Resmed VPAP Adapt SV - for Central Sleep Apnea

[Snoredog]

I just saw research that found that 50% of people with pacemakers had sleep apnea..

I would have expected that number to be higher. Main reason for getting a pace maker is abnormal heart rhythm (arrhythmia). While there can be many causes, an enlarged heart is the main cause. When you overwork your heart from untreated OSA, it causes one side of the heart to become larger, which then throws off the normal heart rhythm so it doesn't pump as efficiently as it should.

They are also finding some people with cataplexy may also benefit from the pace maker and even those with seizure disorders.

[Lubman]

My doctors at Beth Israel are now back from being away, and are considering the ASV issues in advance of my upcoming PSG with them.
I would be happy to relay any further questions, ideas, or suggestions that could make good use of the opportunity to clarify the ASV operation and indications as well as their CO2 regulation strategies.

Well I'm amazed that this string is still underway and am sorry to see SAG and Freqseeker going "at it" .. But let's put the disagreement part of the topic behind us in this thread.

=============

I do think too little information is out there on EERS.

What did I miss on the ASV operation and indications mentioned above?

I am using prescribed dead space tubing and ASV under BI care.
It seems to help. I'm still awaiting test results and will share them
if relevant. I think, for me, it makes the ASV viable treatment.

Since when did ResMed intend their Non Vented mask for patient home use?
The mask does not have clips like the vented version ... I must admit it
does fit better and leaks less, but what kind of life span does the velcro have?

What if any of the ResLink/ResScan data will shed some light upon to what degree the EERS deadspace is helping?

[StillAnotherGuest]

Well I'm amazed that this string is still underway and am sorry to see SAG and Freqseeker going "at it"

Yeah, well, we may be making some progress. We still have to negotiate something in re: the posting at TAS, I feel that attempting to manipulate CO2 levels by altering exhaust rates is still being condoned there:

(March 11, 2007) Mango, are you still better on the partially plugged vents?
The setup that is more properly used for CO2 conservation is a vent located at the other end of the hose tube and all the vents by the face are plugged. The vent is called the Whisper by Respironics that your supplier should be able to give you, if your doctor orders it. Your doctor can contact the Beth Israel doctors, they would be glad to give full info.

(March 12, 2007)I was doing alright with some holes blocked on C-Flex.

Its when I went on S8 Autoset Spirit with it set on auto I had some real problems.

Trying to get back some sleep with it turned on CPAP mode.

(March 12, 2007)Auto is worst of all for people sensitive to CO2 washout. It lets you lose it when you are breathing out with low pressure and it washes it out when it ramps up to address apneas and stays ramped up for its extended period.
I don't know if it gets the right info when some vents are plugged either, might be confusing the machine.

Stick with the cpap if you are blocking some vents, but do try to get the Whisper or the other Respironics separate vent component to put on the end of your mask hose. Then you could block all the vents in the mask.
I am not a doctor and give you this info only for your consideration with your doctor, who could check with Gilmartin and Thomas at Beth Israel (or read their paper).

(March 17, 2007)Frequenseeker, I have posted a graphic at the following URL of one nights output from my Resmed S8 Elite CPAP with pressure 9 and EPR 3, AI=0.7, AHI=2, on day 37. (large image will require scrolling, most likely)

http://www.bearport.org/Downloads/NightProfile.gif

I am wondering how to interpret the areas under the blue AHI curves. For example, for hours 7 to 8, is the blue AHI curve indicating that I am at a reduced respiration rate (lower flow) during this time or what? I am assuming that you cannot conclusively consider these areas to be true hypopneas without knowing the amount of O2 desaturation during the period in question. Could they simply be times that respiration rate is lower to balance CO2 level?

I am sleeping pretty well, now with optilife mask and mouth taping to prevent air blowing out my mouth. Am considering temporarily blocking one of the vent holes in my mask to reduce CO2 purging, since I feel I am overbreathing because of the pressure. If this causes a favorable change in my graph, maybe the CO2 purging is the culprit. Any Comments, anyone??

(March 18, 2007)bgalb,
Yes, got it, yes, this is what mine looked like also on my VPAP III before I found the CO2 info.
I had manuevered my AI to .5 and HI to 3-4 -- but as you point out, the hypopneas were lasting about a full hour "each". Seems like the machine just counted the beginnings. I was in deep trouble all night as my body tried to conserve CO2..

