Let's put together what we KNOW about autopaps, and back it up as best we can

Sleeping Disorder » Obstructive Sleep Apnea » Let's put together what we KNOW about autopaps, and back it up as best we can

Question:

Carl….. i got the distributors manual NOT just the users manual with my Spirit i’m busy for a couple of days, but will look it up to verify it again in the distributor manual (it’s NOT thin!) kate "Carl J." <> wrote in message

news:slrnbkqaj3.5jm.carl@europa.lonestar.org… – Hide quoted text — Show quoted text -> In article <biims6$9ohe…@ID-181334.news.uni-berlin.de>, Tiger Lily wrote: > > i have nothing to back up my story…. it’s purely anecdotal > > i LOVE my AutoSet Spirit……. of course, the pressure range on it is only > > a difference of 4 as recommended by the maker of the machine……. i get > > the results downloaded every so often and adjust the pressure range again > > based on the data recorded by the Spirit > I didn’t know Resmed recommended that the difference should only be 4cm. > Do you have a link or anything to that? > I used to download the data but don’t do it anymore. My machine is > adjusted to only a 1.6cm difference between min and max.

Response:

1) AutoPap can be good for some (many?) folks if set up properly. For me, I can get the same AHI reduction with APAP set at 14-20cm as with CPAP at 18cm. Most of the time I stay below 15, so the comfort is generally better, especially if I awaken for a half hour or so then return to sleep. 2) Not all APAP are for all patients. Different APAP respond to different signals. If you get one which does not respond well to your signals, it will not help. THIS IS IMPORTANT!!! 3) Not all APAP work with all facial interfaces. If you use a combination which does not work well together, your APAP will be ineffective at sensing and thus not work as well as a CPAP. THIS IS IMPORTANT!!!!! 4) Ditto 3) except substitute ‘humidifiers’ for ‘facial interfaces’. 5) APAP are heavier and more expensive than CPAP. From personal experience, I have absolute proof that a Sullivan V and an Oasis passover humidifier are *much* easier for air travel than an AutoSet T and a Humidaire. If you do a lot of air travel, APAP may not be the best solution for you (I am fortunate enough to have an APAP and two ’small emergency backup’ CPAPs). 6) APAP used in place of ‘ST’ BiPap when the problem is Central Apnea is a *VERY* bad thing. THIS IS ABSOULTELY CRITICAL!!!!!!! 7) APAP for those who respond well to it can save a lot of hassle and money by reducing the need for retitration as they age, gain/lose weight, etc. Do not forget that an important function of retitration is to redistribute wealth from the patient to the physician. APAP for those who respond well to it can allow them to have lower pressure most of the time, but have a higher ‘forgiveness’ for occasional times when sleeping in a position different than the one at which titrated, consume a bit of extra alcohol, temporarily use something (NyQuil? Xanax for air travel?….) which can serve as a CNS depressant. 9) APAP discussions are very effective at starting the apneic equivalent of the Islamic Jihad. I am sure some Jihaddin will participate in this discussion (probably both pro- and anti- APAP). 10) You will not take away my APAP until you pry it from my cold dead fingers (or find me a better solution than APAP). regards, eric pearson db2e…@nospammindspring.com – Hide quoted text — Show quoted text -On Tue, 26 Aug 2003 22:20:01 GMT, NormC <no…@socal.rr.com> wrote: >Here’s all I know about autpaps: >I felt lousy with my cpap so I used an Autoset T autopap, for one >week, and a finger oximter (for two nights). It did not have a >humidifer. I did not have any humidification problems. However, >I felt lousy all week, same as Mike has indicated the case was >with him. Mike has had all the surgeries. I have not had any. >In conjunction with a finger oximeter, it showed that my pressure >was fine, but oxy sat levels went to 65% for 5% of the time, >indicating potential endogenous central apnea. >It also showed a bunch of strange things that were posted here >and on Beth’s website and commented on primarily by Eric. >After several months, I began to feel fine. When I asked my >diplomated neurologist sleep doc about the low oxy sat levels, he >said, "Probably poor response from the Autoset T." Made sense to >me, because if I was experiencing and OSA, and the T was slow to >respond. my oxy sat levels would suffer. >The only other thing I know is as follows: >Two or three years ago, I saw a program online for an upcoming >sleep medicine conference. It had no sessions devoted to >autopap. It did for cpap and bipap. >I asked my diplomated neuro sleep doc why that was. His answer, >"Because most sleep medicine specialists, including me, don’t >have great regard for autopaps." >I’ve been reading here and researching sleep apnea since that >time. I have not seen anything to lead me to believe that >anything has changed. Unsupported statement like, "On the other >hand autopaps are in widespread use, and are considered by many >to be more effective than regular CPAPS.

