Respironics Omnilab advanced - 2cm pulses - is it normal?

[echo]

Muse, DD gosh your posts made me think of a lot more things, but I won't go into detail (yeah right, no wait i really will try to bite my tongue this time )

smell sensitivity, check - me too. I'm also - ah- sensitive to criticism/being made fun of. No imaginary friends either .
Light sensitivity too, especially to the TV at night. My skin is a lot more sensitive to stuff too (luckily not to the 3M tape for mouth taping), but that's only in the last 10 years, before that I had no problems with my skin. _Although_ I used to be (and probably still am) allergic to normal 'soap', i get the itches from hell. I also hate , absolutely hate, scents/perfumes/aftershave. I hate air-co and drafts, but I'm wondering if that's not the hypothyroid.
I used to be pretty manic (-depressive) when I was younger, now I'm still pretty wired but that only lasts for a few hours anymore, now I am just too tired to stay wired the whole day. Actually I think the CPAP has helped smooth that out, plus getting more patient as I get older.

HFCS - been allergic (intolerant) to that too! Also brewer's yeast, sugar, chocolate (thankfully not anymore), that's all I can think of right now. The wheat was really the dominant one. I eat it now, but probably shouldn't.
When I slept pre-CPAP, i was like a rock too, nothing could wake me up. Now with CPAP i can wake up, but lately have been sleeping much again. Hungover feeling in the mornings, i think it's the GERD.

Alternative idea on the wheat/grains/peanut allergies: it could be due to the mold that lives on the grains and nuts, rather than the foodstuff themselves. I had done quite a bit of reading on that years ago, but it's probably still relevant. As food gets contained and shipped far distances, the mold has longer to build up. The FDA?USDA? (I forget) has guidelines on acceptable levels of molds on foods, but many times the measured values of the foods on the shelves exceed them (there was one about peanut butter for example).
I'm not a big fan of GMO goods either, but I don't have enough info to say either way whether it might be responsible for allergies (i wouldn't be surprised though).

DD- good question about linking the central's with the o2 levels. But even if o2 levels aren't decreasing, what does that say about arousals? I wish we could have in-home mobile EEGs too!

Random question: I've noticed that on my pulseox, although there are no desats and heart rate seem fine, I've noticed that my heart beat tends to start off faster, then drops to around 60 (or a bit less), then goes slowly up to 70, then a few hours later drops back down again and starts to rise again. SPO2 seems to remain stable the whole time.
Is this pattern normal? Is there a correlation between BPM and sleep stages?

Another random question to muse and DD: What are your breaths-per-minute while sleeping?

[Big Daddy RRT,RPSGT]

Apparently they were using an auto mode during an attended sleep study. Either the tech didn't know how to shut this feature off or was using the auto mode (lazy) and was unaware of this "pulse" feature. I find the pulse annoying too. My S9 gives a more subtle high frequency pulse that doesn't seem to bother me.

The pulse is only a feature on the newest Auto titrating units. It is an improvemnt because it can differentiate between closed airway apneas and open airway apneas. High pressure can cause open airway apneas (central apneas), closed airway events (obstructive apneas) require more cpap pressure.If you get a standard single pressure machine you will never experience this. Also older Auto units don't have this technology (Fisher-Paykel Sens-awake Auto for example). The problem is if you have "central apneas" using an older auto you will get increases in pressure that you may not need. The Fisher-paykel has a feature that allows you to set an upper limit where it ignores apneas altogether to prevent this from happening but then it may be less responsive to your respiratory disturbances above this pressure.

I would contact the sleep lab administrator and complain. They may give you a repeat sleep study for free. If they refuse explain to your sleep Doctor how they were using an Auto CPAP during an attended sleep study and he (or she) will probably hit the roof and insist on a free sleep study for you. (Our sleep doctor would). Anyway get a repeat CPAP titration or try an Auto CPAP obviously do not get the Resperonics System One as it will have this "pulse feature". Good luck.

[Muse-Inc]

...current sweet spot of 10.4....Spo2 as an indicator too...a lot of cross-over between...hypothyroidism, diabetes and sleep apnea.

Curious my 95thcentile is 10.4 and has been all this yr. And the more I read the more the crossover is pretty tight.

[echo]

Once this hypothryoid issue has been all rsearched up (thank YOU muse-inc!) we should write up a wiki article on it....

I'd also like to start doing some reading/research on this topic but other things are preoccupying my time at the moment. Once you reach a natural stopping point in your research, or in the coming few weeks whichever comes first, Muse, will you share your results with us?

My sweat spot is 10.5 but I can't do 0.2cm increments, only 0.5cm.

[DreamDiver]

... I've noticed that on my pulseox, although there are no desats and heart rate seem fine, I've noticed that my heart beat tends to start off faster, then drops to around 60 (or a bit less), then goes slowly up to 70, then a few hours later drops back down again and starts to rise again. SPO2 seems to remain stable the whole time.
Is this pattern normal? Is there a correlation between BPM and sleep stages?

Another random question to muse and DD: What are your breaths-per-minute while sleeping?

There's probably a lot of variability as to what's normal. Mine starts out around 70 as I'm getting to bed, then ramps down to under 60 for most of a mask session. Then back up to 70 or more, depending on whether I get up for a bathroom break. Your overall pattern may be normal.

Almost always 12 breaths per minute during what looks like normal-for-me sleep, I think. Of course, apneas throw that off sometimes.

