VS very high, but doctor is blowing it off

General Discussion on any topic relating to CPAP and/or Sleep Apnea.
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Complikatyed
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VS very high, but doctor is blowing it off

Post by Complikatyed » Wed Jun 30, 2010 12:03 am

Hey folks,

I need some help. I've been on CPAP since the end of April. I'm at 95% compliance and my AHI has dropped from 98 (during my sleep study) to around 5.6 on an average night. That's a big improvement, but I'm greedy and want even better sleep!

I bought the Encore Viewer 2 software and I've been tracking my data since early June. The big piece that concerns me is my VS reading. I have yet to have a single night where my vibratory snoring isn't above 200. Some nights it's over 300! I'm not waking up dry-mouthed, and I have trouble with the chinstrap headgear interfering with my mask headgear, so I haven't been using that, but I did try taping for several nights, with no noticeable difference in my results, either in terms of AHI or VS. I also created a hose rig and cover to keep it from rubbing on the wall, but that has made no difference either.

So, looking at the VS numbers, and greedily wanting even better sleep, I called my doctor to ask about bumping up my pressure a little to see if that would help lower the VS. He told me that the pressure was correctly titrated and that I should use the chinstrap and wait until August, when we would re-examine the data. He also said that "the VS doesn't really tell you anything anyway." When I asked about RERA, his response was "Nobody knows what that is, don't worry about it." I've been pretty pleased with the care I've received aside from this, and he did call me back very promptly, but this is so frustrating!

I'm feeling all YIKES! Can anybody talk me down from this ledge (or alternately, tell me how to hack my machine so I can jack the pressure up myself)?

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Goofproof
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Re: VS very high, but doctor is blowing it off

Post by Goofproof » Wed Jun 30, 2010 12:11 am

It looks to me like snoring would be hard to do, if you were taping correctly. Sometimes the machine picks up noise and scores it as snores, (Water in hose, hose rubbing the headboard), but sometimes it's just parts in our airways flapping in the breeze.

It can be caused by Mouthbreathing, too high a leak spec for the mask, that causes incorrect pressure, or the pressure could be incorrect in the first place. Jim
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Julie
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Re: VS very high, but doctor is blowing it off

Post by Julie » Wed Jun 30, 2010 3:37 am

Have you seen an ear, nose & throat MD to look for 'mechanical' causes such as enlarged turbinates? All the Cpap in the world can't help something like that, though minor surgery can.

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Nord
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Re: VS very high, but doctor is blowing it off

Post by Nord » Wed Jun 30, 2010 6:34 am

Snores can also happen through your nose while taped...

You can be taped and no leaks and large snores can still happen. The vibrations are in the back of your throat.
The snores likely indicate that you still have some breathing restrictions...

The snores may or may not cause apneas or hypopneas. If they do not cause desaturations or apneas, they may not be a worry, just a nuisance.

Nord

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Re: VS very high, but doctor is blowing it off

Post by howkim » Wed Jun 30, 2010 6:45 am

Complikatyed wrote: He also said that "the VS doesn't really tell you anything anyway."
Yeah, that's what my doc said, too. I've gotten a used APAP machine for a backup since that visit and have been trying it. Unfortunately, switching between machines/cards seems to have screwed up my EV and I can't compare data any more.

Note to self: Fix this!!

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Gerald
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Re: VS very high, but doctor is blowing it off

Post by Gerald » Wed Jun 30, 2010 8:31 am

Complekatyed.........

Titration at a sleep lab is NOT an exact science. The pressure they set for you is really just their best guess.....and it probably won't match what you can determine by experimenting while looking at your software reports.

Your doctor is correct...the VS number is not important....BUT, he didn't say what was important. The overall MOST important number is something you aren't measuring....your O2 saturation levels while you are sleeping. You need to hold 93% saturation levels all night....and you can't know for sure unless you are measuring with an Oximeter. The VS number is an INDICATION that your O2 levels MIGHT be low....but no one knows for sure unless measurements are made.

Finally, I've found through my own experiments that my O2 levels aren't high enough while sleeping UNLESS my AHI is below 2.5.

So, I guess this all boils out to the idea that...if you CRAVE better sleep....invest in a recording Oximeter (I love my SPO-7500)....and take charge of your own therapy.

You can do a far better job than any doctor can.

Gerald

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Re: VS very high, but doctor is blowing it off

Post by jdm2857 » Wed Jun 30, 2010 11:04 am

I know that ResMed's AutoSet algorithm (at least up to the S8 series) uses snoring as one of the parameters to determine pressure. So they think that snoring is significant.
jeff

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Re: VS very high, but doctor is blowing it off

Post by Mary Z » Wed Jun 30, 2010 11:21 am

If you jack up your presure your doc would undoubtably KnoW. SO if you want to keep a good relationship with him, and have no reason to think's he's a quack (sounds responsible to me), give it until August- it's not long. Work with the guy instead of around him, at least until you're more experienced.

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Re: VS very high, but doctor is blowing it off

Post by jdm2857 » Wed Jun 30, 2010 1:13 pm

The problem with having the doctor do the analysis and make the adjustments is that every adjustment will take months. (How often will you see your sleep doctor?) The process of finding your "sweet spot" will take forever. Unless you have severe pulmonary disease, CPAP cannot hurt you. And a good sleep doctor (one who values his patients' health over his own ego) should be glad to oversee your progress. My own doctor told me she never had a patient with software or the inclination to adjust his/her own therapy, but was intrigued by the idea. Once she saw that I had done some research and knew what I was talking about and proposed doing, she agreed that my plan was reasonable.
jeff

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Re: VS very high, but doctor is blowing it off

Post by Janknitz » Wed Jun 30, 2010 1:29 pm

I've been curious about this vibratory snore score myself. It's not bothering me, but it does make me wonder.

