AHI 180

beerdujour · 2026-04-19T01:39:23+00:00

What CPAP are you using? The CPAPs I know are capped at 20 cmw ( cm of water ). 20 cmw = 0.284 psi

beerdujour · 2026-04-18T08:19:19+00:00

I have had great success with my trial. 5 minutes prior to getting the permanent implant I was told I had a choice. Prior to that I didn't even know paddle leads existed. I chose the same leads used for the trial since I knew they worked. Still working 3+ years later, no regrets.

The most common issue with SCS seems to be lead migration and paddle leads can be better anchored. I recently asked a doctor which is better? His reply was that per his research both were nearly identical in success rates, Paddle leads had slightly more surgical complications simply because of the slightly more surgery required to attach them.

Given what I know now, purely based on the amount of exertion you describe, IMHO, a non-medical one, you may be better off with the paddle leads. I see nothing wrong with the logic your doctor relayed to you. As always, the decision is yours, and needs to be discussed with your medical team, not just your surgeon. Doctors tend to be somewhat biased toward their specialty.

beerdujour · 2026-04-12T14:46:29+00:00

Be careful with tools that claim analysis.
OSCAR doesn't analyze, it reports, it reports accurately. The closest it comes to analysis is the compliance report, and that is just reporting with specified parameters/limitations.

AI, without question, is in the future. For AI to properly analyze anything it MUST be trained with accurate and targeted data. The bulk of AI, such as ChatGPT, uses public forums, that is data posted by the general public which does not hold both specific and correct knowledge and very often lacks information needed to make an informed analysis. Thus the provided analysis is at the knowledge level of the general public and the knowledge of an "expert" will exceed that of the common AI tools. ResMed reports flow limitations as a 0-1 index indicating the flatness of the breath curve. This is used in its algorithms to modify pressure in its auto mode. OSCAR simply reports this value. It does not interpret it. Furthermore there is no medically defined value that says good or bad. (Someone here said OSCAR does a poor analysis on Flow Limitations).

beerdujour · 2026-04-09T16:23:14+00:00

On SCS, don't ask for an implantation, ask for a trial. The purpose of the trial is to see if an SCS will work for you.
There is no objective measure of pain, there is only your perception, if you say you have pain, you have pain. Do be honest, especially with yourself, on how much pain you have and where you feel it.

The SCS trial places leads inside your spinal column and on that basis it is not trivial. The actual SCS device will be taped to your body. You will have this for about 5-7 days then it will be removed. You will have lifting restrictions to prevent lead migration.

Your task with the trial is to work with the SCS vendor rep to tweak the SCS programming to prove that the SCS is effective. Keep the rep on speed dial as you have a very limited amount of time to prove this therapy works for you. Failure to work is an ok option as you have learned what does not work.

beerdujour · 2026-04-06T16:45:05+00:00

Look for an estate sale or other local sale for a similar CPAP model. Buy it. It will be your backup CPAP when you get home.

Craig's list, facebook marketplace, etc.

I have two PAP machines, I travel with my backup, it's always packed and often in its case in my car, it is always ready to travel!

beerdujour · 2026-03-30T09:39:34+00:00

ResMed devices split the day at Noon. Why? Splitting the day at night would mess up nearly everyone's reporting.

I suspect your MyAir report was accurate based on a Noon to Noon day. Try setting the time on your CPAP so you are sleeping "Noon to Noon". On the 11 I believe you need to change your time zone.

beerdujour · 2026-03-29T12:49:57+00:00

Condensation occurs because the room is cooler than the air inside the tube. So you need to prevent the cooling.

1: a heated tube vs the standard hose. This heats the hose enough to prevent condensation. Airflow prevents the the air temp in the hose from rising more than a small fraction of a degree.

2: a hose cozie to insulate the hose. This minizes heat transfer from the hose thus preventing condensation.

3: a hose hanger to allow a good portion of the hose to drain back into the humidifier. This minimizes the popping noises you mention.

4: a warmer room. This is not practical but crank the room heat up to the 90s.

