPAP to the ST-As setting access and iVAPS but may not have all the comfort controls available.    

WillSleep

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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#90
RE: New on Bipap ASV, have a few questions
It really comes down to whatever brand and whatever device is best suited to tackle the issues tcolar has been dealing with. I really don't care what the device is, just so that's what he gets and/or keeps. Thanks for the explanation.
Dave

OSCAR
Standard OSCAR Chart Order
Mask Primer
Dealing With A DME
Soft Cervical Collar Wiki
INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEBSITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
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