Another newbie question on cpap or apap

Lyn · Post by **Lyn** » Sat Sep 10, 2005 2:16 pm

Hi all.

I’ve been on cpap since Aug 22nd. Could not believe how much better I felt after just a few days. I was no longer having a problem staying awake at work nor was I taking a nap most evenings when I got home from work. Now this week I almost feel as bad as before.

I don’t have the results from my sleep studies yet, but do know that I had an AHI of 15 & my SpO2 was 56% for 70% of the sleep time. So I am assuming (and you know what they say about assuming) that my problem is not the number of events but the duration. After the 1st sleep study the Dr. put me on oxygen at night & for the 2nd sleep study, the SpO2 was 84% for 80% of the time. They did tell me that the Dr. liked to see it at no less than 90% for no more than 20% of the time.

The DME set me up with a ResMed S7 Lightweight (with an adapter for my oxygen) set at a pressure of only 4 & an Activa mask.

My question is, with the above info, does the general consensus say a cpap is ok, or go for an apap?

Thanks for all your hard-earned knowledge!

Lyn

WillSucceed · Post by **WillSucceed** » Sat Sep 10, 2005 2:56 pm

The DME set me up with a ResMed S7 Lightweight (with an adapter for my oxygen) set at a pressure of only 4 & an Activa mask.

A pressure of 4 is almost no pressure at all. Further, given that the Dr. has added oxygen, I would NOT even consider screwing around with an APAP. I suspect, (and I am not a Dr.) that the CPAP of 4 is just to give a bit of 'shove' to get the oxygen into you. If you have an APAP, which will give different pressures during the night, the amount of oxygen being blown into you will change. This is what you don't want to screw around with.

At a pressure of 4, I would not even consider any value in APAP, except that the APAP can tell you what is happening to you, relative to the OSA during the night. I'd strongly suggest that you talk with your Dr. before you make any changes and, I suspect, he will tell you that it is not the pressure that is helping you as much as the oxygen AND the consistent delivery that you are getting via the pressure of CPAP 4.

Again, I'm not a Dr., and I encourage you to talk to your Dr. before you make and changes.

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CPAPopedia Keywords Contained In This Post (Click For Definition): resmed, activa, CPAP, DME, APAP

loonlvr · Post by **loonlvr** » Sat Sep 10, 2005 4:20 pm

Boy , this is an interesting one. It will be interesting to see what your sleep study says. I assume that they tried an Auto during the test and kept raising the pressure which didn't stop the apnea events. I would definitely find out if this is so. It may well be that you are experiencing central apneas which the machine cannot cope. Or your pressure is so high that it is inducing centrals. Let us know what the sleep test says about what pressures they tried. I agree that 4 for a lot of ppl is to low for even normal breathing.

rested gal · Post by **rested gal** » Sat Sep 10, 2005 4:44 pm

Lyn, if you can get hold of the complete results from your sleep study titration, not just a "summary" report, and post the complete results including a picture of the table of what pressures they tried on you during the titration....

Perhaps someone like deltadave will see it. He's a very experienced sleep tech with RPSGT and RRT credentials. He might have a better idea of exactly what went on there.

I'm not so sure that an autopap would have to be ruled out just because you're prescribed supplemental oxygen. I can recall at least one poster (2listless) on this board who uses an autopap along with oxygen bled in.

Lyn · Post by **Lyn** » Sat Sep 10, 2005 8:28 pm

I called & requested a copy of the results & hopefully will get them next week. Also, I have an appointment with the sleep Dr. on the 26th so should know more then.

WillSucceed · Post by **WillSucceed** » Sun Sep 11, 2005 8:13 am

I assume that they tried an Auto during the test and kept raising the pressure which didn't stop the apnea events.

Why would a sleep lab use an autoPAP during a titration study when the tech. is right there, operating the device while monitoring the sats., etc.? My understanding is that during the study, the tech. manages the pressures not leaving it up the an autoPAP to decide. Does not make sense to have an auto running the study if a trained tech. is there.

Or your pressure is so high that it is inducing centrals.

Can't imagine that a pressure of 4 would induce central apnea events.

It may well be that you are experiencing central apneas which the machine cannot cope

If Lyn was having enough centrals to create the low oxygen sats, would not the Dr. have prescribed a bi-level with a back-up rate? Lyn states that her AHI was 15 -not a hugely high number but, obviously high enough, combined with the low oxygen saturation, to be a problem. So, perhaps it is a case of fairly long central apneas -long enough that saturation is a problem. Adding in the oxygen would make sense, but so too would using bi-level with a back-up rate.
Just adding in oxygen does not resolve the issue of blowing off the CO2 and, blowing off the CO2 (exhaling) is crucial.

