Wakeful titration question???

GoofyUT · Post by **GoofyUT** » Sat May 27, 2006 8:05 am

So, I awoke this morning from a relatively good night's sleep, took my Swift off (which stops my ResMed S8 AutoSet Vantage APAP, and went to the bathroom. I then went back to bed, since it was still pretty early and Saturday and I figured I'd doze for a couple hours more. Put the Swift back on which started the S8 and I noticed the screen which said "AutoSet 6.0". I lay back and started watching a favorite movie which had come on, which I figured that I'd watch till I dozed off.

Awhile later (maybe 20 minutes), I realized that I wasn't going to fall back asleep, so I sat up, but before I took the Swift off to stop the S8, I again checked the screen. Loe and behold, it now said "AutoSet 11.0" Somehow, while I was lying there fully awake watching a movie and breathing normally (best as I can tell), the APAP decided that I was having events and titrated me from 6.0 cmH2O to 11.0 cmH2O. This is WHILE I WAS FULLY AWAKE!!!

What gives??????? Can anyone explain to me how this happens? Is this normal??

Chuck

RedThunder94 · Post by **RedThunder94** » Sat May 27, 2006 8:17 am

my auto did that in the dme respiratory therapist's office while he was aquainting me with my new machine, it went from a 6 to 7.5 in the space of about 2 to 3 minutes while i was just sitting there listening to the stuff he was telling me, he even said that it is indicative that i do definitely have a breathing problem if it started to increase the pressure like that while i was fully awake and sitting up, he was suprised.

brasshopper · Post by **brasshopper** » Sat May 27, 2006 9:54 am

I noticed this morning that (watching a movie, same thing) that the exhaust was really blaring. I realized that I was taking a deep breath and pausing for a few seconds, which I do sometimes, and the Respironics APAP had decided that the pauses were events. I'll look at the data later, but my guess is that it deciided II was having issues because of the pausing. Heck, maybe it was picking up the TV sound as snoring!

JamesCPAP · Post by **JamesCPAP** » Sat May 27, 2006 2:02 pm

I've noticed this too. When I got my S8 I was trying to simulate snoring whilst awake and I couldn't make it increase the pressure but I notice some nights when getting into bed that I'll start taking some long deep breaths, or change my inhalation/exhilation slightly so it's like I've just held my breath for a few seconds, and this does increase after about 5 breaths.

From what I recall from when I spoke to ResMed, it takes 5 abnormal breaths before it increases the pressure.

GoofyUT · Post by **GoofyUT** » Mon May 29, 2006 9:09 am

Happened again last night. I was laying in bed watching the Sopranos, fully awake, and checked the screen just before I turned out the light. The S8 had gone from 6.0 to 8.9 while I was lying there just breathing normally. BTW, I use a Swift which I like a lot and I have virtually NO leaks (<0.04 L/s).

Does this happen to anyone else???

Chuck

RedThunder94 · Post by **RedThunder94** » Mon May 29, 2006 6:18 pm

*raises hand* it never fails on my auto, it'll go from 7.5 to 9 sometimes 10 while i'm awake and breathing normal, i just got used to it.

Linda3032 · Post by **Linda3032** » Mon May 29, 2006 10:02 pm

I think it's normal for that to happen. Isn't the machine trying to keep our airways open? I sleep on my side most of the time, and my pressure is usually in the 7 range. But if I lie on my back (with my neck scrunched down - and forget about the double chins), my pressure bumps up. Yes, even when awake - because I have put more pressure on my windpipe.

Yet another reason to have an Auto.

kenrose · Post by **kenrose** » Tue May 30, 2006 3:54 am

I have a remstar auto and normally just pass out with very little presleep time. Had a lot of problems falling asleep last night and discovered my machine titrating up (it went from 11 to 14 in 10 min) while I was awake!
Normally I stay at 12 (checking at bathroom breaks and when I wake up)
If the auto goes too high will the volume of air just wake me or is there a health issue to be considered?

GoofyUT · Post by **GoofyUT** » Tue May 30, 2006 6:34 am

I don't know what the effect of these APAPs titrating themselves up while we're lying there awake is. I don't believe that in most cases, the pressures that we deal with in xPAP are enough that there may be an adverse health effect.

