lankylefty new video against apap...

[Dugy40]

Lankylefty just released a youtube video about 2 hours ago called reras unmasked: silent killer. The way i interpret it  is that apap is causing not only reras but other events. he goes as far as to tell us to try cpap of about what your 95 percent is. i find this very strange and wanted you all to see it and give me your thoughts. i dont think i am allowed to post the link. hes also against epr which from what i read would say he is definetly wrong on that. dont want to start any fear mongering but is he respected in this community? is he in this forum? Thats all i guess. look forward to the comments. 
 its got me wanting to set mine on a cpap of 13... but i dont know enough to make an informed decision from one guys word.

[SuperSleeper]

Jason (LankyLefty) has an Apnea Board forum account, yes.  He hasn't participated in public discussions here, but has provided the OSCAR team with some valuable assistance in order to solve some recent "problems" in the way of supporting a newer machine series that was not previously supported.  I won't go into all the details of that, since I'm not sure how much he wants out there in public.

I've spoken to him on the phone and I'm convinced he's a very talented, experienced and knowledgeable man and I would definitely consider his opinion on such issues to be well-thought-out and likely to carry weight with many folks.   I'm convinced that he truly loves helping people.   I haven't seen the video yet, but I'm sure several folks would be interested in his reasoning.

[Gideon]

The catch 9s to know when APAP isn't cutting it. Many of us here do take users to CPAP mode, or APAPode where min=max.

His big issue with APAP is in the presence of RERAS, which is something that medical teams rarely look at.

[YipeekiOH]

The best money I spent was consulting with Jason about six months after starting CPAP treatment. I was diagnosed with mild OSA in March 2021. I had issues with pressure spikes waking me up while using APAP and finding an appropriate mask. Jason suggested playing with fixed pressure and EPR which I did and made mask suggestions based on my using over a dozen masks in six months with mixed results. Now I sleep very well (my REM and deep sleep numbers are excellent) and my AHI is typically under 1. I also feel so much better. All this being said, I can state unequivocally that fixed pressure is what helped me the most.

[mesenteria]

It seems to me that each patient should be active in 'dialing-in' their own therapy OVER AND ABOVE what their prescription might say. For some, EPR might actually be deadly, but for others it might make all the (great) difference in the world.  For every patient who learns, perhaps the heard way (and this might be Jason's experience), that EPR is death, there must be an equal number, perhaps a majority even, who find that EPR improves their use of their machine by a factor of two.

[Gideon]

Regarding RERAS, APAP algorithms do not respond in any way to RERAS. IF the FL Index indicates a FL (ResMed) then Pressure is increased with the concept of increasing pressure high enough to stop flow limits. Flow Limits are fundamental to RERAS in that they do indicate increased respiratory effort (the RE in RERS) thus managing flow limits is step one of RERA management. The issue is that the decrease in flow is based on a moving average which typically results in all CPAPs significantly underreporting Flow Limits. This is where the APAP algorithm fails. Jason bases his analysis of what represents good normal unrestricted breathing for the patient resulting in a higher degree of accuracy than the machine itself can produce. This is why here at AB we very strongly prefer to see the charts. It is also why a patient with significant RERAS often benefits from a manual mode, whether a CPAP/APAP or a BiLevel.

It's not the APAPs that are bad, its the way they are way too often blindly followed.

[Dugy40]

thank you all for your responses. i felt like jason knew what he was talking about but wasnt sure. he sure made a good case in this new video he put out yesterday. i dont have any reras being flagged but i think my machine is waking me up from the info i got off jasons video. then i see where i am sleeping just fine and the machine raises the pressure. i didnt see any reason for it to raise. an algorithym raised it i think. which is jasons point i think. i just keep reading, watching and listening to all of you, i do see a real sleep dr for an overnight study sept 6th so we will see what he has to say. talk to you all later

[Gideon]

Post your charts here ( in your own thread)

It is hard to comment on when we don't see them.

[JoeP]

The guy seems very knowledgeable and earnest but you have to remember he is also a salesman and probably not a sleep doctor. So probably be careful following any advice.
I think he is also pushing Vcom sales with also the advice to shut off EPR and APAP mode and also go pure CPAP mode fixed pressure with that as well. (Vcom markup must be large since it looks like it costs about 20 cents to manufacture.)

[Sleepy Quixote]

@JoeP

If this forum had a thumbs up feature for posts, yours would have gotten one from me. This will have to suffice.