Response:

I use a Respironics Virtuoso LX. About 3 years now. It was set up for 10 cm. Ordered the software and cable from the guy in the NW. He helped me set it up. Set auto to 8 – 12 cm. Downloaded it about monthly. Reset it to 9-14 I think. 90% of the time I was 10 or below. Presently download it about every 3 months now. Rarely go over 12 cm now. Like monitoring my own situation. Export the info to a data base. has something to give the Doc when I go back in. On fixed pressure don’t get much data back, just time of use. Starting out this newsgroup told me I couldn’t run Adams circuit nasal pillows on my Virtuoso. Uses sound. Called Respironics back then. They didn’t sell and Adams circuit, so wouldn’t ‘officially’ confirm it, but said they had tested it and shouldn’t be a problem. Has worked fine for me. Dave in Topeka "Tim Scott" <tims45@aol[nospam].com> wrote in message

news:biingk0226m@drn.newsguy.com… – Hide quoted text — Show quoted text -> Thanks for initiating this, Norm. I have a personal story about APAP > and an actual scientific reference. I’ll tell the story second. > I don’t have a pointer for the actual article, but this abstract is > very detailed detailed and extremely interesting: > http://nhscrd.york.ac.uk/online/dare/20020690.htm > Berry R B, Parish J M, Hartse K M. The use of auto-titrating continuous positive > airway pressure for treatment of adult obstructive sleep apnea. > Sleep, 2002;25(2):148-173. > If the actual article is online it would be nice to see. > I’ve been using a Respironics RemStar Auto for about 2500 hours. > I have the data card and software for it, and weekly download the > data from its nightly operation. > My DME refused to sell me the card or software; but I was able to > order it over the internet. I am NOT attempting to treat myself > for OSA, but I do want to at least know what this black box is > doing, being hooked up to it for 7 – 8 hours a day. > Part of the reason I have an APAP is I asked for it. In three separate > attempts to get a sleep study (two in home and one in a sleep lab) > I have been unable to sleep. Originally my ENT M.D. went over my case > and prescribed a CPAP set to 9 cm. For months I struggled with > compliance with it. The thing that was missing was heated > humidification. I live in an arid area and it made a tremendous > difference. > Later I went to another ENT who seemed more knowledgable about > sleep medicine and an actual sleep specialist. They both > examined my physiology, my history and looked at the daily outputs > from the RemStar and agreed that lacking a true titration the APAP > ought to work. (I did manage to do an overnight oximetry which > showed acceptable oxygenation.) > With the APAP I can be 100% compliant. It’s set to 4 – 20 cm, > but only goes above 10 cm rarely or if my mask partially slips > off. > When I was at my highest weight (BMI=31.7) the APAP made > a tremendous difference in my wakefulness during the day. I have > lost weight and my BMI is currently 27.3. The average pressure > on the CPAP has gone down too. It used to be 9 – 10 pretty > regularly, now it’s 5 – 7. However I do find that I am still > not as alert during the day as I would like. But part of this > may be disrupted sleep for other reasons. > So in summary, I think I do not have optimal treatment, but it’s > far, far better than none at all. Once a month or so, I find > I can actually sleep through the night without CPAP. But > then I snore loudly (like I used to) which keeps my wife > awake. > I don’t know how useful all this rambling is but consider it > a data point. > Tim S.

Response:

- Hide quoted text — Show quoted text -Nina wrote: > Quick wrote: >> I have read that when autoPAPs *don’t* work for people they >> don’t get effective treatment and it seems more often than not >> they get more than their prescribed pressure. This *has* been >> shown to be potentially dangerous. I believe this is the reason >> that doctors prescribe a range for autoPAPs. Otherwise they >> would all be run wide open (4cm – 18/20cm) and no one >> would need a titration right? > No, my understanding is that the reason for not wanting things wide open > is becasue it is too hard to go from 4 to the needed, say 12, in a few > seconds. It couldn’t happen fast enough to stop/avoid the apnea, > especially since they dont want to design the machine to change > pressures too quickly otherwise it would be disturbing to the sleeper.

What you say seems consistent with what my diplomated neuro sleep doc said about why my O2 levels went so low, when I used an Autoset T for a week. (See original post in this thread.)

Response:

Tiger Lily wrote: > i have nothing to back up my story…. it’s purely anecdotal > i LOVE my AutoSet Spirit……. of course, the pressure range on it is only > a difference of 4 as recommended by the maker of the machine…….

This info is worth its weight in gold <g>. > i get > the results downloaded every so often and adjust the pressure range again > based on the data recorded by the Spirit

But… is the range always 4? > i find i sleep much better and feel far more "rested" when i wake in the > mornings…. AND i know if i have mask issues that go un-noticed while i’m > asleep….. i didn’t get the mask leak information from the basic CPAP…… > just the mask OFF alert

So you get mask leak info. Does the Spirit ‘make up’ for any leaks. That is, does it maintain the pressure you need to overcome any apneas? > my Dr was quite comfortable changing my pressure based on the Spirit’s > report of pressures used/needed

