So here is that discussion....and I will go try to find some report examples in my old files.
Copies of my daily detailed reports. Documentation of clusters of events requiring higher pressures than usual. Higher pressures unrelated to leaks that might drive the pressure up.Papit wrote:Also, you might explain how the Autoset is useful, and why you need it, for "variable pressures" in REM. What was it in the printouts you brought in that showed that the Autoset set for Auto was beneficial for your needs?
I might have some old images somewhere I will look later. Rather than hijack this thread I will point you to the in one of my threads or put some of those images in one of my threads.
Bear in mind that I am documented worse in REM sleep..pretty significantly.
Diagnostic sleep study my non REM AHI was a mere 12 but in REM sleep I had a 53 AHI with desats to 73%. No apparent different in sleeping position though.
While the machines don't/can't really tell us sleep stage...it is fairly easy to see the pattern of clusters and compare those clusters with typical times of REM stage sleep from normal hypnograms.
For the bulk of the night my minimum of 10 APAP would maybe go to 12 or so but sometimes, especially in the wee hours of the morning when REM sleep is longer and more frequent, I would need 16 to 18 cm of pressure. It was reports showing these ups and downs along with my REM history that easily convinced the doctor that APAP was appropriate for me. I did well on APAP. I never knew those 18 cm pressures were happening till I saw the reports..so pressure changes never disturbed my sleep.
While it is common to have more events in REM sleep than in other sleep stages not everyone happens to need a higher pressure with some of those events.
Why did some events in REM require higher pressures and not all REM events? I have no idea.
I do know that I spent 2 months sleeping exclusively on my side to see if supine sleeping was a factor but it did not seem to matter.
Why from APAP to CPAP? For some reason any pressure changes in APAP mode can be disturbing to a person and actually wake them up. Anything that disturbs sleep is unwanted. If someone is prone to centrals APAP with a wide range is not advisable.
Why go from CPAP to APAP? Maybe someone does need more pressure on their back and they don't want to or can't sleep exclusively on their side. In my case REM super duper strong events. I could use CPAP....I would need much higher constant pressure to address those super duper events. I don't want to use 16 or 18 all night long when I might only need those pressures for maybe an hour or less here and there. Using those higher pressures all the time increase chance for aerophagia, maybe centrals and for sure is like sleeping in a wind tunnel. Comfort......hugely important in quality of sleep. If I chose to use less pressure in CPAP mode and just let those super duper REM events happen....I could do that but with a history of desats to 73% I don't really want that risk.
So for me...APAP worked well. I am now using bilevel in auto mode and yes...I still see some increases in pressure above my normals that probably are REM staged increases.
Does it work this way for everyone? Of course not. We are all individuals and have our own quirks and needs and as such we each have to find the path that best suits our own individual needs. Just because I happen to need and/or use auto adjusting pressures doesn't mean that everyone else should.
Finally, one last comment about APAP vs CPAP. With this therapy the mind is a powerful drug.
If someone really is curious about APAP and they read remarkable success stories...the APAP bug bites because everyone wants the "best" and if they don't think they have the "best" their mind can play tricks with them. So I think that if someone wants to try APAP and they have no medical reasons to contradict its use..I don't see the harm and it might let the mind work its powerful magic and they feel better because they are using the "best". In reality...best is only what works for the individual. APAP is no more better than CPAP for some people. It is nice to have it available though...just so that particular itch is scratched.
