Using APAP as diagnostic tool

General Discussion on any topic relating to CPAP and/or Sleep Apnea.
bouncer
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Using APAP as diagnostic tool

Post by bouncer » Fri Oct 13, 2017 1:33 pm

Do you think you could use an APAP machine (set to min. pressure 4 and max. 20) to determine whether or not someone might have OSA? If so, what pressure and AHI readings would suggest someone has OSA and needs further investigation and what readings would suggest someone is "normal" and does not have a problem.

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Goofproof
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Re: Using APAP as diagnostic tool

Post by Goofproof » Fri Oct 13, 2017 1:41 pm

bouncer wrote:Do you think you could use an APAP machine (set to min. pressure 4 and max. 20) to determine whether or not someone might have OSA? If so, what pressure and AHI readings would suggest someone has OSA and needs further investigation and what readings would suggest someone is "normal" and does not have a problem.
Yes you could, but it would be better to start with a narrower range, as the machine can't chase your needs fast enough, I'd start at 7cm to 12 cm, get the Sleepyhead softer to see your data. go from there. It's better to make changes based on 3 days data, we all have bad nights, keep mask and mouth leaks under control. Jim
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TASmart
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Re: Using APAP as diagnostic tool

Post by TASmart » Fri Oct 13, 2017 1:46 pm

If I were trying to determine the potential for sleep apnea I'd set it a low as it goes to see what kind of AHI occurs. The lowest pressure would still likely suppress some apnea/hypopnea, but it's the best you can do. Starting with a wide open pressure you would be seeing if SA were treatable.
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Pugsy
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Re: Using APAP as diagnostic tool

Post by Pugsy » Fri Oct 13, 2017 1:50 pm

I wouldn't set the apap at 7 just for screening purposes.
I would want to establish a need first and then if there is a need then worry about more pressure.
It wouldn't be impossible for someone to have sleep apnea and only need 6 cm pressure to hold the airway open and if we set it to 7 the machine wouldn't ever vary and no events would get flagged and the person might think they don't have sleep apnea because nothing happened.

I would use the minimum that the person would be comfortable with and set it for something like 10 max and then use the software to see what the machine did or didn't do and what it did or didn't flag.
There's still therapy value at 4 cm.
If the machine increases the pressure...it's fighting something it doesn't like that may or may not show up as a flagged event.
I did this screening with my brother in law....the machine went to 8 or 9 cm and pretty much stayed there all night...he's got OSA but the same screening on my sister...pressure never budged off the minimum. Now while it wouldn't be impossible for the minimum to have prevented any apneas...highly unlikely. As it turned out her fatigue issues were medication related...no real evidence of OSA.

I wouldn't necessarily use wide open because if it should want to go way high...that's going to likely cause sleep issues...I would work up to whatever pressure is needed.
So I would first establish the need and then worry about tweaking for optimal pressures.

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Re: Using APAP as diagnostic tool

Post by Guest » Fri Oct 13, 2017 1:51 pm

bouncer wrote:Do you think you could use an APAP machine (set to min. pressure 4 and max. 20) to determine whether or not someone might have OSA? If so, what pressure and AHI readings would suggest someone has OSA and needs further investigation and what readings would suggest someone is "normal" and does not have a problem.
Of course. Kaiser Healthcare has been using them for diagnostic purposes for years. Others are now doing in-home studies with diagnostic devices hooked up to the user in conjunction with APAPs to check the patients for sleep apnea.
Many on the forum have also used this method to circumvent the (expensive) healthcare system when they suspected they had sleep apnea.

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Goofproof
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Re: Using APAP as diagnostic tool

Post by Goofproof » Fri Oct 13, 2017 2:02 pm

Starting at 4 cm is air starvation for many users, the avg user is close to 10 cm, after you get data a few days, then adjust to a 4 cm range, 2 cm under and 2 cm over the most time spent at your best data reading, rinse and repeat. Final setting 2 cm under, 1 cm over, if it goes to the top limit, raise the limit.

Again 3 days works best for collecting data, and watch the leak rate, excessive make the data iffy. Jim

If you do start at 7 cm, and the data stays at 7 cm, lower the start point down. (Move the range!)
Use data to optimize your xPAP treatment!

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Goofproof
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Re: Using APAP as diagnostic tool

Post by Goofproof » Fri Oct 13, 2017 2:19 pm

xxxzx, that answer isn't what he asked...