Yikes! You are very modest. Anecdotal? Nothing to back it up? You’ve provided some very important facts here. How are you doing overall? Seems like you were having some problems in the beginning. Have you gotten them all worked out? Thanks for your input. – Hide quoted text — Show quoted text -> kate > "NormC" <no…@socal.rr.com> wrote in message > news:3F4BDDB4.7090501@socal.rr.com… >>Here’s all I know about autpaps: >>I felt lousy with my cpap so I used an Autoset T autopap, for one >>week, and a finger oximter (for two nights). It did not have a >>humidifer. I did not have any humidification problems. However, >>I felt lousy all week, same as Mike has indicated the case was >>with him. Mike has had all the surgeries. I have not had any. >>In conjunction with a finger oximeter, it showed that my pressure >>was fine, but oxy sat levels went to 65% for 5% of the time, >>indicating potential endogenous central apnea. >>It also showed a bunch of strange things that were posted here >>and on Beth’s website and commented on primarily by Eric. >>After several months, I began to feel fine. When I asked my >>diplomated neurologist sleep doc about the low oxy sat levels, he >>said, "Probably poor response from the Autoset T." Made sense to >>me, because if I was experiencing and OSA, and the T was slow to >>respond. my oxy sat levels would suffer. >>The only other thing I know is as follows: >>Two or three years ago, I saw a program online for an upcoming >>sleep medicine conference. It had no sessions devoted to >>autopap. It did for cpap and bipap. >>I asked my diplomated neuro sleep doc why that was. His answer, >>"Because most sleep medicine specialists, including me, don’t >>have great regard for autopaps." >>I’ve been reading here and researching sleep apnea since that >>time. I have not seen anything to lead me to believe that >>anything has changed. Unsupported statement like, "On the other >>hand autopaps are in widespread use, and are considered by many >>to be more effective than regular CPAPS.

Response:

NormC wrote: > Practice: The authors state that there is insufficient evidence that > APAP can be used to treat patients with significant congestive heart > failure, chronic obstructive pulmonary disease, or significant amounts > of central apnoea.

Very interesting. Per Perry, the other category of people who may not be able to use autoPAP are those who have had surgeries (because it may make affect the pattern in such a way that make the detection algorithm inneffective). I’m sorry I am not backing this up with any data/study, but still wanted to share that tidbit since I got it from Perry and he has done a lot of research in this area. Unfortunately, his job hours have become too hectic to allow him to spend time on forums. -Nina

Response:

Nina wrote: > NormC wrote: >> Practice: The authors state that there is insufficient evidence that >> APAP can be used to treat patients with significant congestive heart >> failure, chronic obstructive pulmonary disease, or significant amounts >> of central apnoea. > Very interesting. Per Perry, the other category of people who may not > be able to use autoPAP are those who have had surgeries (because it may > make affect the pattern in such a way that make the detection algorithm > inneffective).

IIRC, Bear, Mike and others have indicated (first hand?) that cpap may not be usable after some surgeries. If that was, indeed, the case, I can’t see how apap could possibly do any better. My point is, positive air pressure in any form may not be useful after some surgeries. > I’m sorry I am not backing this up with any data/study,

Hey – personal experience and an indication of the source of information is fine. > but still wanted > to share that tidbit since I got it from Perry and he has done a lot of > research in this area.

I’m sure pleased that you did. I’m sure everyone, but perhaps one <g>, has similar feelings. > Unfortunately, his job hours have become too > hectic to allow him to spend time on forums.

Perry’s name has been mentioned here, associated with apaps a number of times. I understand that he has posted on Talk About Sleep extensively, but never here. I know that the TAS group is monitored. Is TAS a commercial endeavor? Do they sell anything? What is Perry’s background? Is he an apap user? Etc. Sometimes commercial interests can interfere with objectivity. TIA – Hide quoted text — Show quoted text -> -Nina

Response:

> "NormC" <no…@socal.rr.com> wrote in message >> anything has changed. Unsupported statement like, "On the other >> hand autopaps are in widespread use, and are considered by many >> to be more effective than regular CPAPS.

If they weren’t considered more effective Autopaps would not exist. Doctors prescribe autopaps all the time. Are you questioning the judgements of doctors in writing autopap prescriptions? That would be ironic because you seemed to imply they are infallible. In article <vkolgn9p155…@corp.supernews.com>, Lori&Mike wrote: > I used Resmed AutoSet T and felt miserable (turned out it aggravated existing or > caused additional central apnea). Interesting comments on Resmed VPAP Bilevel > (used

People’s personal experience is usually the best guide on what works for them. There is probably not any best machine for everyone. I bet that having CSA is difficult. > for central apnea) by Resmed spokesperson > at http://www.talkaboutsleep.com/sleepdisorders/Snoring_apnea_resmedVPAP… > " …. I would also mention that fixed CPAP pressures above 10 cm > H2O have been known to actually increase or cause central apnea in some cases."

That’s interesting Mike. I wish Resmed would provide more information about it. But that explains why my clinicians manual says that the Spirit does not adjust pressures above 10cm in response to apneas but does increase pressures in response to flow limitations. The method of checking for apneas does not distinguish between central and obstructive apneas. (yawn)

Response:

In article <biims6$9ohe…@ID-181334.news.uni-berlin.de>, Tiger Lily wrote: > i have nothing to back up my story…. it’s purely anecdotal > i LOVE my AutoSet Spirit……. of course, the pressure range on it is only > a difference of 4 as recommended by the maker of the machine……. i get > the results downloaded every so often and adjust the pressure range again > based on the data recorded by the Spirit

I didn’t know Resmed recommended that the difference should only be 4cm. Do you have a link or anything to that? I used to download the data but don’t do it anymore. My machine is adjusted to only a 1.6cm difference between min and max.

