Results of first 2 weeks using PAP therapy...more questions!

Maddcow · Post by **Maddcow** » Thu May 22, 2008 3:15 am

Ah, ok. Thanks for that.....most of that makes sense. However, can you clarify this: "its a fact resmed machines don't respond to events over 10cm in Auto mode"? I'm not quite sure what events over 10cm means?

Cheers
Gary

P.S. My titrated pressure was 13cm.

zorrro13 · Post by **zorrro13** » Thu May 22, 2008 3:38 am

If your throat collapses the machine wont increase the pressure any further than 10 to reopen your throat. That could be why you have so many red spikes or events. You need 13cm to keep your throat open enough to breath properly

zorrro13 · Post by **zorrro13** » Thu May 22, 2008 3:45 am

Here is the link explaining why the machine wont respond over 10cm. Also as explained to you before you will need to post your sleep study here regarding the possibility you may have centrals and that's another ball game way out of my league

viewtopic.php?t=31125&highlight=resmed+alogarithm

Maddcow · Post by **Maddcow** » Thu May 22, 2008 4:30 am

Just found my initial sleep study info.

My average supine AHI was 41.6 per hour with the following event breakdown:

*Central Apnoea - 0.0
*Obstructive - 0.8
*Mixed Apnoea - 0.8
*Hypopnoea - 40.0

Maddcow · Post by **Maddcow** » Thu May 22, 2008 4:38 am

zorrro13 wrote:The only thing I can think of is that Resmed do not respond to events in Auto mode over 10cm. In that case you would need to set the Minimum at what your doctor prescribed and leave the max at 20 ( works for me).

According to that link you posted (thanks for that BTW ), isn't the above incorrect? E.g.

If you set your Minimum pressure to say 11 cm in the autoset mode, range effectively then is 11cm to 20 cm. Set up this way the machine will NOT respond to any apnea period. It then only responds to Flow Limitation and Vibratory snore.

and

if current delivery pressure is at or above 10 cm do not respond to apnea events. So if you have the reporting software and similar settings you can confirm this with the reports, if Minimum pressure is at or above 10 cm, the AutoSet machine won't respond to any apnea seen.

These seem to contradict what you were saying about setting the min at 13 and max at 20 using APAP.....have I got that right?

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CPAPopedia Keywords Contained In This Post (Click For Definition): resmed, auto

michaelho · Post by **michaelho** » Thu May 22, 2008 4:42 am

I think you have a mouth leak problem (as I have similar with nasal masks)
I also tried mouth taping with a 'micropore' paper tape and found it improved my experience. I don't like taping much though as it hurts to take off and when you wake up, it feels a bit claustrophobic.
Anyway it seems like you have most things OK, just reckon it must be the open mouth syndrome. Have you woken with a very dry mouth?

Maddcow · Post by **Maddcow** » Thu May 22, 2008 5:10 am

No, I haven't woken with a dry mouth....oh, maybe once or twice in the past 2 weeks. But I've taped my mouth shut for the past 2 nights and if anything, my AHI was worse than normal. Nice to see a fellow Gold Coaster here!

ozij · Post by **ozij** » Thu May 22, 2008 5:39 am

No contradictions in what you quoted.

Resmed autos will respond to flow limitation events (snores, hypopneas) when the event occurs above the pressure of 10. It will not do anything when it see an apnea occur above that pressure, because Resmed has no way of knowing if apnea is obstructive, or pressure incduced. Pressure induced apneas are far more prevalent when the pressure goes above 10 cms - hence Resmed's choice to err on the side of caution.

I've only skimmed the thread (my apologies) but I get the weird impression that the numerical results (a very high HI) and the charts are discrepant. If I'm wrong - tell me to read more seriously and I will (am in a rush now).

The way to handle too many hypopneas on an auto is to raise the minimal pressure.

And some people with a preponderance of hyponeas do better at fixed pressure.

