"please keep me updated about oximeters "
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Dr. Mack D. Jones
Dr. Jones said:
"An AHI of zero is the goal. Two to three apneas per hour over years can be deadly according to Dr Barbara Phillips, past president of the NSF. Repeated hypoxia of +/-20 to 120 seconds does a number on every living cell in your body. It's the accumulation of repeated insults that finally catches up with you. An MRI-DTI brain scan, if it were available, would help settle any question as to how much damage OSA has actually been done to central pain reception and control centers.
Regardless of the findings in such a hypothetical study, the treatment remains the same. Avoid apneas when asleep."
While I do agree with your above statements I find them a little contradicting with your stand on APAP devices. maybe you could explain it for me. From what I have learned an APAP machine has to have events to work. They are programmed to keep the pressure as low as possible. Even when they have succeeded in eliminating events, after a set amount of time, they will drop in pressure. They will continue to drop in pressure until such a time that events begin again, or they hit their programmed floor. In my opinion an AHI of 0 is not possible with a PAP machine set in auto mode. In D. W. Conn's situation it may have been helpful, but in order for the algorithm to kick in an event would have had to happen thus eliminating his abiltiy to have an AHI of 0.
What do I know though? I am just a psg tech.
"An AHI of zero is the goal. Two to three apneas per hour over years can be deadly according to Dr Barbara Phillips, past president of the NSF. Repeated hypoxia of +/-20 to 120 seconds does a number on every living cell in your body. It's the accumulation of repeated insults that finally catches up with you. An MRI-DTI brain scan, if it were available, would help settle any question as to how much damage OSA has actually been done to central pain reception and control centers.
Regardless of the findings in such a hypothetical study, the treatment remains the same. Avoid apneas when asleep."
While I do agree with your above statements I find them a little contradicting with your stand on APAP devices. maybe you could explain it for me. From what I have learned an APAP machine has to have events to work. They are programmed to keep the pressure as low as possible. Even when they have succeeded in eliminating events, after a set amount of time, they will drop in pressure. They will continue to drop in pressure until such a time that events begin again, or they hit their programmed floor. In my opinion an AHI of 0 is not possible with a PAP machine set in auto mode. In D. W. Conn's situation it may have been helpful, but in order for the algorithm to kick in an event would have had to happen thus eliminating his abiltiy to have an AHI of 0.
What do I know though? I am just a psg tech.
Views: 51
Replies to This Discussion
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Permalink Reply by Judy on
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But if your bottom pressure is the pressure that prevented apneas during your titration???
What do I know?? I'm just a patient.
But that is what I read quite consistently in a forum (by experienced patients, not necessarily sleep professionals). 1-2 cms above and below previously titrated pressure if you are trying to auto-titrate at home. And titrated pressure and 2-3 above for set range for "normal" use if you intend to stay in auto mode.
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Permalink Reply by RockRpsgt on
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I do not see going below optimal pressure as being productive at all. By doing this you are inviting events. As you stated above Judy this is info being passed around by patients not the medical community.Dr. Mack is one of the few docs that support APAPs that I have found. How many pts have we seen leave the docs office limited to 2 or 3 above, below, or anywhere near their optimal titration pressure. not many, most people's ranges are set very wide.
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Yup, yup, I could SCREAM when I read of patient after patient sent home w/an auto pressure range of 4-20 cms!!!! Unbelievable. At least a range of 6-15 allows for some BREATHING room! How many people can breathe w/a CPAP set at 4 cms of pressure?
I've read a lot that 4 cms is usually the best range in pressure for most people. Again just stuff I've read in the forums and aside from this forum there are not too many actual sleep professionals frequenting the forums. At least not that post. How many lurk is an entirely different question. A 4 cm pressure range allows the auto paps time to react. Again, just what I've read, don't shoot the parrot. LOL
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If you look at Dr. Mack's or Dr Phillip's theory that no event is a good one, then any pressure under optimal is bad as it will allow events to happen. Even the AASM has taken a more strict role with their titration guidelines allowing for no apneas, and only one hypopnea before a pressure can be adjusted.
