Self-Diagnosis of Complex Sleep Apnea? Help is appreciated.

[DreamDiver]

I couldn't help but do a little research on this ResMed Adapt SV. It seems like a remarkable little device and capable of certainly bringing the AHI down to 0 and increasing time spent in deep and REM sleep. It's hard to argue against it. I know insurance would not cover it given my situation, but I wonder if it might be worth going out-of-pocket to purchase this device? To me, there's nothing more important to me than being 100% energized and completely healthy, and I think it might be worth it.

I did too. One thing I found out is that for some, the adapt SV features can act as a form of sleep arousal for some people. The algorithm for determining pressure is considerably more complex and can lend to some steep changes in pressure quite quickly. I've heard it can take more getting used to than a standard apap or cpap. So that's another thing to consider too.

If you were to get a VPAP Adapt - which you likely will not need - until ResMed comes out with the S9 VPAP Adapt SV, you would probably be without a card reader. The VPAP Adapt, SV I believe, has a serial port on the back, so it would be possible to download data directly via serial connection on a daily basis if you want medium-resolution data. There is no flow data. There maight also be a card interface like the S8, from what I understand, but it's a modified smart card, and you'd have to jerry-rig an adapter card holder and buy a third-party card reader to actually use it. If I'm not mistaken the Adapt SV is an S7 model, from what I remember, but it's flow generator is nearly as advanced as the S9 Autoset's. It's a very old model, but it was way ahead of its time when it was first introduced.

I like that your doctor took what you said into consideration and came back with an appropriate answer and doesn't mind that you are titrating at home. These are good things. It looks like you're on the right path.

[FoodPouches]

I like that your doctor took what you said into consideration and came back with an appropriate answer and doesn't mind that you are titrating at home. These are good things. It looks like you're on the right path.

Last night I used the machine with increased base pressure, IPAP 10, EPAP 8 (previously it was IPAP 7, EPAP5). The numbers were better than my previous average. AHI = 2.9; CA = 1. H = 1.5; OA = .4.

However, I slept worse than I have in about a week or so. I was experiencing the swallowing air (aerophagia, I believe?), and this awakened me probably 10 to 15 times. Toward the end of the night, I also experienced the numbness in my fingers. So, it's almost like the pressure is too high and too low at the same time, haha.

I know it was my first night on a new pressure, so it will take some adjusting. But is there anything I can do about the aerophagia? (other than make sure your head is up instead of curled down, I have made sure to keep mine up) Or is this something you sometimes just have to get used or something that stops after awhile?

Thanks

[DreamDiver]

...I slept worse than I have in about a week or so. I was experiencing the swallowing air (aerophagia, I believe?), and this awakened me probably 10 to 15 times. Toward the end of the night, I also experienced the numbness in my fingers. So, it's almost like the pressure is too high and too low at the same time, haha.

For me, I've found that aerophagia wakes me at around 11.8cm. It's different for everyone. I also have more aerophagia if I'm lying in the falcon position on facing right more so than facing left. From what I understand, there's no getting used to aerophagia. It's physical limit.

About the numbness -- make sure your mask exhaust is not accidentally covered. It may be a CO2 thing. This is important! Also, if I were getting numbness I'd consider starting with smaller steps in changes to the pressure from my original prescription. I hope others smarter than I will weigh in here.

I created this image to explain what happens in my instance, thinking it might be educational for others too.


There is a sweet spot where I have found that I get my best AHI. With time and practice, my body's 'hardwiring' seems to get more and more used to the settings within the sweet spot, and my AHI seems to have continually, albeit increasingly-more-slowly, gotten lower, approaching zero.

I don't have a bipap, so I can't have as wide a gap for exhale pressure as you can. I can't tell you what to do because I'm not a doctor. However, I can tell you that if I had a bipap, I'd remember that the EPAP can stay relatively low (5 or 6) and that I could raise the IPAP a little from my prescribed settings to see if the additional exhale relief will help with my aerophagia. If I still found I was getting aerophagia at 9+ IPAP, I might consider dialing down my IPAP until I got no aerophagia, and then try raising the IPAP in minimal increments until I got to the point where I was just starting to experience aerophagia and then back off the smallest increment possible just enough to keep it from happening.

The image above is what happens for me, but some of it may be applicable for your case too. Everyone has a different sweet spot, but it's usually a case of shifting the curves right or left on the pressure axis. Not everyone experiences aerophagia or crackly lungs. AHI is important, but as you can see from aerophagia and numbness, AHI is not the only thing involved in getting a good night's sleep. Getting your numbers down may give you a sense of control, but don't let it fool you. It's important to remember - they are only numbers, and what's most important is how you feel. Don't make the mistake of assuming that slightly higher numbers for a particular night automatically means you didn't get good sleep that night. It's not just about AHI.

I hope the idealized example will be useful as you figure out the settings that work best for you.

[FoodPouches]

I hope the idealized example will be useful as you figure out the settings that work best for you.

Thank you so much, this information is very helpful.

