POLL: COPD and exhale relief question

[Lizistired]

I'm wondering if those with COPD have more need for EPR or A/C FLEX. My dad has COPD and I am sure I will be diagnosed with it at some point due to years of smoking. Correct me if I am wrong but the loss of elasticity of the lungs makes it more difficult to expel CO2 from the lungs. So it would seem that exhale relief would be more valuable to this group. Comments? Opinions? Experience...?

[avi123]

{My previous post was that Mayo Clinic does not recommend CPAPs for treating COPD}

My new post:

Here is a thread about using BiPAPs for persons who have OSA and COPD:

http://forums.about.com/n/pfx/forum.asp ... pd&tid=184

[Lizistired]

I didn't say anything about xpap being a treatment for COPD. Many people have OSA and COPD.

[ameriken]

That's a good question. Just prior to my sleep apnea dx, I was dx'd with 'emphysematic changes'. I took a lung function test and they told me that it's above normal.

However, I still wake up sometimes with O2 headaches and I am not feeling well rested since starting CPAP.

I will be getting an oximeter next week to check my O2 at night. But I've wondered if my EPAP pressures could be hindering my exhalation and if I am retaining more CO2.

[LarryD]

I have COPD and Type 2 Diabetes. I started using a data capable flex machine in February.

To date, I have not been able to derive any benefit from EPR and I have tried several combinations. Right now, my EPR is off as well as the heater on my humidifier. Last night my AHI was 2.5

My Rx pressure is 8cm, but I get better AHI numbers with a pressure range of 5cm to13cm. My average AHI is 3.7.

I've been looking for information about OSA and COPD but there isn't much out there for APAP applications. If you find anything, please share.

[LarryD]

I forgot to put this link on my last response. It's Medico-babble, but is the only thing I could find that discusses the overlap of OSA and COPD. http://www.rcjournal.com/contents/10.10/10.10.1333.pdf

[ameriken]

I forgot to put this link on my last response. It's Medico-babble, but is the only thing I could find that discusses the overlap of OSA and COPD. http://www.rcjournal.com/contents/10.10/10.10.1333.pdf

Thanks, I'm going to read that and see if I can glean anything from it.

[ameriken]

Very interesting article Larry, if you can get past the terminology. Of interest was this (I noted the oxygen nadir in my own sleep study at 83%):

The most significant sleep abnormality associated with
COPD is nocturnal oxygen desaturation.38,39 Even without
any upper-airway contribution, various studies have reported
that 27–70% of patients with COPD with awake
oxygen saturation of 90–95% can experience substantial
desaturation at night, particularly during REM sleep
(Fig. 1).40-42 Nocturnal oxygen desaturation can be defined
or measured in terms of oxygen nadir or time below some
oxygen-saturation limit, such as 88% or 90%.

This:

It is also still worth emphasizing that, although there
may be no increased association between relatively mild
COPD and OSA, because of the rising prevalence of these
diseases, a patient with one of the disorders will often have
the other disease.

And about our mortality with the overlap syndrome:

Ominously for patients with the overlap syndrome , several pulmonary
parameters have been shown to increase mortality in patients
with OSA.

And finally:

Recent work by Mermigkis showed that, in addition to
increased morbidity and mortality, patients with the overlap
syndrome also have significantly worse quality of life (measured with the St George’s Respiratory Questionnaire),
when compared to COPD-only controls.71 Of note, the
overlap syndrome patients in their study were COPD patients
with habitual snoring but without reported excessive
daytime sleepiness or elevated Epworth sleepiness score,
which highlights the difficulties with clinical diagnosis
and screening.

I've wondered quite a bit about this relationship between the OSA and COPD since I was diagnosed with both in a time frame fairly close to each other. I've been feeling tired even with an AHI of 2 or 3. But everytime I ask a doctor about the relationship, I get an answer that the two are unrelated and have no effect on each other. If I can find out more about this overlap syndrome, I'll be posting it.

[deerslayer]

Today marks 4 years on PAP Therapy . the last 1/2 year have been using Bi Pap w/ exhale relief. consciously i can't tell the diference between auto c pap w/ a or c flex . However when reading data on the bi pap , it shows apnea s are next to nothing . Still use the res. model 510 for naps.

[Slinky]

I was started on CPAP in 2006 and at that time once I got thru the initial acclimation period I quit using both Ramp and EPR (C-Flex on the Respironics). As my COPD progressed it did become necessary to switch me to a bi=level PAP as my pressue need was adjusted upward. Initially my pressure was 7 cm, quickly adjusted to 8 cms. Now I am at IPAP 15, EPAP 10, PS 4. So my experience has been it depends on the severity and progression of your COPD.

I would say no matter how mild your COPD, it is a progresive disease (altho you can live w/it for MANY years) that you insist on a CPAP w/some form of expiration pressure relief from the get-go. Barring unforeseen circumstances you are going to living w/that first CPAP for the next 5 years - or longer.