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General Discussion on any topic relating to CPAP and/or Sleep Apnea.
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Pugsy
 
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Re: Respironics Auto CPAP vs Respironics BiPap Manual

Postby Pugsy on Wed Jan 25, 2012 11:20 am

That 4 AM time with a few increased events??? It is very likely that they are related to REM stage sleep and it is common to have a few more events in REM sleep then at other times and we tend to have more REM sleep in the wee hours of the morning. I do it myself. Always worse during that time frame..
It isn't enough to worry over though. If it is a concern...changing the EPAP of 8 to 9 might help. No need to change IPAP. If this were my report....I would gladly accept it and not change anything if I was feeling well rested.

_________________
Machine: PR System One REMStar 60 Series BiPAP Auto with Bi-Flex
Mask: TAP PAP Nasal Pillow CPAP Mask with Improved Stability Mouthpiece
Humidifier: PR System One 60 Series Heated Tube Humidifier with Heated Tube
Additional Comments: S9 Adapt SV being tried now...not available as menu choice
SleepyHead download site
http://sleepfiles.com/SH/
Pugsy's Pointers Collection (has both software hints and data tutorial links)
http://www.cpaptalk.com/viewtopic/t8900 ... ction.html
Robysue's SH install
http://tinyurl.com/knaqaxh

heartchakra
 
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Re: Respironics Auto CPAP vs Respironics BiPap Manual

Postby heartchakra on Wed Jan 25, 2012 12:10 pm

Dear Pugsy,

These are the reports from the Auto cpap, not the bipap. So no EPAP IPAP in that I think ? The pressure settings are from 8-15 , should I make that 9-15 would you say or leave it ?


:)

Deepak

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Pugsy
 
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Re: Respironics Auto CPAP vs Respironics BiPap Manual

Postby Pugsy on Wed Jan 25, 2012 12:46 pm

heartchakra wrote:Auto cpap, not the bipap


Slap me up the side of the head..I was wondering why the variable pressure line and why the high IPAP because I thought we had decided for much less. :lol: :lol: Not enough morning coffee in me I guess.

I see no need to change anything in the current auto cpap setup. The minor bump to 9cm minimum might be a tiny bit helpful but there really isn't a whole lot of room for improvement shown on these reports.
They are so good right now that I don't think a minor change to 9 cm is going to make any difference at all.
While some people do obtain and AHI of 0.0 most of us do not. The generally acceptable standard is an AHI of less than 5. AHI will vary from night to night even for season cpap veterans. I might see AHI 0.5 one night and the very next night without any changes to anything I might see AHI 3.2. I just shrug my shoulders and move on.

So in other words...unless your dad says the pressure changes wake him up...I see no reason to change the settings. When in APAP mode the machine doesn't come anywhere near maxing out. If you think that the pressure changes may be waking him up (and not his prostrate) then yes...we might increase the minimum and lower the maximum and lessen the variations in pressure which are known to disturb some people.

But just based on the numbers on these reports...there is no need to change anything.
Numbers aren't everything though...so we also have to look at how he feels and how he is sleeping.

_________________
Machine: PR System One REMStar 60 Series BiPAP Auto with Bi-Flex
Mask: TAP PAP Nasal Pillow CPAP Mask with Improved Stability Mouthpiece
Humidifier: PR System One 60 Series Heated Tube Humidifier with Heated Tube
Additional Comments: S9 Adapt SV being tried now...not available as menu choice
SleepyHead download site
http://sleepfiles.com/SH/
Pugsy's Pointers Collection (has both software hints and data tutorial links)
http://www.cpaptalk.com/viewtopic/t8900 ... ction.html
Robysue's SH install
http://tinyurl.com/knaqaxh

heartchakra
 
Posts: 69
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Gender: None specified

Re: Respironics Auto CPAP vs Respironics BiPap Manual

Postby heartchakra on Wed Jan 25, 2012 8:48 pm

:) Pugsy , I have strong Lavazza coffee, perhaps I can send you some :)

Ok, so I have been putting him on the Auto Cpap. The Bipap machine also is there but I get a bit afriad as it is a manual one and I think what if he at some time in his sleep needs higher pressure and I have set it at a lower setting which does not do justice to what he might need. But based on the reports you saw what Bipap settings would you recommend ? Since I have the machines for trial, I would probably put him on the Bipap too and show you the charts.