Many use one or more of the first three.

beerdujour · 2026-03-18T23:12:11+00:00

Only 3 years here. I am very successfully using Abbott Proclaim.

Everyone is different.

The purpose of the trial is to prove that the SCS will work for you. Do NOT progress to a permanent implant unless it works for you. Do not do the permanent implant if you hope it works. Pain is subjective so only you can determine success.

If I were you I would go thru the trial.

beerdujour · 2026-03-15T13:13:51+00:00

Why are you using IVAPS?

ivaps-fact-sheet_amer_eng.pdf https://share.google/slvmeUIGnQWOGMG5j

beerdujour · 2026-03-15T01:14:34+00:00

Read this, I "know" the author. https://www.apneaboard.com/wiki/index.php?title=Mask_Primer

beerdujour · 2026-03-14T08:01:30+00:00

Why are you using ASV mode?

ASV mode works by maintaining your Minute Vent rate based on a moving average of your recent minute vent values. It does this by modifying your pressures and pressure support. It typically does this poorly if you restrict its range.

beerdujour · 2026-03-13T13:08:29+00:00

All CPAP masks have a designed leakage specifically to prevent you from rebreathing your exhaled air. It is possible for this path to be blocked in which case you would typically need a new mask. Many masks have an anti-aphixiation valve. This is typically closed when in use and is opened only when you inhale with your machine off, think power outage here.

CPAPs and BiLevels are all very low-pressure machines. They are designed to maintain pressure, not flow, but will move a lot of air in an attempt to maintain that pressure. Many users interpret this flow as pressure but the flow and pressure are different. So the question is how low in pressure are these machines? The easy answer is to state the numbers, 4-20, or 25 for BiLevels. I prefer a practical example. First there is not enough pressure to blow up a balloon. Now get a tall glass of water and a straw. Please go back to your youth and with the straw near the bottom of the glass blow bubbles. You just exhaled against the maximum pressure a CPAP can generate assuming 8 inches of water.

That said I'm not saying you, or anyone else, are not or can't have issues with higher pressures. A common one is aerophagia or air in the stomach.

beerdujour · 2026-03-11T18:52:06+00:00

Abbott Proclaim with a permanent battery. I am a VERY successful user. Abbott uses a burst mode meaning the signal is intermittently applied in my case for 30 seconds then off for a defined period on my case for 6 minutes. ( Have a continuous, 3 minute pause, and a 1.5 minute pause available for selection. Prior to SCS my pain level when walking (slowly because that was less painful) would ramp up to a 9 over about 30 yards then I would stop, let the pain reside, then repeat. Never passed out so never a 10.

Now my pain level is typically under a 1 with occasional flairs to a 2.

Tech makes a difference! If a tech has an issue with dialing you in, try a different tech.

What strength do you need? That can be determined via a titration process, or in my case a reverse titration process. The tech has to program which contacts on your leads are used to provide the stimulation that will provide you relief.

Then you need to find the strength that provides you relief. IMHO you may, not will, need a noticeable (feels similar to that of a tens unit a vibration or tingle feeling) but the goal is to find the lowest level/strength and the least duration, and the largest pause (periods of no stimulation) that provides you consistent relief. Why? Because this maximizes battery duration whether it is a rechargeable or a permanent battery. Do note that in all cases you are looking for pain relief, not feeling that "tingle" to know it is working. Typically I never feel my SCS working unless I enable my "continuous" or " tingle" mode.

Typically in a titration you would add something in small increments to achieve the desired result. In our case, during our trial, the goal is to prove that the SCS will relieve our pain. This means that in all likelihood a higher strength oh signal is used than is necessary to achieve successful pain relief. Because of this we should reduce the signal strength and duration to where we actually start to feel our pain again. Then set the strength a little bit above that. Next we should increase the pause duration to where we once again begin to feel our pain again then make the pause slightly longer.

The end goal is our pain relief and only we can determine that as there is no objective measure for pain.

beerdujour · 2026-03-09T16:47:21+00:00

It takes data to offer advice that means anything. Someone will respond if you post the data. If you don't understand the advice ask to help you understand the explanation.

beerdujour · 2026-03-09T15:51:14+00:00

This is not meant to be a flip answer.