I had asked around for months about these hour long hypopneas. My local doctors, DME, no help. There were discussions about how autopap was not so good if your problem was more of hypopneas, etc. etc. You probably can find the old posts here.

Now we know. It is big problem stuff and should be attended to promptly.

I would say you are a candidate.

Keep us posted...Good luck!
frequenseeker

This seems to me to be a little different than

I believe I said it a number of times above, but I can understand if it is hard to find in all the posts:

I do not advocate anyone plugging vent holes in their masks.

But fine, let's negotiate.
SAG

[frequenseeker]

I am trying to help someone who already has gone ahead and done it by telling him that there is equipment that provides more properly for it (as in advice re Whisper vent). I am trying to keep him in the loop by asking how he is doing and telling him to get his doctor involved and do it right.

I think what you want is for me to post on TAS and make it clear that blocking vents is not recommended. Those who might benefit from addressing CO2 should deal with that through their doctors and the proper equipment - which is what I was implying for the person I described as a candidate for having this problem and benefiting from addressing it

I have no problem providing clarification, and will. Again, we are gasp in agreement.


Lubman:

What if any of the ResLink/ResScan data will shed some light upon to what degree the EERS deadspace is helping?

The FDA has not cleared the ASV yet for including AHI info in its data.. So I believe it is the tidal volume that is analyzed to see if cyclic breathing is occurring.

[dsm]

SAG & Frequenseeker,

Your negotiations & interactions are doing this discussion forum proud.

Just want to say thanks - inspiration to us all as to what can be achieved here when issues get dealt with with open minds and a will to resolve.

DSM

[StillAnotherGuest]

I think what you want is for me to post on TAS and make it clear that blocking vents is not recommended. Those who might benefit from addressing CO2 should deal with that through their doctors and the proper equipment - which is what I was implying for the person I described as a candidate for having this problem and benefiting from addressing it

Why do you feel that this person would be a candidate?

(March 17, 2007)6'-2"", 240 lb. Probably between overweight and obese.
Also 72 years, which is an OSA contributing factor.

Sleep Study - 90 events /hr on back and 60 on side , 75% O2 minimum
Headache every morning, Sleepy, High BP

Now on day 37 with AI = .6, AHI = 2.3
No headaches, not sleepy, BP is going down.

Feeling pretty good. Sleeping pretty good.

Whenever I hear "morning headaches", the first thing that comes to mind is hypercapnia, not hypocapnia. EERS has a better chance of being contraindicated here. Besides, this person is doing perfectly, what would you be fixing?

OK, to your credit, I see you have avoided replying to this one (I suppose it's academic if that was influenced by "Black Bart" or not)

(March 21, 2007)Hi,

I read your comments on previous thread re co2 levels with great interest.I am on Autopap Resmad Spirit S8 and get AHI of around 5 - despite this I feel lousy most of the time and the issue of co2 was flagged on a sleep study here in the UK.

I would really like to try out a non vented mask and a vent at bottom of hose - any ideas where to get one ?

but I think this demonstrates where Atomic Bart came from. Single poster, no history, auto doing who knows what, "Let's plug up the holes". Now you have uncontrolled proliferation of an untried, unpredictable modification that may not (and statistically, probably not) be appropriate to the underlying disease state anyway.

It might be interesting to see what the CO2 issue is. And identifying just exactly what it is they're trying to fix.
SAG

[StillAnotherGuest]

I had asked around for months about these hour long hypopneas. My local doctors, DME, no help. There were discussions about how autopap was not so good if your problem was more of hypopneas, etc. etc. You probably can find the old posts here.

Now we know. It is big problem stuff and should be attended to promptly.

By-the-by, we did figure out what the "hour-long hypopneas" in AutoScan are, didn't we?
SAG

[frequenseeker]

Yes on the AutoScan hypopneas - the graphica info is just on the number. However, we still don't know anything about the duration, and prolonged hypopnea periods might be possible. One more reason to have a full PSG to get accurate information.

Now you have uncontrolled proliferation of an untried, unpredictable modification

I disagree, I would say, now we have a growing awareness of this additional SDB dysfunction possibility, which is a good thing.

