What would be the CPAP strategy if you have REM phase apnea not measured by your CPAP?

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Hoeksel
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What would be the CPAP strategy if you have REM phase apnea not measured by your CPAP?

Post by Hoeksel » Thu Jan 27, 2022 12:24 am

Hi all,

My second post as a few things have now been cleared up, my first and rather long post is https://www.cpaptalk.com/viewtopic/t183 ... fects.html. This was about my CPAP therapy all of a sudden stoppen being effective after 4 months of small positive steps.

Details: 46 year old male, 93 kg's/187 cm (BMI ~26). Diagnosed with mild OSAS (AHI < 15) June 2021, after years of health issues and no clue why. Due to my severe issues I was granted a CPAP which I started a week later. I have been 100 % compliant from the start. Starting pressure was 5,4 without ramp/ERP on a ResMed 10 AutoSet with N20 mask which was reduced to 5.0 after 6 weeks as my AHI monthly average was 0.5. First 4 months I had small positive steps, then 2 months going down hill fast (had to call in sick for 2 months as I slept 2-3 hours on average), got a new machine as I did not trust it anymore and re-started therapy at 5.4. I felt better within a few days (now I sleep 5-7 hours and I feel less stressed), but my sleep remains broken and I never feel refreshed. This was reason for the hospital to do a second sleep test with CPAP.

So recently a second sleep test was done, this time with CPAP, to see what is going on. I am still waiting for the sleep report, but the main message I already have. Although my Resmed 10 AutoSet reports a jealous making monthly average of 0.1 AHI, in reality I have an AHI of 3 during deep sleep and an AHI of 10 during REM sleep. This is close to my AHI of 15 I started this therapy with. I was told they see this more often, that the CPAP gives nice numbers but in reality sleep apnea is not controlled. To be honest I was not surprised, as by now I know "what it feels like if I had events" and my smart watch already showed several desaturations during sleep with perfect AHI. So in a way I am happy, as I clearly should trust my body more, I have learned the hard way you should never focus on AHI alone and last but not least, there is still potential in CPAP therapy for me. Additionally, no RERA's (on my request they checked for UARS) and I woke up 8 times during my sleep session. This explains why I always feel broken after sleep.

Now towards the questions.

Based on the outcome where I have AHI 10 in REM phase, the hospital proposed to change the setting from CPAP 5.4 to APAP with range 5.4-7.0. My concern is, that I now know my CPAP does not properly detect my apnea's so it cannot respond correctly right? So I would have expected at least to increase the baseline pressure (also because with the new device I went from 5.0 to 5.4 and it made a huge difference for me). But they did not do this. As far as I know APAP responds quite well to flow limitations, which I indeed see. My 95 % average FL used to be around 0.08 +/- 0.02 and in APAP mode it goes to 0.01 +/- 0.01. But I have no idea if these FL's are relevant for my situation. Result of my first night in APAP mode is exactly the same as on CPAP mode at 5.4. I woke up as always around 04:00, dozed off again and woke up around 06:00 being fully awake like every day feeling broken and not recovered at all. In OSCAR I can see several moments with aroussals.

So if you have a CPAP where you know it does not detect your events properly, and you have high AHI during your REM phase (where all your muscles relax), what would be the normal strategy to improve your therapy? My guess was to slowly increase the baseline pressure, in CPAP or APAP mode, maybe APAP to reduce flow limitations.

Maybe good to add:
- I read here on the forum (I think Pugsy) somebody who wrote she could open her mouth while on CPAP with nose mask without air going through her mouth. I tried this and I have the same if I lie down awake. My throat will be completely blocked. No doctor has checked my throat/tongue yet.
- I bought the Welleu O2 ring (waiting for delivery) as my best bet to have some measurable/showable indications of events besides my own body. I so do not like knowing I cannot trust my CPAP ;-(.
Resmed 10 AutoSet in CPAP mode.
ResMed N20 mask with heated hose.

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Julie
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Re: What would be the CPAP strategy if you have REM phase apnea not measured by your CPAP?

