Correct type machine?

[jtmarten]

I recently had a split sleep study done; AHI 70.3/hr. 21 OSA, 189 CSA over the measured time.
My Dr prescribed a standard CPAP; the resp therapist he sent the script to doesn't sell machines, only leases them. They told me they'd bill my ins $850 for the first month, and really wouldn't tell me what the monthly charge was (screw that!). So, I bought a new Respironics M-Series (basic) off craigslist for $180, including a comfortgel mask.
My sleep study tech mentioned something while she was fitting different masks, etc. She had me breathe normally for about a min, then hold my breath, the machine gave a few small puffs of air; she said during a CSA they would jump start my breathing without waking me up.
What is that function called? I've been researching like crazy and haven't found anything related to that. I've see C-Flex, A-Flex, X-Flex functions, but it seems they're basically a Bi-PAP mode on a CPAP machine.
The M-Series has "breath detection", but no info on what that means. I've tried holding my breath, but don't detect anything similar to during the sleep study. The sleep tech recommended 7cm, so is that maybe too low a pressure to detect those puffs oof air?

Thanks!

[Pugsy]

My sleep study tech mentioned something while she was fitting different masks, etc. She had me breathe normally for about a min, then hold my breath, the machine gave a few small puffs of air; she said during a CSA they would jump start my breathing without waking me up.
What is that function called? I've been researching like crazy and haven't found anything related to that. I've see C-Flex, A-Flex, X-Flex functions, but it seems they're basically a Bi-PAP mode on a CPAP machine.
The M-Series has "breath detection", but no info on what that means. I've tried holding my breath, but don't detect anything similar to during the sleep study. The sleep tech recommended 7cm, so is that maybe too low a pressure to detect those puffs oof air?

Sigh.
Please tell us exactly which M Series CPAP machine you bought.
CPAP machines don't have a function to jump start your breathing if you are having a central apnea. That function is available on ASV type of machines...adapto servo ventilation...non invasive ventilators.

You probably should read up on central sleep apnea. that is what your AHI is primarily made up of and straight regular cpap machine likely are not going to be much help. With central apnea you just stop breathing..the airway is already open.

This video may help. While it is mainly for complex sleep apnea (a mixture of obstructive and central apneas which your sleep study points to) it kinda gives a nice overview of everything.
http://www.youtube.com/watch?v=CU-XTcfg ... e=youtu.be

[jtmarten]

My sleep study tech mentioned something while she was fitting different masks, etc. She had me breathe normally for about a min, then hold my breath, the machine gave a few small puffs of air; she said during a CSA they would jump start my breathing without waking me up.
What is that function called? I've been researching like crazy and haven't found anything related to that. I've see C-Flex, A-Flex, X-Flex functions, but it seems they're basically a Bi-PAP mode on a CPAP machine.
The M-Series has "breath detection", but no info on what that means. I've tried holding my breath, but don't detect anything similar to during the sleep study. The sleep tech recommended 7cm, so is that maybe too low a pressure to detect those puffs oof air?

Sigh.
Please tell us exactly which M Series CPAP machine you bought.
CPAP machines don't have a function to jump start your breathing if you are having a central apnea. That function is available on ASV type of machines...adapto servo ventilation...non invasive ventilators.

You probably should read up on central sleep apnea. that is what your AHI is primarily made up of and straight regular cpap machine likely are not going to be much help. With central apnea you just stop breathing..the airway is already open.

This video may help. While it is mainly for complex sleep apnea (a mixture of obstructive and central apneas which your sleep study points to) it kinda gives a nice overview of everything.
http://www.youtube.com/watch?v=CU-XTcfg ... e=youtu.be

Correct, my AHI on the CPAP was 6/hr, so it helped quite a bit.
Respironics M-Series (basic, no x-Flex, no frills, basic).
I guess I'll try to get ahold of the sleep tech, find out what the function was.