Last night, I kicked my base pressure down one notch from EPAP 8 IPAP 10, to EPAP 7.5 IPAP 9.5. My numbers were similar to last night's, but I feel better, and I did not wake up as many times. The aerophagia was just about nonexistent and did not wake me up. The numbness from low oxygen at times or the CO2 (whatever it may be), was a little worse.

Taking your suggestions to heart, I believe that tonight I will try a straight BiPAP with IPAP on 10 and drop the EPAP to 5 or 6. I do not believe it it possible on my machine to set the Auto to have the base IPAP and EPAP more than 2 cms apart. The only other number settings I see on the setup, other than Min EPAP and Max IPAP is Max PS, and I am not sure what this is. Mine is set at 8.0

I am excited about having options to exercise in my therapy now. If one night doesn't go great, it's possible to make adjustments, and that is awesome.

Thanks again for your help!

[ozij]

PS stands for Pressure Support and is the difference between EPAP and IPAP.
On your machine, PS - that is the IPAP / EPAP difference can vary between a minimum of 2 and a maximum of 8.

[Mary Z]

I would give it at least a
week to get used to new setings before I change them. I would also wait and see what my doc said before making any changes. I will be impossible for him to evaluate the effectiveness of your therapy if you start making changes yourself right now. I'd go back to my original settings until I have a chance to be seen.

[DreamDiver]

I would give it at least a
week to get used to new setings before I change them. I would also wait and see what my doc said before making any changes. I will be impossible for him to evaluate the effectiveness of your therapy if you start making changes yourself right now. I'd go back to my original settings until I have a chance to be seen.

I have to agree with Mary Z on this one, FoodPouches. Bouncing around and trying lots of different stuff when your AHI is already fairly low is a waste of time -- especially with your body so new to the experience. I would stop at one set of settings for a while and see how I stabilize at those settings for no less than a week or so. The body has to get used to this. Changing stuff around every night may be a recipe for making things worse.

[rested gal]

The only other number settings I see on the setup, other than Min EPAP and Max IPAP is Max PS, and I am not sure what this is. Mine is set at 8.0

Since your machine is a Philips Respironics System One BiPAP Auto, the links below might be helpful in understanding what the "Max PS" (maximum pressure support) setting does.

My explanation, as I understand it, of the Maximum Pressure Support setting -- like two dogs on a leash.
Jul 14, 2007 subject: What is 'Max Press Sup'
viewtopic.php?t=22099

That setting is called "Max PS" in the Philips Respironics System One BiPAP Auto.
It's called "Max Press Sup" in the M series BiPAP Auto.
It's called "PS" in the older non-M series BiPAP Auto.
Same thing.

More about "max pressure support" in the Respironics BiPAP Auto --

Dec 08, 2006 subject: Question for BiPap users - UPDATED 12/14/2006
viewtopic.php?p=132154#p132154

___________________________________________________

The "pressure support" setting is handled differently by ResMed in their VPAP Auto machine.

Jeff's (jnk) great explanation about the difference in how the ResMed VPAP Auto (and "25") and the Respironics BiPAP Auto use the
"PS" (Pressure Support) setting:

topic: ResMed VPAP Auto 25 Clinician's manual
viewtopic.php?p=376749#p376749

Jeff (jnk) answering IFLEW's questions:
topic: ResMed Pressure Support
viewtopic.php?p=428022#p428022

[FoodPouches]

Okay, based on all of your suggestions, I will try to stick with consistent settings for at least a week. I am wondering if I should remain on the prescribed settings? (10 IPAP, 8 EPAP) or if I should use the settings I slightly adjusted and did a little better on? (IPAP 9.5, 7.5 EPAP) With the prescribed settings, I had aerophagia waking me up quit a number of times, and it actually gave me a worse night's sleep than I was getting right before the doctor prescribed the new settings.

My big question concerning this is: Can your body get used to aerophagia? Or can your pipes or esophagus (whatever it is) strengthen in response to the forced air? I'm getting conflicting opinions on this. I'm hoping that my body can get used to this because I feel like the prescribed settings are pretty appropriate and that the only real issue is the aerophagia.

If the answer is that, no, your body cannot get used to the aerophagia, then what is it about a particular setting that your body has to get used to? I ask this because many folks are saying that your body does take time to get used to a particular setting, and I am confused about exactly what in particular it is getting used to.

One more questions: Does anyone know if there is a way to set the Remstar System One Auto BiPAP so that the beginning IPAP and EPAP pressures can be more than 2 cm apart while in auto mode? I know how to do this in straight BiPAP mode, but I have searched the machine up and down and cannot find a way to do this on Auto BiPAP mode.

Thanks everyone. This is quite an amazing forum with some great and intelligent people!

[FoodPouches]

One more questions: Does anyone know if there is a way to set the Remstar System One Auto BiPAP so that the beginning IPAP and EPAP pressures can be more than 2 cm apart while in auto mode? I know how to do this in straight BiPAP mode, but I have searched the machine up and down and cannot find a way to do this on Auto BiPAP mode.

