PB Good Knight 420E and hypopneas

[ozij]

I've been looking at the details part of the Silverlining report. Due to runaway pressures, my machine is set with ifl1=0 (off). Nowehere, and I mean absolutely nowhere, in many hours of reporting, does the machine react with a pressure raise to hypopneas. With the cpap functioning I do not snore , and it is very obvious that the pressure changes only in reaction to apneas. - and this is true on both my trial machine, and my own one, and was also true of the one night in which ifl1 was activated.
Which brings up a number of questions:
Is the PB 420E not programmed to react in any way to hypopneas?
When the Silverlining sets a recommended pressure for X% of the time - does it take hypopneas into account, in addition to apneas - despite the fact that it does no change pressure in reaction to them?
Would it be right to say, that hypopneas are something midway between a snore and an apnea, and will disappear if the minimum pressure were higher?
I'm very curious if others using the pb420e have noticed that.
O.

[snork1]

I am not sure if this is pertinent or not.....

My sleep doc told me to totally IGNORE the hypopneas on my Remstar Auto readout. According to my doc, this is based on my oxygen levels staying relatively unchanged during hypopneas during my sleep studies and only plunging with apneas. Since the Remstar (or any machine) is not registering oxygen levels, it can be responding to an event that, in effect, does not matter.

I am still not sure I totally buy into this, but he is the doc.

Of course my BIG question is really, at the price we pay for these machines, how come they are not monitoring and responding to our blood oxygen levels. With all the junk on my face, I think I could handle a finger clip if it made a significant difference on them therapy.

_____________

[-SWS]

O, my take on the 420e is that it will not trigger on a free-standing hypopnea by design. Rather, it will trigger only on the "hypopnea + FL" sleep events. The other modern AutoPAPs are similar by design as well regarding hypopneas.

They seem to leverage hypopnea treatment via proactive techniques rather than reactive. When they do treat hypopneas on a reactive basis, the hypopnea triggering criteria seems to require either concomitant snore and/or flow limitation. My guess is that a hypopnea that is concomitant with one of these events tends to be obstructive versus central in nature.

In my own guestimation, it is theoretically possible for some hypopnea patients to be poorly treated by any given autoPAP's algorithm. A patient might manifest significant numbers of hypopneas that neither accompany snore/flow-limitation, nor might they be preceded by those same events (snore and/or flow limitations) as precursor signals. If that patient either desaturates because of those unaddressed hypopneas and/or experiences significant cortical arousals, then Snork's doctor's advice about ignoring hypopneas is absolutely rotten advice in my opinion.

[glassgal]

Thanks -SWS!

After Ozij posted the first time I went back and looked at my detail graph, and found almost no stand alone hypopneas. There were always other events happening at the same time as the hypopneas with a few exceptions. The machine did NOT respond when there was no other event recorded.

-SWS's post makes perfect sense. I know that I am getting good treatment as a recent overnight pulse oximetry recorded all night above 90%. My AHI is usually below 2. I have the IFL1 turned off due to runaway pressures.

I still record quite a few snores (indexed at 22.5 over 3months 11 days), but my sister reported on a recent trip that I no longer snore audibly (quite a change from before, when I carried earplugs for roomies!). I suspect that the snores that the machine is picking up is really bruxism -- I wear an acrylic night guard and suspect that clenching/grinding on that is what the machine picks up. I also use the NasalAire II, and there could be some turbulence in the small hoses? I have decided not to get too excited about the snores, as my treatment seems to be working.

Thanks for making that clear -SWS!

[chrisp]

Thanks SWS. Great answer as always.

OZIJ, Try increasing the lower pressure by .5 and see what happens. Continue increasing till improvement occurs. My hypopneas are severe also. Titrated pressure is 11. Hypopnias are 15-25 range until lower pressure was raised to 7.5. This reduced them to 5-10. A pressure of 9.5 reduces hypopneas to 3. I should raise it more but then why have an auto. Its only when allergies are active that a severe # of hypopneas occur. I also have FL1 switched off.

Cheers,

Chris

[gailzee]

Yes, I thought it was ME. I too, have the 420E. Have more hypop's than ap's. I am wondering the same thought as you?
I also was told that the hypop's were not as ''serious'' as the down and out ap's, but my question to THAT was, well if it's NOTHING, than why does the program built expressly for hte 420E, report them THEN? huh? Got no ans. for that, from DME (zip on her knowledge) or Dr. who wanted to ram me with an old straight CPAP.

I have raised my pressure as a thought, from 4-14 to 6-14. You will not believe this, but most nights I go between 8-10 combination, pops/ap's, also I've never been able to find out should we be counting the ap's with cardiac oscillation #, and the hypop w/flow limitation. My hypop w/fl is usually always a ZERO. My ap's w/cardiac, I get a low number of those.

My total number for ap's, ap's w/cardiac, pops, pops/w fl limitation was a grand total of 8. I think this is a good number.

If I could find someone in 'authority' who could verify this I'd be happy, but I think overall it's pretty low and I feel good about that, this was on 6 hrs of sleep.
It's also interesting that now that allergies are starting, hypop's are up. hmm?

What do you think?
txs
Gail

I've been looking at the details part of the Silverlining report. Due to runaway pressures, my machine is set with ifl1=0 (off). Nowehere, and I mean absolutely nowhere, in many hours of reporting, does the machine react with a pressure raise to hypopneas. With the cpap functioning I do not snore , and it is very obvious that the pressure changes only in reaction to apneas. - and this is true on both my trial machine, and my own one, and was also true of the one night in which ifl1 was activated.
Which brings up a number of questions:
Is the PB 420E not programmed to react in any way to hypopneas?
When the Silverlining sets a recommended pressure for X% of the time - does it take hypopneas into account, in addition to apneas - despite the fact that it does no change pressure in reaction to them?
Would it be right to say, that hypopneas are something midway between a snore and an apnea, and will disappear if the minimum pressure were higher?
I'm very curious if others using the pb420e have noticed that.
O.

[ozij]

Thanks for all your explanations and suggestions!
I'll keep you posted --

O.