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Therapy numbers, lack of them, weight loss, etc
#91
RE: Therapy numbers, lack of them, weight loss, etc
(09-13-2014, 04:55 PM)retired_guy Wrote: Hummphhh. What's that? One lousy OA? Geezzzzz, you'd think you were a old pro at this. .......and by gum you'd be right! Congrats on the great results. Galactus. The machine could not have done it without you.

Thanks man! I couldn't have gotten this far without you all helping me. And I feel like though I am doing well (maybe by sheer luck) I have a bunch to learn yet.
If everyone thinks alike, then someone isn't thinking.
Everyone knows something, together we could know everything.
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#92
RE: Therapy numbers, lack of them, weight loss, etc
(09-13-2014, 04:47 PM)Galactus Wrote: I don't understand how the machine is working, and the math that you are providing doesn't add up for me. My presumption is that is because I just don't get it. I think the one thing that I specifically don't get is the PS. I had thought till this post that PS raised and lowered EPAP and IPAP, but after reading this post I think I am revising that thought to understand that even though when we start at IPAP=EPAP+PS that is not to say these numbers depend on each other, or that PS raises them as I previously thought. It seems that in actuality IPAP EPAP and PS all raise and lower independently of each other based on their specific algorithms. Is that correct or am I still missing this?

Hi Galactus,

There are a few basic points on which we need to refocus, so that you will see more clearly how the machine works. After we focus on a few basic points, I think the math I provided earlier will make more sense to you.

Please forgive me for being repetitive in what follows.

Point #1. As you know, the basic definitional relationship is EPAP + PS = IPAP. This relationship is always maintained. It is never violated.

Point #2. Your machine has an algorithm for raising and lowering EPAP. I think the EPAP-adjusting algorithm never messes with PS. In other words, at the points in time when the EPAP is changed, PS isn't changed.

IPAP continues to equal EPAP + PS. In other words, at the points in time when EPAP changes, IPAP and EPAP move in tandem.

If you look at plots where EPAP did change, every time EPAP changed, both IPAP and EPAP moved in tandem. (Looking only at the times at which EPAP changed, you do see that IPAP and EPAP moved in tandem, right?)

Point #3. Your machine has an algorithm for raising and lowering PS. I think the PS-adjusting algorithm never messes with EPAP. In other words, when the PS changes, EPAP doesn't change.

IPAP continues to equal EPAP + PS. When PS changes, EPAP stays the same and IPAP changes.

In the plots you posted, if you want to see the times at which PS changed, these are all the times at which IPAP changed but EPAP did not change. (Looking at the plots, does this make sense now?)

Point #4. There is not a separate algorithm for adjusting IPAP. IPAP changes any time the EPAP-adjusting algorithm adjusts EPAP and any time the PS-adjusting algorithm adjusts PS, maintaining the relationship IPAP = EPAP + PS.

Point #5. There are settings (limits) for how low EPAP can go (the Min EPAP setting, which can be set as low as 4 but can be set higher) and for how high IPAP can go (the Max IPAP setting, which can be set as high as 25 but can be set lower).

EPAP can never be lower than the Min EPAP setting, but how high can it go as it auto-adjusts? It can go only as high as Max IPAP minus the present value of PS, so that the Max IPAP setting will not be violated.

Point #6. There is a setting which limits how high PS can go (the Max PS setting, which can be set as high as 8 but can be set lower). BUT, the PS will not necessarily be able to go as high as the Max PS setting would seem to allow it to go. A low Max IPAP setting can also limit how high PS can go. The PS can go only as high as would not cause IPAP to go higher than the Max IPAP setting.

For example, if EPAP is presently 16 and Max IPAP is 20, even if the Max PS setting is 7, PS would be temporarily limited to 4, because the present value of IPAP cannot be higher than the Max IPAP setting. Only when the present value of EPAP is 13 would the PS be able to go as high as 7 without violating the Max IPAP setting.

