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Side vs. Back sleep - APAP tuning
#11
Salty, your centrals pose less of a potential hazard then do obstructive events. They may be due to the fact that you are less comfortable on your side and you may be waking up occasionally from that. On the other hand, if you get obstructive events of long enough duration to cause your body to go into panic mode, that sort of disturbance is exactly what CPAP is trying to prevent. I don't say centrals are always less important, but perhaps in your case they may be the lesser evil that you should choose.

Best regards,

Dude
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#12
(01-30-2015, 07:46 PM)surferdude2 Wrote: Salty, your centrals pose less of a potential hazard then do obstructive events. They may be due to the fact that you are less comfortable on your side and you may be waking up occasionally from that. On the other hand, if you get obstructive events of long enough duration to cause your body to go into panic mode, that sort of disturbance is exactly what CPAP is trying to prevent. I don't say centrals are always less important, but perhaps in your case they may be the lesser evil that you should choose.

Best regards,

Dude

Thanks for the reassurance. I wake up at night, notice I am on my back, and roll over on my side. I hurt in places I didn't used to so I don't stay comfortable anywhere for long, unless I take half of a Tylenol PM. Thanks, again.
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#13
(01-29-2015, 04:32 PM)crwheelr Wrote: ...I suspect that obstructive is only happening while sleeping on my back. During those moments between awakeness and sleep I have on occasion sensed my airway closing, like a valve would snap shut. Is this true or mostly true that obstructive apnea happens only on back sleep?

Be that the case, we would want an APAP algorithm that could adjust quickly to the breathing pattern changes as one shifts sleep positions. If on side, the PAP should be able to settle into the low limit setting an stay there. A transition to sleep on back - the tool should be able to ramp up rather quickly on the first or second event so as to minimize total obstructive events while sleeping on back.

Can an S9 Autoset pressure "gain" be adjusted (maybe maximized), so that when obstructive events start (move to sleep on back) the pressure will increase quickly to maximum limit?...

For many patients, obstructives happen regardless of sleep position. It seems to me that such an algorithm is not practical, nor any more helpful than what we have now. It also does not seem to be either safe or therapeutic to raise pressure when there are no events to warrant it.

It also seems that the only way it could even tell if you were on your back would be if it could see you. It needs a infrared camera and optimal positioning, plus a guarantee of no false positives. None of that seems practical, and it is sort of Big-Brothery to boot, not to mention probably a pretty expensive upgrade.

Assuming we could even get over those hurdles, if you designed the APAP to have a slight difference in the pressure range when on your back, that might be OK, but the less aggressive the change would be the less effective it would be, and the more aggressive the change would be the riskier it would be. And it does not seem like there could be a sweet spot where added risk is low and efficacy is improved all that much.

Assuming you need more pressure when on your back, which may be true, or may not be true, the APAP mostly does this already; it is designed to provide more pressure when you need more pressure, but in response to events, not in anticipation of them. It is also smart enough to do this without having to know whether you are on your back or not. If you need more pressure, it gives it to you; knowing whether you are on your back or not is not relevant to knowing when to give you more pressure; it knows how to do that regardless.

Anticipating an event simply because you rolled onto your back and raising pressure to prevent it could be good, but the drawback is that raising pressure always runs the risk of creating CA events. Medicine errs on the side of caution, which is sort of what the "first do no harm" thing is all about.

That said, nice out-of-box thinking. Could you find someone to fund a grant to study whether this would be a worthy pursuit? Would it turn out to be significant enough to inform APAP design? My best guess would be no to both. But I would be happy to be proven wrong.

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#14
I was thinking that the smart machine Qui suggested might only be helpful if it came with cables that can shock you out of the "bad position" when the tennis ball sewn into the back fails (-:

I find myself wondering as I go through masks in the search of comfort, of the mask that feels like "home" when I put it on, how fast is the technology advancing in both machines and masks. I also marvel that the machines seem easier to make "good" than the masks, but then, there are less variants.

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#15
(01-31-2015, 03:55 AM)TheManseHen Wrote: I was thinking that the smart machine Qui suggested might only be helpful if it came with cables that can shock you out of the "bad position" when the tennis ball sewn into the back fails (-:

I find myself wondering as I go through masks in the search of comfort, of the mask that feels like "home" when I put it on, how fast is the technology advancing in both machines and masks. I also marvel that the machines seem easier to make "good" than the masks, but then, there are less variants.

Oh, you are soo close to being the next recipient of Excellence award. Keep on thinking, the smart algorithm could definitely morph to include shock therapy! ALLPAP is not just for PAPers anymore!

QAL
Dedicated to QALity sleep.
You'll note I am listed as an Advisory Member. I am honored to be listed as such. See the fine print - Advisory Members as a group provide advice and suggestions to Apnea Board administrators and staff concerning Apnea Board operation and administrative policies. Membership in the Advisory Member group should not be understood as in any way implying medical expertise or qualification for advising Sleep Apnea patients concerning their treatment.
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#16
I'm hoping to see in the next generation of machines not only the ability to prompt you to change positions, but more data....like what sleep stage did I achieve and for how long? Did I achieve REM sleep?
I don't know what to say about mask issues, fit, leakage, etc., and the hundreds of dollars you will probably spend to find that perfect mask. Oh-jeez
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#17
goggle "home EEG monitors"

I am anxious to try the right one. I don 't see it on the market, yet. But, soon...
Dedicated to QALity sleep.
You'll note I am listed as an Advisory Member. I am honored to be listed as such. See the fine print - Advisory Members as a group provide advice and suggestions to Apnea Board administrators and staff concerning Apnea Board operation and administrative policies. Membership in the Advisory Member group should not be understood as in any way implying medical expertise or qualification for advising Sleep Apnea patients concerning their treatment.
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#18
(01-31-2015, 01:12 PM)quiescence at last Wrote: goggle "home EEG monitors"

I am anxious to try the right one. I don 't see it on the market, yet. But, soon...

Go to [link removed] and search for EEG. You'll get a boat load of sellers of them. They seem to be around $250. Also search for CPAP. . . Wow! There are a bunch of those too. I'd be afraid to try one though.

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#19
yeah emphasis is on "right one" - it is almost here though. It is sort of in infant stage with EPOC or NeuroSky, not that these are best offerings, but just representative of many people all thinking the same thing.

Now, I think this thread is the only one that is actively talking about the ALLPAP. But, some of this other motion is running parallel.

"these are the days of miracles and wonder" - Paul Simon
Dedicated to QALity sleep.
You'll note I am listed as an Advisory Member. I am honored to be listed as such. See the fine print - Advisory Members as a group provide advice and suggestions to Apnea Board administrators and staff concerning Apnea Board operation and administrative policies. Membership in the Advisory Member group should not be understood as in any way implying medical expertise or qualification for advising Sleep Apnea patients concerning their treatment.
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#20
I was an exclusive side/stomach sleeper before going on an apap machine. Now I'm a side/back sleeper due to the mask inhibiting me from sleeping on my stomach. I had an AHI of 25 before and now it's around 1. With that being said, there are so many variables going on (sleeping on my back vs. stomach, using the apap machine, AHI dropping from 25 to 1) that I can't really pinpoint weather or not changing sleeping position helped me or not. So in other words, I would try to sleep in position that is most comfortable to you and let the machine do its job.
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