Resmed S9 or Respironics Something-or-other (confusing names

[Sleepy Pilot]

Thanks for the feedback. I really feel the power of this site and it is comforting to know I'm not alone in my battle. I will figure out how to post my Sleepy Head graphics in the morning.

[4betterO2]

There are indeed separate entries for PB and central apneas. They are 2 separate categories.

Can the entries for central apneas be seen on the screen of the machine itself, besides from the SD card? how are they labeled, "CAI"?

The concern for the OP is not the low PB% value, but the fact that it is increasing, and could be caused and worsened further by CPAP use. I would think periodic breathing causes hypopnea...?

The ASV machine is designed both for Cheyenes-Strokes and for periodic breathing, see the first page of this Respironics Titration Guide:

Shttp://www.healthcare.philips.com/asset.aspx?a ... otocol.pdf

[4betterO2]

I do believe I need to be far more proactive in my therapy

It's a 2-way street, I hope you have a sleep doctor who returns phone calls personally, if not I hope you can find on who does, and thus can call the DME with a Rx change after talking to you on the phone. Saves much time and $! It allows you to get a quick change if you get a new setting that is uncomfortable, etc. It does take time to fine-tune the settings, it is really an individual thing. Especially if you do move to a BiPAP solution (Respironics 760), the auto-titration of the machine does not work well for all patients, different manual settings may need to be tried, so then having a good phone dialogue situation with your doctor is very precious: any Rx-dependent change on the machine such like, pressure, must be ordered by the Dr., and there may not be an appointment available soon enough, for you to come for an office visit...
Hope you keep in mind the alert I wrote earlier, I'm still encouraging you to watch closely you PB %, etc., due to your occupational urgency...
Good luck!

P.S. received these links you might like, from -SWS in the ASV thread:

btw do you now a link to technical/clinical training material for the ASV?

This clinical document is a PDF file: BiPap autoSV Advanced-- System One clinical applications guide. That's the only clinical training material for your machine I know of. But I bet there's plenty more kicking around out there for professionals. You might ask your DME for a copy of the clinician's manual or request one here: http://www.apneaboard.com/adjust-cpap-p ... tup-manual.

[Pugsy]

The concern for the OP is not the low PB% value, but the fact that it is increasing, and could be caused and worsened further by CPAP use

3 to 4 to 5 % of time spent in PB doesn't mean anything byself.
How have you determined that use of cpap has made things worse?

Yes I know ASV machines are designed to help PB but no one has shown one bit of data that points to PB being anything that bears concern.

I am too ill to go find all the examples that I want to show you that might help you understand that while I appreciate your cocern.....it just too soon to grab up everything and dump in in an ASV basket because of some unevaluated PB.
Trust me...I understand where you think you are needing to come for but you are rushing things. You need to know the whole story.

We need to see the actual reports....then we can toss around pros and cons of other treatment modalities.

[4betterO2]

@ Pugsy:
Sorry to hear you are so ill. I admire you for giving so much care to the board to help people, when you are in that situation. Best wishes for your health!

[Sleepy Pilot]

Hey Gang,

I'm looking at Sleepy Head trying to determine what to post. Which graphs would help you see data? I have noticed that I am feeling less rested each consecutive day and just wonder why. I am not looking for a diagnosis, but merely more knowledge about my condition so I can have a more educated conversation with my doctor on Feb 4th., my next appointment. Any opinions, comments or ideas will be taken as such and I will leave the actual diagnosis to the doctor. The hospital states he practices in Internal Medicine, Pulmonary Disease, and Sleep Medicine, so I feel he may be able to help me. This will be my first face-to-face appointment, both previous times have been ten minute phone calls for the diagnosis and prescription.

Does this tell you anything about last night?

[Sleepy Pilot]

Pugsy, are you feeling any better today?

[Pugsy]

Pugsy, are you feeling any better today?

Hit or miss. Mostly miss. The upper respiratory flu has morphed into a stomach flu. Double whammy.
Thank you for asking.

I like to mainly look at the events graph, the flow graph, the pressure graph (if auto adjusting pressures are used) and the leak graph. Maybe snores if they are very exciting.

Question....how is your sleep been? 5 1/2 hours....not enough hours of sleep for one thing. But for being new to all this therapy probably not bad. I think it took me 6 weeks to work up to 4 or 5 hours.

Were you asleep pretty much during the 5 1/2 hours on this report or was there some time where you were maybe awake?
Do you find that you wake often during the night for any reason?

If you were asleep most of the time then it appears that your pressure is not quite optimal (assuming your other reports look similar)...meaning it is allowing those little clusters of obstructive apneas and hyponeas to happen. Probably related to supine sleeping and and maybe REM stage sleep.
Both are common.