(09-13-2014, 04:47 PM)Galactus Wrote:
(09-12-2014, 05:51 AM)vsheline Wrote: Regarding, "I don't understand how Max EPAP is unable to reach 18 with a Max PS setting of 7. I thought that if Min EPAP =13 and Max EPAP = 20 with a Max PS of 7 that 13+7=20 and that with a Min PS of 1 that Max IPAP could =20 and Max EPAP could =19 which left both numbers above my original script."

Yes, in your example, EPAP could be as high as 19, but only if PS happens to be 1. EPAP and PS are separately getting raised or lowered in accordance with their separate algorithms, and I think the EPAP algorithm is not allowed to change PS and the PS algorithm is not allowed to change EPAP.

Keep in mind that whenever EPAP is adjusted IPAP is adjusted by the same amount, so that PS will be unchanged.

Let's take the case that Max IPAP is 20, and EPAP has been adjusted to 15, and PS has been adjusted to 4. (EPAP is 15 and IPAP is 19, which is 1 less than Max IPAP.) In that scenario, if your machine senses that a higher EPAP is needed, it can adjust EPAP to 16. (EPAP raises to 16 and IPAP raises to 20, which happens to be Max IPAP.)

One thing I think you have missed, the max on the unit is 25 and not 20. That was part of my consideration in using 20 as being 2 over my 18 as 18 + 7 (PS) = 25 (in my mind) which meant I couldn't get over the script by more than 5 and couldn't be over the machines 25. Because even if EPAP being set to 13 was raised to my script value of 18 and PS =7 then IPAP would still be at 25 which was the machines max. Did I interpret that correctly or miss the boat?

The Max IPAP setting can be set as high as 25, but when the Max IPAP setting is set to 20 then PS cannot be raised if that would result in raising IPAP above the Max IPAP setting.

(09-13-2014, 04:47 PM)Galactus Wrote: The one thing I got was IPAP = EPAP + PS. With that in my mind, starting EPAP at 13 and PS at 1 the IPAP = 14. Then I read the line for PS Max and it said "This is the max difference permitted between IPAP & EPAP. So if start EPAP = 14 and 7 = Max difference than 14 + 7 = 21 leaving me 4 under machine max. And in the event the machine raised IPAP to 18 (using what I believed was PS's number) then 18 + 7 (Max allowed difference) = 25 which was the machine max.

When the Max IPAP setting is 20, IPAP will never be allowed to go higher than 20; the machine's max capability of delivering a pressure of 25 has no bearing when the Max IPAP setting is less than 25.

(09-13-2014, 04:47 PM)Galactus Wrote:
(09-12-2014, 05:51 AM)vsheline Wrote: If it so happens that your machine later senses that a still higher EPAP would be beneficial, I think the EPAP could not go to 17, because if EPAP were to be raised any higher, IPAP would also need to be raised by an equal amount, which is not allowed because IPAP is already at its limit.

I believe this changes once you adjust the max to 25 vs 20, but I am not sure.....

Only if the Max IPAP setting is changed to 25 will the IPAP be allowed to go as high as 25.

(09-13-2014, 04:47 PM)Galactus Wrote: I've also posted todays numbers as well, so you can see where we are. And when I look at the graph on the right for pressure I don't see IPAP and EPAP moving in tandem, it appears they are moving independently of each other and it make me think somehow I am missing this yet again.

If you look at the points in time at which EPAP did change, every time EPAP changed, both IPAP and EPAP moved in tandem.

(09-13-2014, 04:47 PM)Galactus Wrote: [Image: rk0nr8.jpg]

The Advisory Member group provides advice and suggestions to Apnea Board administrators and staff on matters 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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#93
RE: Therapy numbers, lack of them, weight loss, etc
(09-14-2014, 12:08 AM)vsheline Wrote:
(09-13-2014, 04:47 PM)Galactus Wrote: I don't understand how the machine is working, and the math that you are providing doesn't add up for me. My presumption is that is because I just don't get it. I think the one thing that I specifically don't get is the PS. I had thought till this post that PS raised and lowered EPAP and IPAP, but after reading this post I think I am revising that thought to understand that even though when we start at IPAP=EPAP+PS that is not to say these numbers depend on each other, or that PS raises them as I previously thought. It seems that in actuality IPAP EPAP and PS all raise and lower independently of each other based on their specific algorithms. Is that correct or am I still missing this?

