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General Discussion on any topic relating to CPAP and/or Sleep Apnea.
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Haztek
 
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CPAP to APAP-PB/CSA increased-any ideas??

Postby Haztek on Sat Apr 14, 2012 6:49 am

I was on CPAP at a pressure of 11 from May 2001 until I received my new machine in mid-December 2011. Was retested in mid-November and pressure was raised to 14. Listed below is a comparison of the last 22 days on CPAP at a pressure of 14 and the past 22 days at APAP pressure of 12 - 15, C-Flex X1. In looking at the numbers, my AHI's are pretty close, CA .81 in CPAP, APAP is lower, HY about the same, OA is double, and my PB/CSA went from .98% in CPAP to 2.70% in APAP. Any suggestions about my pressure range also? (Also, lost 32 pounds since being retested in mid-November 2011)

3/1 to 3/22 Pressure: 14 CPAP C-Flex +X1 3/23 to 4/13 Pressure: 12-15 APAP C-Flex X1
From Sleepyhead: AHI 1.31 From Sleepyhead: AHI 1.39
CA .81 CA .63
HY .28 HY .31
OA .22 OA .46
PB/CSA .98% PB/CSA 2.70%

Thanks, Haztek

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Pugsy
 
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Re: CPAP to APAP-PB/CSA increased-any ideas??

Postby Pugsy on Sat Apr 14, 2012 7:18 am

Other than the PB numbers the differences are minimal.
Unsure what you are asking here. A different APAP range? Or stick with cpap at 14?
Did you notice feeling or sleeping better with cpap vs APAP?

PB is periodic breathing and Cheyenne Stokes Respiration is just a special periodic breathing. There are other breathing rhythms that will get flagged as PB but they don't meet the criteria for CSR. Have you looked at your PBs to see if they are mostly a general small waxing and waning of the flow or do they look like CSR. I have see PB when I used the PR S1 but only one out of 5 flagged events even remotely resembled CSR.
Were you concerned with the difference in PB?

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avi123
 
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Re: CPAP to APAP-PB/CSA increased-any ideas??

Postby avi123 on Sat Apr 14, 2012 7:27 am

Pugsy wrote:Other than the PB numbers the differences are minimal.
Unsure what you are asking here. A different APAP range? Or stick with cpap at 14?
Did you notice feeling or sleeping better with cpap vs APAP?

PB is periodic breathing and Cheyenne Stokes Respiration is just a special periodic breathing. There are other breathing rhythms that will get flagged as PB but they don't meet the criteria for CSR. Have you looked at your PBs to see if they are mostly a general small waxing and waning of the flow or do they look like CSR. I have see PB when I used the PR S1 but only one out of 5 flagged events even remotely resembled CSR.
Were you concerned with the difference in PB?


Question,

Could you show examples of how PB and Cheyne Stokes respirations would show up in SleepyHead?

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Haztek
 
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Re: CPAP to APAP-PB/CSA increased-any ideas??

Postby Haztek on Sat Apr 14, 2012 7:36 am

Thanks Pugsy:

1. Yes, I am wondering about my pressure range.
2. Yes, I am a little concerned about the difference in PB
3. I feel good- I go 5 miles/day on my treadmill and have energy.
4. I feel better with APAP-maybe because of less air going into my system. I met with a sleep doctor(1st time in 11 years on CPAP) and asked about APAP. He said he only uses it for patients that can't tolerate the pressure. I told him I had lost 30+ pounds since I was retested and he said he may have to lower my pressure-will probably want to retest me in Sept.
5. I am not sure how to look at PB's to see if they are a general small waxing and waning of the flow or CSR.
Thanks, Haztek

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Mask: Mirage Activa™ LT Nasal CPAP Mask with Headgear
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Re: CPAP to APAP-PB/CSA increased-any ideas??

Postby avi123 on Sat Apr 14, 2012 7:43 am

[quote="Haztek"]I was on CPAP at a pressure of 11 from May 2001 until I received my new machine in mid-December 2011. Was retested in mid-November and pressure was raised to 14. Listed below is a comparison of the last 22 days on CPAP at a pressure of 14 and the past 22 days at APAP pressure of 12 - 15, C-Flex X1.

Question,

If your test result came out at 14 cm on CPAP then why have they not tested you on a BIPAP too? The reason could be that you have not complained about the exhaling pressure being uncomfortable. A decent Technician would have asked you this. But since the AASM rules state that if a patient complain about it "only" then a BIPAP should be tried. This rule lets Techs escape this obligation. Still, a pressure close to 15 cm on CPAP indicates a preference for a BIPAP.

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Haztek
 
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Re: CPAP to APAP-PB/CSA increased-any ideas??

Postby Haztek on Sat Apr 14, 2012 7:48 am

No, the Tech did not ask me about BIPAP, nor the sleep doctor. I can tolerate the 14, but on APAP my weighted average for the 22 days was 12.17.

Thanks,
Haztek

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Re: CPAP to APAP-PB/CSA increased-any ideas??

Postby avi123 on Sat Apr 14, 2012 8:11 am

Haztek, I have examples of PB and CSR but in ResScan graphs:

Here are examples:


The following graphs (from a past poster) indicate a Cheyne Stokes respiration which is a type of Central Sleep Apnea Syndrome (CSAS):


Image

Notice above the crescendo-decrescendo of the respiration flow. This usually show up after a Central Apnea event.


The following graphs indicate Periodic Breathing which is another type of CSAS:


Image

In the following graphs I was checking if I had CSAS b/c I often get more CA than OA. But I don't see that I do. My respiration waves don't show it.