My response to the poster would be, take this information to your doctor and get evaluated to know if you have the need and if so, what setup to use for it. Tell your doctor that the setup exists (nonvented mask and remote vent) and the information is available for him to use in evaluating you.

[StillAnotherGuest]

bgalb posted a great gif link to explain the Night Profile Graphic over there at TAS:

The bgalb link

Gad, I looked all through the 5.7 help, where the heck is that graphic at?

Thanks to bgalb.
SAG

[dsm]

bgalb posted a great gif link to explain the Night Profile Graphic over there at TAS:

The bgalb link

Gad, I looked all through the 5.7 help, where the heck is that graphic at?

Thanks to bgalb.
SAG

Yes that is a very good graphic - but the inclusion of an apnea as a blue step had me a tad confused as I always interpreted the steps as hypopneas & the red line as an apnea & the height of the red line as apnea duration.

My question remains, is the apnea duration represented by both the height of the red line and the duration of a corresponding blue step.

Here is a sample chart from a spotty nights sleep & it is a bit hard to tell if the apnea is represented both vertically in red & hrozontally in blue.

http://www.internetage.com/cpapdata/menu_110107.html

DSM

[rested gal]

In the bgalb arrow-marked one hour section, it looks to me like there are at least 5 hypopneas. And maybe more, if each little stair step leading into the last two big plateaus of that hour are counted. I don't think the last two long blue plateau lines that are marked with the "apneas" are marked correctly. I think the long horizontal blue lines have nothing to do with apneas and are indicating two more hypopneas during the latter part of that hour.

But I could be very wrong about that. I never liked the way the autoscan graph displays hypopnea info.

Actually, I thought the notion that a horizontal blue line extending across an hour showed "an hour long hypopnea" had been laid to rest by James Ball's good post a long time ago...almost two years ago...in this thread on TAS:
http://www.talkaboutsleep.com/message-b ... hp?t=11178

The quotes below are from that thread in July 2005.

the graph showed each of the 2.5 hypopneas occurred in each of the last three hours of the night, and each lasted at least 45 minutes.

Frequenseeker,

It has been awhile since I have posted to this board. As you may recall, I have the Reslink and the associated software for the Resmed VPAP III. I have been monitoring my nightly data since Sept 9, 2004. One thing I noticed is that the software records events per hour and truncates the data at the beginning of each hour. So, if you have one or two HI's at the beginning of the hour, say 5:02 am, it will record 2 HI until 6:00 am. So, if you have 2 or 3 event at the beginning of the hour the rest of the hour will be a plateau until the next hour arrives and you start back at zero. I am thinking that this maybe what you are seeing in your data. The actual HI events probably last for a short time. In fact, as far as I can tell, the software does not tell you how long one is in an hypopnea state. The software will tell you how long you were in apneas by marking each event with a number (number of seconds in apnea) but it does not do this for HI. It simply puts a blue mark on the graph indicating an HI had occurred. You must have reduced respiration for at least 10 seconds to be marked as have an HI. If you were really having hyponeas for 45 min your HI would be very, very high. One time I had a cold and could not breathe through my nose and used a full face mask. It was better than nothing but not much better. There were stretches of time during the night where I had an AHI of 90+ - just like my sleep study. I was having a lot HI and AI and they were recorded as single events.

Bottom line, the software does not record time in HI. I do no think you were in hyponea for 45 min if the only indication you had was the software.

(bold emphasis mine)

Jim, whew thanks very much!!

Great to know that I am not being moribund for 45 minutes every time there is the dreaded long blue line on the graph

So, I don't understand why bgalb was told this, in March 2007:

Yes, got it, yes, this is what mine looked like also on my VPAP III before I found the CO2 info.
I had manuevered my AI to .5 and HI to 3-4 -- but as you point out, the hypopneas were lasting about a full hour "each". Seems like the machine just counted the beginnings. I was in deep trouble all night as my body tried to conserve CO2..

I had asked around for months about these hour long hypopneas. My local doctors, DME, no help.

(bold emphasis mine)

I think it's good to make people aware of CSBD --complex sleep breathing disorder. But I also think it's far more likely that when most people are not feeling well after being on cpap for awhile, the problem just might be underlying health issues that have nothing to do with sleep disordered breathing and are ongoing despite "cpap" doing its part of the job quite well.

