Tweaking pressure to fight OSA when sleeping supine

[Oldern]

Bear with me. I posted this in another thread and was afraid it would get lost so I created this new thread with the right graph.
Background: CSA and OSA with OSA worse if sleeping on my back. Agreed to sleep on my side if that was what it took.

Update after visiting with my sleep doctor about the excessive daytime sleepiness and needing relief from discomfort in shoulders which I believe is aggravated by side sleeping. Based on the large number of apneas shown in this graph which I think are attributable to sleeping supine, I asked him about raising the pressure in small increments over time to try to control the OSA's. He agreed and wrote a script for the DME as follows: VPAP Adapt SV. EPAP min 5, EPAP max 15, PS min 5, PS max 10.

My settings from the final sleep study were: EEP 5, IPAP min 5, IPAP max 10, with a statement that in the non-supine position, no central sleep apnea was seen and no OBA's were seen at these pressures. In the supine position, a few events were noted.

Shouldn't the script simply read: Change IPAP maximum to 15 with no changes resulting in EEP? I can change the settings (in small increments) but I do want to inform my RT with the DME about the change.

I don't think my machine type (VPAP Adapt SV enhanced) is showing up. I have it in my profile. How can I correct this.

Any comments will be appreciated.

Many thanks.
Oldern

[NateS]

I have the same machine you do, due to a diagnosis of mixed/central apneas, unless the word "Enhanced" indicates a yet newer model.

My settings are shown below in my sig line.

I sleep 95-99% of the night on my back.

Here are my results from a typical night last night:



(I was adjusting my mask around 4am.)

Are you sure your machine is flipped to VPAP and not CPAP? The last time I got an awful Events reading like yours above was when I had accidentally flipped the machine to CPAP.

Regards, Nate

[Guest]

Nate:
My machine, a VPAP Adapt SV, is apparently also known as the S7, Enhanced, Model. I acquired it in 7/2010 (subsequently replaced in Dec 2010 or Jan 2011 because of a problem) and really had a time getting the enhanced version. If it weren't for this website, I wouldn't have known about it. Fwiw, the ResMed Rep serving the DME wasn't familiar with it.

I see you read and responded to the post, "Difference between the ResMed VPAP Adapt SV & S9 VPAP Adapt." And, according to that post, my Enhanced version, which cost about $6,500 in 2010, can now be purchased for about $300. That is a very informative post about the history of the models. I learned elsewhere that the S/N includes the manufacturing date. My current machine, received in Jan of 2011, I believe, was a replacement for the first one. The difference in the size and weight of the two models, the Enhanced and the S9 is remarkable.

The therapy mode set on my machine is "ASV" I believe it is titled and not CPAP the other option.

[Oldern]

I wasn't logged in when I posted the previous reply about my VPAP Adapt SV. Dang it. They oughta' take a rope and hang me.
OldErn

[avi123]

I don't know what could be Oldern's purpose of showing these graphs? Why look at the graphs from 22:00 till 22:40 when the machine apparently has not treated those 30 obstructive events? How the sleep position was determined, and how can I tell if the events were treated OK between 22:40 and 05:00 and what were the sleep positions then?

[NateS]

I don't know what could be Oldern's purpose of showing these graphs? Why look at the graphs from 22:00 till 22:40 when the machine apparently has not treated those 30 obstructive events? How the sleep position was determined, and how can I tell if the events were treated OK between 22:40 and 05:00 and what were the sleep positions then?

avi, I didn't notice that the operational period of the machine was switched between the top and bottom graphs. All I noticed was a terrible streak of apnea signposts! Thanks for pointing that out.

Oldern, can you replace the bottom graph with one for the whole night and also give us your Stats view? Also thanks for explaining you do not have an S9, although that probably wouldn't make any difference on the issue you are inquiring about.

Regards, Nate

PS - I assume you selected the bottom range to show back sleeping, but how would you know that was when you were on your back if you were asleep?

[Oldern]

avi123 and Nate
Thanks for responding.

Let me clarify if I can.
My notes:

"Background: CSA and OSA with OSA worse if sleeping on my back. Agreed to sleep on my side if that was what it took.

Update after visiting with my sleep doctor about the excessive daytime sleepiness and needing relief from discomfort in shoulders which I believe is aggravated by side sleeping. Based on the large number of apneas shown in this graph which I think are attributable to sleeping supine, . . . ."

avi123

I don't know what could be Oldern's purpose of showing these graphs? Why look at the graphs from 22:00 till 22:40 when the machine apparently has not treated those 30 obstructive events? How the sleep position was determined, and how can I tell if the events were treated OK between 22:40 and 05:00 and what were the sleep positions then?

