APAP to CPAP?

General Discussion on any topic relating to CPAP and/or Sleep Apnea.
User avatar
Pugsy
Posts: 63941
Joined: Thu May 14, 2009 9:31 am
Location: Missouri, USA

Re: APAP to CPAP?

Post by Pugsy » Wed Sep 17, 2014 9:19 am

How's the belly this morning? Aerophagia make an appearance?

_________________
Machine: AirCurve™ 10 VAuto BiLevel Machine with HumidAir™ Heated Humidifier
Additional Comments: Mask Bleep Eclipse https://bleepsleep.com/the-eclipse/
I may have to RISE but I refuse to SHINE.

If you want to try the Eclipse mask and want a special promo code to get a little off the price...send me a private message.

User avatar
Sleepysuz
Posts: 165
Joined: Thu Jul 31, 2014 9:31 pm

Re: APAP to CPAP?

Post by Sleepysuz » Wed Sep 17, 2014 9:51 am

Happy belly.
Just wondering what to do with settings now and if bipap is still even a consideration

_________________
MachineMask
Additional Comments: CozyHose Boss with clip modified on APAP, Sleepyhead

User avatar
Pugsy
Posts: 63941
Joined: Thu May 14, 2009 9:31 am
Location: Missouri, USA

Re: APAP to CPAP?

Post by Pugsy » Wed Sep 17, 2014 10:25 am

BiPap would allow you to probably use more pressure (needed to zap that one big cluster) and avoid the belly pain should the higher pressure needed trigger the belly pain.

Looking at the pressure line during the cluster...the machine didn't respond like I would have thought it should have responded. It sure had ample time.
Pressure line is actually fairly stable and the wild variations are pretty much totally gone. Opening up the max wouldn't have helped because the machine didn't even try to hit 12.
I don't know if this is something you are going to see every night or if this was a one off fluke thing.
More minimum is needed in this situation since the pressure didn't really try to increase to fight the little buggers.

Your choice...leave the settings as they are for another night and see if it happens again or just go ahead and react with more preventative measures with a minimum that can hopefully prevent the cluster better.

Den's initial idea of 9 cm is looking real good.

FWIW...I still sometimes get an occasional ugly cluster like you see here. It just happens and there's no rhyme or reason to it.
Since it is rare and I sleep well and feel decent I just shrug my shoulders and blame it on the aliens and move on and don't worry about it. I don't panic if I see something ugly on a rare occasion but then I have 5 years of reports so I know that my good nights FAR outweigh any bad nights I might have.

Should you want to try 9 cm minimum...you can leave max at 12 if you wish because I don't think the machine is ever going to need to go there anyway and if it doesn't go there it sort of becomes a moot point...and with the 9 cm should aerophagia rear its ugly head...then bipap might be a good option. But if you don't have the aerophagia issues and you sleep well...there's no real reason to make the switch to bipap if we can get good results with the APAP.

But one thing is definitely for sure....15 cm cpap....that's like using the atomic bomb to kill a fly when a little fly swatter would work just fine. You aren't going to need anything near 15 cm....way over kill in your situation.
Yeah, it would kill everything and you would likely have the most boring reports in the whole world but your belly would absolutely hate you.

_________________
Machine: AirCurve™ 10 VAuto BiLevel Machine with HumidAir™ Heated Humidifier
Additional Comments: Mask Bleep Eclipse https://bleepsleep.com/the-eclipse/
I may have to RISE but I refuse to SHINE.

If you want to try the Eclipse mask and want a special promo code to get a little off the price...send me a private message.

User avatar
Wulfman...
Posts: 6688
Joined: Mon Sep 01, 2014 6:41 pm
Location: Nearest fishing spot

Re: APAP to CPAP?

Post by Wulfman... » Wed Sep 17, 2014 12:03 pm

Pugsy wrote:Den's initial idea of 9 cm is looking real good.
I'm not going to say "I told you so." just yet, but........

Switching to CPAP or APAP (same pressure minimum and maximum) should get rid of those pressure probes. I'm not sure how much affect they have on the sleeping quality, but at some point I'd like to see what a night or two of that looks like.

I'm not sure how valid something I once heard about the (Respironics) Autos is, but it had to do with needing at least 3 cm. of pressure in order to respond to events. I'm not sure if that even applies to this scenario, but if it does, it might partially explain why it didn't respond as Pugsy anticipated. Another reason for the single pressure is that I wouldn't want it "bumping" on Flow Limitations or Snores or anything else. You have a "sensitive" situation with your stomach and don't need any more influences on the possibility of swallowing air.

I'm not a doctor or play one on TV, but have seen many of these situations on the forum. There are no hard and fast answers, but it helps to try to narrow down the possibilities of what could be contributing factors. The more "constants" you can have, the better. (in my opinion)

At this point, things look promising. Carry on.......