Response:

In article <biingk02…@drn.newsguy.com>, Tim Scott wrote: > Later I went to another ENT who seemed more knowledgable about > sleep medicine and an actual sleep specialist. They both > examined my physiology, my history and looked at the daily outputs > from the RemStar and agreed that lacking a true titration the APAP > ought to work. (I did manage to do an overnight oximetry which > showed acceptable oxygenation.)

So you used an Autopap for self-titration. I wonder if that becomes more common in the future? Perhaps some day they will get a home machine that can do a titration as well as an expensive hospital titration. Wouldn’t that be great? – Hide quoted text — Show quoted text -> With the APAP I can be 100% compliant. It’s set to 4 – 20 cm, > but only goes above 10 cm rarely or if my mask partially slips > off.

Response:

I had a devilbviss autocpap for awhile and no matter how I changed the settings it did not seem to adjust for me. With my spontaneous arousals which increase I think when using any type of pap machine is a problem also. I did have software that told me what was going on and nothing really went on as it would not adjust for me and my pressures were higher than what I set so that model was not a good choice for me. I know that Perry was quite experienced in autocpaps and tested many of them. One way that might help is as was mentioned, talking to sleep techs who have experience in patients that have used them. One thing I would not use is the providers of the equipment as my very first one was very dishonest and I have talked to a couple of other supplies and they did not even know which masks we preferred, nasal pillows/breeze which is a very popular choice. "NormC" <no…@socal.rr.com> wrote in message

news:3F4BDDB4.7090501@socal.rr.com… – Hide quoted text — Show quoted text -> Here’s all I know about autpaps: > I felt lousy with my cpap so I used an Autoset T autopap, for one > week, and a finger oximter (for two nights). It did not have a > humidifer. I did not have any humidification problems. However, > I felt lousy all week, same as Mike has indicated the case was > with him. Mike has had all the surgeries. I have not had any. > In conjunction with a finger oximeter, it showed that my pressure > was fine, but oxy sat levels went to 65% for 5% of the time, > indicating potential endogenous central apnea. > It also showed a bunch of strange things that were posted here > and on Beth’s website and commented on primarily by Eric. > After several months, I began to feel fine. When I asked my > diplomated neurologist sleep doc about the low oxy sat levels, he > said, "Probably poor response from the Autoset T." Made sense to > me, because if I was experiencing and OSA, and the T was slow to > respond. my oxy sat levels would suffer. > The only other thing I know is as follows: > Two or three years ago, I saw a program online for an upcoming > sleep medicine conference. It had no sessions devoted to > autopap. It did for cpap and bipap. > I asked my diplomated neuro sleep doc why that was. His answer, > "Because most sleep medicine specialists, including me, don’t > have great regard for autopaps." > I’ve been reading here and researching sleep apnea since that > time. I have not seen anything to lead me to believe that > anything has changed. Unsupported statement like, "On the other > hand autopaps are in widespread use, and are considered by many > to be more effective than regular CPAPS.

Response:

Tim Scott wrote: > Thanks for initiating this, Norm.

Thank you for your absolutely wonderful input. Just what I was hoping we might find. Not only the link, but your own, well described, experienc(s). Clear evidence that we don’t have to put up with unsubstanciated, unsupported, bullcrap here. It should be emphasized that this was not a study per se. It was a review of studies that had been done up until the time of this review. And it should be noted that this was through some date in 2002, quite recent in terms of the ‘age of apnea.’ The following is a paragraph from the link, that may be of value to many. The entire link is very worth reading. What are the implications of the review? Practice: The authors state that there is insufficient evidence that APAP can be used to treat patients with significant congestive heart failure, chronic obstructive pulmonary disease, or significant amounts of central apnoea. Research: The authors recommendations for future research are many, some are listed here and the others can be found in the report. Further studies are needed to determine the effectiveness of APAP in mild OSA; to determine the safety and efficacy of initial titration of APAP in CPAP-naive patients in an unattended setting; and to determine whether chronic treatment with APAP can increase acceptance or adherence with positive pressure treatment. No study has yet shown that APAP improves patient outcomes. There is little information on the safety of unattended APAP in at-risk patient groups, and more information is needed on patients who need high levels of CPAP. There are few data comparing different APAP technologies. – Hide quoted text — Show quoted text -> I have a personal story about APAP > and an actual scientific reference. I’ll tell the story second. > I don’t have a pointer for the actual article, but this abstract is > very detailed detailed and extremely interesting: > http://nhscrd.york.ac.uk/online/dare/20020690.htm > Berry R B, Parish J M, Hartse K M. The use of auto-titrating continuous positive > airway pressure for treatment of adult obstructive sleep apnea. > Sleep, 2002;25(2):148-173. > If the actual article is online it would be nice to see. > I’ve been using a Respironics RemStar Auto for about 2500 hours. > I have the data card and software for it, and weekly download the > data from its nightly operation. > My DME refused to sell me the card or software; but I was able to > order it over the internet. I am NOT attempting to treat myself > for OSA, but I do want to at least know what this black box is > doing, being hooked up to it for 7 – 8 hours a day. > Part of the reason I have an APAP is I asked for it. In three separate > attempts to get a sleep study (two in home and one in a sleep lab) > I have been unable to sleep. Originally my ENT M.D. went over my case > and prescribed a CPAP set to 9 cm. For months I struggled with > compliance with it. The thing that was missing was heated > humidification. I live in an arid area and it made a tremendous > difference. > Later I went to another ENT who seemed more knowledgable about > sleep medicine and an actual sleep specialist. They both > examined my physiology, my history and looked at the daily outputs > from the RemStar and agreed that lacking a true titration the APAP > ought to work. (I did manage to do an overnight oximetry which > showed acceptable oxygenation.) > With the APAP I can be 100% compliant. It’s set to 4 – 20 cm, > but only goes above 10 cm rarely or if my mask partially slips > off. > When I was at my highest weight (BMI=31.7) the APAP made > a tremendous difference in my wakefulness during the day. I have > lost weight and my BMI is currently 27.3. The average pressure > on the CPAP has gone down too. It used to be 9 – 10 pretty > regularly, now it’s 5 – 7. However I do find that I am still > not as alert during the day as I would like. But part of this > may be disrupted sleep for other reasons. > So in summary, I think I do not have optimal treatment, but it’s > far, far better than none at all. Once a month or so, I find > I can actually sleep through the night without CPAP. But > then I snore loudly (like I used to) which keeps my wife > awake. > I don’t know how useful all this rambling is but consider it > a data point. > Tim S.