Also, on the Cpap I will change the minimum to 9 and see if that makes any change.

About the ramp settings - is 5 pressure and 5 minute setting alright ?

He does have BPH ( benign enlarged prostrate ) and takes medicines for it .

Thanks :)

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Re: Respironics Auto CPAP vs Respironics BiPap Manual

Postby Pugsy on Wed Jan 25, 2012 8:58 pm

On the APAP...the pressure barely made it to 12 cm. I think 12 IPAP on the BiPap machine will be quite adequate but you could use 13 IPAP...to have a little extra measure of security.
EPAP.. 8 or 9 cm should be fine.

Ramp is really up to your dad and how comfortable he is with the pressure as it gently increases. 5 cm starting for 5 minutes should be fine. If he needed a minimum (or EPAP if using the BiPap) much higher than he is using now then we might make it a little longer but the difference between 5 and 8 or 9 starting point is rather mild and should be fairly easily adjusted to. Especially when using the BiPap machine.
We don't even have to use ramp if we don't want to. It is strictly a comfort feature.

_________________
Machine: PR System One REMStar 60 Series BiPAP Auto with Bi-Flex
Mask: TAP PAP Nasal Pillow CPAP Mask with Improved Stability Mouthpiece
Humidifier: PR System One 60 Series Heated Tube Humidifier with Heated Tube
Additional Comments: S9 Adapt SV being tried now...not available as menu choice
SleepyHead download site
http://sleepfiles.com/SH/
Pugsy's Pointers Collection (has both software hints and data tutorial links)
http://www.cpaptalk.com/viewtopic/t8900 ... ction.html
Robysue's SH install
http://tinyurl.com/knaqaxh

heartchakra
 
Posts: 69
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Re: Respironics Auto CPAP vs Respironics BiPap Manual

Postby heartchakra on Thu Jan 26, 2012 11:43 am

Dear pugsy,

Have tweaked the auto cpap setting today from 8-15 to 9-15 , just to see if the morning REM time AHI's decrease with a slightly increased minimum pressure.


Just wanted your advice that there is no problem making this slight increase, right ?


Love,
Deepak

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Pugsy
 
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Re: Respironics Auto CPAP vs Respironics BiPap Manual

Postby Pugsy on Thu Jan 26, 2012 11:56 am

heartchakra wrote:Just wanted your advice that there is no problem making this slight increase, right ?


No problem at all. I doubt it will have any serious impact on an already near perfect AHI number but it won't hurt anything to raise the minimum a little. The APAP will settle in with whatever pressure it thinks is needed anyway. There comes a point with these pressures that when we already have really good reports that we just don't see much change on the nightly details. At least not to the point that they are really noticeable because the AHI will change from night to night even with no changes at all in the settings. With the past reported AHI...you dad is at that point. There just is not much we can do to "better" an already excellent report. To strive for an AHI of 0.0 is an unrealistic goal. It may happen from time to time be it is not something we can expect to get every night even with the best of tweaking.

So that leaves the other variable...how do we feel...if the pressure variations in APAP mode are disruptive to a person's sleep then we don't want that to happen. So that might be a reason to change the pressure even when AHI is optimal.

I think you will find that there is a rather large "window" where your dad would do quite well with either the APAP or the BiPap. I did quite well on APAP with 10 min and 20 max...I get pretty much the exact same AHI reports when using the BiPap, in straight pressure mode like your BiPap Pro, with settings of 9 EPAP and 13 IPAP. So there is a rather large window that gives me the same results on paper..the reason I like the BiPap set the way it is ...is because it feels so much more comfortable while awake and I actually feel better during the day using the BiPap. Even if my BiPap data was less than perfect compared to the APAP data, I would still use the BiPap because it is how I feel that is most important and not a slight difference in AHI numbers.

_________________
Machine: PR System One REMStar 60 Series BiPAP Auto with Bi-Flex
Mask: TAP PAP Nasal Pillow CPAP Mask with Improved Stability Mouthpiece
Humidifier: PR System One 60 Series Heated Tube Humidifier with Heated Tube
Additional Comments: S9 Adapt SV being tried now...not available as menu choice
SleepyHead download site
http://sleepfiles.com/SH/
Pugsy's Pointers Collection (has both software hints and data tutorial links)
http://www.cpaptalk.com/viewtopic/t8900 ... ction.html
Robysue's SH install
http://tinyurl.com/knaqaxh

heartchakra
 
Posts: 69
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Gender: None specified

Re: Respironics Auto CPAP vs Respironics BiPap Manual

Postby heartchakra on Sat Feb 04, 2012 1:11 pm

Dear Pugsy,

Hello.