I configured the graph the way I did to show that there were lots of apneas for that particular time period when I was consciously trying to sleep on my back. I have no way of knowing whether I was sleeping supine during the rest of the night. However, for 2 years I've been consciously trying to sleep on my sides and believe I pretty much was doing that. I did purposely go to sleep on my back.

There was another spell later on in the AM with a number of apneas but not nearly as many as during this early time period. It is likely that I was sleeping on my back-no certainty, of course. If there is any data in ResScan to indicate positions while sleeping, let me know.

I am very much interested in any of your comments, but particularly what you think about the prescription and how and what adjustments you would make in the pressure.

Many thanks.
Oldern

[NateS]

…I am very much interested in any of your comments, but particularly what you think about the prescription and how and what adjustments you would make in the pressure.

Many thanks.
Oldern

Oldern,

Most people would find 5 to be too low to be able to jump in and squelch apneas before they happen. I did. Here is the way I worked up, from bottom to top, to find my best EPAP/iPapLo. Notice that after going past 8 to 9, I backed down to 8 and have kept it there:





I am assuming that, like mine, your machine sets iPapLo by adding 3 to EPAP.

Regards, Nate

[Oldern]

Here is the same graph configured slightly differently.
Oldern

[NateS]

What were you doing in the first hour after turning on the machine - during all those Events? Asleep? Awake? If awake, position?

Regards, Nate

[avi123]

Oldern, there are pillows (that you rest your head on) that are shaped to prevent you to sleep on your back and vice versa.

Otherwise, if you wear an Actigraph it could record your body position throughout the night.

http://www.actigraphcorp.com/products/

In above graphs only the Pressure, Events, and Leak graphs are important to us. It's interesting that the VPAP Adapt SV does not show any Central Events. If it did show any Centrals left you could then enter complaint to Resmed that the machine did not do a good job.

In the following 2007 report I see that this machine suppose to stabilize and normalize the AHI:


http://www.sleepdt.com/adaptive-servo-v ... hen-brown/

[Oldern]

Oldern

I configured the graph the way I did to show that there were lots of apneas for that particular time period when I was consciously trying to sleep on my back. I have no way of knowing whether I was sleeping supine during the rest of the night. However, for 2 years I've been consciously trying to sleep on my sides and believe I pretty much was doing that. I did purposely go to sleep on my back.

Last sentence should have read, "I did purposely go to sleep on my back that night and I'm fairly certain I was sleeping supine during the first outbreak of apneas. My guess is that I was likely sleeping supine during the other two outbreaks, but I have no way of knowing. I had a couple of other nights or so when I didn't worry about sleeping one way or the other.
Nate:

I am assuming that, like mine, your machine sets iPapLo by adding 3 to EPAP.

I believe that is correct. The minimum IPAP in my graph is 10, which I presume is EPAP of 5, and Min PS of 5.

So you chose to raise the EPAP Min from 5 units to 8 which effectively reset IPAP three units higher. I was thinking of raising the Max Pressure Support to 15, slowly 1 unit at a time instead of the EPAP. Why or why not?

I like your idea of keeping up with all the changes and their effects.

Oldern

[BasementDwellingGeek]

For considerably less than the cost of the Actigraph a 3 axis accelerometer/ data logger can be had. Check out this thread http://www.basementdwellinggeek.org/CPA ... ition.html and the contained link http://www.gcdataconcepts.com/xlr8r-1.html.

[NateS]

Oldern, there are pillows (that you rest your head on) that are shaped to prevent you to sleep on your back and vice versa.

Otherwise, if you wear an Actigraph it could record your body position throughout the night.

http://www.actigraphcorp.com/products/

In above graphs only the Pressure, Events, and Leak graphs are important to us. It's interesting that the VPAP Adapt SV does not show any Central Events. If it did show any Centrals left you could then enter complaint to Resmed that the machine did not do a good job.

In the following 2007 report I see that this machine suppose to stabilize and normalize the AHI:


http://www.sleepdt.com/adaptive-servo-v ... hen-brown/

Can you/anyone point me to any study demonstrating a relationship between sleep position and central apnea? I understand logically the connection with obstructive apnea, but what's the basis for a causal connection vis-a-vis central apnea?

Regards, Nate

[NateS]

So you chose to raise the EPAP Min from 5 units to 8 which effectively reset IPAP three units higher. I was thinking of raising the Max Pressure Support to 15, slowly 1 unit at a time instead of the EPAP. Why or why not?

Oldern

It's a matter of readiness to squelch apneas. It's not so much a matter of how high it can go but how fast it can get there.

You'll notice that my IPAP goes up as high as it wants to, into the low twenties momentarily when needed, beyond my PSMax setting.

Regards, Nate