Den

.
(5) REMstar Autos w/C-Flex & (6) REMstar Pro 2 CPAPs w/C-Flex - Pressure Setting = 14 cm.
"Passover" Humidification - ResMed Ultra Mirage FF - Encore Pro w/Card Reader & MyEncore software - Chiroflow pillow
User since 05/14/05

User avatar
Sleepysuz
Posts: 165
Joined: Thu Jul 31, 2014 9:31 pm

Re: APAP to CPAP?

Post by Sleepysuz » Wed Sep 17, 2014 12:19 pm

So Den would you try starting with a constant 9 or 10 or 11 tonite? Actually the 8 felt good so not concerned about freaking out on too much now (which is why I tried the auto last nite)

Second question although it may not apply to me if I don't need one. I know how a bipap works as my mom had one. I am curious as to how it might help in a situation with lower pressures The doc seems to think they are for people who need over 15. Would the exhale relief bring the pressure down quickly so that you don't get the continuous blasting or something like that? Anyone care to educate me a little on that.

Not so Sleepysuz

_________________
MachineMask
Additional Comments: CozyHose Boss with clip modified on APAP, Sleepyhead

User avatar
Wulfman...
Posts: 6688
Joined: Mon Sep 01, 2014 6:41 pm
Location: Nearest fishing spot

Re: APAP to CPAP?

Post by Wulfman... » Wed Sep 17, 2014 12:39 pm

Sleepysuz wrote:So Den would you try starting with a constant 9 or 10 or 11 tonite? Actually the 8 felt good so not concerned about freaking out on too much now (which is why I tried the auto last nite)

Second question although it may not apply to me if I don't need one. I know how a bipap works as my mom had one. I am curious as to how it might help in a situation with lower pressures The doc seems to think they are for people who need over 15. Would the exhale relief bring the pressure down quickly so that you don't get the continuous blasting or something like that? Anyone care to educate me a little on that.

Not so Sleepysuz
I think at this point, I would not advise using 10 or higher. So, 8 or 9 would be my suggestions. Take your pick. At this point, we're trying to keep your tummy happy. If there are some clusters, you'll probably know the reason, but I wouldn't be concerned about them.......we're looking at the totality of the night.......the "big picture" if you will.

Do you take antacid medications?

The problem with this condition is that there are no concrete answers......"this works" or "that works"......what works for some may or may not work for others. It's a trial and error experiment. For some, no exhale relief (straight pressure) works and for some, more exhale relief works.....including bi-level therapy.

Your positive comments about last night are an indication that you may be on the right track and just need to try to fine tune things for the time being. But, we need some time to do some tweaking.

And, at this point, I wouldn't be taking too much of that doctor's advice. He/she works for YOU. YOU are in the driver's seat and need to point out to him/her what you're finding and what's actually working.
Maybe carry a portable "air tank" into their office and tell them to stick the hose in their mouth while you open up the air valve......and see if they can mentally relate.


Den

.
(5) REMstar Autos w/C-Flex & (6) REMstar Pro 2 CPAPs w/C-Flex - Pressure Setting = 14 cm.
"Passover" Humidification - ResMed Ultra Mirage FF - Encore Pro w/Card Reader & MyEncore software - Chiroflow pillow
User since 05/14/05

User avatar
Sleepysuz
Posts: 165
Joined: Thu Jul 31, 2014 9:31 pm

Re: APAP to CPAP?

Post by Sleepysuz » Wed Sep 17, 2014 12:52 pm

Will try that Den. Got a plan in place!

Yes I do take antacid for silent reflux but it is under control as far as my ENT is concerned. No longer have post nasal drip which was the symptom of acid inflamed sinuses.

Not overweight or other factors.
I was thinking of this being like a sink with a slow leak in the drain. You need to trickle the water in just fast enough to keep the level up but not overflow it with a fire hose. The 15 would have been the totally nuts. Can't believe I was even considering listening to them

_________________
MachineMask
Additional Comments: CozyHose Boss with clip modified on APAP, Sleepyhead

User avatar
Pugsy
Posts: 63941
Joined: Thu May 14, 2009 9:31 am
Location: Missouri, USA

Re: APAP to CPAP?