So I have been tweaking dad's auto cpap setting and he seems to be getting best readings at 8.5 - 15 setting. The pressure on the chart mostly ranges from 8.5 to below 13. He only gets up once in the night now to go to the bathroom. But, sometimes he complains in the day that he feels as if the air has gone inside his head and heaviness in the head at times.

I am planning to again put him on the manual Bipap and see how he feels in the day with that. Would you say IPAP 13 and EPAP 9 would be the settings to go with ?

Also, what do you think of an Auto Bipap ? Would that be the best machine to go with if one can afford it or would you say that is not needed and a manual Bipap would do just as fine ? I just get a bit nervous in the manual Bipap one , thinking what if at some point in the night he needs more than 13 pressure ?

Love,
Deepak

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Re: Respironics Auto CPAP vs Respironics BiPap Manual

Postby Pugsy on Sun Feb 05, 2012 12:25 am

heartchakra wrote:Would you say IPAP 13 and EPAP 9 would be the settings to go with ?


I think that would be a great place to start.

Let me tell you a little story about me and maybe it will put your mind at ease about using straight bilevel vs APAP.
I used APAP for 2 1/2 years. My settings were 10 minimum and 20 maximum. My long term overall average was just under 12 cm..my long term 90% pressure was around 13. There were times (usually couple times a week) that my APAP would go up to 16 to 18 cm and I couldn't blame it on leaks. When I started using the BiPap at straight bilevel pressures of EPAP 9 and IPAP 13....I was a bit concerned about those times that happen when I used to see 18 cm. I worried about possibly seeing some events increase because I didn't have a higher IPAP. You know what? I don't see them like I thought I would. I still have some ranges with my AHI anywhere from 0.5 to a little over 4.0. I had the same thing on the APAP. If my IPAP of 13 is letting some events sneak past the defenses...I sure don't see it on my reports. If they are happening, they certainly are not occurring in any great numbers.

Short of using 20 cm straight pressure all night we can't expect to completely eradicate all events and even then I am not so sure we can. Obviously no one wants to use 20 cm all the time. We want to use the lowest pressure that we can which will give us good consistent results AND still be comfortable and sleep well with. So sometimes we compromise just a little.

If your dad rarely goes above 13 cm now..there is no reason to think that the pressure would need to be above 13 on the BiPaP except for a very rare circumstance and sometimes those happen no matter what the pressure.

Obviously if you could find a BiPap Auto somewhere then you would have the best of both worlds.
I have a BiPap Auto. I did use it in Auto mode. My results were pretty much identical to what I see in straight Bilevel mode. Auto mode wasn't any huge "improvement" because straight bilevel did a great job anyway. I just like the way straight bilevel feels while I am awake and since there is no huge change with auto mode..I elected to use what is most comfortable while awake.

Give the BiPap a trial. See how your dad feels about it. He might like the APAP better, you never know.
It sounds like he will do pretty well with either. Let him try the other to see if it feels better in general. I think on paper...both machines will more than take care of the events. Just see if one machine "feels" better to him.

_________________
Machine: PR System One REMStar 60 Series BiPAP Auto with Bi-Flex
Mask: TAP PAP Nasal Pillow CPAP Mask with Improved Stability Mouthpiece
Humidifier: PR System One 60 Series Heated Tube Humidifier with Heated Tube
Additional Comments: S9 Adapt SV being tried now...not available as menu choice
SleepyHead download site
http://sleepfiles.com/SH/
Pugsy's Pointers Collection (has both software hints and data tutorial links)
http://www.cpaptalk.com/viewtopic/t8900 ... ction.html
Robysue's SH install
http://tinyurl.com/knaqaxh

heartchakra
 
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Pugsy

Postby heartchakra on Sun Feb 05, 2012 9:42 am

Dear Pugsy,

Thanks so much for all the love :)

I am sending you a link for the charts for the last 3 days . For 3rd feb I have also copied the EVENTS section from the chart.....are pressure pulse and resp effort related arousal levels important to look at at all ?