Centrals (clear airway events) don't seem to be an issue. Mainly plain jane vanilla OSA.

Things to work on...
1....hours of sleep.....the machine can't work its magic on 5 hours of sleep.

Talk to your doctor about the elevated AHI...it's a little higher than I would want to see and from my own past experience with clusters just like yours...they can impact how a person might feel more so than a person might initially think.
Either a little more cpap pressure or utilize APAP mode and let the machine try to do a better job preventing the clusters.

If you are having trouble getting the hours of sleep...talk about it and try to figure out what the problem might be.

Mainly you need time, patience and maybe just a wee bit more pressure.....and experience.

[4betterO2]

This will be my first face-to-face appointment, both previous times have been ten minute phone calls for the diagnosis and prescription.

Just to make sure, are you saying you did not have a sleep study, including a titration study?

I have noticed that I am feeling less rested each consecutive day and just wonder why.

As for myself, I could not expire against an EPAP pressure of 10. You have to use your chest muscles much harder than normal to achieve that. Maybe that is a factor in your tiredness?
You might benefit from having differential IPAP and EPAP pressures. (In the PR line, the current machine for that is the BiPAP Auto Bi-Flex 760, though there might be a cheaper one that does BiPAP but without doing its own auto-titration).

[4betterO2]

Did you know that awake breathing can fool the machine real easy and flag green PB bars all over the place and it means nothing because the person was awake?

Very interesting.
How does the machine know you are awake?
And in what ways does awake breathing differ from breathing during sleep?

[Pugsy]

Very interesting.
How does the machine know you are awake?
And in what ways does awake breathing differ from breathing during sleep?

The machine doesn't know if you are awake or not. It just flags it like it sees it.
Awake breathing is much more irregular than asleep breathing. Assuming that someone doesn't have some sort of lung disease or other respiratory problem we can't put any stock into awake breathing irregularities that might get flagged.
It's called sleep apnea for a reason. Not awake apnea.

[4betterO2]

the doctor. The hospital states he practices in Internal Medicine, Pulmonary Disease, and Sleep Medicine, so I feel he may be able to help me.

if you need to change to a more expensive machine, yours should be on a rental basis, thus it should be no problem to exchange it for anothe type, the monthly charge will stop and be replaced by the one for a new machine.
As far as insurance coverage, I'm concerned if you did not get a sleep study in an accredited sleep center, and if your doctor is not a board-certified sleep specialist (or neurologist, I forgot what they require), "practicing" may not be enough here.
You might want to check about all this if you want to make sure your machine will be covered.
Good luck!

[archangle]

Did you know that awake breathing can fool the machine real easy and flag green PB bars all over the place and it means nothing because the person was awake?

Very interesting.
How does the machine know you are awake?
And in what ways does awake breathing differ from breathing during sleep?

One of the reasons you need a CPAP machine with airflow waveforms is to help figure this stuff out. With a little practice, you can sort of tell with some of the apneas. You're probably not going to hold your breath for very long if you're awake. With some experience looking at your waveforms, you can also often see a degree of roughness to the breathing patterns when you're awake that will give you a clue.

Don't overstress about breathing flagged as PB, unless it's bad. Bad would be in terms of large percentage of the night, and in terms of how low your breathing rate gets in the valleys, and how long the valleys last. There are some feedback mechanisms in terms of O2 and CO2 in your lungs and body. Sometimes, there is sort of wavy pattern to how this works, and it's not necessarily harmful if it doesn't get too deep.

Some people have PB/CSR bad enough that it does cause problems in terms of oxygen levels and sleep disturbance.

[Sleepy Pilot]

4betterO2,

Yes, I had two sleep studies before I received a prescription. Both were at the hospital's sleep disorders center. The first study was monitoring only. The second was a titration. The doctor and DME seam uninterested and quick to throw a prescription at me and move on to the next patient. That is why I believe I need to be more proactive. They were surprised when I insisted on getting my titration study results. I'm still trying to get the results of my first study and the actual prescription. It is making the DME nervous.

[4betterO2]

I'm still trying to get the results of my first study and the actual prescription. It is making the DME nervous.

Sorry to hear that!
The doctor or his nurse should print out the 2 study reports for you.
The DME should print out the Dr's orders for the machine, it includes the Rx.
It's your body, your health, insist on getting these. Your new doctor will need them too.
But the Rx shows also in the settings that you can see on the machine screen, as long as the DME faithfully followed the DR.'s orders.

It's very important to have a good relationship with your DME, I hope yours will improve because the DME does have a clinical role besides the Dr. There are settings on the machine that are set only by Dr. Rx, others that are set and can be changed by the DME.
Best wishes for your FAA situation.