But, it makes me wonder about how well the algorithms actually perform if they detect what I consider to be normal wakeful breathing patterns as events that require treatment, and therefore, increase the pressure. Kinda makes you wonder if they can get wakefulness so wrong, what do they do with sleep?

Only good news here is that I had heard that this was primarily a ResMed problem, though from the responses of at least two of you, its a Respironics problem as well. Puritan-Bennett anyone??

Chuck

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rested gal · Post by **rested gal** » Tue May 30, 2006 8:19 am

Linda3032 wrote:I think it's normal for that to happen. Isn't the machine trying to keep our airways open? I sleep on my side most of the time, and my pressure is usually in the 7 range. But if I lie on my back (with my neck scrunched down - and forget about the double chins), my pressure bumps up. Yes, even when awake - because I have put more pressure on my windpipe.

Yet another reason to have an Auto.

I agree with Linda.

I don't know about other people, but for me, if I really pay attention, I can feel the back of my throat beginning to close if I deliberately let my throat relax as much as possible -- while wide awake and even while sitting up.

"Limited flow" situations are probably happening if I get very relaxed while watching TV or reading, even though I'm awake and not noticing it. Like Linda, I'm glad to have a machine that notices the subtle signs of impending airway collapse and takes preemptive action to keep the airway open.

All the more reason, imho, to put on the mask and turn on the machine (any xPAP machine) if you're going to read or watch TV and know from past experience that you are likely to drift off into a catnap or two. Ever find yourself having to re-read a page even though you're sure you didn't actually go to sleep?

apneaicinisrael · Post by **apneaicinisrael** » Tue May 30, 2006 10:32 am

I also notice that my throat starts to "close up" as soon as I am relaxed in that pre sleep haze. Even if I am sitting up. Funny that I never noticed it before CPAP, was simply not aware. So yes, definately a good idea to don the mask when even heading in the sleep direction...

When I first got my Comfort Lite 2, I had my glasses on "under it" because I wanted to be able to read the booklet. Then I rolled over to go to sleep, and was annoyed that it was so uncomfortable when I was on my side. Then I realized that I had forgotten to remove my glasses. OOPS.

Good night to all,
AII

Sleepless in St. Louis · Post by **Sleepless in St. Louis** » Tue May 30, 2006 4:54 pm

With all respect to those who are speculating why this is happening. It's really a moot point. It just does not matter what the machine thinks you are doing while you are awake. It is designed to react to changes in your breathing WHILE YOU ARE ASLEEP!! The machine can't really know if you are asleep or not. How could it? But breathing patterns while asleep are different than those while awake. The machine is looking for changes to your sleeping breathing patteren, which the engineers who designed the software that controls the blower studied to know when a problem is occurring. I would not worry about this. Personally, it is acting how I would expect. Not that the pressure is raising for no reason, but that the machine is reacing to changes to your wakeful breathing. One of these days, concentrate on your wakeful breathing. It is not usually slow and steady but varies by what you are thinking, doing, talking about, etc. That's my theory anyway.

GoofyUT · Post by **GoofyUT** » Wed May 31, 2006 6:57 am

Well, I'm n ot sure that this makes sense to me. You're saying that the machine is better aware of changes in my breathing pattern when I'm awake than I am, cause if you ask me, my breathing is completely normal during that time while I'm watching the news, and still it titrates up.

Anyhow, it did it again last night, but I slept VERY WELL, with my best numbers ever:
AHI 4.0, AI 0.1, HI 3.9, so...WHO CARES????!!!!!!!

Chuck

Sleepless in St. Louis · Post by **Sleepless in St. Louis** » Wed May 31, 2006 9:36 am

AHI 4.0, AI 0.1, HI 3.9, so...WHO CARES????!!!!!!!

Exactly. That was really the point I was trying to make. If the machine does its job throughout the night, why would you care what it does when you are awake? Except for the fun of debating why it happens, I cannot see a point to trying to figure it out. Time better spent would be concentrating on how to keep your numbers low night to night...even though I think the machine cares about your sleeping breathing pattern, not your awake pattern (steady as that may be).

Tim

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