Even SLEEP RESEARCH Experts disagree why your PAP Therapy sleep is horrible.

[@Freecpapadvice]

I love this video topic probably more than any other and find it fascinating that even researchers have completely different opinions. Let me know what you think, share your own experiences, and THANK YOU for watching! Order Dr. Krakows "Life Saving Sleep": amzn.to/3Y0yupl Order Dr. Noahs VCOM: bit.ly/38yPlXk Links: 1. Have a PAP Analysis with me at: axgsleepdiagnostics.com 2. As an Amazon Associate, I earn on Qualified Purchases: amzn.to/3drPax1 Check out this videos sponsor! cpapsupplies.com/lanky-lefty-27 Use my CPAPSupplies.com (affiliate link): bit.ly/38yPlXk Use Discount Code: LANKYFALL and get 25% off. You can always used LEFTY20 for 20% off. Check out my new Amazon Store: www.amazon.com/shop/thelankylefty27 (or....use my Amazon affiliate link every time you shop Amazon. I earn on all qualifying Amazon Purchases using the link. Thanks!) Join this channel to get access to perks: kzbin.info/door/g_Rj5qrxlCo4OX6MMq08gQjoin

[@cebruthius]

That was quick getting my wish granted :D Hit me up if you want to discuss my ASV self-titration adventures

[@Dan-dg9pi]

I am impressed how Jason manages to say "Obviously go through your doctor's recommendations" with a straight face while we all know that he is thinking "Obviously call me because your doctor knows nothing about this stuff". :-)

[@Freecpapadvice]

Just seeing this. 🤣

[@ians-ideas]

First off, thanks for the shout out! That is far too kind. Second, I definitely fall under the category of slightly chubby with high AHI and likely undiagnosed UARS. Jason, you are the only person who took my complaints seriously and determined that I would benefit from bilevel. So thanks again!

[@RyanWilliams222]

I love that you’re making this kind of video. Thank you, and keep it up!

[@JH-lz4dh]

You make a lot of sense. You alleviated a lot of my husband’s suffering AND mine because the sleep doctor was absolutely useless

[@beefcreeb96]

Did you acquire a BiLevel?

[@JH-lz4dh]

@@beefcreeb96 no

[@beefcreeb96]

Great follow up, Jason. I had just been to my sleep therapist when I watched the Dr. Noah video. If I wasn't already PO'ed, that video sure put me over the top. My therapist described UARS as a mild form of apnea, which I took to mean, the insurance company won't reimburse us for ASV/BiLevel treatment without a great deal of effort so, good luck pal. My OSCAR data clearly shows FL and UARS but my therapist/doctor have no interest in going that granular. Their paychecks cash the same whether I get treated or not, obviously.

[@cebruthius]

12:55 The Philips ASV algorithm doesn't have this "flaw" since it reacts to *all* differences in peak flow between breaths. It does not depend on any flow limitation detection heuristic like the one offered by ResMed, which is nice but of course not perfect.

[@5redwine1]

In Dr. NOAHS interview with CPAP Reviews, he said that you could use 2 vcoms back to back in line on your cpap hose. This has helped me very much. My sleep has really stabilized. I have not heard any comments from you about this idea.

[@scotchvelo]

My sleep doc had never even heard of OSCAR. So that's awesome.

[@cebruthius]

8:28 This just means that the minPS setting on the ASV was too low

[@eddiememphis1]

Interesting... I am thin, in good shape and have never snored. Changing the pressure has never made much difference in the quality of my (poor) sleep. I guess I need to do more research on UARS.

[@preetimittal2123]

My father is non diabetic person but when he start cpap for 6 months his blood sugar start raising and hba1c level just check is it 5.7 why it is can you please tell me i have no knowledge ?

[@joeshmoe7899]

There are other factors than flow restriction. Chronic pain, insomnia (from stress), tbi, etc. After correcting flow restrictions with bilevel/asv, some still don't get refreshing sleep without an anti-inflammatory and/or low dose amitriptyline, oxybate. Everybody is different.

[@preetimittal2123]

@@joeshmoe7899 may be today i download oscar to see his data i hope everything will be correct

[@preetimittal2123]

@@joeshmoe7899 yes that's why i download oscar therapy today

[@mstewie9718]

Something complicated, just got more complicated.....neat.

[@KPHVAC]

Almighty Jason - I made the switch to set pressure! I switched from a range of 13 to 14 to a set pressure of 14. I guess I'm fully converted now.

