How a Harvard Sleep Doctor fixes the most Challenging CPAP Patients

Hi cpap friend it’s me Mary S. What a great interview! Could you also interview this Dr. Petcus from Florida? Dr Petcus is on the Buteyko breathing program bandwagon saying he can get people off their machines. I hope he gives credit to Dr. Buteyko though. I cannot recommend Petcus’s program because I’m not going to purchase it but an interview would be cool. Optimal Circadian Health . Com

WOW Andrew! What a most informative conversation you had with Dr. Thomas, (thank you so much also for the sup-titles). Clearing up or more like broadening the understanding of loop gain was a big help for me to know more about what studies or not have been going on in this field. I liked the comparison the doctor had of adding strings to an musical instrument to have it play at different or higher levels, as well as the question as to what current sleep study professionals can do to improve? the answer being "the have to practice best science sleep medicine, not best evidence. I thank you as well as I'm sure many others around the world appreciate your work and research your doing on our behalf. Continue to soldier onward...My Best Frank

Wowwww supérb!!!!

"There are just a lot of people in high positions who don't want to rock the boat, keep it very convenient. Just blame the patient for lack of success." So true 😭

Wow this is awesome, really enjoyed this!

Very informative- but….What is ERS?

whats is high loop gain? how does Diamox works on sleep whats the mechanism?

Thank you. Very interesting and informative.

I’ve been suffering with cpap for past 4 years and have never been able to use it more than a few days and I’m 26 it started when I was just 21 22 since then it’s been a horrible ride it’s feel like I’m just stuck in this eternal loop of fatigue and weakness symptoms nobody seems to find out what’s really wrong I hope there is something you guys can help me with

Intensely interesting. Thanks for sharing the interview. Always better to have first hand info.

What was the lose weight comment? You shook your head while he stayed about people gaining 3 lbs .

I didn't understand the significance of his example of the study referred to where somebody had AHI 3 %/44 arousals - AHI at 4% of 3.1
So was he comparing that? If you change the percentage it only appears that someone's having less arousals? Or is the significance of the statement that Even with AHI 3.1 you still have a problem.
Or Is the statement, that he had 44 per hour events but the machine still marks it as 3.1?
You both had a reaction like you understood what he was talking about. I'm just trying to understand this. I understand only that he was talking about insurance coverage at this point, but I'm more curious about. Is he saying that even if you got it below five episodes per hour, the magic number that my sleep doctor keeps stating, that even 3.1 means you still got a problem? Problem? Or is he talking 34 about that? They're not counting the 44 arousals And that the person still has a significant issue but under insurance you wouldn't be covered because they're not counting the other disturbances?

One word- RAMA.

Fascinating

Great interview!!!

i live at 6k ft altitude and was diagnosed with severe central and obstructive apnea. i did an oxygen monitoring test and they said it is fine. i do however wake up several times a night, generally during REM sleep. still, i sleep much much better on the bipap than without it. i'm trying to understand the high-altitude issues because i do not believe that i had central apnea until i moved to the highlands. so, i thank you for this interview - even though it opens up so many areas for self education. it is indeed a shame that my sleep doctor is not knowledgeable or helpful to the degree that i want him to be.

Interesting, see if you can bring some more experts on. Nice to be educated and see what they think and for patient empowerment.

What software did he mention?

Great video. Thank you for the helpful upload.

If I’m not mistaken, adding EERS to my bilevel means my BOLT score (CO2 sensitivity) will likely improve? Not sure if anyone is following the claims about higher Bolt scores and better sleep (I believe regular CPAP and Bilevel have shrank my CO2 tolerance over the years).

Also, as someone with mainly UARS, while additionally having small amounts of obstructive events only in REM, what might help with being easily woken up? Since I’m REM-dominant and I’m assuming sedatives aren’t recommended, anyone have any ideas about what might help other than sleep restriction (CBD?)?

Hey I have rem related OSA and UARS due to my tongue which creates a constant partial obstruction. I have seen more then 10 specialists across 3 countries but no treatment is working; cpap, INAP, MAD, tongue retainer...
I soon have my 4th sleep study but I'm skeptical ...
I know its a long shot but any treatment ideas you can think of?

Hey @CPAPfriend, I've been struggling to use PAP for years. I can never fall asleep. I need at least 10.6cm to not feel like I'm suffocating. On my APAP with EPR 3 I have trouble with aerophagia and breathing out against the pressure, on my BiPAP with PS of around 6 I do much better with the aerophagia, but I don't like how the BiPAP changes from IPAP to EPAP. I feel like I have to breath for the machine. Always focused on starting my inhale so the machine knows to switch to IPAP. On BiPAP whenever i do start to fall asleep I forget to breathe and jerk awake with a big breath. I've tried all the trigger/cycle settings. I don't have this problem on the CPAP but still can't sleep because of the high pressure/aerophagia. Any tips? Thanks a ton!

This was great. Thank you for posting this

Thank you for this. Great info

Hey brother I gotta say thanks for everything that you do. I found you on a reddit thread and I've been going super deep into the stuff that you post. I'm active duty military and I just got diagnosed with sleep apnea. My life has pretty much changed since this diagnose, I've always wondered to myself why the hell am I always so damn tired, why am I falling asleep everywhere, why am I only getting like 2 hours of sleep a day. It's been a pretty difficult life to balance on top of doing military shit. So stressful, I've relied on my willpower for these last couple years to get through the day but man has it been hard. I get my CPAP machine in a week or so. I'm really looking forward to it, but I don't wanna get my hopes up only to be crushed lol. Maybe one day I'll be able to sleep 7 hours straight...........

Wow this is amazing

How can you detect hight loop gain in Oscar or in a polysomnographic test?

So is he saying ASV is not good therapy for UARS?

Great interview! I just discovered your channel and am finding it incredibly valuable. I learned a lot in this interview about the topic of loop gain and breathing stability, which I previously did not know much about. The most interesting part of the conversation for me, though, was not what Dr. Thomas said, but rather, what he didn't say. At 48 minutes in, you asked him a fascinating question about what you're seeing in OSCAR. It sounds like you're seeing a potential "PES signature" of breathing waveforms. These waveforms appear to be flow-limited, due to their flat peaks rather than rounded peaks. It sounds like you believe this is a RERA, which is a potentially problematic breathing disruption and arousal, but Dr. Thomas dismisses it as a "transient arousal", which it is "normal" to have some of. I would be curious to know if there are any differences between Dr. Thomas's view of UARS and Dr. Rama's. It sounds to me like Dr. Thomas may be ahead of other sleep Dr's in terms of his knowledge of loop gain and breathing stability, but potentially behind other sleep Dr's in terms of his appreciation for the harmfmul effects of RERAs and similar subtle variants of sleep-disordered breathing. I'm curious what Dr. Thomas would think of Dr. Rama's observation that WatchPAT can detect arousals missed by PSG.

Was he recommending acetazolamide or buproprion to help sleep with a cpap?

Holy moly. Very interesting discussion!

I’m going to need you to become an expert in this and then explain it to me. tries to imagine how to determine whether loop gain is the main issue rather than other factors

I actually really like C programming, I wonder if I’d be any help for sleep help anywhere later into my career. I’d love to be able to help people with my own struggles because I know how bad they feel

Important topic!