[Pugsy]

Actually if you have AHI available on the machine LCD screen your machine is more than just a basic machine.

What does it say on the top of the machine? Auto? Pro?

M series machines don't score centrals. There is zero way to know if that AHI is central in origin or not.
The PR System One machines do score centrals (clear airway).
The PR System One machines do use little puffs of air to help determine if the airway is open or closed and that is their only function and certainly not enough to jump start breathing from centrals.
CPAP machines are not usually the machine of choice when someone has predominately centrals. Their design and function is to maintain enough pressure to hold the airway open to prevent obstructive collapse events.
They do nothing to help you initiate a breath on your own when the airway is open.

[jtmarten]

No Pro, Auto or anything. Basic.
The AHI #'s are from my sleep study. I've used the M-Series only a few nights and haven't even looked at the display. I'll look at it tonight and see what it shows.

[Pugsy]

No Pro, Auto or anything. Basic.
The AHI #'s are from my sleep study.

Okay, sorry, I thought was from machine data. AHI of 6 was that the titration sleep study? Math doesn't work for it to be your original diagnostic sleep study.

How are you feeling using the machine?

I wouldn't be happy using a non data machine at all but especially with a history of centrals.
I would be wanting to monitor them real close. A few centrals are no big deal but you had way more than a few.

[squid13]

If you have a prescription for a machine and you have insurance go find you another DME. You don't have to accept the one your Doctor sent you to if you don't want to. Find a DME that will give you what you want and use the machine you bought as a back up machine.

[jtmarten]

No Pro, Auto or anything. Basic.
The AHI #'s are from my sleep study.

Okay, sorry, I thought was from machine data. AHI of 6 was that the titration sleep study? Math doesn't work for it to be your original diagnostic sleep study.

How are you feeling using the machine?

I wouldn't be happy using a non data machine at all but especially with a history of centrals.
I would be wanting to monitor them real close. A few centrals are no big deal but you had way more than a few.

Yeah, it went from 70.x during the diagnostic phase down to 6.x during the CPAP titration. I don't have the docs with me at work, I'll have to get more specific data this afternoon after I get home.

Today is the first day I feel non-tired after using it. I'm still getting used to it, still dialing in the humidifier setting.

[jtmarten]

If you have a prescription for a machine and you have insurance go find you another DME. You don't have to accept the one your Doctor sent you to if you don't want to. Find a DME that will give you what you want and use the machine you bought as a back up machine.

If I have to get a different machine I likely will; just don't see a need to spend the 20% (ins covers 80%) on another machine right now.

[archangle]

My sleep study tech mentioned something while she was fitting different masks, etc. She had me breathe normally for about a min, then hold my breath, the machine gave a few small puffs of air; she said during a CSA they would jump start my breathing without waking me up.
What is that function called? I've been researching like crazy and haven't found anything related to that.

Some of the higher end bilevel machines do something like that. It may be called ASV or ST(Self Timed?) mode. It's possible the machine in the sleep study was some higher end machine like that does ASV or ST mode.

Some Auto CPAP machines send pulses to detect central apnea, but not to treat it.

Your DS100 does no puffs of any kind, and doesn't collect any data other than the time it's turned on and being used.

Be careful, you may need a machine that's more complicated and expensive than CPAP, APAP, or even simple bilevel. You may need this if you have central apnea.

By the way, "BiPAP" and "VPAP" are just trademarks for a particular brand of bilevel machines.

You do need some kind of data capable CPAP machine, especially with that many centrals. Otherwise you won't know if your therapy is working.

