pressure plateau

[milboltnut]

When you're being treated by Dr. Dolittle, despite seeing things to act on, patients will fail to get proper therapy.

No, not everyone needs a machine more than APAP, but there's a certain amount of patients that do need BPAP/VAuto, ST, ST-A, or ASV. I do not think any one of these is for everyone. It would be nice to test via sleep study on several of these level of devices and determine which is most likely to help the patient succeed.

I am sure the test machines can do this, but almost all the time it's cookie cutter here's a CPAP, congrats and use it to meet compliance, see me in about a month and I bet you'll be doing fine. If you have any problems, you're doing something wrong. Either you are not using it right or enough. Here it is, get used to it. That was what I was told by the pulmonary doctor when on CPAP and BPAP both. The same doc that told me that also said I didn't need to go through bariatric surgery at 300 lb. but I needed to get serious about losing weight after the bariatric surgery got me down to 200. Apnea must mean deal with a bunch of stubborn doctors in some little known language.

 see me in about a month and I bet you'll be doing fine.

based on........ that my Dr....Dr. Do-little and yeah they do little.. said "I want to see you under 5 AHI" and have a nice day... he never really properly addressed CA's UNTIL I did.

 If you have any problems, you're doing something wrong.

I told him that the APAP wasn't working... but I think if I did challenge him and his staff about Titration..... to two of his staff members....... and the 'CPAP tech' filled him in on what I gathered WITHOUT him...... and him saying he didn't like that she is a "bulldog", and I told him, it's good that she is... there's nothing wrong with that, I said sternly glaring at him.

Apnea must mean deal with a bunch of stubborn doctors in some little known language.

unless you don't care about optimal performance.... it's your life. I encourage to try harder. I have a neighbor who has that attitude.

patients will fail to get proper therapy.

that's thier fault........ If I can win an argument with an Ins. Agent in 10 minutes, why can't they?  It's a fast paced quick fix world we live in. And some things take pain staking hard work roll up your sleeves from time to time.. and if a titration test on an ASV doen't help raise minute ventilation, then they will keep working on it.

[milboltnut]

Based on my graphs, would you be able to say I am...Hypoxemia or Hypercapnic....

Or is Titration the only way to tell.

[SarcasticDave94]

I want to mention a few things, because it seems we are not on the same page. You and I do not need to be in agreement at any time, but it sounds like you're not understanding at all these phrase quotes from my earlier post. So I'm just clarifying my points.

Apnea must mean deal with a bunch of stubborn doctors in some little known language.

unless you don't care about optimal performance.... it's your life. I encourage to try harder. I have a neighbor who has that attitude.

This seems to infer you think I don't care about properly performing machines, therapy, and good results. Take my quote this way, doctors tend to handle those with apnea with a cold and stubborn demeanor. Doc to patient "my way or the highway". That is not what I believe would translate to a good doc/patient relationship.

patients will fail to get proper therapy.

that's thier fault........ If I can win an argument with an Ins. Agent in 10 minutes, why can't they?  It's a fast paced quick fix world we live in. And some things take pain staking hard work roll up your sleeves from time to time.. and if a titration test on an ASV doen't help raise minute ventilation, then they will keep working on it.
[/quote]

Now you use this quote to say if patients fail, it's their fault? Really, that's the attitude some doctors portray. This is my actual quote "When you're being treated by Dr. Dolittle, despite seeing things to act on, patients will fail to get proper therapy." Patients will fail CPAP when doctors fail to diagnose and act on the data with the patient's best interest first. Most doctors see apnea and translate that to Obstructive and nothing else. Aren't you dealing with that now also? So by your take, it's your fault.

If you have questions on what I post, just ask. So far though, it seems you're not getting what I say as shown above. Like I said if you want clarification, ask me. Just don't go about quoting me, stating I meant some idea or other as fact if you yourself don't know if it is fact.

[milboltnut]

Sorry I was rambunctious.... just jittery..... alot of centrals last night but that doesn't excuse my quotes being out of sorts...... I am just so sick about what happened, that I am jumping the gun sometimes. Sorry Dave.

I'm not saying you or anybody in particular.... just the ones who kinda give up.... that's all. I wasn't attacking you or anyone in particular.
However doing your homework before hand is very important.......... I should have gotton a copy of my sleep study and blasted my insurance company Before I started therapy on this APAP.....

So far this site has extremely helpful, but if I could ask for you to be more clearer in the future with verbage in particular.

I was in support of patient not Dr....if that's what you mean.

"Most doctors see apnea and translate that to Obstructive and nothing else. Aren't you dealing with that now also? So by your take, it's your fault."

My centrals were addressed but not enough.... to me. And I believe it was my fault to a point...... Getting a 10 minute appointment from my Polmonary DR, not asking him to Tell ME EVERYTHING, which my wife told many times before to do.... so yes It was partially my fault. I don't plan on letting that happen again.

[SarcasticDave94]

I know where you're coming from, but except for forums like this one, some have absolutely zero assistance from their doctor, DME, and RT. Those are likely the ones that do fail and quit. I cannot blame the patient if his or her medical "care" team doesn't care and lacks the ability to support and do all possible to help that patient from failing. I also know that from many comments here and elsewhere, that is the common scenario on the bizarre world of apnea. Few other medical conditions foster this unprofessional treatment by the doctor. We both have experienced it in various degrees. Again, but for this AB group of patients supporting one another, both you and I would likely have been apnea therapy failures too.

No hard feelings here, but I felt compelled to clarify what can be seen as counter to what I believe. That's all there was. A great rest of today to ya.

[milboltnut]

Thank You Dave....

I appreciate it very much and more so for only slapping me on the back of my wrist !

[milboltnut]

ASV- Targets the patient’s minute ventilation,
continually learning the patient’s
breathing pattern and instantly
responding to any changes

ASV Auto- Provides an ASV algorithm plus expiratory
positive airway pressure (EPAP) that
automatically responds on the patient’s
next breath to flow limitation, snore and
obstructive sleep apneas

Is the auto ASV better for my condition? My FL index has been 0.43 Would that require ASV auto?

[milboltnut]

The O2 is important when doing a titration test as that shows effective treatment if the o2 remains over 90%. Any drop in o2 even on ASV will warrant further investigation

and what would test would have to be done if 02 was below 90%?

[jaswilliams]

The O2 is important when doing a titration test as that shows effective treatment if the o2 remains over 90%. Any drop in o2 even on ASV will warrant further investigation

and what would test would have to be done if 02 was below 90%?

If o2 levels are less than desired then additional o2 may be necessary.

[milboltnut]

The O2 is important when doing a titration test as that shows effective treatment if the o2 remains over 90%. Any drop in o2 even on ASV will warrant further investigation

and what would test would have to be done if 02 was below 90%?

If o2 levels are less than desired then additional o2 may be necessary.

Ja.... then something more than BPAP?

Couldn't believe this from last night's OSCAR....all of them were like this.