Is absence of snoring a good indicator of xPAP efficacy?

oneantonee · Post by **oneantonee** » Thu Apr 13, 2006 12:26 am

One of the main reasons that I am pursuing CPAP for a third time, after 2 dismal failres, is because my snoring is preventing me from sleeping with my sleep partner. I am hoping that, this time by doing the proper research before hand, and having the right equipment (the C-Flex is going to be very helpful), I will succeed.

Once I have determined that I am going to stay with the Remstar Auto with C-Flex, I will purchase the software and SmartCard reader. I am also going to try and get a pulse oximeter at some point during my initial therapy.

In the meantime, however, will I be able to gauge the effectiveness of the CPAP by how much my snoring decreases (as indicated by my sleep partner)?

Best regards,

Antonio

dsm · Post by **dsm** » Thu Apr 13, 2006 2:14 am

I consider my sleep partner to be my greatest source of effective feedback.
I have learned more from her than any data extracted from my APAP.

Like having a sleep in nurse

Cheers

DSM

Tn-Ken · Post by **Tn-Ken** » Thu Apr 13, 2006 6:25 am

Hey Antonio - I was (until three nights ago) a total snorer. The cracks in the walls are because of it (I'm told by my wife!!)

I've had my equipment for the grand total of 3 nights and haven't snored out loud once in that time. The equipment says I try to but the machine takes care of it.

Good luck with yours!

Guest · Post by **Guest** » Thu Apr 13, 2006 10:55 am

I think snoring has driven more couples into separate bedrooms than the world will ever know. Thats probably one of the main reasons anyone bothers to get diagnosed. The spouse or significant other is driven crazy.

But how can you learn more about your OSA from your sleep partner --other than the snoring I mean- than you can from the data extracted from your APAP? Maybe I will save myself the money of getting the software if all I need to go by is no more snores. Iknow my mate is satisfied that its taken care of. So is the software only useful for people that keep snoring even on APAP or never snored to begin with?

roztom · Post by **roztom** » Thu Apr 13, 2006 12:01 pm

I often question the veracity of the snore index on the data for the Remstar Auto.

My partner doesn't report any snores, she used too but the data says I'm still snoring.

The APAP responds to snores and that is the primary trigger for increasing pressure. Whether it is an audible snore or a flow disruption from a Hypopnea or pre-apnea condition is open to discussion.

From my observations what is labelled in the data as a snore can actually be a low level pre-hypopnea.

Best,

Tom

oneantonee · Post by **oneantonee** » Thu Apr 13, 2006 12:42 pm

[quote="roztom"]I often question the veracity of the snore index on the data for the Remstar Auto.

My partner doesn't report any snores, she used too but the data says I'm still snoring.

The APAP responds to snores and that is the primary trigger for increasing pressure. Whether it is an audible snore or a flow disruption from a Hypopnea or pre-apnea condition is open to discussion.

From my observations what is labelled in the data as a snore can actually be a low level pre-hypopnea.

Best,

Tom

RestInSeattle · Post by **RestInSeattle** » Thu Apr 13, 2006 1:30 pm

Just thought I'd mention that it's important to remember that OSA is usually shown by the presense of snoring, but some OSA suffers may not snore "audibly".

An example is that someone may have UPPP surgery or other methods that remove tissue that generates the "snore" but still have obstructed sleep. So it's important to follow up with a another sleep study after having surgeries, or other methods that eliminate snoring, to ensure that the OSA is also resolved or not.

Many may perform the surgeries to have lower pressures, but still require the equipment.

rested gal · Post by **rested gal** » Thu Apr 13, 2006 2:32 pm

VERY good point, RestInSeattle. Thanks for mentioning that.

Guest · Post by **Guest** » Thu Apr 13, 2006 6:40 pm

The way I understand it, the only thing my sleep partner can tell me is that I've stopped snoring and you're telling me that doesn't necessarily mean I'm not having apneas.

I guess I'll spring for the software.

Wulfman · Post by **Wulfman** » Thu Apr 13, 2006 6:51 pm

Anonymous wrote:The way I understand it, the only thing my sleep partner can tell me is that I've stopped snoring and you're telling me that doesn't necessarily mean I'm not having apneas.

I guess I'll spring for the software.

Good idea!

dsm · Post by **dsm** » Fri Apr 14, 2006 2:05 am

Some of us appear to be luckier than other in regard to what our partner observes. It may be that some of us just have more astute partners.

Mine will tell me if my breathing patterns change markedly (she is a light sleeper).

She will tell me if I stop or slow my breathing. It was her feedback that I was able to map against the data from my Remstar AUTO and my ResMed spirit AUTO that prompted me to move to a BiLevel. - When I had my AUTOs she commented that after a the initial few months she was observing me slowing & stopping my breathing again. I only got the corroborative evidence from one of these machines.

I attribute my wife's observations as the reason I learned not to trust the snore index of one brand and also to question the veracity of other data it reported. Not many people actually get the opportunity to compare the results from different machines in similar periods & thus can be lulled into thinking the data from their machine is scientific when it is nowhere near so.

There has been a tendency here for some folk to regard the data from their particular machine as a new gospel written by a higher authority and ready to be added to the good book when in fact there is very strong evidence that what some machines report is unique to those machines & that in fact other machine may tell an entirely different story.