Post by Pugsy » Wed Sep 17, 2014 1:14 pm

Wulfman... wrote:I'm not sure how valid something I once heard about the (Respironics) Autos is, but it had to do with needing at least 3 cm. of pressure in order to respond to events. I'm not sure if that even applies to this scenario, but if it does, it might partially explain why it didn't respond as Pugsy anticipated.
I don't think it has anything to do with the pressure needing 3 cm change available. The machine responds to a set set of parameters...snores, flow limitations and/or OAs within a certain time frame and for some reason the machine didn't see any of those parameters. Maybe "frank" OAs are what was going on here. Odd that there would be a truck load of frank apneas but as you well know...nothing is impossible when it comes to this sleep apnea stuff. Spaced out just far enough not to trigger the machine into realizing something is going on. OAs have to be present so many within a certain time frame (and I forget the time frame) or haves snores or FLs to trigger the response. These OAs look close together at this scale but they likely have more time in between them than we think.
It should have pegged out the max of 12 but it didn't get close. I am scratching my head on this one.
Maybe my alien buddies decided to pay a visit.
Sleepysuz wrote:I know how a bipap works as my mom had one. I am curious as to how it might help in a situation with lower pressures The doc seems to think they are for people who need over 15. Would the exhale relief bring the pressure down quickly so that you don't get the continuous blasting or something like that?
Yes, with bipap the exhale relief is dramatic and how dramatic it is depends on the EPAP (exhale) and IPAP (inhale) pressure settings...the difference between the 2. In a situation like this if on BiPap we might use the 8 cm as the EPAP pressure and the IPAP pressure be at 12...so a difference of 4. It's hugely more comfortable than using straight 12 and with the lower EPAP your body isn't blasted with the continuous 12 cm so chances of aerophagia are lessened.

Let's speculate....supposed you figured out that you do need 12 to 14 cm pressure to keep those ugly clusters of OAs away but that 12 to 14 pressure brings on really bad aerophagia symptoms. Using the bipap at 8 EPAP and 12 IPAP (or 10/14) might also keep the ugly clusters away and NOT cause the belly problems. Figuring out where aerophagia gets triggered is just trial and error. There's no hard fast rule. RobySue gets really bad aerophagia when her IPAP stays at 8 very long.

If you want to try 9 cm cpap mode (or the equal to cpap in apap with min and max equal) then go for it.
In cpap mode Flow limitation flagging is turned off but you can mimic cpap mode by setting in apap mode for the minimum at 9 and maximum at 9. That way you get a fixed pressure but don't lose FL flags. Not that you are having enough of them to worry about but sometimes they point to minor airway obstructions that could be a warning sign that something is not quite optimal and we can't see them if in cpap mode.

I don't know how much fixed pressure you are going to need to break up one of those ugly clusters. It might be 10....it might be 15 or more.

Sometimes we have to make compromises....decide which is the worst evil...an ugly cluster on a rare occasion or aerophagia all the time.
If the ugly clusters bug a person too much and killing them means belly pain....then bipap would be the next step. You can use higher pressures with bipap and not make the belly so mad at you because you can get by with a significant drop on exhale which doesn't push so much air into the belly.

_________________
Machine: AirCurve™ 10 VAuto BiLevel Machine with HumidAir™ Heated Humidifier
Additional Comments: Mask Bleep Eclipse https://bleepsleep.com/the-eclipse/
I may have to RISE but I refuse to SHINE.

If you want to try the Eclipse mask and want a special promo code to get a little off the price...send me a private message.

User avatar
Wulfman...
Posts: 6688
Joined: Mon Sep 01, 2014 6:41 pm
Location: Nearest fishing spot

Re: APAP to CPAP?

Post by Wulfman... » Wed Sep 17, 2014 1:19 pm

Sleepysuz wrote:Will try that Den. Got a plan in place!

Yes I do take antacid for silent reflux but it is under control as far as my ENT is concerned. No longer have post nasal drip which was the symptom of acid inflamed sinuses.

Not overweight or other factors.
I was thinking of this being like a sink with a slow leak in the drain. You need to trickle the water in just fast enough to keep the level up but not overflow it with a fire hose. The 15 would have been the totally nuts. Can't believe I was even considering listening to them
This situation popped out in my mind when I first saw your initial reports. GERD (and the silent version) will drive an APAP nuts when run in a range of pressures. When I was new to the forum (early 2005) there was a user "loonlvr" who had a Respironics APAP and some of the ugliest reports you could possibly imagine. That saga made a lasting impression on me as to the effect GERD (and its related conditions) could have on the user.
Here is some of loonlvr's reports posted by Derek:

search.php?keywords=loonlvr&terms=all&a ... mit=Search

One of the reports is even at a fixed pressure of 12 cm.
Somewhere along the line, they figured out how to resolve the problem......switching to a PB420E machine (which is no longer made but had a special setting- "command on apnea"). I recently read some of those older posts and found the summary page here (which I posted not long ago in another thread).

viewtopic.php?f=1&t=5551&p=49920&hilit=GERD#p49920

It's an interesting read if one has the time. But, as I said, following that saga in my early years on the forum made a lasting impression on me.


Den

.
(5) REMstar Autos w/C-Flex & (6) REMstar Pro 2 CPAPs w/C-Flex - Pressure Setting = 14 cm.
"Passover" Humidification - ResMed Ultra Mirage FF - Encore Pro w/Card Reader & MyEncore software - Chiroflow pillow
User since 05/14/05

User avatar
Sleepysuz
Posts: 165
Joined: Thu Jul 31, 2014 9:31 pm

Re: APAP to CPAP?