Hi Galactus,

There are a few basic points on which we need to refocus, so that you will see more clearly how the machine works. After we focus on a few basic points, I think the math I provided earlier will make more sense to you.

Please forgive me for being repetitive in what follows.

Oh no, you don't apologize, you feel free to repeat yourself as many times as you can stand so I can get this. Thank you in advance.

(09-14-2014, 12:08 AM)vsheline Wrote: Point #1. As you know, the basic definitional relationship is EPAP + PS = IPAP. This relationship is always maintained. It is never violated.

Perfect, I got that.

(09-14-2014, 12:08 AM)vsheline Wrote: Point #2. Your machine has an algorithm for raising and lowering EPAP. I think the EPAP-adjusting algorithm never messes with PS. In other words, at the points in time when the EPAP is changed, PS isn't changed.

IPAP continues to equal EPAP + PS. In other words, at the points in time when EPAP changes, IPAP and EPAP move in tandem.

If you look at plots where EPAP did change, every time EPAP changed, both IPAP and EPAP moved in tandem. (Looking only at the times at which EPAP changed, you do see that IPAP and EPAP moved in tandem, right?)

Yes, yes, I see that, only when EPAP changes does IPAP and EPAP move in tandem. Got it, and see it.


(09-14-2014, 12:08 AM)vsheline Wrote: Point #3. Your machine has an algorithm for raising and lowering PS. I think the PS-adjusting algorithm never messes with EPAP. In other words, when the PS changes, EPAP doesn't change.

IPAP continues to equal EPAP + PS. When PS changes, EPAP stays the same and IPAP changes.

In the plots you posted, if you want to see the times at which PS changed, these are all the times at which IPAP changed but EPAP did not change. (Looking at the plots, does this make sense now?)

So PS doesn't change EPAP, it only changes IPAP, and these are the times when I see IPAP raise on the graph with EPAP remaining wherever it was but showing no movement. Got it, got it.

(09-14-2014, 12:08 AM)vsheline Wrote: Point #4. There is not a separate algorithm for adjusting IPAP. IPAP changes any time the EPAP-adjusting algorithm adjusts EPAP and any time the PS-adjusting algorithm adjusts PS, maintaining the relationship IPAP = EPAP + PS.

So IPAP doesn't change itself, it is either changed by PS going up and adding to IPAP whereby EPAP remains the same, or IPAP is changed when EPAP is raised, and then IPAP is raised by the same amount so they remain in tandem. Got it.

(09-14-2014, 12:08 AM)vsheline Wrote: Point #5. There are settings (limits) for how low EPAP can go (the Min EPAP setting, which can be set as low as 4 but can be set higher) and for how high IPAP can go (the Max IPAP setting, which can be set as high as 25 but can be set lower).

EPAP can never be lower than the Min EPAP setting, but how high can it go as it auto-adjusts? It can go only as high as Max IPAP minus the present value of PS, so that the Max IPAP setting will not be violated.

So if max IPAP is set to unit max at 25, and Max PS is set at unit max of 8 then 25-8=17 as such max IPAP is 17. Is that correct? Oh wait that would only be correct if PS had adjusted up to 8 otherwise if it was at Min PS of 1 then IPAP could get all the way to 24. Right?

(09-14-2014, 12:08 AM)vsheline Wrote: Point #6. There is a setting which limits how high PS can go (the Max PS setting, which can be set as high as 8 but can be set lower). BUT, the PS will not necessarily be able to go as high as the Max PS setting would seem to allow it to go. A low Max IPAP setting can also limit how high PS can go. The PS can go only as high as would not cause IPAP to go higher than the Max IPAP setting.