The reasoning behind this would be to maybe treat the aerophagia with more exhalation relief, as DreamDiver suggested. But I do not want to lose the auto in exchange for it. Just wondered if there was a way to do this.

[Mr Bill]

...Finally—and I know how ridiculous this may sound—is I "feel" like I have central sleep apnea. It was surprise to close friends and even sleep technicians that I had sleep apnea. I am 23 years old, 175 lbs, 6'2" tall, and have great diet and exercise. I have been healthy up until this point, which I realize may not mean much from a sleep apnea standpoint. But this, in conjunction with everything else makes me have a hunch that there might be something else going on. Things such as: I don’t feel like my breathing ceases during sleep due to obstruction, but rather due to “forgetting” to breathe. I notice that I sometimes “forget” to breathe often when I am awake as well and have to tell myself to resume breathing. That, in addition to no history of snoring when asleep, as well as the pattern of my overall breathing when in bed. This is something I as well as my ex-girlfriend had noticed...

I agree with dream diver and have also had a tendency to forget to breath at least since high school. I did self diagnose that mine were mostly central and was not believed till I got in the sleep lab. My guess is that missing just a few breaths while sleeping may not be actionable as far as insurance is concerned. An ASV unit is a lot more expensive. I am a newbi here, others with far more experience will hopefully weigh in.

I second the comment about ASV's possibly waking you up. Its true in my experience that mine will wake me up while trying to fix up my breathing. I see it in the data the next morning, support pressures going up for several minutes followed by me taking off my mask.

P.S. Put your equipment into your profile, it helps others see where you are coming from.

[rested gal]

Does anyone know if there is a way to set the Remstar System One Auto BiPAP so that the beginning IPAP and EPAP pressures can be more than 2 cm apart while in auto mode?

I don't think there's any way to make it start out more than 2 cms apart. I think that's how the Respironics BiPAP Auto is designed to always start when using autotitrating bilevel mode...starts with IPAP using 2 cm more pressure than what the minimum EPAP is set at.

[FoodPouches]

I agree with dream diver and have also had a tendency to forget to breath at least since high school. I did self diagnose that mine were mostly central and was not believed till I got in the sleep lab. My guess is that missing just a few breaths while sleeping may not be actionable as far as insurance is concerned. An ASV unit is a lot more expensive. I am a newbi here, others with far more experience will hopefully weigh in.

If you wouldn't mind, could you tell me if there were some signs, other than the forgetting to breathe, that made you think that you had central or complex sleep apnea? I wonder if it's similar to things I am experiencing?

I second the comment about ASV's possibly waking you up. Its true in my experience that mine will wake me up while trying to fix up my breathing. I see it in the data the next morning, support pressures going up for several minutes followed by me taking off my mask.

I realize the pressure support is potentially disrupting, but is this something that just takes some getting used to, as all CPAP devices take some time to get used to? Out-of-pocket price is really not a concern for me if I am to find out that I can do better on another machine, so I am just trying to get all the information I can about central apnea and the ASV.

I wonder, how are you doing with the ASV overall? I hope that it keeps improving you and that you are doing well

Thanks for any help

[Mr Bill]

Find my very first post and read it. I was getting nearly no sleep despite trying and as it got worse and worse I began to fear sleeping because as I got to the end of the day and the coffee wore off, I would start to fall asleep, and then I would wake suddenly gasping. I noticed that as I fell asleep, my body just wanted to totally relax, including not breathing. That increased my fear of falling asleep and I began to really pay attention to the feelings as I fell asleep and as I woke up. After a while I concluded that it was not that I was trying to breath but could not because of obstruction, but that I was simply not trying to breath. As soon as my attention was not on my breathing, I was frequently stopping and it seemed to get worse the more tired I got.

As to the other question, an ASV will rapidly ramp the support pressure if it senses you are not breathing. So its not just discomfort from pressure, its sudden rise in pressure. My first few nights on my machine, I was so tired, that I fell asleep despite my fears. The first and second night, there were several periods of 5-10 minutes where the software says I made no voluntary breaths and it took over. Once I had gotten a few nights of sleep, those pressure pulses started waking me; especially when they would punch in during that initial falling asleep phase. But as I have become better rested I also seem to be breathing better and it is not having to run up the pressure very often. By adding a low backup rate, the machine lets me breath slower while falling asleep without punching up the pressure. But once asleep, on this unit, I breath quickly and shallowly, with a minute rate of 8-9L/min and 17-18 bpm. I don't know if that is my actual normal breathing pattern or just what the ASV wants me to have. If I am breathing like that and even slow down a bit, it immediately begins punching in more air. So, I guess its figured out my tidal volume (a little over half a liter) and wants 8-9L/min put through. I've even learned to just start breathing that shallow quick way and slip into sleep.

I wonder if my tidal volume will change if I loose some weight? I will ask my DME at my meeting tomorrow. With a full breath I can fill a 4 liter cubitainer in one go.