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Technical, professional instruction for Docs to set APAP treatment
#1
Does anyone know where to find (preferably online but at med library, Amazon etc. would be useful too) books/articles/manuals on how a physician should analyze and set the APAP?

I want this for at least two reasons:

1) To learn as much as possible

2) To understand the current training that sleep docs have available
Sweet Dreams,

HerbM
Sleep study AHI: 49 RDI: 60 -- APAP 10-11 w/AHI: 1.5 avg for 7-days (up due likely to hip replacement recovery)

"We can all breathe together or we will all suffocate alone."
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#2
I usually go to PubMed which is the website of the National Library of Medicine for information esp research. You might check out sleep medicine textbooks on amazon as well.
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#3
(02-02-2014, 12:41 PM)herbm Wrote: Does anyone know where to find (preferably online but at med library, Amazon etc. would be useful too) books/articles/manuals on how a physician should analyze and set the APAP?

I want this for at least two reasons:

1) To learn as much as possible

2) To understand the current training that sleep docs have available

Try typing "american journal of sleep medicine" into the google search engine. Lots of information available. A lot of it requires a solid understanding of biology, anatomy and physiology, internal medicine, and so on.

I think a good way for you to get started is by reviewing your own data in SleepyHead and asking questions here. I've learned a lot here and have never even taken a college-level biology class.
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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#4
Agreed about reviewing our own data and asking questions, but I am specifically looking for the professional instruction.

The AJSM is a good lead, as is PubMed but I believe that those will likely require memberships.

Amazon: Anyone have any idea which books offer recent and specific instruction for docs?

Since I had very little trouble with cardiology, my guess is that these can be deciphered also. Smile

These are possibilities available on the Internet:

ABC of Sleep Medicine
Sleeping Medicine Anus
ATLAS OF SLEEP MEDICINE

Sweet Dreams,

HerbM
Sleep study AHI: 49 RDI: 60 -- APAP 10-11 w/AHI: 1.5 avg for 7-days (up due likely to hip replacement recovery)

"We can all breathe together or we will all suffocate alone."
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#5
(02-02-2014, 06:27 PM)herbm Wrote: Amazon: Anyone have any idea which books offer recent and specific instruction for docs?

The journals should have reviews of textbooks. You live near a university with a medical college so you might check the library. They should have back copies of the journals.

Check the university bookstore for textbooks. Bring your credit card. You'll need it! :grin:


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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#6
(02-02-2014, 04:08 PM)Sleepster Wrote: I've learned a lot here and have never even taken a college-level biology class.
Either moi, I don,t have or need a uni degree. My machine designed by scientists to adjust pressure as required during the night.
As for setting, no brainer, I figured it out on my own with the help of readily available info around here
Doctors who don,t prescribe APAP, usually they don,t have a clue and doctors who dont followup with their patients also clueless



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#7
(02-02-2014, 06:27 PM)herbm Wrote: These are possibilities available on the Internet:

Did the spellcheck feature in your browser pull a fast one on you? (Did you meant "Sleep Medicine Atlas"?) If so, you can edit your post for clarity.
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. The Advisory Member group provides advice and suggestions to Apnea Board administrators and staff on matters concerning Apnea Board operation and administrative policies - not on matters concerning treatment for Sleep Apnea. I think it is now too late to change the name of the group but I think Voting Member group would perhaps have been a more descriptive name for the group.
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#8
(02-02-2014, 12:41 PM)herbm Wrote: Does anyone know where to find (preferably online but at med library, Amazon etc. would be useful too) books/articles/manuals on how a physician should analyze and set the APAP?

I want this for at least two reasons:

1) To learn as much as possible

2) To understand the current training that sleep docs have available

Hi herbm,

I think a good place to start may be to review suggested procedures to be followed during titration studies. These procedures are short, easy to understand and provide insight into how the pressure settings are arrived at.

I think ResMed and Philips Respironics have suggested titration procedures on their web sites (at least they used to), plus introductory educational materials.

I'll see what I can find using google and will add edits below.

Take care,
--- Vaughn

Edits:

(1) Philips Respironics Titration protocol reference guide:
http://sleepapnea.com/downloads/1002159_...fGuide.pdf

(2) ResMed Sleep Lab Titration Guide:
http://www.resmed.com/us/documents/10139...-guide.pdf

(3) American Association of Sleep Technologists titration guidelines:
http://www.aastweb.org/Resources/Guideli...ummary.pdf

(4) The real deal, professional practice guidelines:
American Academy of Sleep Medicine Practice Parameters
http://www.aasmnet.org/Resources/Practic...Update.pdf
http://www.aasmnet.org/Resources/Practic...ate_ET.pdf
http://www.aasmnet.org/practiceparameters.aspx?cid=102


Note: From looking at our own sleep data we know our pressure needs vary hour-to-hour and day-to-day, but the protocol below for simple fixed-pressure CPAP titration, from article (3) above, requires a minimum of only 15 minutes at the titrated pressure as long as some REM sleep is included.