[jtmarten]

OK, here's the info from my sleep study:
Diagnostic phase: (3.6hrs)
AHI: 70.3/hr
Central apneas: 189
Mixed apneas: 0
Obstructive apneas: 21
Hyponeas: 40
Hyponea index: 11.2/hr
Desaturation index: 54.0/hr
Resp Effort related arousals: 2
Resp Effort related arousal index: 0.6/hr
Respiratory disturbance Index: 70.8/hr

AHI supine: 119.0/hr
RDI supine: 119.0/hr
AHI Non-REM: 78.3/hr
RDI Non-REM: 78.6/hr
AHI REM: 0.0/hr
RDI REM: 2.7/hr
Max event duration: 24.5sec
Cheyne Stokes breathing: none

Baseline O2 awake: 93%
Low O2 saturation: 85%
Avg O2 saturation: 92%
SaO2 of <89%: 9.6min

N1 sleep: 43.6%
N2 sleep: 22.5%
N3 sleep: 23.7%
REM sleep: 10.3%
REM latency: 140.0min
Sleep efficiency: 89.3%
Sleep onset: 5min


Treatment (CPAP) phase (max CPAP pressure 7cm, titration time 3.9hrs):
AHI: 8.3/hr
Central apneas: 18
Mixed apneas: 0
Obstructive apneas: 1
Hyponeas: 13
Hyponea index: 3.4/hr
Desaturation index: 5.2/hr
Resp Effort related arousals: 1
Resp Effort related arousal index: 0.3/hr
Respiratory disturbance Index: 8.6/hr

AHI supine: 7.0/hr
RDI supine: 7.6/hr
AHI Non-REM: 10.5/hr
RDI Non-REM: 10.8/hr
AHI REM: 1.1/hr
RDI REM: 1.1/hr
Max event duration: 28.5sec
Cheyne Stokes breathing: none

Baseline O2 awake: 93%
Low O2 saturation: 87%
Avg O2 saturation: 92%
SaO2 of <89%: 1.5min

N1 sleep: 13.2%
N2 sleep: 44.4%
N3 sleep: 19.0%
REM sleep: 23.4%
REM latency: 52.5min
Sleep efficiency: 77.8%
Sleep onset: 8.5min

[Pugsy]

Sleep study tech and their machine that offered whatever the puffs of air were to jump start your breathing...is a far cry from the machine that you are now using. That sounds like an ASV type of machine (there are various models with varying functions) and they would have had one at the sleep lab.
You had a truckload of centrals even without being on the machine.
Plain CPAP/APAP are not normally the machines that people with a lot of centrals need but sometimes insurance requires a trial with them because they are so much cheaper than the ASV machines which are what is normally used to treat people with centrals.

I would be clarifying with the doctor about which machine and why and what is to be expected.....
Plain cpap machines don't do anything if you forget to breath. They can't act with enough force to force you to breath.

[jtmarten]

After looking around again, I'm betting it was the RemStar AutoSV. So looks like the M-Series goes back on craigslist, and prob this Fall I'll pick up an SV, most I've seen have a hefty $3200 used pricetag.

[Pugsy]

Someone had one of the older Respironics Auto SV units for sale here not long ago. Don't remember if it sold or not.
For sure was priced a lot less than $3200.
Software is available and the older units need the card reader for software use but those are still available for around $40.

Have you checked with your insurance company to see what your portion of the cost would be? Doesn't matter what the DME bills out...it matters what the insurance allows and what your payment portion would be.

Check out this machine offered by Grand-Pap
viewtopic.php?f=1&t=78622&p=714807#p714807
It's not a new model but it might offer what you need. I don't remember price.
Also might ask him if he has heard of any other ASV machines.
It is a ResMed machine but I believe it offers same features you need.. You would need to investigate it to make sure but I know it is used for people with centrals.

[jtmarten]

Thanks for the info!
I talked to the ins co, they pay 80% as long as the script specifies an SV machine. I found used SV machines for $800-980, just waiting for the Dr's office to call back so I can have them modify the script.

But then .... I got a reply from the sleep technician. She only used basic 7cm CPAP for the results, so the M-Series I have will work just fine.

I don't know if its worth persuing an SV machine now on the chance a standard CPAP will not effectively treat the CSA's in the future.