An Experiment

[Bookbear]

Happy new year to all!

I am going to try an experiment for the next week or so. I have an ResMed Vantage S-8 (I know, I know... ) and have been on APAP therapy for 7 months now. AHI's, AI's, and HI's have all dropped gradually, but in the last month, they seem to have hit a trough, even increased a little; and my pressure has increased a bit as well. No other changes in health or life.

Currently, my pressures are set at a range of 9-13, with the average of the first six months being 10.6. Leaks are consistently 0.0 (zero). Previous six month averages for AHI 4.46, AI was .2, and HI was 4.31. My AI's are low, but the HI's are stubbornly at 4 and above. I consistently sleep an average of eight and a half hours.

My experiment is going to straight CPAP of 10.6 with EPR on a 2. I am going to see if using CPAP rather than APAP makes a difference in the HI's. No other changes will be made.

Does this sound at all logical? And am I (mildly) concerned over not very much i.e. that a high-ish HI on a ResMed machine is not a big concern if the AI's are below 1?

Inquiring minds want to know......

[Julie]

Just curious what your rationale for doing it is and how you came up with the number?

[Sleepless in St. Louis]

My question is: How do you feel. Are you rested, alert and feeling good? Are you just trying to improve the numbers or the way you feel? If you trying to improve the way you feel, then it may pay off for you. If you are just trying to improve the numbers, I'd consider skipping it.

[JeffH]

If you feel good why mess with it?

I live by the motto if it works, don't fix it.

[bdp522]

I get better numbers and feel better on cpap instead of apap. Good luck with your experiment!

Brenda

[kteague]

Bookbear,
I too use a ResMed machine and the HI is stubborn to budge below 5 with any mask but the Breeze. With the Breeze my AHI was usually around 2 or 3 and my leak rate was negligible, but the headgear was real uncomfortable and waking me up a lot, and I thought maybe another mask would help my compliance - and it has. Haven't been able to reproduce those low numbers with other masks though. Since folks have said a higher HI is not unusual with a ResMed, I decided to go for increased compliance over lower numbers. I am interested in how your experiment goes. Please do let us know.

Funny numbers story: Woke up today, sat up to look at numbers. Got so excited to see 0.0 AHI, since it hasn't been below 9 in a long time. My first thought was going to post my success here. Since increasing mask time has been an ongoing effort, I scrolled to hours of usage. Daggone, I had slept past noon so I was looking at only 17 minutes of data! No bragging rights yet.

Kathy

[GoofyUT]

Bear, as you may remember, I switched from a ResMed S8 Vantage to a REMstar Auto (tank) about 5 months ago, and I've been sleeping like a baby since.I just was NOT a good match for the ResMed algorithm and found that its sharp attack of events would rouse me. Otehrs, as you know, value the ResMed expressly because of its prompt response to flow degradations which pre-empt the occurence of events.

I still have my S8 Vantage which I use as my travel machine, and I LOVE it in that application. I do run it in CPAP mode only, with an EPR setting of 3 cms. I find it to be very effective and uncanily soothing, much more so than the C-flex on my REMstar.

ResMeds DO aggressively score hypops, and most folks will find that their AHI is comprised mostly of an inordinately high number of hypops and resulting HIs. I can't say that this is to be ignored however. I do believe though, that it bears looking into, and I'll bet that an overnight pulse/oximetry will revesal that most of those hypops do not result in ANY desaturations, and are therefore, not clinically significant. But, see for yourself.

Cheers!!!

Chuck

[christinequilts]

Daggone, I had slept past noon so I was looking at only 17 minutes of data!

Too funny Kathy! I was so prepared when I switched from my Respironics Synchrony BiPAP ST to the ResMed VPAP Adapt to lose overnight data at noon and have leaks reported in liters per minute, but wouldn't you know ResMed changed everything just to confuse me. Overnight data stays until I use it for more then a couple minutes, even if turned off, and even more surprising, leaks are in liters per hour.

[Bookbear]

Sleepless and Jeff, I was interested in trying this since I seem to have hit a plateau in treatment, after having slow but steady improvement. In earlier posts, I had indicated that I did not experience the 'overnight miracle' that some do with therapy. For me, its was very small but eventually noticeable improvements, but for the last month, stasis. I have also noticed a recurrance of yawning in the mid afternoon, something that had gone away in the past few months. Also, the rise in pressure on the daily reports for the last month bothered me, the pressure had been declining.

I figured it was worth a try. I DO feel better than I did starting therapy seven months ago, but I also feel I have room for improvement. I don't feel as sharp as I once did (mentally), and still get tired some afternoons, even with a good unbroken eight and a half hours of sleep. Since the hypopneas haven't budged downward, I was wondering if a change might improve them and therefore also improve my overall sense of well-being.

[Bookbear]

Julie, I came up with the number by looking at the average pressure for the 6 month period prior to December (when the pressure started rising). That number was 10.6 as I indicated in my post. I figured that was a good place to start. I was titrated at 10, but from day one, the APAP ran at a higher pressure, averaging 10.6, never going below 10 and one night rising to 12.8.

[Bookbear]

Well, after two weeks, I am going back to APAP. What I noticed while on CPAP was that, while my pressure went down (of course; it was set at a fixed 10.6 so it could not go above that level), my AI, HI and AHI numbers all went up, most noticeably, the AI -- up from an average of .2 to above 3. AHI went from an average of 3.3 to over 5, and the HI went up from an average of 3.7 to over 7. Nothing that was under my control changed during the two weeks: same bed, same sleeping positions, same mask, same humidifier setting, same room temp, etc. I had no abnormal congestion during the period.

I did not notice any improvement in daytime yawning or energy levels, but no degradation, either. Essentially, no change in the way I feel. I wonder if I continued with CPAP if I would notice a slow decline in the way I felt, given the higher numbers I was experiencing with the CPAP mode

So, its back to APAP. If I get the chance sometime, I would be interested in trying a Respironics auto unit to see if their algorithm is better suited to my needs, a la GoofyUT's experience.

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CPAPopedia Keywords Contained In This Post (Click For Definition): respironics, CPAP, AHI, auto, APAP

[HP]

I haven't heard of zero leakage.
Maybe that's just a special situation with your apap.
Normally, a certain amount of leakage is required to vent CO2 during exhales.
I suspect a good bit of seemingly unsufficient treatment may be due to excessive leakage.

[lvwildcat]

Kathy-I looove your response-too funny!!!! Sounds like something I would do!

[Bookbear]

HP, the ResMed unit has a mask setting that, as I understand it, compensates for the venting of CO2, so that the reported figures reflect the measured leak minus the vent flow rate built in to the specific mask.

The mask I use (Breeze) is not one of the ones there is a setting for, but the setting I use is close (not exact) to the manufacturer's stated vent flow rate for the Breeze, so the figure should be fairly accurate. I very occasionally get a leak rate registering on the machine, but it is negligible. The few times I used a full face mask UMFF (I have a full beard and 'stache), it ALWAYS registered very high leak rates, so I assume the machine is working as intended.

[cpapjack]

When I had my S8 and was using my Breeze, I consistently had 0 leakage. Evry now and then it would be something like .04, but 99.9% of the time, it was zero. I think DreamStalker mentioned he had the same results with his S8 and Breeze.

Jack