For example, if EPAP is presently 16 and Max IPAP is 20, even if the Max PS setting is 7, PS would be temporarily limited to 4, because the present value of IPAP cannot be higher than the Max IPAP setting. Only when the present value of EPAP is 13 would the PS be able to go as high as 7 without violating the Max IPAP setting.

Perfect, so Max PS is not allowed to raise IPAP beyond the Max IPAP setting regardless of the units ability to exceed max IPAP. I get that.

(09-14-2014, 12:08 AM)vsheline Wrote:
(09-13-2014, 04:47 PM)Galactus Wrote:
(09-12-2014, 05:51 AM)vsheline Wrote: Regarding, "I don't understand how Max EPAP is unable to reach 18 with a Max PS setting of 7. I thought that if Min EPAP =13 and Max EPAP = 20 with a Max PS of 7 that 13+7=20 and that with a Min PS of 1 that Max IPAP could =20 and Max EPAP could =19 which left both numbers above my original script."

Yes, in your example, EPAP could be as high as 19, but only if PS happens to be 1. EPAP and PS are separately getting raised or lowered in accordance with their separate algorithms, and I think the EPAP algorithm is not allowed to change PS and the PS algorithm is not allowed to change EPAP.

Keep in mind that whenever EPAP is adjusted IPAP is adjusted by the same amount, so that PS will be unchanged.

Let's take the case that Max IPAP is 20, and EPAP has been adjusted to 15, and PS has been adjusted to 4. (EPAP is 15 and IPAP is 19, which is 1 less than Max IPAP.) In that scenario, if your machine senses that a higher EPAP is needed, it can adjust EPAP to 16. (EPAP raises to 16 and IPAP raises to 20, which happens to be Max IPAP.)

One thing I think you have missed, the max on the unit is 25 and not 20. That was part of my consideration in using 20 as being 2 over my 18 as 18 + 7 (PS) = 25 (in my mind) which meant I couldn't get over the script by more than 5 and couldn't be over the machines 25. Because even if EPAP being set to 13 was raised to my script value of 18 and PS =7 then IPAP would still be at 25 which was the machines max. Did I interpret that correctly or miss the boat?

The Max IPAP setting can be set as high as 25, but when the Max IPAP setting is set to 20 then PS cannot be raised if that would result in raising IPAP above the Max IPAP setting.

So for my 18+7 to work the Max IPAP would need to be set at 25 not at the 20 it is set at because as discussed PS can not raise IPAP above Max IPAP. I got it now.

(09-14-2014, 12:08 AM)vsheline Wrote:
(09-13-2014, 04:47 PM)Galactus Wrote: The one thing I got was IPAP = EPAP + PS. With that in my mind, starting EPAP at 13 and PS at 1 the IPAP = 14. Then I read the line for PS Max and it said "This is the max difference permitted between IPAP & EPAP. So if start EPAP = 14 and 7 = Max difference than 14 + 7 = 21 leaving me 4 under machine max. And in the event the machine raised IPAP to 18 (using what I believed was PS's number) then 18 + 7 (Max allowed difference) = 25 which was the machine max.

When the Max IPAP setting is 20, IPAP will never be allowed to go higher than 20; the machine's max capability of delivering a pressure of 25 has no bearing when the Max IPAP setting is less than 25.

Ok, I fully understand that. Finally!

(09-14-2014, 12:08 AM)vsheline Wrote:
(09-13-2014, 04:47 PM)Galactus Wrote:
(09-12-2014, 05:51 AM)vsheline Wrote: If it so happens that your machine later senses that a still higher EPAP would be beneficial, I think the EPAP could not go to 17, because if EPAP were to be raised any higher, IPAP would also need to be raised by an equal amount, which is not allowed because IPAP is already at its limit.

I believe this changes once you adjust the max to 25 vs 20, but I am not sure.....

Only if the Max IPAP setting is changed to 25 will the IPAP be allowed to go as high as 25.

Yes because otherwise it violates the Max IPAP setting, understood.

