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General Discussion on any topic relating to CPAP and/or Sleep Apnea.
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Jasba64
 
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Cpap with REM

Postby Jasba64 on Wed May 17, 2017 8:21 pm

I recently had a 2nd sleep study and was told I have a lot of REM sleep. That most likely explains my higher AHI's during the REM sleep. The sleep tech prefers I stay on a CPAP versus APAP but wouldn't it make more sense to need the extra pressure during the REM sleep and go with an APAP? Does anyone else experience this and what conclusions have you drawn? I see my doctor Friday and I will discuss this with him. My Sleepyhead data is: http://jasba64.imgur.com/

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LSAT
 
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Re: Cpap with REM

Postby LSAT on Wed May 17, 2017 8:35 pm

Jasba64 wrote:I recently had a 2nd sleep study and was told I have a lot of REM sleep. That most likely explains my higher AHI's during the REM sleep. The sleep tech prefers I stay on a CPAP versus APAP but wouldn't it make more sense to need the extra pressure during the REM sleep and go with an APAP? Does anyone else experience this and what conclusions have you drawn? I see my doctor Friday and I will discuss this with him. My Sleepyhead data is: http://jasba64.imgur.com/


Your most recent AHI is great...The APAP mode is doing what is should. Your machine will not continue as an APAP..it will revert to CPAP mode. I would think that a fixed pressure of 14 would be appropriate.

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Pugsy
 
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Re: Cpap with REM

Postby Pugsy on Wed May 17, 2017 8:59 pm

My OSA is worse in REM sleep (that's fairly common). Documented on the initial sleep study where the AHI was around 12 in Non REM sleep but around 53 per hour in REM.
Not only is my OSA worse in REM sometimes I need a lot more pressure to prevent those REM stage sleep events.
Sometimes as much as 16 to 18 cm pressure and in Non REM I might only need 8 to 10 cm pressure.

Obviously I prefer APAP and auto adjusting pressures because if I had only cpap and fixed pressures I would have to use 16 to 18 all night just to cover the sometimes maybe time when I might need higher.
I much prefer using around 10 for the bulk of the night and using the higher pressures only when needed.
REM normally makes up around 20 % of the night. I would much prefer using the higher pressures for 20% of the night instead of 100%.

Now not everyone needs more pressure when those REM events happen. Those people might not need the versatility of the apap auto adjusting mode.
Or maybe they only need 1 or 2 cm more and the difference isn't as remarkable as it is with my case.
I could probably do the fixed pressure thing but that would require cpap at probably at least 15 cm all night long and probably compromising a bit and letting a few OAs happen. Increases the chances of aerophagia issues...increases leak potential issues... and just in general isn't nearly as comfortable as lower pressures.

I like comfort...so I prefer apap in my situation.

Now if your OSA is worse in REM but you don't see any changes in pressure needs during REM...fixed cpap would probably work.
What to look for...clusters of OAs or hyponeas during probable REM stage sleep (which is fairly predictable once you learn the stages).
Clustering points to sub optimal therapy and the need for more pressure. If you aren't seeing any events happen then whatever cpap pressure you are using is probably doing a good job. No urgent need for more pressure if you aren't seeing any events during REM.

Unsure why the sleep tech is so "pro" cpap but there are people out there that still don't understand apap or like apap. Some docs are that way too.
I think a good bit of it might be from simply not understanding how apap works and how to set it up to work optimally with a proper minimum pressure. They think only of setting it wide open 4 to 20 and then unhappy because it can't do a good job....well duh...it can't go from 4 to 14 in a blink of an eye...it's no wonder it doesn't work well for those people.

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Sleepyv
 
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Re: Cpap with REM

Postby Sleepyv on Wed May 17, 2017 9:16 pm

Does Bipap pressure change during Rem? I was told that my Apnea is mostly in Rem and I am on Bipap.

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Pugsy
 
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Re: Cpap with REM

Postby Pugsy on Wed May 17, 2017 9:32 pm

Sleepyv wrote:Does Bipap pressure change during Rem? I was told that my Apnea is mostly in Rem and I am on Bipap


If your BiPap is set for a range of pressures then if your REM sleep requires more you should see the increase in pressure by using the software available to look at the pressure line.
The basics are the same no matter if a person is using single pressures or bilevel dual pressures...if it's in auto mode and more pressure is needed then the pressure goes up.
Is more pressure always needed? No, some people won't see much of a change in pressure needs. Not sure why some do and some don't but just probably another one of those cpap things that have that big YMMV sticker on it.

Sleeping position may play a factor too...but it doesn't always. I thought my pressure changes might be related to being on my back so I rigged up a wall to keep me on my side for sure with zero way of ending up on my back and I did that for about a month and I still saw the pressure changes regularly in probable REM stage.

Here's an example of a bilevel pressure graph showing a substantial increase in pressure needs. I don't remember all the specifics on this one but it's a nice clear example of what REM sleep pressures might do for some people.

Image

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Sleepyv
 
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Re: Cpap with REM

Postby Sleepyv on Fri May 19, 2017 8:37 am

Thanks Pugsy, I will check my sleepyhead and I do think the pressure changes.

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ajack
 
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Re: Cpap with REM

Postby ajack on Sun May 21, 2017 9:58 am

xxy, that statement is simply not true, do you make this stuff up as you go along?

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xxyzx doesn't know a lot and tends to misinterpret stuff, I would read elsewhere

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Okie bipap
 
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Re: Cpap with REM

Postby Okie bipap on Sun May 21, 2017 6:06 pm

Just because you have more events while in REM sleep, that does not always mean you need more pressure during your REM sleep. I have tried several settings with my machine, some variable and some fixed pressure, and I have found I have my best treatment at a steady 20 cm pressure with 3 cm pressure relief. Even with this pressure, I still find I have the occasional night where my AHI goes pretty high, but these nights are the ones where I do not really get into a good, deep sleep.

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SleepyBobR
 
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Re: Cpap with REM

Postby SleepyBobR on Mon May 22, 2017 6:24 am

Other than when a person cannot tolerate the changing pressure of an auto machine and is awakened by it, when would CPAP give better results than APAP, assuming the pressure range is correct? I'm not saying this is never the case but I can't imagine why it would be. I've tried it both ways and it's a pretty easy choice.

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palerider
 
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Re: Cpap with REM

Postby palerider on Mon May 22, 2017 11:07 am

SleepyBobR wrote:Other than when a person cannot tolerate the changing pressure of an auto machine and is awakened by it, when would CPAP give better results than APAP, assuming the pressure range is correct? I'm not saying this is never the case but I can't imagine why it would be. I've tried it both ways and it's a pretty easy choice.

it's easy to blame those "mad pressure changes" for arousals, but it's much more likely that something else is causing it, and the apap is just getting the blame.

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