[dsm]

In the bgalb arrow-marked one hour section, it looks to me like there are at least 5 hypopneas. And maybe more, if each little stair step leading into the last two big plateaus of that hour are counted. I don't think the last two long blue plateau lines that are marked with the "apneas" are marked correctly. I think the long horizontal blue lines have nothing to do with apneas and are indicating two more hypopneas during the latter part of that hour.

But I could be very wrong about that. I never liked the way the autoscan graph displays hypopnea info.

Actually, I thought the notion that a horizontal blue line extending across an hour showed "an hour long hypopnea" had been laid to rest by James Ball's good post a long time ago...almost two years ago...in this thread on TAS:
http://www.talkaboutsleep.com/message-b ... hp?t=11178

The quotes below are from that thread in July 2005.

the graph showed each of the 2.5 hypopneas occurred in each of the last three hours of the night, and each lasted at least 45 minutes.

Frequenseeker,

It has been awhile since I have posted to this board. As you may recall, I have the Reslink and the associated software for the Resmed VPAP III. I have been monitoring my nightly data since Sept 9, 2004. One thing I noticed is that the software records events per hour and truncates the data at the beginning of each hour. So, if you have one or two HI's at the beginning of the hour, say 5:02 am, it will record 2 HI until 6:00 am. So, if you have 2 or 3 event at the beginning of the hour the rest of the hour will be a plateau until the next hour arrives and you start back at zero. I am thinking that this maybe what you are seeing in your data. The actual HI events probably last for a short time. In fact, as far as I can tell, the software does not tell you how long one is in an hypopnea state. The software will tell you how long you were in apneas by marking each event with a number (number of seconds in apnea) but it does not do this for HI. It simply puts a blue mark on the graph indicating an HI had occurred. You must have reduced respiration for at least 10 seconds to be marked as have an HI. If you were really having hyponeas for 45 min your HI would be very, very high. One time I had a cold and could not breathe through my nose and used a full face mask. It was better than nothing but not much better. There were stretches of time during the night where I had an AHI of 90+ - just like my sleep study. I was having a lot HI and AI and they were recorded as single events.

Bottom line, the software does not record time in HI. I do no think you were in hyponea for 45 min if the only indication you had was the software.

(bold emphasis mine)

Jim, whew thanks very much!!

Great to know that I am not being moribund for 45 minutes every time there is the dreaded long blue line on the graph

RestedGal,

Good find & that works for me

Thanks

DSM

[JimW]

My understanding is that apneas are represented by the red lines, with their height corresponding to their duration. The blue stepped lines represent AHI, with one step for either apnea or hypopnea. For each hour, the blue line starts at zero; each time you have an event, the line goes up one step and stays at that level (horizontally) until the next event, when it goes up another step. The increases continue until the end of the hour, at which point the blue line (indicating hourly events) drops to zero again.

[rested gal]

The blue stepped lines represent AHI, with one step for either apnea or hypopnea.

Gosh, that seems even more confusing, if that's the way autoscan handles it.

If that's so, what then do you make of the horizontal blue plateaus to the right of the two vertical red apneas in bgalb's one hour example? If a blue step can mean either apnea or hypopnea, can anything be concluded for sure about those step ups to the last two blue plateaus? Are they associated with the two apneas, or are they hypopneas? Or can anything be concluded about them other than that "one or the other" happened at that point since they are so close to the vertical red apneas?

[dsm]

The blue stepped lines represent AHI, with one step for either apnea or hypopnea.

Gosh, that seems even more confusing, if that's the way autoscan handles it.

If that's so, what then do you make of the horizontal blue plateaus to the right of the two vertical red apneas in bgalb's one hour example? If a blue step can mean either apnea or hypopnea, can anything be concluded for sure about those step ups to the last two blue plateaus? Are they associated with the two apneas, or are they hypopneas? Or can anything be concluded about them other than that "one or the other" happened at that point since they are so close to the vertical red apneas?

http://www.internetage.com/cpapdata/menu_130107.html

The above chart sort of supports the step per event theory.

And yes, on reflection it is very confusing !.

DSM

#2

But this chart seems to show no blue step
http://www.internetage.com/cpapdata/menu_0826.html
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CPAPopedia Keywords Contained In This Post (Click For Definition): AHI, Hypopnea