2.2.1 CPAP Titration

Patients < 12 years old
CPAP minimum = 4 cm H2O
CPAP maximum = 20 cm H2O

Patients > 12 years old
CPAP minimum = 4 cm H2O
CPAP maximum = 20 cm H2O

Increase pressure by a minimum of 1 cm H2O with an interval of no less than 5 minutes when you see [any of] the following:

Patients < 12 years old
1 obstructive apnea
1 hypopnea
3 RERAs
1 min. of loud or unambiguous snoring

Patients > 12 years old
2 obstructive apneas
3 hypopneas
5 RERAs
3 min. of loud or unambiguous snoring

You have achieved an optimal titration when you see [all of] the following:
1. The Respiratory Disturbance Index (RDI) is < 5 per hour for a period of at least 15 minutes at the selected pressure and within the manufacturer’s acceptable leak limit.
2. The SpO2 is above 90% at the selected pressure.
3. Supine REM sleep at the selected pressure is not continually interrupted by spontaneous arousals or
awakenings.

You have achieved a good titration when you see [all of] the following:
1. The Respiratory Disturbance Index (RDI) is < 10 per hour (or is reduced by 50% if the baseline RDI was < 15) for a period of at least 15 minutes at the selected pressure and within the manufacturer’s acceptable leak limit.
2. The SpO2 is above 90% at the selected pressure.
3. Supine REM sleep at the selected pressure is not continually interrupted by spontaneous arousals or
awakenings.

You have achieved an adequate titration when you see the following:
1. The Respiratory Disturbance Index (RDI) is NOT < 10 per hour, but the RDI is reduced by 75% from baseline.

An unacceptable titration does not meet any of the above grades. Repeat titration should be considered.
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. The Advisory Member group provides advice and suggestions to Apnea Board administrators and staff on matters concerning Apnea Board operation and administrative policies - not on matters concerning treatment for Sleep Apnea. I think it is now too late to change the name of the group but I think Voting Member group would perhaps have been a more descriptive name for the group.
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#9
vsheline: (Re: spellchecker or typo) No, that was the title AS I FOUND IT -- it didn't download so I cannot check the actual book (yet).

BUT THANK YOU SO MUCH for the excellent reference -- that will certainly get me started to understand professional education on this subject.

And you are correct, there are several textbooks on Amazon but all quite expensive. I have been working long hours and haven't had time (and likely won't for a bit) to go to my university library and grab what is there.

When I get a chance I will also turn my (considerable) Google skills to this using your stuff to prime the pump.

Thanks again.
Sweet Dreams,

HerbM
Sleep study AHI: 49 RDI: 60 -- APAP 10-11 w/AHI: 1.5 avg for 7-days (up due likely to hip replacement recovery)

"We can all breathe together or we will all suffocate alone."
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#10
(02-02-2014, 10:14 PM)zonk Wrote:
(02-02-2014, 04:08 PM)Sleepster Wrote: I've learned a lot here and have never even taken a college-level biology class.
Either moi, I don,t have or need a uni degree. My machine designed by scientists to adjust pressure as required during the night.
As for setting, no brainer, I figured it out on my own with the help of readily available info around here
Doctors who don,t prescribe APAP, usually they don,t have a clue and doctors who dont followup with their patients also clueless

You seem to be implying that you just let an APAP machine decide the pressure. If so, I disagree.

If you set the minimum pressure too low, many people find it uncomfortable because they start at too low a pressure and have to spend the first part of their therapy with the machine slowly adjusting upward to get the pressure right. You also tend to get a suffocating feeling until the pressure adjusts upwards. It also makes mask fitting more difficult because the pressure goes up after you fall asleep and it may start to leak even if it fit at low pressure when you put it on.

There are also several reasons to limit the upper pressure.

However, I agree everyone should get an APAP instead of a CPAP. You just don't want to leave the APAP wide open at 4-20 cmH2O pressure for most patients. You can always tame the APAP if it's not finding the right pressure, but you can't make the manual CPAP do Auto.
Get the free SleepyHead software here.
Useful links.
Click here for information on the main alternative to CPAP.
If it's midnight and a DME tells you it's dark outside, go and check it yourself.
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