These runaway aberations are killing me!

[Wulfman]

I concur with ozij's line of thinking, too. You have two machines and could see which one gives you better therapy. The REMstar Auto can be set with the minimum and maximum to the same pressure, too. That would show any Flow Limitations or Non-Responsive events in the reports.

Den

[Goofproof]

More reasons to try 10 CM, 10 cm is close to the avg pressure needed by sleep apnea patients, and you are use to that much pressure.

With your APAP you can set the low and high the same in apap, that lets you have FL in the reports. If you continue to have problems I'd try a good fitting FF mask, (If there is one) I don't think what you are using is doing you justice.

After 4 or more days at 10 Cm try 4 at 10.5 cm, until you find a sweet spot.

At 10 cm you may nave some events, but you have to start some where and most of them should be stopped. Jim

[plr66]

Thanks to OziJ, Den, and Jim for your considered opinions and knowledge. As obsessively as I have read everything on this board for the past 4 months, there still seems to be so very much I don't yet know how to figure out with this therapy, so every response is an education and helpful to me.

Well last night was a complete wash (Hmm....seems like my starting night with each major thing here has had that pattern! ). We had a pretty furocious wind blowing all night which kept me waking up at frequent intervals, fully expecting a tree to fall on my house by the constant clatter of large branches on the roof. What a night. Luckily, no damage that I yet know of.

Hadn't prepared myself with use of my new battery, but the power did flash on & off a few times for more awakenings. Just in case I thought I might catch a nap in between falling branches. Yow. I am curious about the fact that my Smart Card did not record the entire second half of the night (likely after one of those power outs), despite fact that I reformatted the card just 3 days ago. Any ideas about that?

I was using my Remstar last night, reset to 10 - 10 apap. Will set up the 420E tonight for the same.

Jim, I'm not sure I understand your continued feedback about my mask, as I have consistently had a leak rate for 4 months which is 98% of the time right at the mfg's recommended level of 31-33 or so at pressure of 10. Can you explain?

Regarding the suggestions to have my Remstar machine checked, the "DME" is cpap.com. Would I be contacting them for this, or Respironics directly?

[Wulfman]

Thanks to OziJ, Den, and Jim for your considered opinions and knowledge. As obsessively as I have read everything on this board for the past 4 months, there still seems to be so very much I don't yet know how to figure out with this therapy, so every response is an education and helpful to me.

Well last night was a complete wash (Hmm....seems like my starting night with each major thing here has had that pattern! ). We had a pretty furocious wind blowing all night which kept me waking up at frequent intervals, fully expecting a tree to fall on my house by the constant clatter of large branches on the roof. What a night. Luckily, no damage that I yet know of.

Hadn't prepared myself with use of my new battery, but the power did flash on & off a few times for more awakenings. Just in case I thought I might catch a nap in between falling branches. Yow. I am curious about the fact that my Smart Card did not record the entire second half of the night (likely after one of those power outs), despite fact that I reformatted the card just 3 days ago. Any ideas about that?

I was using my Remstar last night, reset to 10 - 10 apap. Will set up the 420E tonight for the same.

Jim, I'm not sure I understand your continued feedback about my mask, as I have consistently had a leak rate for 4 months which is 98% of the time right at the mfg's recommended level of 31-33 or so at pressure of 10. Can you explain?

Regarding the suggestions to have my Remstar machine checked, the "DME" is cpap.com. Would I be contacting them for this, or Respironics directly?

Sorry to hear about the weather and power situation......and data loss.

As far as having the machine checked, that would have to be done through CPAP.COM.......however, I'd wait for the time being to see what your "trials" show. I actually suspect that the machine IS doing what it "thinks" it's supposed to, but due to a number of factors and unknowns, it's a little hard to interpret from the reports. I suspect it may have started with a little leakage and then after the pressure started escalating and then your apneas became more frequent, and then it became a "runaway".

Den

[Goofproof]

Jim, I'm not sure I understand your continued feedback about my mask, as I have consistently had a leak rate for 4 months which is 98% of the time right at the mfg's recommended level of 31-33 or so at pressure of 10. Can you explain?

I suspect it may have started with a little leakage and then after the pressure started escalating and then your apneas became more frequent, and then it became a "runaway".