Response:

i have nothing to back up my story…. it’s purely anecdotal i LOVE my AutoSet Spirit……. of course, the pressure range on it is only a difference of 4 as recommended by the maker of the machine……. i get the results downloaded every so often and adjust the pressure range again based on the data recorded by the Spirit i find i sleep much better and feel far more "rested" when i wake in the mornings…. AND i know if i have mask issues that go un-noticed while i’m asleep….. i didn’t get the mask leak information from the basic CPAP…… just the mask OFF alert my Dr was quite comfortable changing my pressure based on the Spirit’s report of pressures used/needed kate "NormC" <no…@socal.rr.com> wrote in message

Response:

Thanks for initiating this, Norm. I have a personal story about APAP and an actual scientific reference. I’ll tell the story second. I don’t have a pointer for the actual article, but this abstract is very detailed detailed and extremely interesting: http://nhscrd.york.ac.uk/online/dare/20020690.htm Berry R B, Parish J M, Hartse K M. The use of auto-titrating continuous positive airway pressure for treatment of adult obstructive sleep apnea. Sleep, 2002;25(2):148-173. If the actual article is online it would be nice to see. I’ve been using a Respironics RemStar Auto for about 2500 hours. I have the data card and software for it, and weekly download the data from its nightly operation. My DME refused to sell me the card or software; but I was able to order it over the internet. I am NOT attempting to treat myself for OSA, but I do want to at least know what this black box is doing, being hooked up to it for 7 – 8 hours a day. Part of the reason I have an APAP is I asked for it. In three separate attempts to get a sleep study (two in home and one in a sleep lab) I have been unable to sleep. Originally my ENT M.D. went over my case and prescribed a CPAP set to 9 cm. For months I struggled with compliance with it. The thing that was missing was heated humidification. I live in an arid area and it made a tremendous difference. Later I went to another ENT who seemed more knowledgable about sleep medicine and an actual sleep specialist. They both examined my physiology, my history and looked at the daily outputs from the RemStar and agreed that lacking a true titration the APAP ought to work. (I did manage to do an overnight oximetry which showed acceptable oxygenation.) With the APAP I can be 100% compliant. It’s set to 4 – 20 cm, but only goes above 10 cm rarely or if my mask partially slips off. When I was at my highest weight (BMI=31.7) the APAP made a tremendous difference in my wakefulness during the day. I have lost weight and my BMI is currently 27.3. The average pressure on the CPAP has gone down too. It used to be 9 – 10 pretty regularly, now it’s 5 – 7. However I do find that I am still not as alert during the day as I would like. But part of this may be disrupted sleep for other reasons. So in summary, I think I do not have optimal treatment, but it’s far, far better than none at all. Once a month or so, I find I can actually sleep through the night without CPAP. But then I snore loudly (like I used to) which keeps my wife awake. I don’t know how useful all this rambling is but consider it a data point. Tim S.

Response:

On Wed, 27 Aug 2003 03:55:35 GMT, Quick wrote: >"Charles Perrin" wrote: >> On Tue, 26 Aug 2003 16:36:19 -0700, Quick wrote: >> >I’m curious as to how this works. (here in the States at least) >> >2) On the other hand the manufacturers do not publish their >> >algorithms for detection and adjustment for their autopaps. >> They invariably patent them which means the algorithms (to some >> detail) are published. >Wow. Excellent point! Why have I always been under the >impression that it was like the recipe to Coca-cola?

Probably because you haven’t turned over your CPAP and looked up the patent numbers. US Patent 4944310 (the "Device For Treating Snoring Sickness") should be very interesting to those who want to understand their CPAP. Just be happy your mask looks nothing like the one in the patent — it looks like The Mother Of All Torture Devices. Trade secret protection would NOT work for an AutoPAP because you can legitimately discover a trade secret (with a few exceptions) by reverse engineering. Reverse engineering is how they made IBM PC clones back in the olden days. Now, it seems to be that the standard PC is pretty much independent of what IBM does: it’s more Intel and Microsoft standards in 2003. As to Coca-Cola: Advanced organic chem lab students not infrequently play with Coca-Cola when they are learning how to use a mass spectrometer. It’s cheaper to buy the stuff from the Coca-Cola Company.