O.

zorrro13 · Post by **zorrro13** » Thu May 22, 2008 5:47 am

Maddcow wrote:
zorrro13 wrote:The only thing I can think of is that Resmed do not respond to events in Auto mode over 10cm. In that case you would need to set the Minimum at what your doctor prescribed and leave the max at 20 ( works for me).
According to that link you posted (thanks for that BTW ), isn't the above incorrect? E.g.
If you set your Minimum pressure to say 11 cm in the autoset mode, range effectively then is 11cm to 20 cm. Set up this way the machine will NOT respond to any apnea period. It then only responds to Flow Limitation and Vibratory snore.
and
if current delivery pressure is at or above 10 cm do not respond to apnea events. So if you have the reporting software and similar settings you can confirm this with the reports, if Minimum pressure is at or above 10 cm, the AutoSet machine won't respond to any apnea seen.
These seem to contradict what you were saying about setting the min at 13 and max at 20 using APAP.....have I got that right?

Maddcow · Post by **Maddcow** » Thu May 22, 2008 6:11 am

ozij wrote:I've only skimmed the thread (my apologies) but I get the weird impression that the numerical results (a very high HI) and the charts are discrepant. If I'm wrong - tell me to read more seriously and I will (am in a rush now).

Ozij, perhaps you can make more sense of everything when you have the time to read the thread. I'm as confused as you re. the seeming-discrepancy between the numerical results and the charts......but that's what they are.

Maddcow · Post by **Maddcow** » Thu May 22, 2008 6:12 am

zorrro13 wrote:It doesn't matter if you set your machine at straight Cpap of 14 or at Apap at 14 (min). They will both blow at 14cm so your taking the above info out of context. To avoid confusion just go straight Cpap and see if it helps tonight.

Cool. Will do. Thanks again

Maddcow · Post by **Maddcow** » Thu May 22, 2008 7:50 pm

I tried CPAP at 14cm last night with EPR of 3. Below are the results:

AI: 6.3
HI: 15.8
AHI: 22.1

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CPAPopedia Keywords Contained In This Post (Click For Definition): CPAP

NightHawkeye · Post by **NightHawkeye** » Thu May 22, 2008 8:21 pm

Maddcow wrote:I tried CPAP at 14cm last night with EPR of 3. Below are the results:

AI: 6.3
HI: 15.8
AHI: 22.1

Very interesting data, Gary. A most interesting aspect of it is that your chart pressure is not the same value as your stated pressure. Your chart indicates that the pressure the machine used for you was only about 12.5 cm. I assume this is because you have EPR on.

If you'll pardon me for a few sentences, I'll speculate just a little: I would guess that your titration was performed without benefit of EPR, so even though you increased pressure last night, your average pressure was still slightly below your titrated value. Bi-level therapy (EPR is a form of bi-level) often provides equivalent treatment while lowering overall pressure, but that is not always the case. Studies have shown that some folks actually require higher average pressures with bi-level therapy than CPAP therapy.

So how did you feel dealing with the increased pressure last night, Gary? Are you up to increasing it again tonight? The other thing you could do is simply leave it where it is for a few days and see if your average results are any better than in the preceding days when your pressure was just slightly lower. It might easily take a week or so of data averaged over that entire time to reveal a trend though.

Regards,
Bill

zorrro13 · Post by **zorrro13** » Thu May 22, 2008 8:43 pm

Gary as Bill said. If you scroll back you will see where I mentioned inc press for EPR for eg if you select an EPR of 1 and your regular pressure is 14, you may then need to increase that to 15cm.
EPR2 16cm
EPR3 17cm
How do you handle straight cpap without EPR?

Maddcow · Post by **Maddcow** » Thu May 22, 2008 10:10 pm

NightHawkeye wrote:So how did you feel dealing with the increased pressure last night, Gary? Are you up to increasing it again tonight?

The most noticeable difference last night was that it was a lot harder to keep my mouth closed. I found that my cheeks would suddenly fill with air occasionally and I'd end up having to swallow it because I'd taped my mouth closed. However, at around 5am this morning I removed the damp tape and started mouth-leaking (you can see it on the leak chart!).

I'll have to see how I go with increasing the pressure......up to 16 or 17 is getting pretty darn high so I might see how I do without EPR.

I also called my sleep physician today to make an appointment and try to get to the bottom of what's happening, because I'm sure that something isn't right here. I may have been mis-diagnosed or the titration study was flawed.....I dunno. I found it quite funny when I called and explained my situation, and was then told that the sleep clinic normally only sees patients 1 year later to see how they're going. If I'd left it for a year then I'd probably have given up after 2 months or so when I saw that it didn't seem to be working! A year - what the heck are they thinking??!??! If it were me, I'd be seeing patients within the first 4-6 weeks to review how things were going.

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