Post by Sleepysuz » Thu Sep 18, 2014 5:16 pm

here's my update Did auto 9 min/ 9 max last night No problem with that comfort level. Belly ok too.
Was on my left side hugging a pillow almost all nightStill a big cluster about same time (REM?) but only a few strays later until 5:30 when I woke up and deliberately went supine onto my back to test the impact of position (note it made a big cluster)

Noticed more FLs than the night before when I did the 8-12 auto range . Not sure what that's about

Do you think I should change to 10-10 or do 9-10 or 9-12?


Image
Image

_________________
MachineMask
Additional Comments: CozyHose Boss with clip modified on APAP, Sleepyhead

User avatar
Wulfman...
Posts: 6688
Joined: Mon Sep 01, 2014 6:41 pm
Location: Nearest fishing spot

Re: APAP to CPAP?

Post by Wulfman... » Thu Sep 18, 2014 5:38 pm

I really think you should not make any more changes for a little while. I believe you need to give these settings some time to see if a pattern develops, or not.
You had a really good night up until that last little bit when "something" happened.


Den

.
(5) REMstar Autos w/C-Flex & (6) REMstar Pro 2 CPAPs w/C-Flex - Pressure Setting = 14 cm.
"Passover" Humidification - ResMed Ultra Mirage FF - Encore Pro w/Card Reader & MyEncore software - Chiroflow pillow
User since 05/14/05

User avatar
Pugsy
Posts: 63941
Joined: Thu May 14, 2009 9:31 am
Location: Missouri, USA

Re: APAP to CPAP?

Post by Pugsy » Thu Sep 18, 2014 6:24 pm

The flow limitations are something that the machine would respond to with a little more pressure if it could. It can't when you are using fixed pressures. So it isn't unexpected to see a few more FLs get flagged. Also wouldn't be unexpected to see a few OAs if they also needed more pressure.

Sometimes we make compromises. Pros and cons to both ways of doing things.

You need to pick something and stick with it for a few nights though....changing things nightly won't ever let you see any sort of pattern.

If this pattern continues then you need more pressure still yet. If you want to continue with fixed pressures...then maybe 9.5 or 10 might be something to try...if this pattern continues. Or if you wish to also try apap with a little range then maybe 9.5 to 12.

Whatever you wish to try you really need several nights with whatever choice you make unless the results are just horrible.

_________________
Machine: AirCurve™ 10 VAuto BiLevel Machine with HumidAir™ Heated Humidifier
Additional Comments: Mask Bleep Eclipse https://bleepsleep.com/the-eclipse/
I may have to RISE but I refuse to SHINE.

If you want to try the Eclipse mask and want a special promo code to get a little off the price...send me a private message.

User avatar
Sleepysuz
Posts: 165
Joined: Thu Jul 31, 2014 9:31 pm

Re: APAP to CPAP?

Post by Sleepysuz » Thu Sep 18, 2014 7:46 pm

Thank you both! Will see how the next few nights go at one setting. Sweet dreams
Suz

_________________
MachineMask
Additional Comments: CozyHose Boss with clip modified on APAP, Sleepyhead

User avatar
Wulfman...
Posts: 6688
Joined: Mon Sep 01, 2014 6:41 pm
Location: Nearest fishing spot

Re: APAP to CPAP?

Post by Wulfman... » Thu Sep 18, 2014 7:55 pm

......until 5:30 when I woke up and deliberately went supine onto my back to test the impact of position (note it made a big cluster)
I'm not sure how I missed this part of your post......had been gone all afternoon and was in a hurry reading, I guess.
But, that would explain the "something" happening.


Den

.
(5) REMstar Autos w/C-Flex & (6) REMstar Pro 2 CPAPs w/C-Flex - Pressure Setting = 14 cm.
"Passover" Humidification - ResMed Ultra Mirage FF - Encore Pro w/Card Reader & MyEncore software - Chiroflow pillow
User since 05/14/05

User avatar
palerider
Posts: 32300
Joined: Wed Dec 16, 2009 5:43 pm
Location: Dallas(ish).

Re: APAP to CPAP?

Post by palerider » Thu Sep 18, 2014 8:07 pm

Wulfman... wrote:I'm not sure how I missed this part of your post......had been gone all afternoon and was in a hurry reading, I guess.
But, that would explain the "something" happening.
*bonk*

_________________
Mask: Bleep DreamPort CPAP Mask Solution
Additional Comments: S9 VPAP Auto
Get OSCAR

Accounts to put on the foe list: dataq1, clownbell, gearchange, lynninnj, mper!?, DreamDiver, Geer1, almostadoctor, sleepgeek, ajack, stom, mogy, D.H., They often post misleading, timewasting stuff.