Response:

"Charles Perrin" <c.l.perrin…@att.net> wrote > As to Coca-Cola: Advanced organic chem lab students not infrequently > play with Coca-Cola when they are learning how to use a mass > spectrometer. It’s cheaper to buy the stuff from the Coca-Cola > Company.

I know a tiny bit about mass spectrometers too… Back when I was in school I worked at the College of Pharmacy, Ohio State University running their IBM 43xx (it was more or less a 2 man computer department for the staff who mostly did research. They managed to get a mass spectrometer. It was one of the 2 largest in the country? The other was in Chicago. I vaguely remember, it was so long ago. The magnets were super cooled (super conductors?). You had to occasionally top off the liquid nitrogen which simply provided insulation for something colder. If it ever warmed up and shut off it would have taken days to get started again. They also worked with some nasty biological stuff. I once asked about the large red alarms in the halls. One of the Profs said "You don’t need to worry about those. If they go off its way too late." -Quick

Response:

"NormC" <no…@socal.rr.com> wrote in message

Well, hopefully anyone over 7 years old is aware that making unsupported blanket statements is called opinion. I used Resmed AutoSet T and felt miserable (turned out it aggravated existing or caused additional central apnea). Interesting comments on Resmed VPAP Bilevel (used for central apnea) by Resmed spokesperson at http://www.talkaboutsleep.com/sleepdisorders/Snoring_apnea_resmedVPAP… " …. I would also mention that fixed CPAP pressures above 10 cm H2O have been known to actually increase or cause central apnea in some cases." Mike

Response:

Quick wrote: > I haven’t read anything to indicate that there > is any real harm other than discomfort like bloating, muscle aches, > etc. to being at your full prescribed pressure throughout the night. > Yes, I realize that there hasn’t been enough time to draw this > conclusion decisively, but at the moment it seems to be the case.

If I were at my full prescribe pressure all night, I would be awake 80% of the time. A nice thing about the autoPAP, which allows me to be compliant with xPAP at all, is that it is at a lower pressure when you are in lighter phases of sleep. Perhaps this is not a problem wit deep sleepers, but with me, if I have that thing blasting at 12 all night I would wake up between each cycle (and wouldn’t be able to get back to sleep). While I can sleep through 12 when I am in deep sleep, I cannot otherwise. Since it’s all about sleep, this is an important issue.

Response:

Quick wrote: > I have read that when autoPAPs *don’t* work for people they > don’t get effective treatment and it seems more often than not > they get more than their prescribed pressure. This *has* been > shown to be potentially dangerous. I believe this is the reason > that doctors prescribe a range for autoPAPs. Otherwise they > would all be run wide open (4cm – 18/20cm) and no one > would need a titration right?

No, my understanding is that the reason for not wanting things wide open is becasue it is too hard to go from 4 to the needed, say 12, in a few seconds. It couldn’t happen fast enough to stop/avoid the apnea, especially since they dont want to design the machine to change pressures too quickly otherwise it would be disturbing to the sleeper.

Response:

- Hide quoted text — Show quoted text -NormC wrote: > NormC wrote: >> Here’s all I know about autpaps: >> I felt lousy with my cpap so I used an Autoset T autopap, for one >> week, and a finger oximter (for two nights). It did not have a >> humidifer. I did not have any humidification problems. However, I >> felt lousy all week, same as Mike has indicated the case was with >> him. Mike has had all the surgeries. I have not had any. >> In conjunction with a finger oximeter, it showed that my pressure was >> fine, but oxy sat levels went to 65% for 5% of the time, indicating >> potential endogenous central apnea. >> It also showed a bunch of strange things that were posted here and on >> Beth’s website and commented on primarily by Eric. >> After several months, I began to feel fine. When I asked my >> diplomated neurologist sleep doc about the low oxy sat levels, he >> said, "Probably poor response from the Autoset T." Made sense to me, >> because if I was experiencing and OSA, and the T was slow to respond. >> my oxy sat levels would suffer. >> The only other thing I know is as follows: >> Two or three years ago, I saw a program online for an upcoming sleep >> medicine conference. It had no sessions devoted to autopap. It did >> for cpap and bipap. >> I asked my diplomated neuro sleep doc why that was. His answer, >> "Because most sleep medicine specialists, including me, don’t have >> great regard for autopaps." >> I’ve been reading here and researching sleep apnea since that time. I >> have not seen anything to lead me to believe that anything has >> changed. Unsupported statement like, "On the other hand autopaps are >> in widespread use, and are considered by many to be more effective >> than regular CPAPS > " are nothing more than opinions.