Also, if the chart shows AHI at 6 during a certain time period does it mean that dad had 6 apnea events at the time or thats not the way to look at that number ?

Does one generally assume that if the AHI numbers are good , the oxygen levels also are good ?

Link to charts -

http://www.flickr.com/photos/74904217@N03/

( Click 2 times on the chart for it to become big ) .


Regards,
Deepak

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Pugsy
 
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Re: Respironics Auto CPAP vs Respironics BiPap Manual

Postby Pugsy on Sun Feb 05, 2012 10:14 am

heartchakra wrote:Does one generally assume that if the AHI numbers are good , the oxygen levels also are good ?


Pretty much so if the AHI is low and there is no history of any other health problems which might impact Oxygen levels. Without the overnight pulse ox we can't tell for sure but generally if you look at the events individually and they are relatively short like 10 to 20 seconds and not having a whole bunch of them back to back, then the likelihood of having an O2 drop is minimal. In that event tab..you can click on the event category (like OA) then you will see each individual event and the time that it occurred. In parenthesis after the time...is a number that will closely correlate with the duration in seconds of the event. I say loosely correlate because PR S1 machines don't score event duration (ResMed machines do) but I have gone through hundreds of these individual events and zoomed in to actually count the seconds of reduced flow and the number in parenthesis is very close to what I count. So it is a very close approximation of event duration. Sometimes right on and sometimes might be off by a couple of seconds. Close enough that if I see a 45 in the parenthesis I know that the event very likely is a very long event. You can click on an individual event and the graph will change so that you can see that single event up close and see how long it last.

Pressure pulses are just the little puffs of air that the machine uses to help it determine what to call a potential event. It is just checking the status of the airway...open or closed.. this number you can simply disregard. It is not an indicator of level of effectiveness of the therapy.

RERAs...very small reductions in flow that might indicate a little arousal from sleep. Seen often if we have a restless night for some reason. Unless we consistently see large numbers..every hour...every night we don't worry much about them if the AHI is well within acceptable limits.

heartchakra wrote:Also, if the chart shows AHI at 6 during a certain time period does it mean that dad had 6 apnea events at the time or thats not the way to look at that number ?


This particular piece of data tends to scare people. Yes, it does mean that within time period (yes that particular hour timespan) 6 events occurred. Then we see the other "hours" not much is going on and we end up with a nice low AHI. This is common. Perhaps someone rolls over on their back and they have a few more events when on their back. Perhaps they needed just a little more minimum pressure to get to where the events could be better prevented. Perhaps a combination of these factors. Perhaps using the ramp allowed the pressure to be just a we bit too low and the events popped up. In general if I saw something like this very randomly...I would ignore. If I saw something like this happening often every night...then I might increase the minimum just a wee bit or not use the ramp.

Finally...we have to realize that sometimes these little "clusters" showing within a certain hour may just happen from time to time despite everything that we do. It is impossible to anticipate every oddball possibility.

_________________
Machine: PR System One REMStar 60 Series BiPAP Auto with Bi-Flex
Mask: TAP PAP Nasal Pillow CPAP Mask with Improved Stability Mouthpiece
Humidifier: PR System One 60 Series Heated Tube Humidifier with Heated Tube
Additional Comments: S9 Adapt SV being tried now...not available as menu choice
SleepyHead download site
http://sleepfiles.com/SH/
Pugsy's Pointers Collection (has both software hints and data tutorial links)
http://www.cpaptalk.com/viewtopic/t8900 ... ction.html
Robysue's SH install
http://tinyurl.com/knaqaxh

heartchakra
 
Posts: 69
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Re: Respironics Auto CPAP vs Respironics BiPap Manual

Postby heartchakra on Sun Feb 05, 2012 11:20 am

Dear Pugsy,

Thanks. :)


I am not too clear on the duration and back to back thing you mentioned . I am attaching two charts here ( titled event chart and event chart1) highlighting Hypopnea in one and OSA on the other. Could you please explain what the numbers in the brackets are telling and also what the corresponding graphs are ??

http://www.flickr.com/photos/74904217@N03/

Also, did you have a chance to go through the graphs I attached in the last link ?

According to you are all the parameters shown on the chart good ?