[@preetimittal2123]

My father is non diabetic person but when he start cpap for 6 months his blood sugar start raising and hba1c level just check is it 5.7 why it is can you please tell me i have no knowledge ?

[@KPHVAC]

@@preetimittal2123 I think you have asked me this before or someone else asked the same question. I don't think it's possible for CPAP to raise blood sugar. I would think it's something different he is eating. I'm not a doctor so I'm certainly no expert.

[@Freecpapadvice]

Welcome to the C5 cult.

[@preetimittal2123]

@@Freecpapadvice please response to my msg also

[@exxr]

What you showed when ASV "dorks up" is just an artefact of the algorithm taking over full control of the breathing. Since ResMed doesn't identify it as such, you can't tell but it is stuck in backup rate (ie. machine breaths or ventilator mode). The flow graph will look perfect at this point. I don't understand exactly why this happens but I see it every night with mine.

[@cebruthius]

Interesting. I prefer using the Philips ASV because it actually has a BPM setting that allows one to turn off all backup rate. I use mine (for UARS) with BPM off.

[@exxr]

@@cebruthius Yes, I have UARS as well and I actually think that this strange behavior might possibly be beneficial somehow (at least to me). I've tried it with backup rate off (patched firmware) and of course this no longer happens but I also feel correspondingly worse in the morning. As I said, I don't know quite what exactly triggers this behavior but if I had to theorize, I'd say it promotes consolidated deep sleep during these periods.

[@exxr]

@@cebruthius I remember now that there were some central-like pauses (as Barry Krakow puts it) without backup rate and even though my body is used to the pressure support by now and I'd say I no longer suffer from TECSA, these pauses probably kick the machine into taking over control. Though, I still don't know why it takes a relatively long time for the machine to relinquish control and come out of ventilator mode. I wonder if my body is happy to be taken for a ride, so to speak, and doesn't offer up a spontaneous trigger in time so the machine just keeps on going? (of course the ResMed ASV doesn't allow for configurable Trigger since it relies on its automatic Easy-Breathe adjustments).

[@danieljrgensen133]

Jason, what's your opinion on mask compensation settings, on Resmed AS10 machines? Dr. Noah said the feature is crap and works opposite of its intention. What's your take on this....should all CPAP users just use "full face" setting on Resmed pillow/nasal masks? 🤔😉

[@ericelfner]

Jason - are there any non-PAP treatments for UARS? I absolutely fall into the classic UARS characteristics, but could not get PAP therapy to work after much trying including consulting with you.

[@scowell]

You need a good ENT... watch some Vic Veer.

[@Freecpapadvice]

If there are I don't know of them. Mandibular advancements is something that may work, but I know that it also doesn't help in some people. Hyoid advancement may work.....but there is no way in hell I'd have that done to myself.

[@ericelfner]

@@Freecpapadvice Thanks for this. I have several over-the-counter MAD devices. I hope to dedicate more time to getting them to work or I may even get professional help for this.

[@jonvongeronimo]

I had jaw surgery (MMA & genioplasty) in 2021 for sleep apnea/UARS, and it didn’t help my sleep at all. Now I’m stuck with a crooked jaw, crooked nose, and bite issues. I miss my old face. Jaw surgery is probably the dumbest thing I’ve ever done.

[@ericelfner]

@@jonvongeronimo very sorry to hear that, but I appreciate you sharing. I'm going to keep hoping for better options and wishing for good sleep for all. 💤

[@christianhammond6752]

Hi, thank you for your videos they are super helpful. I have uars and I have experienced everything you describe. I currently am on ASV due to central apnea, would bipap st be a potentially better option due for uars?

[@devnull1313]

Ditched CPAP and just took to sleeping 12 hours/day. I can take use 2 hours of my wake time, walk, and get 0 4% drops in O2 saturation instead of 50+

[@scowell]

wat

[@devnull1313]

@@scowell tl;dr: My "sleep medicine" practitioners were just objectively bad, and my own incompatibilities with CPAP proved insurmountable. Saturation drops during "sleep" might/might not be a bad sign, but my doctors were not really into the nuts and bolts of any of my irregularities. It's nice to see a video of professional doctors clearly looking into things unique to specific populations, and trying to solve problems.

[@beefcreeb96]

@@devnull1313 Kinda headed the same route. My therapist just wants to read out of the insurance company's handbook.

[@unclefester9113]

The V-Comm thing was hard to feel comfortable. Hard to get air in ..... Secondly - You'd think it would come with a rubber adapter to attach the plastic adapter !!!

[@pbrian9527]

When I tried vcom, my breathing was very shallow even with increasing the IPAP.

