(04-30-2015 06:08 AM)iSnore Wrote: Mr. Porter was essentially given manual transmission cars that have to be completely stopped in order to change gears--and then told it was illegal to do so. For those who don't get the analogy, completely stopped means he would have to pause his sleep journey and wake up to adjust the pressures. His manual transmission was placed in a gear needed to get over hills along his route, but inappropriate for the majority of his journey, i.e. his night's sleep. Allowing Mr. Porter to change that gear before the journey might make him more comfortable, but might not get him over those hills. An automatic transmission could.
I have no illusion that automatic xPAP algorithms are optimal, or that one in the default range of 4-20 or 25 cm would be comfortable for the patient or would react fast enough from a low of 4 cm. And I recognize that a fixed pressure works better for some patients. But I think in this day and time, when we have automatic xPAPs with an alternate fixed pressure mode (like an automatic transmission with manual shifting capability), it's unconscionable lesser options are even sold, much less pushed by DMEs.
Edit to add: We on this forum are one-percenters--representing probably less than one percent of the xPAP-using population. Yet even here, not everyone has the knowledge or time to self-titrate, especially with a fixed pressure machine. While I don't believe the lie of illegality should be told, I do believe allowing the general population of users to adjust pressures will undoubtedly result in many, if not most, essentially untreated. For the one-percenters who have guidance from a forum of experienced users, both the ResMed and Respironics current models make it easy to access the clinician/provider menus by holding down the knob and button. What's really needed IMO is more education of doctors and DMEs.
You know what? I want you to know that your comment really really said a lot, and I totally must agree with you. You know, I think that if there was MORE EDUCATION, there would be such a profound difference. The thing is, there is so many people, so many patients who use xPAP and who just use it, not knowing really much about it, or anything hardly at all. I know of one friend who I have been blessed dearly by. She has a CPAP machine. She does not even know her own pressure. Every time I see her, I always ask her what her pressure is and she is like, "Well Peter? I have not looked." I think that DMEs AND patients really need to be educated. DMEs need to be educated and then taught to help and educate their patients. Because I've heard of horror stories where the machine was just delivered, and very quick instructions were given, and then the machine was left with the patient. Essentially, the machine was given to the patient, and the DME provider, OR EVEN WORSE, the DELIVERY person, who really has no idea what it is for, much less how it is used, just drops the piece of equipment off at the patient's door, says something like the following, and then leaves.
Oh yeah, I am here to deliver your breathing machine. You just plug it in, put some water in the humidifier, put the mask on, turn it on, and then, you're ready to go to sleep."
There is not even a mask fit performed. One of numerous masks is given to the patient, that mask may be a nasal pillows selection, may be a nasal mask, or may be a full face mask.
AND THEN WHAT?
The delivery person leaves.
When the patient goes to bed that night, they realize that something is not right.
Well, DUHHHHHHHH, They were not instructed in regards to the usage of the RAMP BUTTON, they were not instructed on exactly how much the humidifier needs to be filled. They were not instructed on the usage of the device itself, much less what exactly the machine is used for. They were not instructed on so many many more things that are of such profound importance.
They are just given the machine, and then kicked to the kurb as you might call it.
Now that is utterly sad.
I think for PAP therapy, EDUCATION of the DME, AND, the patient is CRITICAL for successful usage chances at all. I could go on and on for hours. FOR HOURS. And the mask fit thing? Uhhhhhhhhh, Not every patient is going to do well with a nasal pillows selection interface. Not everybody is going to do well with a Nasal mask. Not everybody is going to do well with a Full Face Mask. I have seen it happen to people before, and really? It is just down right heart breaking.