Love,
Deepak

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Re: Respironics Auto CPAP vs Respironics BiPap Manual

Postby Pugsy on Sun Feb 05, 2012 11:46 am

heartchakra wrote: I am attaching two charts here ( titled event chart and event chart1) highlighting Hypopnea in one and OSA on the other. Could you please explain what the numbers in the brackets are telling and also what the corresponding graphs are ??


You actually have the same image twice. I didn't see a single obstructive. The Hypnea which is a reduction in flow...the number in parentheses (49) is the approximate length in seconds that this event sustained. Hyponeas are hard to see the beginning and end because the reduction in flow is not so obvious. Give me a few minutes and I will find some examples of mine that show back to back stuff as well as clearly define reductions so they are easier to measure.

Yes I did look at the graphs. Not really much that is very remarkable. We see the breaks in therapy due to the bathroom breaks and we see the one time where there were 6 events during that one hour. When I looked at it I couldn't really tell if the lower pressure (using ramp) or the minimal or maybe both allowed those 6 events to sneak past the defenses. If this were my report and I saw repeated times where I saw the 6 per hour every night...I would either discontinue the ramp or increase the minimum just a tiny bit.
If this 6 per hour was a random thing...I would shrug my shoulders and move on.

Let me go find some examples that might help you understand back to back events and event duration. May take a bit to find one that covers all bases.

_________________
Machine: PR System One REMStar 60 Series BiPAP Auto with Bi-Flex
Mask: TAP PAP Nasal Pillow CPAP Mask with Improved Stability Mouthpiece
Humidifier: PR System One 60 Series Heated Tube Humidifier with Heated Tube
Additional Comments: S9 Adapt SV being tried now...not available as menu choice
SleepyHead download site
http://sleepfiles.com/SH/
Pugsy's Pointers Collection (has both software hints and data tutorial links)
http://www.cpaptalk.com/viewtopic/t8900 ... ction.html
Robysue's SH install
http://tinyurl.com/knaqaxh

User avatar
Pugsy
 
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Re: Respironics Auto CPAP vs Respironics BiPap Manual

Postby Pugsy on Sun Feb 05, 2012 12:16 pm

Okay...Here is an example of several events sort of back to back. It's the closest grouping I could find. This is unusual grouping for me. I don't see this often and I just shrug my shoulders and move on. I circled the grouping on the top graph that these events relate to. These start at roughly 9:25 AM (was out of town and went to bed at around 3 AM) and end at around 9:34 AM. So a 9 minute time span with 7 events. Not quite 1 per minute. None were hugely long. Ignore the U1 flag. It is something I am playing with in preferences. So in general I don't get excited unless I see a large cluster of events and those events happen to occur within a short time span.
Image

Now this one (different night) shows what 2 events look like when I just click on the single event #7 in the event tab.
Image

And same image if I zoom in on that same #7 event and I can actually count the markers for seconds. You can see that they roughly correlate to the number in parentheses by the timed event. It may not be perfect but it is close. It's enough to see that the events were not hugely long in duration.
Image

_________________
Machine: PR System One REMStar 60 Series BiPAP Auto with Bi-Flex
Mask: TAP PAP Nasal Pillow CPAP Mask with Improved Stability Mouthpiece
Humidifier: PR System One 60 Series Heated Tube Humidifier with Heated Tube
Additional Comments: S9 Adapt SV being tried now...not available as menu choice
SleepyHead download site
http://sleepfiles.com/SH/
Pugsy's Pointers Collection (has both software hints and data tutorial links)
http://www.cpaptalk.com/viewtopic/t8900 ... ction.html
Robysue's SH install
http://tinyurl.com/knaqaxh

heartchakra
 
Posts: 69
Joined: Tue Dec 20, 2011 1:54 pm
Gender: None specified

Pugsy

Postby heartchakra on Mon Feb 06, 2012 9:35 am

Dear Pugsy,

I am sorry - I thought I had attached the OSA chart too......I am attaching it in the link below , titled OSA EVENT CHART

A few questions

1) The OSA numbers in the brackets seem smaller than the hypopnea numbers in brackets. Is OSA the important one to see and not the hypopnea one ?

2) In the chart you showed and when you zoomed in on the OSA event, how do you count the number of seconds from the bars ? Where do u stop counting the bars ?

http://www.flickr.com/photos/74904217@N03/


Love,
deepak

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