There are other factors involved though. For one, an autopap has a chance of catching UARS events that are undetected in a sleep study and are being untreated. I suspect one possible cause of compliant CPAP users who dont see relief in their symptoms are due to untreated UARS events. People can have UARS even of they have hypopneas and or apneas, just as people who have apneas can also have hypopneas. Another, is that with an autopap, you dont limit yourself to the 95% percentile as you do with CPAPS (out of comfort). If at some point in the night you need, for example, 14 to keep your airway open, you get a presssure of 14. With a CPAP, you would get, say, a pressure of 12 because that covers most of the cases and having the pressure at 14 all night is too hard to take. There are also the other benefits. For example, being pregnant, I am sure glad I have an autopap. People who drink occasionally or engage in other sporadic activities that might make a significant difference in the callapsability of their airway also benefit from the automatic detection of pressure needs. Perry’s caveat about autopaps is that each has a different algorithm and each person has a different sleep-disordered breathing pattern. And although many autopaps can work for most people, some people will only have a match with certain autoPAPs. And for some individuals, autoPAPs just wont work. [Perry wrote an excellent 32 page paper "Why Autopaps Work and Fail" on autoPAPs, how each one works, and is hoping to eventually get it up on the web]. For example, in my case, the Autoset Spirit works for me, but the PB Goodnight 418P did not respond at all. Fortuntely, I tried the 418P after the Autoset. Had I tried the 418P, I might have though autopaps don’t work. Also, although I am able to use the AutoSet Spirit "wide open" (my pressures go up as high as 12.5), that seems to cause problems for many people/machines. So some lack of response in autopaps may just be poor/incomplete setup. I wouldn’t write off the autoPAP wholesale because of your experience. It may not work for everyone, but neither does CPAP. I am 100% compliant on autoPAP, but can’t sleep with CPAP even one night (Couldn’t fall asleep at the sleep study, which is why I got an auoPAP. Also, when the Goodnight 418P didn’t respond, I changed it to CPAP mode, but couldn’t get to sleep that way). -Nina

Response:

On Tue, 26 Aug 2003 16:36:19 -0700, Quick wrote: >I’m curious as to how this works. (here in the States at least) >2) On the other hand the manufacturers do not publish their >algorithms for detection and adjustment for their autopaps.

They invariably patent them which means the algorithms (to some detail) are published. >4) It seems that these specific algorithms are kept from the >medical community as well. Otherwise I would expect doctors >to disclose this information to patients in discussions, etc.

Anyone who wants to dig can find out how it’s done. ResMed states how they do it: http://www.resmed.com/us/1005093118974.html >I just couldn’t get past the secret algorithm/operation of the things

How many OTHER things are in your home that have a secret algorithm? And if it has one, do you really care how your CD player does its proprietary error correction algorithm? One can find more in the open literature about how an AutoCPAP works than how their DVD player works…. DMCA doesn’t apply.

Response:

"Charles Perrin" <c.l.perrin…@att.net> wrote in message

news:al6okvsocjurhl0im346c78dge5m4jac2j@4ax.com… > On Tue, 26 Aug 2003 16:36:19 -0700, Quick wrote: > >I’m curious as to how this works. (here in the States at least) > >2) On the other hand the manufacturers do not publish their > >algorithms for detection and adjustment for their autopaps. > They invariably patent them which means the algorithms (to some > detail) are published.

Wow. Excellent point! Why have I always been under the impression that it was like the recipe to Coca-cola? > >4) It seems that these specific algorithms are kept from the > >medical community as well. Otherwise I would expect doctors > >to disclose this information to patients in discussions, etc. > Anyone who wants to dig can find out how it’s done. > ResMed states how they do it: > http://www.resmed.com/us/1005093118974.html > >I just couldn’t get past the secret algorithm/operation of the things > How many OTHER things are in your home that have a secret algorithm? > And if it has one, do you really care how your CD player does its > proprietary error correction algorithm?

Well, listening to poorly reproduced music can be painful but probably less potentially damaging than my CPAP machine. > One can find more in the open literature about how an AutoCPAP works > than how their DVD player works…. DMCA doesn’t apply.

I actually have a basic understanding of how my CD player works and does error correction… Good points all! I was just reading a thread on www.talkaboutsleep.com where people were experiencing their Spirits ramping up to max and staying there. Apparently the algorithm is called A10 and caps at 10 while compensating for cessation but will run unrestricted up to 15 for what it determines to be either snoring or restriction. I think they mentioned that they were set for 7min and 15max. A couple figured the units were misconfigured or in need of repair and another said his Dr. thought it was a bit of skin vibrating in his nose… -Quick

Response:

"NormC" <no…@socal.rr.com> wrote – Hide quoted text — Show quoted text -> Here’s all I know about autpaps: > I felt lousy with my cpap so I used an Autoset T autopap, for one > week, and a finger oximter (for two nights). It did not have a > humidifer. I did not have any humidification problems. However, > I felt lousy all week, same as Mike has indicated the case was > with him. Mike has had all the surgeries. I have not had any. > In conjunction with a finger oximeter, it showed that my pressure > was fine, but oxy sat levels went to 65% for 5% of the time, > indicating potential endogenous central apnea. > It also showed a bunch of strange things that were posted here > and on Beth’s website and commented on primarily by Eric. > After several months, I began to feel fine. When I asked my > diplomated neurologist sleep doc about the low oxy sat levels, he > said, "Probably poor response from the Autoset T." Made sense to > me, because if I was experiencing and OSA, and the T was slow to > respond. my oxy sat levels would suffer. > The only other thing I know is as follows: > Two or three years ago, I saw a program online for an upcoming > sleep medicine conference. It had no sessions devoted to > autopap. It did for cpap and bipap. > I asked my diplomated neuro sleep doc why that was. His answer, > "Because most sleep medicine specialists, including me, don’t > have great regard for autopaps." > I’ve been reading here and researching sleep apnea since that > time. I have not seen anything to lead me to believe that > anything has changed. Unsupported statement like, "On the other > hand autopaps are in widespread use, and are considered by many > to be more effective than regular CPAPS.