Image

See this source of information on it:

http://emedicine.medscape.com/article/304967-overview

Image

Cheyne Stokes: This polysomnogram represents Cheyne Stokes breathing. Cheyne Stokes breathing has a classic crescendo-decrescendo breathing pattern. [Notice that it occurs between central apneas events.]

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Machine: S9 AutoSet™ CPAP Machine
Mask: Mirage™ SoftGel Nasal CPAP Mask with Headgear
Humidifier: S9™ Series H5i™ Heated Humidifier with Climate Control
Additional Comments: CareFusion chinstraps (under the mask's straps), ResScan 5.1; S9 Elite as back up.
Last edited by avi123 on Sat Apr 14, 2012 9:29 am, edited 1 time in total.

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Haztek
 
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Re: CPAP to APAP-PB/CSA increased-any ideas??

Postby Haztek on Sat Apr 14, 2012 8:15 am

Thank you AVI123. later today I will look at my graphs in Sleepyhead and try to compare them to the ones posted.

Thanks,

Haztek

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Re: CPAP to APAP-PB/CSA increased-any ideas??

Postby Pugsy on Sat Apr 14, 2012 8:17 am

To check for PB using SleepyHead....zoom in on the green area that is the reported PB.
Click and drag mouse to change the flow graph to show PB zoomed in up close.
Or click on the individual PB event if shown on the event tab.

Here is an example of what CSR looks like...from the web..not my reports.
Image

Here is an example of my PR S1 flagging PB...but it is only a general waxing and waning of the flow and doesn't look anything like true CSR. This is what I see most of the time when PB has been flagged.
Image

And here is an example from my machine that probably stands a good chance of being real CSR. I don't see these often at all.
Image

So just remember....not all PB is true CSR and even an occasional true CSR doesn't mean we have to go into panic mode. When in doubt about what you see and is it a concern ask your doctor.

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Haztek
 
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Re: CPAP to APAP-PB/CSA increased-any ideas??

Postby Haztek on Sat Apr 14, 2012 8:28 am

Thank you Pugsy! That will help me very much to check things out. An interesting tibit: The DMR rep gave me my equipment, showed me how to use it, warned me NOT to try to LOOK at my data and have not heard from the rep since that day on 12/13/2011. When I made the appointment with the sleep doctor, which took 2 months to make, I asked if I should bring my SD card and was told they had no way to read it! I brought my printouts from Sleepyhead with me to the appointment. I had my yearly physical shortly after that and my PCP was very impressed with Sleepyhead print outs and told me that if he had sleep apnea he would want access to his data.

Thanks,
Haztek

_________________
Machine: PR System One REMstar Auto CPAP Machine with A-Flex
Mask: Mirage Activa™ LT Nasal CPAP Mask with Headgear
Humidifier: PR System One Heated Humidifier
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Pugsy
 
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Re: CPAP to APAP-PB/CSA increased-any ideas??

Postby Pugsy on Sat Apr 14, 2012 8:37 am

Haztek wrote:The DMR rep gave me my equipment, showed me how to use it, warned me NOT to try to LOOK at my data and have not heard from the rep since that day on 12/13/2011


Idiots. Sad but this is typical. Diabetics monitor their blood sugar and we are treated like ugly and stupid stepchild. Treat me like a moron and I get mad really fast and I get my revenge by taking my business elsewhere.

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Machine: PR System One REMStar 60 Series BiPAP Auto with Bi-Flex
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Pugsy
 
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Re: CPAP to APAP-PB/CSA increased-any ideas??

Postby Pugsy on Sat Apr 14, 2012 8:40 am

BTW... if you don't see many PBs that really look like CSR...and with your low Clear Airway index...I wouldn't worry about the PB at all and I would use APAP at current settings if I felt better using APAP.
The difference in reports are minimal. I would need to see a lot more PB than 2% and have it look like CSR and have a bunch of Centrals with it....before I started to worry.

I have also found that some of my "PB" times were likely scored when I was awake. Most often when I am waking up.

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Machine: PR System One REMStar 60 Series BiPAP Auto with Bi-Flex
Mask: AirFit™ P10 For Her Nasal Pillow CPAP Mask with Headgear
Humidifier: PR System One 60 Series Heated Tube Humidifier with Heated Tube
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Haztek
 
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Re: CPAP to APAP-PB/CSA increased-any ideas??

Postby Haztek on Tue Apr 17, 2012 10:00 am

Well, I changed my APAP to A-Flex 1 from C-Flex 1 for the past 3 nights. (No other changes) I had only 1 PB/CSR on one night, zero the other two nights. The one I had, I was lying there awake ready to get up for the morning!
Hazek

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Mask: Mirage Activa™ LT Nasal CPAP Mask with Headgear
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Re: CPAP to APAP-PB/CSA increased-any ideas??

Postby Pugsy on Tue Apr 17, 2012 10:10 am

Haztek wrote:Well, I changed my APAP to A-Flex 1 from C-Flex 1 for the past 3 nights. (No other changes) I had only 1 PB/CSR on one night, zero the other two nights. The one I had, I was lying there awake ready to get up for the morning!


Excellent. Sometimes the least little change works magic.
I also sometimes saw PB being flagged when I know I was awake. The machines are really good within the their limits. They just call them as they see them but sometimes they don't see the whole picture because they simply don't have that data available to look at.

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Machine: PR System One REMStar 60 Series BiPAP Auto with Bi-Flex
Mask: AirFit™ P10 For Her Nasal Pillow CPAP Mask with Headgear
Humidifier: PR System One 60 Series Heated Tube Humidifier with Heated Tube
Additional Comments: S9 Adapt SV being tried now...not available as menu choice


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