DSM

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dsm · Post by **dsm** » Fri Apr 14, 2006 2:18 am

Another point re detecting snoring.

The earliest AUTO machines actually had detection cicruits built into them to detect sound patterns similar to snoring. This was how these early machines decided when to vary the pressure.

But this approach was quickly seen as flawed and the next approach was to add flow-sensors into the airflow and to use newly developed algorithms to detect 'shudder' in the airflow (a sure sign of impending or actual snores).

I think some machines used both sound and airflow monitoring. It may be that some may still do it this way.

Any machine that still uses sound detection to listen for snores is behind the times. I don't actually know if any still do. Does any one here have any knowledge of this ?

One other bit of humour re detecting snoring, anyone with a Remstar, try talking while you have the mask & machine on & then analyse the data. I suspect that anyone who talks in their sleep is recorded as a heavy snorer - add to that burping (a constant side effect from aerophagia) the data recorded gets quite amusing.

Cheers

DSM

ehusen · Post by **ehusen** » Fri Apr 14, 2006 6:07 am

Hmmm, I dont' like hearing that the detections algorithms for APAP machines may "not be that great". It concerns me to hear that. For many of us, we only get one machine to use and we have to hope that it is effective in doing its job.

Oh well, in response to the thread topic. I was a horrible snorer all my life and it did drive my loving wife to almost murderous thoughts. With the APAP I simply don't snore at all. My wife did say I would gasp for breath as well. So, for me, I think there is a strong correlation between lack of snoring and improvement in my OSA. But as others have said, it really can vary from individual to individual.

Unfortunately, the machine I have (ResMed Response) does not report session data so I cannot get any actual numbers on it. But according to my wife's analysis, I do sleep a lot sounder now.

Brent Hutto · Post by **Brent Hutto** » Fri Apr 14, 2006 6:35 am

ehusen,

A couple separate issues here.

To address your main observation...yes, if your treatment is working then you should no longer gasp for breath and you should no longer snore. However, the thing people were pointing out is that your snoring can go away even if your underlying OSA is not being completely addressed so you can't use absence of snoring as a criterion for CPAP therapy success.

About the APAP thing...one of the first things that was tried in designing APAP machines was to in effect listen with a microphone for snoring sounds and bump up the pressure when they are detected. Not surprisingly, that was a too-crude approach to work consistently. So they quit doing that and starting using more sophisticated and direct measures to flow limitation. So an up-to-date machine can be very, very effective without trying to detect and cure snoring per se. If you happen to have an old-fashioned machine that's a snoring-detector it may well work for you, there's just too many cases where it does not work well which is why they improved them.

Hope this helps.

KLM · Post by **KLM** » Fri Apr 14, 2006 8:54 am

dsm wrote:When I had my AUTOs she commented that after a the initial few months she was observing me slowing & stopping my breathing again. I only got the corroborative evidence from one of these machines.

I attribute my wife's observations as the reason I learned not to trust the snore index of one brand and also to question the veracity of other data it reported. Not many people actually get the opportunity to compare the results from different machines in similar periods & thus can be lulled into thinking the data from their machine is scientific when it is nowhere near so.

Putting aside the issue of snores for a moment, I think it is important to point out that changes in breathing -whether it be slowing down or speeding up- are completely normal throughout the night depending on the stage of sleep you're in and the stage of sleep you're moving into and out of. It is not a bad or unusual thing for anyone--whether or not they have OSA- and is not an indication the apap machine had a problem with detection.

Stopping breathing, on the other hand, is not normal. I agree with ehusen, it is disappointing to hear dsm's machines did not sense he had stopped breathing -as reported by his wife. But how do we know the machine did not sense it and correct it (as it would in a perceived obstructive event), or sense it and attempt to correct it but then stop (as it would in a perceived central event)?

I think while we're questioning how much one can rely on apap detection, we must logically also question how much one can rely on visual observation. DSM, I am assuming since you based your opinion of the accuracy of your machine on its disagreement with your wife's observations, she was charting your breathing variations each time she observed them throughout the night by documenting the exact time they occurred, how many seconds they lasted, whether or not there was any respiratory effort, the amount of time until the next complete breath stoppage, etc. Then I'm assuming you compared her data with the data as reported by the software and tried to match up these events based on the timeline her charts indicated they occurred. Is that the method you employed which lead you to question the veracity of the data reported by your apap? I must admit I am more inclined to question the accuracy of this methodology than I am inclined to assume poor detection on the part of the apap.

I agree there are a few individuals who may find the algorithms used by one manufacturer are better suited to their breathing patterns than another. But I also want to emphasize the majority will receive effective treatment from any apap. Apap event detection and the reporting software is not the gospel. But it's the best method currently available. We know clinically defined hypopneas cannot be detected without an oximeter and clinically defined centrals cannot be detected without a respiratory effort belt, but we also know the algorithms currently used employ highly complex techniques for discerning these events to the best of their programmed ability.

ehusen wrote:Hmmm, I dont' like hearing that the detections algorithms for APAP machines may "not be that great". It concerns me to hear that. For many of us, we only get one machine to use and we have to hope that it is effective in doing its job.

Ehusen, don't lose faith in the apap's detection ability. Understand that it is imperfect, but also keep in mind it is highly effective in doing its job no matter which manufacturer's apap you use. Unquestionably, apap therapy is effective in treating OSA.