the rest of my sleep study test (cont)

[d.green]

[Slinky]

Ahhh, that's better!! The higher pressures were causing the Centrals as I read this. Others can correct me if I'm wrong. I'm just a patient, not a medical or sleep professional.

In auto mode I'd keep my top pressure no more than 10 cms. And mebbe go ahead and set your lower pressure at 5 or 6 cms. 7cms to 9 cms does look like a good range for you. And that is easily attainable w/the Elite set at 9 w/an EPR of 2 or even 3.

The main thing is to set that Vantage at a specific range and then STAY THERE ONE FULL WEEK!!!Then check your data. And keep a close eye on your leak rate.

[DreamStalker]

If they are all centrals ... doesn't he need to be using the Sandman or P&B auto?

[Slinky]

The centrals appear to be caused by the higher pressures used during the bi-level portion of the titration. At least to me they do. Perhaps someone more experienced would care to jump in here and comment.

[ozij]

If they are all centrals ... doesn't he need to be using the Sandman or P&B auto?

No, not really.

While it is very true he had far more apneas at higher pressures or bipap, Dan was having central apnea at lower pressures too, as can be seen on other page he posted. A Puritan Bennett or Sandman auto can identify central apnea well enought to avoid responding to all those it identifies - but that would not give Dan the therapy he needs.
Dan needs a machine that will either jog him into breathing, or breath for him with when he stops. There's no need to clear obstructions in his case, there's a big need to get air into his lungs - since he desaturates pretty badly even when when he only has hypopneas.

So, to answer your original question on another post "am I getting proper treatment for central apnea" my impression is that you're not, Dan.

O.

P.S. Dan, you can alway reply to your own thread, if you want to post further data, you don't have to start a new one each time.

[d.green]

If they are all centrals ... doesn't he need to be using the Sandman or P&B auto?

No, not really.

While it is very true he had far more apneas at higher pressures or bipap, Dan was having central apnea at lower pressures too, as can be seen on other page he posted. A Puritan Bennett or Sandman auto can identify central apnea well enought to avoid responding to all those it identifies - but that would not give Dan the therapy he needs.
Dan needs a machine that will either jog him into breathing, or breath for him with when he stops. There's no need to clear obstructions in his case, there's a big need to get air into his lungs - since he desaturates pretty badly even when when he only has hypopneas.

So, to answer your original question on another post "am I getting proper treatment for central apnea" my impression is that you're not, Dan.

O.

P.S. Dan, you can alway reply to your own thread, if you want to post further data, you don't have to start a new one each time.

Thank you I will remember that. I am going to see the doc today. I realize I am not getting the right treatment, but I have Kaiser and it's a HMO. Wish me good luck.

Dan

[Slinky]

Thanks, Ozij. You are MUCH more experienced than I am!!! I shouldn't ever discuss pressures except my own.

In re-checking the data posted: he spent
32.9 minutes at 5 cms, had 2 centrals, an AHI of 2 including RERAs
30.4 minutes at 7 cms, and had 2 centrals, an AHI of 2 including RERAs
94.3 minutes at 9 cms, had 4 centrals, an AHI of 7 and 12 for AHI + RERAs
40.9 minutes at 12 cms, had 12 centrals, an AHI of 13 and 17 AHI + RERAs

When they started him on bi-level it got worse:
41.3 minutes at IPAP 14, EPAP 10 cms, had 35 centrals - and AHI of 30 including RERAs
44.3 minutes at IPAP 15, EPAP 11, had 9 centrals, 13 AHI including RERAs
9.3 minutes at IPAP 16, EPAP 12, had 2 centrals, an AHI of 6 and 7 for AHI & RERAs

I didn't think Dan's desats were that bad (maybe 'cause I have COPD so figure anything above 90% is okay). He spent 255.2 minutes at 95% or greater, 3.3 minutes at less than 90% and his maximum desat was 86.0% as near as I can read. The figures are all so small on my monitor I have to really squint to read them. Time in bed was 346.2 minutes and 90.9 minutes of that time he was awake.

[ozij]

Yeah, I had to squint too, but there's how to get over it:
Hold the control (ctrl) button, and then use the scroll button on your mouse; if you don't have that, IE has a magnifying glass in the corner.

You're absolutely right about the general desats. I was thinking of the desat's during the events themselves - and I may have exagerated the importance of that: Mean desat associated with respiratory event was 89.6, minimum was 85. I thought the fact those hypopneas could bring him to less than 90% was significant - but I may be wrong about that.
Good luck, Dan.
O.

[Slinky]

Well, you still know better than I do!!! Thanks for the tip on enlarging that print! I'm not blind, I just can't see and that will help!

[Snoredog]

He is doing pretty good here:

viewtopic/t36714/Last-night-CPAP-numbers.html

Here are my numbers from my CPAP.
Press: 8.2
Leak: 0.18 l/s
AHI: 10.8
AI: 1.2
HI: 9.6

Can anyone tell me what they mean.