So, again, I'm not a Dr., and I really encourage Lyn to talk to her Dr. about this and get more info. I'm still inclined to suspect that Dr. thinks Lynn needs the oxygen and sees the CPAP of 4 as enough pressure to keep her airway open and, to give the oxygen a shove into her system. Shallow breathing during sleep, perhaps.

Boy , this is an interesting one. It will be interesting to see what your sleep study says.

I'd certainly agree, this is really interesting. My comments are just a guess based on what Lyn has posted. Hopefully Lyn, you will continue to get good treatment and also, will get more info/answers from your Dr.

loonlvr · Post by **loonlvr** » Sun Sep 11, 2005 12:40 pm

Boy guess i worded my response weird. Yea I know they wouldn't use a Auto, they manually raise pressures. As for cenrals, I meant that as they raised the pressure during test, it induced centrals.Is it a practice to use a xpap machine to help deliver oxygen?

WillSucceed · Post by **WillSucceed** » Sun Sep 11, 2005 3:23 pm

Is it a practice to use a xpap machine to help deliver oxygen?

Really good question. I don't know the answer. I still suspect that Lyn needs some pressure to keep her airway open AND needs the O2 as well.

barbyann · Post by **barbyann** » Sun Sep 11, 2005 6:57 pm

Lyn, I was wondering if there might be other causes for your low oxygen levels. Do you take any medication that might effect your depth of breath. Any painkillers, seizure meds, alcohol? My oxygen sats were 79% during my study and I also had a low AHI. I may be looking forward to oxygen myself soon enough. Been on APAP for a week now and feel no different during the day. I am having problems with the skin on my face breaking out with rashes. Yours is an interesting example. Please keep us informed.

loonlvr · Post by **loonlvr** » Mon Sep 12, 2005 5:01 am

Yes, plz do keep us informed. We LOVE new and interesting problems. Just sorry someone has to have them

Lyn · Post by **Lyn** » Fri Sep 16, 2005 6:10 pm

I requested copies of my sleep test, but all I ended up getting was a Summary of Results for the first study & nothing for the titration study.

Right off the bat I'm wondering how accurate the test was. It says I had a sleep latency time of 18.0 minutes. It's my understanding that sleep latency is the time it takes you to get to sleep. Am I wrong? Anyway, I started my test at 10:30 PM & didn't get to sleep til around midnight. And that's not a guess on my part. When the sleep tech was uhooking me the next morning she commented that she wondered if I was going to ever get to sleep "but you finally did about 12."

Anyway, here goes. Summary results:

Sleep Staging:
Sleep time - 367.5 min (? - see above)
Stage 1 - 2.6%
Stage 2 - 78.6%
Delta sleep - 7.1%
REM sleep 11.7%

AHI:
Total of 102 apneas & hypopneas with an AHI of 16.7/hour
Longest apnea - 77 seconds

SAO2:
Basal saturation was 92% with the lowest oxygen saturation recorded at 56%
82% of the patient's saturations were below 89%

Assessment:
1. Mild to moderate / Severe sleep apnea syndrome.
2. Severe nocturnal desaturations are noted

Also, I had an appointment with my internist Wed. & she wrote me a script for an auto cpap with no hesitation. Don't know yet if the DME will order it for me. They were to check & call me today or Monday. We'll see. If not I'll go to billmyinsurance.com.

I realize I probably don't need the apap, but I can always use it as a cpap & will have the option to try other things if need be.

Lyn

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

Sleepless on LI · Post by **Sleepless on LI** » Fri Sep 16, 2005 6:27 pm

1. Mild to moderate / Severe sleep apnea syndrome.

Anyone else find something wrong with this line? Can they just pick one, or maybe two? But mild, moderate to severe? What am I missing?

loonlvr · Post by **loonlvr** » Fri Sep 16, 2005 6:57 pm

Well, the oxygen desats are pretty severe, but the AHI isn"t. The apneas seem to be few but last a long time. Thats what I see anyway.

Lyn · Post by **Lyn** » Fri Sep 16, 2005 7:17 pm

Sleepless,

I agree about the Mild to moderate / Severe comment. But that is exactly how it reads on the summary.

As I said before ... I wonder about the accuracy of the test &/or report. Would like to have the full report, but I think I'm going to have trouble getting anymore out of this Dr than HE wants me to have. Decided I'm not going to worry too much about it tho cause, thanks to my Dr, I have my script for an apap & am going to order the software & with all the very helpful people on this forum hope to work it out myself.

My biggest worry is getting the oxygen level up so I can get rid of the oxygen machine.

Lyn

Sleepless on LI · Post by **Sleepless on LI** » Fri Sep 16, 2005 8:31 pm

Lyn,

Sounds like a good plan. APAP, software and this site. Who needs doctors? And I'm not being facetious or sarcastic. I really mean it.

Best of luck to you. I'm sure you're going to go great.