[@jakec5618]

How do you get the bilevel? Do you need a special prescription to get it ? I was given the resmed apap and it didn't really help me. Tried if for several months and eventually gave up.

[@mstewie9718]

Apap sucks.... respiratory relief sucks more.... and yes, you need a script for a bi-level.

[@semiephemeral9]

Jason, great vid. So, if one takes an ASV and sets ps min/max to the same value it's essentially bi-level right?

[@Freecpapadvice]

You can't do that. But if you could, setting PS min and max to the same number would make it CPAP.

[@semiephemeral9]

@@Freecpapadvice what if you set both to say 4cm? Wouldn't that be ps of 4?

[@preetimittal2123]

My father is non diabetic person but when he start cpap for 6 months his blood sugar start raising and hba1c level just check is it 5.7 why it is can you please tell me i have no knowledge ? His sugar level always comes with range 76 , 82 and when he hooked on cpap his range like 109 sometimes , 117 suddenly fasting sugar

[@RebelRobot01]

I'm a Type 1 Diabetic. It actually sounds like your father is slightly hypoglycemic, but his blood sugar raises to a more normal level after therapy.

[@carlvonfuckwits2934]

He has more energy, and if you are more active it raises your blood sugar some. In others it can be higher and then the cpap makes it lower.

[@Whatcha_Gonna_Do]

Great video Jason, Thanks! I'm on ASV, how should I program it to address this?

[@Freecpapadvice]

I wouldn't change anything unless you have a reason (data) to show that a change is needed. To answer your question though: ASVs are tough because you can't lock in a steady IPAP.

[@OneIdeaTooMany]

I flashed the vauto firmware firmware on my airsense 10. I'm quite large so i need a really IPAP to open the airway but i need more than 3cm of pressure support. I can breathe through up to 14.6cm with no pressure support but after than i needed pressure support.

[@scowell]

Turns out that blood chemistry (partial pressures of gasses) works this way too... after about 15cm you *need* 'EPR' to help blow off the extra CO2. Sounds like you haven't done a lab bi-level titration yet... it was not cheap, but they found I needed 21/17cm (PS4)... sleep much better now... *and* now that my deductible is met I made insurance buy me a new Aircurve 10! I also have the firmware and stuff to flash it... main machine right now is an Elite I got during the Sleeplay 299$ sale... running vAuto! MyAir thinks it's an Aircurve, hilarious. Ran the real Aircurve until I got compliance taken care of, now it's in the closet with the other dozen Ax10's I have collected... I buy one every time I see one for less than 100$.. yes, a sickness... someday the Open Source community will come out with the good stuff for all of us. I ramble.

[@semiephemeral9]

@@scowell how hard was this? you have to buy a programming cable and a bunch of stuff right?

[@scowell]

@@semiephemeral9 First, get your hands on the firmware. If you own an Aircurve, or have a friend with one, this job's done. Then you need the STM probe and push-pin cable... then you need to connect them. Then you need to run the STM utility to dump and replace the firmware. SleepHQ has everything in the Dev chat for this. Good luck.

[@SaintGGod]

How does BiLevel accomplish what CPAP can't? Isn't it just for 2 different pressures? I'm new to this

[@shirleyfenile3393]

I have hypopnea. Diagnosed w/45 apneas per hr. Not heavy at the time. Fastward age 69, 170 lbs and really ticked off. Sleep therapy drs just do not care. Lately, it's not working right for me. I pull off the gear@ 4 a.m.

[@CPAPfriend]

I believe all that matters is what physiological response, if any, follows any given breathing. All else is secondary. Here the secret lies; here lies the entire story.

[@Travis2024papEr]

Jason how do I get vcom

[@gaillawrence1102]

In an effort to get better results, I reset epr from 3 to off and lowered my min and max pressures by 3. Sure enough, the OA's and CA's went down a lot but were replaced by increases in H's and RERA's. I have been moving my pressures up by 1 each night for the past few nights and am getting the similar results. There is not much auto action--pressure jumps to near the max and does not vary a lot. Flow limits are noisier and average from .25-.43 in the 95th and 99th percentile. I am overweight and was diagnosed with severe apnea. So, I am left with this tradeoff---EPR on but more apneas or EPR off with more H and RERA's. Or, do I go for a bilevel? My AHI's are usually below 5 so my chart result looks acceptable but I am really tired during the day. Thanks.

[@westonmickey3890]

Is there anyway to hire you to help me adjust my c-pap?...