(09-14-2014, 12:08 AM)vsheline Wrote:
(09-13-2014, 04:47 PM)Galactus Wrote: I've also posted todays numbers as well, so you can see where we are. And when I look at the graph on the right for pressure I don't see IPAP and EPAP moving in tandem, it appears they are moving independently of each other and it make me think somehow I am missing this yet again.

If you look at the points in time at which EPAP did change, every time EPAP changed, both IPAP and EPAP moved in tandem.

I got it, you have explained it for me perfectly, took me some time to get there, but I'm pretty certain I'm there with you now.

OK! So now that I understand, and you see the numbers, what do you think? Is there a reason to change anything at this point? From my perspective it looks like this is going in the right direction. EPAP starting at 13 and moving between 13 and 14 looks ok to me. And IPAP starting at 14 and 16 for 95% and spiking to 18 rarely looks ok to me as well. Do you feel there is a reason to change anything at this point or should I stay where I am and keep recording the week and see where I'm at then?

(09-13-2014, 04:47 PM)Galactus Wrote: [Image: rk0nr8.jpg]
[/quote]

If everyone thinks alike, then someone isn't thinking.
Everyone knows something, together we could know everything.
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#94
RE: Therapy numbers, lack of them, weight loss, etc
(09-14-2014, 01:17 AM)Galactus Wrote:
(09-14-2014, 12:08 AM)vsheline Wrote: Point #5. There are settings (limits) for how low EPAP can go (the Min EPAP setting, which can be set as low as 4 but can be set higher) and for how high IPAP can go (the Max IPAP setting, which can be set as high as 25 but can be set lower).

EPAP can never be lower than the Min EPAP setting, but how high can it go as it auto-adjusts? It can go only as high as Max IPAP minus the present value of PS, so that the Max IPAP setting will not be violated.

So if max IPAP is set to unit max at 25, and Max PS is set at unit max of 8 then 25-8=17 as such max IPAP is 17. Is that correct? Oh wait that would only be correct if PS had adjusted up to 8 otherwise if it was at Min PS of 1 then IPAP could get all the way to 24. Right?

Right, assuming you meant to write:
"So if max IPAP is set to unit max at 25, and Max PS is set at unit max of 8 then 25-8=17 as such max EPAP is 17. Is that correct? Oh wait that would only be correct if PS had adjusted up to 8 otherwise if it was at Min PS of 1 then EPAP could get all the way to 24."

IPAP can always get as high as the Max IPAP setting.

And thanks for restating/rewording some of my points. This will undoubtedly make the points more clear to others reading this.

(09-14-2014, 01:17 AM)Galactus Wrote: OK! So now that I understand, and you see the numbers, what do you think? Is there a reason to change anything at this point? From my perspective it looks like this is going in the right direction. EPAP starting at 13 and moving between 13 and 14 looks ok to me. And IPAP starting at 14 and 16 for 95% and spiking to 18 rarely looks ok to me as well. Do you feel there is a reason to change anything at this point or should I stay where I am and keep recording the week and see where I'm at then?

I see no reason to change. I suggest waiting the rest of another week, watching the data daily if feasible, and then reconsidering.

The Advisory Member group provides advice and suggestions to Apnea Board administrators and staff on matters 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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#95
RE: Therapy numbers, lack of them, weight loss, etc
(09-14-2014, 02:38 AM)vsheline Wrote:
(09-14-2014, 01:17 AM)Galactus Wrote:
(09-14-2014, 12:08 AM)vsheline Wrote: Point #5. There are settings (limits) for how low EPAP can go (the Min EPAP setting, which can be set as low as 4 but can be set higher) and for how high IPAP can go (the Max IPAP setting, which can be set as high as 25 but can be set lower).

EPAP can never be lower than the Min EPAP setting, but how high can it go as it auto-adjusts? It can go only as high as Max IPAP minus the present value of PS, so that the Max IPAP setting will not be violated.

So if max IPAP is set to unit max at 25, and Max PS is set at unit max of 8 then 25-8=17 as such max IPAP is 17. Is that correct? Oh wait that would only be correct if PS had adjusted up to 8 otherwise if it was at Min PS of 1 then IPAP could get all the way to 24. Right?