Den

As Den says: Also with all the trouble you have been having another mask, (FF), might be useful in sorting out your problems, by by-passing some of the things that could be taking place, leak wise. It 's good to have a FF Mask as a fall back option. Jim

[plr66]

Jim, I'm not sure I understand your continued feedback about my mask, as I have consistently had a leak rate for 4 months which is 98% of the time right at the mfg's recommended level of 31-33 or so at pressure of 10. Can you explain?

I suspect it may have started with a little leakage and then after the pressure started escalating and then your apneas became more frequent, and then it became a "runaway".

Den

As Den says: Also with all the trouble you have been having another mask, (FF), might be useful in sorting out your problems, by by-passing some of the things that could be taking place, leak wise. It 's good to have a FF Mask as a fall back option. Jim

Thank you to both Den and Jim. I think I get it now. I do have a FF back-up mask I've worn 3-4 times, but for now I think I'll try the constant pressure trial with my Swift LT, since with the FF mask I'd be introducing the error factor of having to get that leak rate optimized. Think I'll try that FF mask next week, if I can't get some clarity to what's happening. Thanks for the suggestion.

[rested gal]

I wonder if untreated or undertreated GERD might be a factor on those random nights when so many obstructive (presumably) apneas and pressure climbs are happening.

Case in point - loonlvr's saga:

Nov 05, 2005 subject: SUCCESS AT LAST-GERD,420E, PRILOSEC AND BENADRYL -SWS's thoughts on loonlvr's massive clusters of events and loonlvr's followup post.
viewtopic.php?t=5551

Apr 28, 2006 subject: Articles about Acid Reflux, Sinus and Nasal congestion. Links posted by RestInSeattle
viewtopic.php?p=95185

[plr66]

I wonder if untreated or undertreated GERD might be a factor on those random nights when so many obstructive (presumably) apneas and pressure climbs are happening.

Thanks for the idea, Laura. I am still at work and will check the links at home. But I have never had any acid reflux--and have had heartburn 3-4X at most in my lifetime. Hard to imagine that this could be the issue, since I had no symptoms of anything at all during these episodes... Don't know much about the mysteries which may be involved with GERD, however.

[plr66]

Thanks for the links, Laura. I found them interesting, and will need to read SWS's paragraphs again, but I do follow. So I gather that it is suggested that I try Prilosec despite no symptoms that I am aware of? Is Prilosec OTC? Any alternatives to that? I don't eat a meal at nights, have very little acid in my diet, sleep with head slightly elevated on a pillow, and never sleep on my hose--believe me! I'm not opposed to trying this. I just am still unclear that there are any real indications for GERD, since I don't know what is meant by "silent" GERD.

And a question about setting up my 420E tonight. Do I set every setting to APAP pressure of 10, including the "Max pressure for command on apnea"? I have never used Ramp, so is that at 10 as well?

[rested gal]

I just am still unclear that there are any real indications for GERD, since I don't know what is meant by "silent" GERD.

Silent GERD -- none of the obvious symptoms of acid reflux. No feeling of "heartburn." Person doesn't know he/she has it. An exam of the esophagus by a good ENT would be the way to find out.
http://www.medscape.com/viewarticle/516189
http://www.sciencedaily.com/releases/20 ... 080008.htm

http://www.medicalnewstoday.com/articles/32944.php
Excerpt:
"All patients with sleep apnea should be evaluated for gastroesophageal reflux," said J. Barry O'Connor, M.D., of Duke University Medical Center, one of the investigators.

Prilosec is OTC.

If I were going to try a straight pressure of, say 10, with an autopap...yes, I'd keep the machine in auto mode and put every pressure setting on " 10 ", including "Max command on apnea" with the 420E. If a person wants to use ramp, it would be ok to make an exception to " 10 " there. Ramp could be set to start at any pressure you like.

I think it's always a good idea to try some straight pressures if a person is having difficulty with autopap. As others have said (and I agree, absolutely)... just because a person has an autopap machine, it doesn't mean the machine ought to be used in auto mode.

What matters is how effective the treatment is. I'd use whatever treatment mode works best regardless of what type of machine I had. An autopap range suits me fine, but a single straight pressure does suit some better.

[plr66]

Thanks, Laura (RG). That explanation and the links helped a lot.
And I hope this thread was not so personalized to my experience that others could not benefit from the feedback as well. So many smart people here with such great knowledge!