D.Green

He has to stay under 9.0 cm pressure, he needs to work on getting more REM sleep.

Yes, a Sandman Auto would be a much better machine for him, he could see the Central Apnea and most of all not have to worry
about the machine falsely responding to them. However, he would have to lower the default Maximum pressure for Command on Apnea from default 10 to 9.0. This would allow the Sandman to respond to frank apnea seen above 10 cm which may improve therapy over fixed CPAP he is using now. Sandman would also go after some of the Flow Limitations not even seen on his PSG.

While he has traits that suggest Complex Sleep Disordered Breathing AI is down to 1.2. I should be on a SV also but I get by just fine on a 420e. I haven't seen anything that indicates he has any Periodic Breathing. He is one of those people that when they get over 9.0 cm pressure their sleep falls apart.

If it was me, I would want the Sandman Auto, treat the obstructive, ignore the central and with its cardiac oscillation detection it is the best equipped to do that (it and the 420e).

[ozij]

Snoredog,

He has to stay under 9.0 cm pressure, he needs to work on getting more REM sleep.

However, he would have to lower the default Maximum pressure for Command on Apnea from default 10 to 9.0. This would allow the Sandman to respond to frank apnea seen above 10 cm which may improve therapy over fixed CPAP he is using now. Sandman would also go after some of the Flow Limitations not even seen on his PSG.

(added emphasis mine)

How in can anyone reach a pressure of 10 when they stay below 9?
The "Maximum pressure for apnea" means the machine will not respond to any apneas above that pressure. That is what that limitation is there for. That is what maximum means. It is there to make sure one can limit the pressure in response to any kind of apnea, because the PB maybe very wrong about distinguishing a central apnea from an obstructive. It only identifies those central apneas that have cardicar oscillations - but some people have central apnea with no cardiac oscillations, and the PB will treat them as obstructive. So we tell keep it from causing pressure induced apnea by giving it a "maximum pressure for apnea command". And then it will not respond to any apnea that occurs above that pressure. ANY.


You're ignoring the hypopneas, and the PSG data.
Dan is not feeling well.
There are no "Central apneas" that the Resmed is misidentifying and responding in this night's report.
He is at a pressure of 8.2 - and you have no idea whether he has or does not have REM sleep, nor can he "work on it".

The PSG showed he had 12 central apneas when the pressure was 10. And no obstructives.

If it were me, I would want a knowledeable sleep doc.

O.

[Snoredog]

proof is in the pudding, its in his AHI.

[ozij]

Snoredog,

He has to stay under 9.0 cm pressure, he needs to work on getting more REM sleep.

However, he would have to lower the default Maximum pressure for Command on Apnea from default 10 to 9.0. This would allow the Sandman to respond to frank apnea seen above 10 cm which may improve therapy over fixed CPAP he is using now. Sandman would also go after some of the Flow Limitations not even seen on his PSG.

(added emphasis mine)

How in can anyone reach a pressure of 10 when they stay below 9?

The following response is irrelvant:

proof is in the pudding, its in his AHI.

The "Maximum pressure for apnea" means the machine will not respond to any apneas above that pressure. That is what that limitation is there for. That is what maximum means. It is there to make sure one can limit the pressure in response to any kind of apnea, because the PB maybe very wrong about distinguishing a central apnea from an obstructive. It only identifies those central apneas that have cardicar oscillations - but some people have central apnea with no cardiac oscillations, and the PB will treat them as obstructive. So we tell keep it from causing pressure induced apnea by giving it a "maximum pressure for apnea command". And then it will not respond to any apnea that occurs above that pressure. ANY.

Snoredog responded

proof is in the pudding, its in his AHI.

You're ignoring the hypopneas, and the PSG data.

Snoredog responded

proof is in the pudding, its in his AHI.

Dan is not feeling well.
Snoredog responded

proof is in the pudding, its in his AHI.

There are no "Central apneas" that the Resmed is misidentifying and responding in this night's report.
He is at a pressure of 8.2 - and you have no idea whether he has or does not have REM sleep, nor can he "work on it".
Snoredog responded

proof is in the pudding, its in his AHI.

The PSG showed he had 12 central apneas when the pressure was 10. And no obstructives.
Snoredog responded

proof is in the pudding, its in his AHI.

O.

[d.green]

I am back from the doc, and I returned the CPAP. I did not get to speak with the doc, and for me to get a VPAP would cost me $1,700.00 out of pocket. My doc will not make the VPAP medically needed. Kaiser is not willing to here what I have to say. I was look for a new doc and get back on the hose asap.

Dan

[jules]

Dan,

Were you diagnosed using a home study in the first place? If so what monitors did they use if you can remember?

Were you only put in the lab for the cpap part of the test?

What was the diagnosis you were give if you know that?