First, I have great numbers overall. My AHI is always under one, and lately, with a new mask (Swift FX) it's around 0.2 or 0.3 per night. Leaks are great, and I feel very good (still a bit tired during the day, but not sleepy tired).

Despite that, I do have somewhat high VS numbers (or I thought it was high until I saw this post ) My pressure settings are 9 to 15, and when I'm passing through that 10, 11, and 12 cm range, I have a lot of VS--up to 54 per hour. This is usually well into my deep sleep phase, when I am probably in REM. I don't move around much in my sleep. I sleep on my side, and wake up in exactly the position I went to sleep in, so I don't think it's artifact from the hose moving around--and my PR S1 keeps the hose bone dry, no rainout issues that could cause this score.

My 90% pressure average is a little over 12 cm. Once my pressure rises above 12, the VS goes down to 0. And I have 0 VS when my pressure is only at 9, though it doesn't stay there long.

When I'm sort of half awake in the morning, I find that I do snore softly at times, and it's usually with the pressure between 11 to 12 cms at that time of the morning. My husband doesn't hear any snoring during the night--my snoring before CPAP drove him out of the bedroom.

Inquiring minds just want to know what that VS score is all about.
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Re: VS very high, but doctor is blowing it off

Post by GTOJim » Wed Jun 30, 2010 3:21 pm

Reading this poses questions in my mind. The last few years I haven't spent much time here so please go easy on me.

When the auto CPAPs first came on the market, people were trying to understand how they worked, or reacted to changes in breathing, Apnea, flow limitations etc. It appeared these machines were very sensitive to VS (snores). It was felt the machines reacted to VS increasing the pressure as a preventive measure to stop apneas. The airway was starting to slightly close, this slight throat closure caused VS. Encore Pro would show pressure increases caused by VS. Often there was no change in pressure from an apnea.

This might not be exactly how it was presented back then but this is basically what I understood of how the process worked. Granted this was 5 years ago. Do today's machines react differently? My 5 year old Auto just died, last week I replaced it with a S9 auto. So far my average pressure seems to be a bit lower with the S9.

If new machines are still very sensitve to VS then it would seem the pressure could be bouncing up and down all night, when a slight increase in pressure might greatly reduce a persons VS thus reducing a lot of pressure fluctions. I realize from reading above there can be other causes for snoring which a pressure change might not help. I believe in most cases an increase in pressure would lower VS. Is my thought process wrong?

Thanks in advance for your opinions.

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jdm2857
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Re: VS very high, but doctor is blowing it off

Post by jdm2857 » Wed Jun 30, 2010 3:28 pm

The ResMed S8 AutoSet II (and its predecessors back to the S7s) use measurements of snore, flattening, and apneas to control the pressure. Apneas do not affect pressure when the pressure is already at or above 10, to avoid inducing centrals. Flattening is an index that measures flow restriction.

ResMed had introduced a new algorithm in the S9 series. I suspect that this has something to do with the S9s ability to detect open-airway apneas which are most probably centrals. I have not details on this new algorithm.
jeff

GTOJim
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Re: VS very high, but doctor is blowing it off

Post by GTOJim » Wed Jun 30, 2010 3:52 pm

Thanks for the info on the S9

My old machine was a Respironics. Unless the machines have changed. The manfactures must have felt VS was very important as the machines seemed to be the most sensitive to VS. If this still holds true then I would think VS is still an important consideration. Although as pointed out, not in all cases.

I know in my case higher pressure lowered VS and also lowered my AHI. I realize everyone is different, execptions to every rule.

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Complikatyed
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Re: VS very high, but doctor is blowing it off

Post by Complikatyed » Thu Jul 01, 2010 6:46 am

Thank you, everyone, for your replies!

I agree that waiting until August is not unreasonable, and I'll do that before I start monkeying around with anything. I do feel better, though, knowing that while VS is probably important in my case, there are also probably multiple variables involved.

The getting an O2 monitor also feels like a step I can take and feel more responsible for my own care & data without risking my relationship with my doctor (who really is a cool guy).

My insurance purchased my CPAP, so I may be stuck with it, but I'm wondering about the advisability of trying to talk my doctor into letting me rent an APAP, at least for a brief interval, to see if that changes either the AHI or the VS. Has anybody had experience with talking a physician into switching from CPAP to APAP?

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Gerald
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Re: VS very high, but doctor is blowing it off

Post by Gerald » Thu Jul 01, 2010 7:44 am

Since you're tangled up with an insurance company, here's what you might find to be the best course of action:

1. Get a hard copy of your prescription
2. Research APAP machines and decide which one is best for you
3. Be sure the APAP you select has software available that works with it
4. Purchase (on your own) the APAP and the software to go with it from CPAP.com
5. Purchase a Recording Oximeter with software (SPO-7500 recommended....from Turnermedical.com)
6. Shift to APAP machine and religate your "insurance cheapie" to backup status
7. Take charge of your own therapy
8. Sleep better....live longer

G