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my titration protocol calls for me to eliminate all events whenever possible. Which is the majority of the time.
Rock Hinkle said:If you look at Dr. Mack's or Dr Phillip's theory that no event is a good one, then any pressure under optimal is bad as it will allow events to happen. Even the AASM has taken a more strict role with their titration guidelines allowing for no apneas, and only one hypopnea before a pressure can be adjusted.
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So, a goal of 0.0 AI is not at all unreasonable? Even a goal of an AHI of 0.0 is not unreasonable? So many times I"ve seen someone post that 0.0 AI or AHI as their goal and been told as long as their AHI is under 5.0, relax. That a consistent AI or AHI of 0.0 was unrealistic and unattainable.
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Permalink Reply by D. W. Conn on
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While an AHI is most desirable at time cannot be achieved. A patient that has an AHI of 110 and desaturations as low as 68%, in my opinion- better off with an AHI of 4 and SpO2 as low as 89 for brief periods. I do agree however that over time the accumulation of events and desaturations will impact the patient’s health. We can and have brought patients back 3 to 6 months later for a retitration beginning with 2 cm below their last titration. At times the MD has asked for a total re-start for the titration.
This is why we encourage and should monitor patient’s diet, exercise life style, smoking habits etc.
Obesity is treated with diet maybe lap band etc. The patient’s psychological treatment is just as important. Without the treatment of psychological needs they will end up back in the obese range. The entire patient has to be treated. So it stands to reason that-
A treatment for Sleep Apnea begins with nPAP. It isn’t the magic pill.
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Judy honestly I do not know as I am not a PAP user. I do not yet truly understand or know what the full capabilities of the end user machines are. In a lab setting if I have the opportunity I titrate to an AHI of 0.0. About 90% of the time I am successful. 0 is always my goal. When I am not successful I usually spend the majority of the following day thinking what about I could have done different. I will review the study until I can't look at it anymore. I ask myself questions like should I have used a different mask, or put them in a supine position sooner. In theory with the right pressure, mask, and sleep environment an AHI of 0.0 should be attainable. it is these three thing that are sometimes unreasonable.
Judy said:So, a goal of 0.0 AI is not at all unreasonable? Even a goal of an AHI of 0.0 is not unreasonable? So many times I"ve seen someone post that 0.0 AI or AHI as their goal and been told as long as their AHI is under 5.0, relax. That a consistent AI or AHI of 0.0 was unrealistic and unattainable.
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Thanks, Rock and D.W. We are so fortunate to have you two and others in this forum!!!!
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Ahhh, Rock. jnk may be a patient, but he's pretty savvy and he sees things from the patients' point of view. He sure doesn't claim to be a pro.
No auto is ever going to take the place of a good RPSGT and jnk will be among the first to attest to that. But, autos are going to be utilized more and more and thank goodness manufacturers are TRYING to develop them to do as close to a PSG titration as they can. I'm thinking RPSGTs are going to have to eventually develop as good skills learning and using the various manufacturers's algorhythms and APAPs as they are PSG equipment, software, etc. Maybe not in my lifetime but the way the health care dilemna is going ....... I still prefer a PSG and a good RPSGT but ...
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jnk is a brilliant man Judy. i believe that him and i have been debating autos since my finding SG. My statement was meant to poke him in the ribs.
Judy said:Ahhh, Rock. jnk may be a patient, but he's pretty savvy and he sees things from the patients' point of view. He sure doesn't claim to be a pro.
No auto is ever going to take the place of a good RPSGT and jnk will be among the first to attest to that. But, autos are going to be utilized more and more and thank goodness manufacturers are TRYING to develop them to do as close to a PSG titration as they can. I'm thinking RPSGTs are going to have to eventually develop as good skills learning and using the various manufacturers's algorhythms and APAPs as they are PSG equipment, software, etc. Maybe not in my lifetime but the way the health care dilemna is going ....... I still prefer a PSG and a good RPSGT but ...
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