Muse-Inc. - I'm currently trying 9cm pressure and have been since the study on Sunday. My sleep lab showed no events at 8 or 9, and only one hypopnea at 7cm. The lab report suggested 9 cm, so I'm trying it. The thing is, I'm still seeing centrals on my machine at home, though not as many as at 10.4. Still no obstructive apneas at all. Obviously the method for recording types of apnea are drastically different between the S9 and the XLTek sleep scoring software used by the lab. I can't say I'm sleeping any better than at 10.4. But I'm not sleeping any worse either. Weird. I still have the headaches, etc. I'm not entirely convinced SpO2 at the finger is the same as SpO2 in the brain, though under normal circumstances I would imagine blood vessels elsewhere would begin limiting flow in order to prioritize blood to the brain and heart if desats go too low.

The lab manager confirmed that she had not known there was a 2cm 'clear airway apnea detection' pulse and that she would be asking the Respironics rep about it on Teusday.

[-SWS]

I know you asked DD these questions -SWS but I'm going to answer anyway
For what it's worth.... I remember that from my sleep study we conjectured (translation issues) that I also had a lot of spontaneous arousals. I also have a high breaths-per-minute (will that be on the poll too -SWS?) but only at night (I think). During my titration I had only 202 minutes of sleep time including 14 minutes of REM, and AHI of 11, but 30 arousals+awake index, with 28 changes in sleep state and 3 min in Stage 1 sleep. During my initial PSG I had slightly more arousals+awake (38) than AHI (35), and most of my AHI are actually H's and those are mostly in non-REM sleep.

-SWS start the poll & thread..maybe collectively we can share ideas and come up with some things to try to help each other.

Alrighty... I'll launch that thread Friday for sure... I'm hoping we can share tricks and tips for sensitive sleepers at the very least!

Echo, I'll be sure to fit something in about breath rate. Anybody have other ideas for that thread?

[alstatan]

Do you still need help with this? I am an RPSGT and I have some contacts that might be able to shed some light here. I can ask them this directly if you still need the help. I looked over this whole thread and I can confirm that this feature is not one we have been notified of. And I am sorry your tech couldn't find the manometer

[DreamDiver]

Do you still need help with this? I am an RPSGT and I have some contacts that might be able to shed some light here. I can ask them this directly if you still need the help. I looked over this whole thread and I can confirm that this feature is not one we have been notified of. And I am sorry your tech couldn't find the manometer

Alstatan,
Thanks for your reply. It's been quite a number of months since this happened, but other forum members on other threads have also found similarly. It's not a 'bug', but rather a 'feature' of the newer Phillips Respironics (PR) line of machines. The tech did actually get a manometer out after first suggesting they didn't have one because I suggested something along the lines of, "Come on, you know there is no way any decent sleep lab is going to be without a reliable manometer. Do you want to see what's wrong with your machine?" She actually bent over backwards to help. Sleep Techs are the backbone of the industry, and without them the whole thing would fail. We tried lots of things, but nobody - not her, not the lab manager, not the PR rep - seemed to know how to turn it off. From what I've heard, there's really not a lot we can do about the current versions of the OmniLab Advanced, unless the firmware can be reprogrammed by PR with the feature to turn it off. It's unfortunate that this algorithm acts as a wake cue for me and plenty of others. Perhaps the best that can be done is to report it to your PR rep as a real problem. If the machine that's supposed to be titrating the patient also intentionally acts as a wake cue, you can see why the titration results will be entirely skewed - perhaps even wrong - using the Omniab Advanced. That means thousands of people are being misdiagnosed. I cannot understand why PR would include the feature in the first place if the machine is meant to be used in coordination with eeg and belts that do the job of central detection anyway. At the very least, it should be designed to turn off in a lab setting.

Modern PR machines work great for some people and not for others. For me, the entire PR line of machines act like a slap in the face. C-Flex/A-Flex is intrusive and causes racing breathing and sweating. Clear Airway Apnea Detection slaps me awake. The PR algorithm is wrong for me. For others, this algorithm is exactly what they need. While I suspect the ResMed machines tend to be more conducive to sleep for most people, there are some for whom ResMed algorithm is likewise disturbing. All labs should be familiar with and use both brands of titrating machines to work with the patient. Anything less is a disservice to the patient.

Here's how you can help:

• You can test your machine yourself. Check it out by putting it into System One auto or elite mode. Hook it up directly to your manometer with the mask attached to a T connector on the other end. Hold your breath for ten seconds after establishing a normal breathing pattern. You should see several 2cm pulses several seconds apart. You should also be easily able to feel it.
• Show your lab manager the problem.
• Show your PR rep the problem.
• Make sure you have two or more brands of titrating machine in your lab and be familiar with their quirks.
• Try to notice when a patient is obviously not sleeping well with a particular algorithm and switch out to another brand to see if the patient will sleep better with that algorithm.
• Keep notes about which brand/algorithm is most therapeutic for the broadest number of patients and use that one most of the time, but also use the other one(s) where you think they would serve better.

[tetech]

It happens to me whenever I breathe slow.
THE ANSWER IS: I have been an electronics repair tech for 30 years, so I just called Respironics Tech Support (Ray) at 1-800-345-6443 menu option 1, 4, 1 on this. Ray says a firmware update will solve this exact issue. He does not know which serials have the old firmware (cpap.com replaced it 3 times early on, but back then the buggy firmware was the same in the replacement units), so if it happens ask for a firmware update. My RMA this time is RT25106.

[KB0RAE]

I just had a sleep study done on Saturday. My first one. I don't use a CPAP yet but they did tell me I would be getting one. They used the Omnilab Advanced System One. I was impressed with the machine, but not the way they used it. It worked real good for the first six hours. Then I got the 'SLAP' on-off every two seconds (or less) that woke me up. It almost put me in a panic. I called the attendant and he did say he turned on that mode. I told him I could not breath that fast. He tried to say it had been on that mode for a while, but the way I woke up, I don't think so. I think it had been on for only a few seconds. He said he would increase the time between pulses and I was able to sleep some more even tho the time was still too fast for me.