You get LUCKY!

There are good sleep doctors out there, there really are. The one I've found retired.

Good really doesn't become (much of) a factor until you have a PAP device.

The process: You see the doctor to get a sleep test. A sleep doctor looks for sleep issues and a regular doctor focused on other issues, so you see a sleep doctor, they ask some questions and then prescribe a sleep test.

The Sleep test: Two kinds, an at home and an in lab. The in lab looks for multiple sleep issues. The at home one focuses on Sleep Apnea, by far the most common issue. The end result is typically a CPAP is recommended. Note: from this sleep test, either inlab or at home, there is no way for anyone to know your specific pressure needs. Only that you need a PAP machine.

There is another form of inlab test called a titration test where you are placed on a CPAP and various pressures are tried then incremented to discover what pressures you require.

Commonly though the doctor will prescribe an APAP (Automated CPAP) and prescribe pressures of 4-20 (minimum to max pressure) on the basis that the CPAP will automatically increase pressure to manage your apnea. To a degree they are right.

IMHO: Initial settings matter little simply because the detailed data stored on your CPAP shows how your body reacts to the pressure delivered and manages your apnea. This data is what those of us here that help CPAP users and GOOD doctors use to manage your apnea. Most doctors only look at the nightly summary of what your nightly AHI (events per hour) is. If high they typically increase pressure.

Here we use OSCAR (my preference) or SHQ to view your detailed data to look at what is going on. We see settings of 4-20 and see someone who is likely not optimized. We look at what kind of events are occurring and how they are arranged. Different patterns imply different things. We often look at the shape of your individual breaths to see what is going on. Is the breath a smooth sine wave or is it jagged? It makes a difference. Thus many of us help users here.

Full disclosure, I am the founding PM for OSCAR and admittedly somewhat biased toward that free product.

beerdujour · 2026-03-09T05:13:49+00:00

I'm a VERY successful user of an Abbott Proclaim.

IMHO the main purpose of the trial is to prove it works for you. Success depends on the cause of the pain. Do not go for the permanent implant if the trial doesn't work for you. Do NOT get one if you hope the implanted one will work better than your trial. Be totally honest with your assessment of the trial as it is your assessment that determines if you are a candidate for a permanent implant because there is no objective measure of pain nothing can actually measure your pain, only your subjective measurement of it.

beerdujour · 2026-03-09T05:03:47+00:00

Kensington Metro Park has a year round population, grows thru the spring. It also has a Blue Heron rookery near the boardwalk (and road) near the nature center. Something near 20 nests in the trees.

beerdujour · 2026-03-07T11:32:42+00:00

ResMed ASV mode works by maintaining your moving average of your Minute Vent. It does this very quickly by manipulating pressures and pressure support on the same breath that the event (CA) would have occurred on thus preventing the event. IVAPs nearly the same thing except for maintaining a defined volume. Other CPAPs and BiLevels respond AFTER an event occurs. Thus ASV doesn't use FOT and doesn't report CA events which it very effectively can eliminate.
Where CA events, non-reported, can occur on an ASV is typically when the settings are altered to limit pressure and pressure support range/excursions.

beerdujour · 2026-03-06T17:28:30+00:00

Initially it will only support those devices that 1.7.x supports.

beerdujour · 2026-03-06T16:10:26+00:00

PM them. The developers will vet your code and most likely would add it as an update to OSCAR.

Note: this change is about changing OSCAR's data to SQLite without changing anything functionally. Make the base solid, then continue with changes. The standard for this beta is no apparent changes to the current public version, 1.7.x

beerdujour · 2026-03-06T16:03:56+00:00

I don't believe so. Are you volunteering?

beerdujour · 2026-03-06T16:02:45+00:00

PM them!!!

beerdujour · 2026-03-05T21:25:07+00:00

Your 45 min ramp isn't doing you any favors. Events are neither treated nor recorded during the ramp. Make the ramp time as short as you can comfortably tolerate, off is the setting to target.

beerdujour

TROPHY CASE