I’m curious as to how this works. (here in the States at least) 1) Autopaps being classified as medical equipment and requiring a prescription must be approved by the FDA? 2) On the other hand the manufacturers do not publish their algorithms for detection and adjustment for their autopaps. 3) My *assumption* is that they do submit their algorithms to the FDA who keeps them confidential. I just can’t imagine that the FDA would go on empirical data alone. 4) It seems that these specific algorithms are kept from the medical community as well. Otherwise I would expect doctors to disclose this information to patients in discussions, etc. 5) The FDA is not known for consistent brilliance. Given the above I can understand (and agree with) doctors being somewhat hesistant/suspect of autoPAPs when CPAPs and BiPAPs are a well/better understood treatment. From the (minimal) amount of reading I’ve done I understand the benefit of autoPAPs is that you can be under less pressure for some part of the night than the pressure to treat the worst part of the night. To a lesser extent they presumably will accomodate changes in your treatment pressure over time. I haven’t read anything to indicate that there is any real harm other than discomfort like bloating, muscle aches, etc. to being at your full prescribed pressure throughout the night. Yes, I realize that there hasn’t been enough time to draw this conclusion decisively, but at the moment it seems to be the case. I could see risking an autoPAP if compliance is a problem and might be improved with one. Thats not generally the case though is it? My guess is that the overwhelming majority of autoPAP users did not have a serious compliance problem with CPAP (if they ever had a CPAP to begin with). For most I think its like having a luxory car as opposed to a Corolla. I have read that when autoPAPs *don’t* work for people they don’t get effective treatment and it seems more often than not they get more than their prescribed pressure. This *has* been shown to be potentially dangerous. I believe this is the reason that doctors prescribe a range for autoPAPs. Otherwise they would all be run wide open (4cm – 18/20cm) and no one would need a titration right? Being a bit of a techno gadget freak I browsed the literature on all the autoPAPs and thought about buying one so I would have the latest/greatest in treatment. I just couldn’t get past the secret algorithm/operation of the things and decided that since I don’t have a large problem tolerating my CPAP and it seems to be one of the better ones that I’d just stick with it. -Quick

Response:

Here’s all I know about autpaps: I felt lousy with my cpap so I used an Autoset T autopap, for one week, and a finger oximter (for two nights). It did not have a humidifer. I did not have any humidification problems. However, I felt lousy all week, same as Mike has indicated the case was with him. Mike has had all the surgeries. I have not had any. In conjunction with a finger oximeter, it showed that my pressure was fine, but oxy sat levels went to 65% for 5% of the time, indicating potential endogenous central apnea. It also showed a bunch of strange things that were posted here and on Beth’s website and commented on primarily by Eric. After several months, I began to feel fine. When I asked my diplomated neurologist sleep doc about the low oxy sat levels, he said, "Probably poor response from the Autoset T." Made sense to me, because if I was experiencing and OSA, and the T was slow to respond. my oxy sat levels would suffer. The only other thing I know is as follows: Two or three years ago, I saw a program online for an upcoming sleep medicine conference. It had no sessions devoted to autopap. It did for cpap and bipap. I asked my diplomated neuro sleep doc why that was. His answer, "Because most sleep medicine specialists, including me, don’t have great regard for autopaps." I’ve been reading here and researching sleep apnea since that time. I have not seen anything to lead me to believe that anything has changed. Unsupported statement like, "On the other hand autopaps are in widespread use, and are considered by many to be more effective than regular CPAPS.

Response:

- Hide quoted text — Show quoted text -NormC wrote: > Here’s all I know about autpaps: > I felt lousy with my cpap so I used an Autoset T autopap, for one week, > and a finger oximter (for two nights). It did not have a humidifer. I > did not have any humidification problems. However, I felt lousy all > week, same as Mike has indicated the case was with him. Mike has had > all the surgeries. I have not had any. > In conjunction with a finger oximeter, it showed that my pressure was > fine, but oxy sat levels went to 65% for 5% of the time, indicating > potential endogenous central apnea. > It also showed a bunch of strange things that were posted here and on > Beth’s website and commented on primarily by Eric. > After several months, I began to feel fine. When I asked my diplomated > neurologist sleep doc about the low oxy sat levels, he said, "Probably > poor response from the Autoset T." Made sense to me, because if I was > experiencing and OSA, and the T was slow to respond. my oxy sat levels > would suffer. > The only other thing I know is as follows: > Two or three years ago, I saw a program online for an upcoming sleep > medicine conference. It had no sessions devoted to autopap. It did for > cpap and bipap. > I asked my diplomated neuro sleep doc why that was. His answer, > "Because most sleep medicine specialists, including me, don’t have great > regard for autopaps." > I’ve been reading here and researching sleep apnea since that time. I > have not seen anything to lead me to believe that anything has changed. > Unsupported statement like, "On the other hand autopaps are in > widespread use, and are considered by many to be more effective than > regular CPAPS