Right, assuming you meant to write:
"So if max IPAP is set to unit max at 25, and Max PS is set at unit max of 8 then 25-8=17 as such max EPAP is 17. Is that correct? Oh wait that would only be correct if PS had adjusted up to 8 otherwise if it was at Min PS of 1 then EPAP could get all the way to 24."

Ah yes you caught me. I had one of those moments when you wonder Is it I-PAP before E-PAP except after C-PAP?? Grammar jokes what can I say? But yes, you are correct that is what I meant.

(09-14-2014, 02:38 AM)vsheline Wrote: IPAP can always get as high as the Max IPAP setting.

Yes, got that part too.

(09-14-2014, 02:38 AM)vsheline Wrote: And thanks for restating/rewording some of my points. This will undoubtedly make the points more clear to others reading this.

I hope anyone else who reads this is less confused than I was.

(09-14-2014, 02:38 AM)vsheline Wrote:
(09-14-2014, 01:17 AM)Galactus Wrote: OK! So now that I understand, and you see the numbers, what do you think? Is there a reason to change anything at this point? From my perspective it looks like this is going in the right direction. EPAP starting at 13 and moving between 13 and 14 looks ok to me. And IPAP starting at 14 and 16 for 95% and spiking to 18 rarely looks ok to me as well. Do you feel there is a reason to change anything at this point or should I stay where I am and keep recording the week and see where I'm at then?

I see no reason to change. I suggest waiting the rest of another week, watching the data daily if feasible, and then reconsidering.

Oh you bet I am watching the data, this thread will have all 14 days (first 7 on cpap, next 7 on bipap) before I even think I might begin to be happy, or consider it Smile

Here is today, and it looks like I had a pretty high rise in pressures. Wife asked me this morning to look at the data at around 4am as I had a leak that woke her and it seems that is what precipitated the machine raising the pressures, but I think overall I am looking good so far, and it really seems like this machine is doing it's job, and knows what to do. I'm pretty happy to have gotten this far.

[Image: 2jba4h.jpg]
If everyone thinks alike, then someone isn't thinking.
Everyone knows something, together we could know everything.
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#96
RE: Therapy numbers, lack of them, weight loss, etc
Day #4 on bipap for anyone following along. I think we are moving along.

[Image: 2h3wl1x.jpg]
If everyone thinks alike, then someone isn't thinking.
Everyone knows something, together we could know everything.
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#97
RE: Therapy numbers, lack of them, weight loss, etc
Hey guys or gals, what is VS and VS2? I know it is snore but does it have any significant impact on anything?

And here's today, I am so happy you guys convinced me to get this machine!

[Image: insnec.jpg]
If everyone thinks alike, then someone isn't thinking.
Everyone knows something, together we could know everything.
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#98
RE: Therapy numbers, lack of them, weight loss, etc
VS and VS2. That is some really bad stuff! Just kidding! Those are the 2 different types of snore that PR records. I am not sure the difference but someone more familiar can come by and educate us both.

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#99
RE: Therapy numbers, lack of them, weight loss, etc
I don't know. I heard they are two separate indicies about snoring that JediMark discovered when he was working on the Respironics machine for Sleepyhead. I have also heard no one knows if they're good, bad, or indifferent.

My guess is they're a measurement of snoring vibration from two different viewpoints, and doesn't mean much until or unless it gets to the jet engine stage.
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RE: Therapy numbers, lack of them, weight loss, etc
(09-16-2014, 08:54 PM)retired_guy Wrote: My guess is they're a measurement of snoring vibration from two different viewpoints,

What??!! Viewpoints?? Like someone is watching me through my machine at night when I sleep? And from two places?? WTH!!

Seriously though I wonder why they would record them if they aren't of any help. I don't like extraneous information. It IRKS me!! And you know how I can be.

Hey PaytonA, I guess RG is not gonna be of help on this one.

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Everyone knows something, together we could know everything.
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