Another thought on my answer on setting 4 cm to 20 cm, "Even a Blind Squirrel finds a Nut once and a while, But he usually doesn't get Fat enough to survive the Winter." Jim
Use data to optimize your xPAP treatment!

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bouncer
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Re: Using APAP as diagnostic tool

Post by bouncer » Fri Oct 13, 2017 2:21 pm

Sorry for my ignorance, but what is an IHT?

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ChicagoGranny
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Re: Using APAP as diagnostic tool

Post by ChicagoGranny » Fri Oct 13, 2017 2:23 pm

xxyzblind wrote: an oximeter to help tell if you have OA
Too many false negatives. The patient goes off to suffer untreated for years. Then it becomes a crisis, and he gets a sleep study.

xxyzsquirrelly wrote:other symptoms work to diagnose better than a cpap
sleepy , need naps , cant think as fast , obese, large neck, snore, ......
Again, too many false negatives.

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Goofproof
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Re: Using APAP as diagnostic tool

Post by Goofproof » Fri Oct 13, 2017 2:27 pm

bouncer wrote:Sorry for my ignorance, but what is an IHT?
It's what lazy people do when they can't spell or hold a thought long. He means a home sleep study, not good enough, also Pulse ox is a tool the gives a indication of a problem, or not, also not best for proof.

APAP, I'd trust with Sleepyhead to read the data. Jim
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ChicagoGranny
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Re: Using APAP as diagnostic tool

Post by ChicagoGranny » Fri Oct 13, 2017 2:35 pm


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Pugsy
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Re: Using APAP as diagnostic tool

Post by Pugsy » Fri Oct 13, 2017 2:36 pm

Yes, 4 cm might not be comfortable for some people and that's why I said
Pugsy wrote:I would use the minimum that the person would be comfortable with
Just because we might not be comfortable at 4 cm doesn't mean everyone feels the same way.
and besides there are some people that think 4 cm is hurricane force winds.

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Goofproof
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Re: Using APAP as diagnostic tool

Post by Goofproof » Fri Oct 13, 2017 2:39 pm

Pugsy wrote:Yes, 4 cm might not be comfortable for some people and that's why I said
Pugsy wrote:I would use the minimum that the person would be comfortable with
Just because we might not be comfortable at 4 cm doesn't mean everyone feels the same way.
and besides there are some people that think 4 cm is hurricane force winds.
They need a pill for that, must be careful when walking into the breeze. Jim
Use data to optimize your xPAP treatment!

"The art of medicine consists in amusing the patient while nature cures the disease." Voltaire

bouncer
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Re: Using APAP as diagnostic tool

Post by bouncer » Fri Oct 13, 2017 2:47 pm

OK thank you for all your replies - very helpful. So, if we tried CPAP 4 or 5 (continuous) as a starting point, would an AHI reading of 5 or less be classed as "normal" (assuming 4 or 5 gave no theraputic input) and no treatment necessary.

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Re: Using APAP as diagnostic tool

Post by Pugsy » Fri Oct 13, 2017 3:09 pm

bouncer wrote: So, if we tried CPAP 4 or 5 (continuous) as a starting point, would an AHI reading of 5 or less be classed as "normal" (assuming 4 or 5 gave no theraputic input) and no treatment necessary.
You can't rely on the AHI or lack of AHI as "normal" or not when using any pressure be cause any pressure even that 4 cm pressure has therapy value and could be keeping the airway open.

A person could have severe OSA with an AHI of 50 and have it be totally dealt with at a pressure of 5 cm and the report will show pretty much nothing. Do you see what I am getting at here?
You can't use the AHI from a therapeutic machine as a way to establish severity of OSA.
You don't know if 4 or 5 cm is therapeutic for this person or not.

Now if you use 5 cm and the AHI comes out being 10.0....you have a pretty definitive answer as to whether someone has OSA or not but you can't establish severity at all.
And if you use 5 cm and the AHI comes out 2.0...you don't know if not much happened or the 5 cm prevented a bunch of apneas.

So you might have a clear cut answer and you might not but it's worth trying.
I would use auto mode though...see if the machine does anything because it won't increase the pressure without a good reason and if you see pressure increases you will have an answer.

Now for severity of the OSA...can't really know for sure how bad with would be without cpap unless someone had a sleep study without cpap.

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