[@Nameloc1989]

I have a question, I’ve been hearing about switching your resmed to full face no matter what mask you have. I heard the flow is better and more comfortable. I have an airfit n20 and I’m thinking of switching to full face setting. Would this negatively impact my therapy even though it’s supposed to be set at pillows?

[@kbh95207]

So I could use some advice. I normally average 2-3 ahi on my machine. Occasionally higher around 6 ahi . On Monday September 30th I got an epidural shot on my L4 and had to sleep straight on my back. For two nights my AHI has been 20. Any tips for the next three days to help me keep my ahi low while sleeping on my back until I can start sleeping on my side again?

[@AdamsLab]

I have a AirSense 11, obviously a CPAP machine but it has a "Expiratory Pressure Relief" is that the same thing, or close enough to BiPAP? I have been struggling with CPAP since I started with it, still waking up super tired, etc. I wonder if BiPAP is the answer for me... I have a prescription for CPAP, would a vendor sell me a BiPAP machine with a CPAP prescription?

[@joeshmoe7899]

If your tech skills are good, Asmageddon has a github for you. If not, gray market... Afterthought: I hear some people find doctors useful.

[@JosephBolen]

I am on a ResMed AirCurve 10 in VAuto mode. However, after watching the last series of videos I am wondering if I should switch to Spontaneous mode with a specific IPAP and EPAP settings. Any thoughts on VAuto versus Spontaneous? 🤔

[@scowell]

If you move to S mode be aware that you probably want EasyBreathe turned on... it's automatically applied with vAuto but is default OFF if you switch to S. I use an Aircurve 10 (really an Airsense 10 running vAuto firmware) and I set 21/17cm PS4... so basically S mode with EasyBreathe ON... I've verified no difference... but your FL's are not logged in S mode, so I went back to vAuto. It's like the APAP thing, why wait to have problems when you can just set the pressures you need and not make the machine hunt for them? The machines are pretty stupid after all, they make mistakes all the time, best to just set a single set of pressures.

[@preetimittal2123]

My father is non diabetic person but when he start cpap for 6 months his blood sugar start raising and hba1c level just check is it 5.7 why it is can you please tell me i have no knowledge ? His sugar level always comes with range 76 , 82 and when he hooked on cpap his range like 109 sometimes , 117 suddenly fasting sugar

[@scowell]

@@preetimittal2123 Stress takes away sugar. The numbers you cite are not worrisome. Lower stress is good.

[@mamatobz2890]

My husband can’t CPAP. BYPAP doesn’t work. Tried several masks. During night the machine ramps up so high he can’t exhale and rips it off

[@PKJane1]

I used to have the same problem. Then my dentist introduced me to a mandibular advancement device and now I sleep peacefully. It has changed my life!

[@sirus312]

@@PKJane1 won't it mess up teeth?

[@sirus312]

He has to slowly stick with it IMO, make sure the settings are dialed in. I went from NO WAY 1st night to finally just being able to get an hour or so of sleep after months. Most I had it on was 6 hours and my eyes turned bright and clear everyone asked me what I did!

[@joeshmoe7899]

Krakow seems more practical for me.

[@InsaneFilms]

God i hate that lego guy

[@KPHVAC]

Cult Lanky!!!

[@the1toblame485]

I tried CPAP at every single pressure possible. I have UARS ~6 AHI +30 RDI. CPAP helped marginally (maybe 30-40%). I switched to Bilevel V Auto and I feel so much better. I still don’t feel 100% but my day to day is like 60-80%. Still locking in pressure. My wave forms look way more smooth with less expiratory pressure intolerance as Krakow would say. Anyone with high RDI and low AHI should try bilevel.

[@the1toblame485]

I am tempted to try ASV but I am a little worried about the SERVE-HF trial safety data. Though the contraindication is only for LVEF

[@the1toblame485]

Additionally I just want to comment on the potential utility of the Vauto algorithm. Yeah it’s not the best. But I typically run 9-13 PS4 and if I raise PS I get a ton of TESCA and if I raise EPAP I get more aerophagia. I only was getting apneas in REM. The past few days I tried using a 9-14 PS 4 and it has improved my sleep by increasing EPAP in REM and haven’t had issues with aerophagia. Just my experience

[@catallergiccat]

@@the1toblame485CPAP gas is also a big problem to me. I was even diagnosed with SIBO which is obviously caused by increased intra-abdominal pressure. I also have UARS, BiLevel helps with FL, but introduces a lot more CAs. I even dual use vcom with bilevel, because vcom does reduce bloating.