Post by Julie » Thu Jan 27, 2022 6:32 am

Why oh why didn't you post this (and the previous one) in the threads of all your other posts? You're driving us crazy trying to see what happened in those older ones.

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Pugsy
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Re: What would be the CPAP strategy if you have REM phase apnea not measured by your CPAP?

Post by Pugsy » Thu Jan 27, 2022 6:48 am

So....how about posting the detailed report showing the change to apap mode?
Just the regular big picture...no need to zoom in on anything.

95% numbers of anything don't really mean much.

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Pugsy
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Re: What would be the CPAP strategy if you have REM phase apnea not measured by your CPAP?

Post by Pugsy » Thu Jan 27, 2022 6:51 am

BTW...I personally have REM worse OSA documented by an in lab sleep study. Like 5 times worse in REM than in non REM.

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Miss Emerita
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Re: What would be the CPAP strategy if you have REM phase apnea not measured by your CPAP?

Post by Miss Emerita » Thu Jan 27, 2022 12:41 pm

Your results don't support the conclusion that your machine fails to detect obstructive events. Your AHI for the night is calculated by dividing your total events by the number of hours you slept. So here is the kind of thing that can be going on:

You sleep for 8 hours. One hour is deep sleep, and one hour is REM sleep. Six hours are light sleep. You have 3 OAs during deep sleep, 10 OAs during REM sleep, and no OAs during light sleep. Your AHI for the night would be 13 divided by 8, or 1.6.

I give this example just to illustrate the way the AHI for the whole night can be a lot lower than the AHI during REM and/or deep sleep.

To be able to help you, we'd really need to see a daily chart from Oscar. Do you use this software already? if not, would you be willing to try?
Oscar software is available at https://www.sleepfiles.com/OSCAR/

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Julie
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Re: What would be the CPAP strategy if you have REM phase apnea not measured by your CPAP?

Post by Julie » Thu Jan 27, 2022 1:20 pm

I think he has it - posted before elsewhere - this is so not his 2nd post!

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Pugsy
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Re: What would be the CPAP strategy if you have REM phase apnea not measured by your CPAP?

Post by Pugsy » Thu Jan 27, 2022 1:38 pm

Julie wrote:
Thu Jan 27, 2022 1:20 pm
I think he has it - posted before elsewhere - this is so not his 2nd post!
He has only one other thread/topic and it is a bit long and wordy....and distracting...and he linked to that thread here.
It's not like he's done a gazillion different topics. He's a newbie and this is second topic/thread.

Lighten up...take a chill pill...it's not worth getting all in a dither about. :lol: :lol:

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Julie
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Re: What would be the CPAP strategy if you have REM phase apnea not measured by your CPAP?

Post by Julie » Thu Jan 27, 2022 2:10 pm

But I like dithering... not expected to have an actual answer! :lol:

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Re: What would be the CPAP strategy if you have REM phase apnea not measured by your CPAP?

Post by chunkyfrog » Thu Jan 27, 2022 6:44 pm

We who dither . . .
Salute you.

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Hoeksel
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Re: What would be the CPAP strategy if you have REM phase apnea not measured by your CPAP?

Post by Hoeksel » Wed Feb 02, 2022 3:27 pm

Thanks for the replies. Sorry for the late reply, for some reason notifications do not work for me. But I also concluded this forum is just not for me, I will stick to another forum that fits me better. Cheers!
Resmed 10 AutoSet in CPAP mode.
ResMed N20 mask with heated hose.

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zonker
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Re: What would be the CPAP strategy if you have REM phase apnea not measured by your CPAP?

Post by zonker » Wed Feb 02, 2022 6:40 pm

Hoeksel wrote:
Wed Feb 02, 2022 3:27 pm
Thanks for the replies. Sorry for the late reply, for some reason notifications do not work for me. But I also concluded this forum is just not for me, I will stick to another forum that fits me better. Cheers!
good luck at apneaboard where they'll tell you what you want to hear.
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people say i'm self absorbed.
but that's enough about them.
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