I have read some of the discussion about DMEs but not all of it. I agree that arguing about it doesn't necessarily help anyone maximize their therapy. However, I believe there can be some value in telling one's "war story"--whether it's about a DME, a doctor, or even a family member who isn't supportive. (Don't we all want someone to hear our story when we've been wronged?) It's a way for people in this community to verbalize--to get things off their chests in front of people who can relate. If we tell our war stories to our everyday friends, most of them aren't interested, or don't get it. Mine don't, at least. So I think that if someone wants to tell a DME war story without arguing about who's right and who's wrong, that can be a good thing. No harm done.

I posted something that was a "personal recollection" of my 11 years as a papper, and it became a contest that was extremely unpleasant. So, for me, the way I want to approach it is in consensus building.

Guest wrote:Would you be willing to explain how the algorithm works on the Intellipap Auto?

. . . The DeVilbiss IntelliPAP® AutoAdjust® is a flow-based autotitrator that senses and categorizes events as either responding and nonresponding events (ie, potential central events). The AutoAdjust will increase pressure to detected responding events and will maintain pressure to nonresponding events, because a pressure response may complicate the event. Once breathing stabilizes, the AutoAdjust will reduce the pressure gradually to avoid arousals.

. . . The responding events are snoring, obstructive apneas, and hypopneas. The algorithm analyzes flow patterns the same way a sleep technician would visually identify respiratory events during a sleep study. Snoring is defined as an interruption of the flow signal on inspiratory waveform. Obstructive apneas are defined by a major decrease in the amplitude of the total respiratory waveform, and hypopneas are defined by a partial reduction of the respiratory waveform. A unique feature of the DeVilbiss AutoAdjust algorithm is the ability to change the sensitivity of the algorithm by changing definitions of respiratory events, almost creating a customized algorithm.

. . . As the cycle of sleep apnea begins, a precursor to obstructive apneas and hypopneas is snoring. The DeVilbiss AutoAdjust algorithm senses snoring and begins to increase the pressure prior to obstructive apneas and hypopneas in an attempt to prevent these events from occurring. The patient may still have apneas and hypopneas, especially during REM or while in a supine position during the night. There is a need to respond to apneas and hypopneas as they occur during a patient's sleep cycle to keep the airway patent. Dynamic changes in pressure are able to keep the airway open as the patient needs change.

Autopapdude wrote:. Give me Mozart and no drama anytime.