APNEA -v- HYPOPNEA

Wulfman · Post by **Wulfman** » Fri Jun 30, 2006 8:45 am

Congratulations, Chuck!
Some people do better with fixed pressure and some do better with a range.
Same thing with the pressure relief (EPR or C-Flex). Sometimes it takes awhile to see what works best for YOU.

Hope those numbers stay low for ya.

Den

Rastaman · Post by **Rastaman** » Fri Jun 30, 2006 9:05 am

[quote="GoofyUT"]Well, its now 8:30 and I just woke up. I FEEL GREAT! My AHI was 2.4, AI was 0.4 and most importantly, my HI was 2.0, my lowest ever! Usage total was 8.9 hrs. I tried a CPAP trial at 8.0 cmH2O/no EPR/30 min ramp.

Now, I'm loathe to proclaim miracles after one night, but I feel really refreshed despite my couple of hour wakeful interval. And, I'm pretty sure that I actually dreamt!. All in all, a GOOD night's sleep.

Regardless of whether this is a fluke or not, BRAVO SWS et. al.!!!! You have my DEEPEST THANKS!!!!

Chuck
[/i]

Hmmmmm. I was at 5.5 AHI last night. Your results are starting to intrique me. And from what I've been reading an APAP can actually cause your AHI to be higher than it would be otherwise with straight CPAP only. I'm wondering what your numbers will go to if you use EPR. If they are about the same then that feature could be turned off. But if they're worse numbers and you actually 'feel better' without EPR, this too would be intriging. No?

I've resolved myself to give feedback on only the machines and masks I've used and not very much feedback at that because others can word it better and have more experience. Which puts me into the "reader" catagory and by that I mean that I'm just reading what applies to me or could apply to me based on the S8 Vantage and the Activa mask only.

Guest · Post by **Guest** » Fri Jun 30, 2006 1:19 pm

Chuck:

Glad it worked out for you. As mentioned that 1cm pressure can make a huge difference in how one feels. It is very hard for them to capture this data in single night's titration study in a lab unless the lab tech you have is dedicated and very experienced. If they have more than a couple patients or a split-night study their time is even shorter to spend with you.

I really wish Resmed or someone else like Derek would rework Resmed's reporting capabilities. While having the ability to display 95% pressure, AI and HI information from the LCD is a very nice feature to have, it doesn't tell you the whole story of what happened immediately before or after a pressure increment.

Those factors can be very important if the machine you are using "triggers" on a particular event and that event determines your 95% pressure while masking others. Had the reports given you the data you needed, you would have spotted that sweet pressure dip at a much earlier. While Resmed likes to boast how good their algorithm is, it is not perfect as you have found. Not to beat up on them, it is just fact. It is a machine and we are human.

I only knew about this because I have owned all the different autopap machines along with their reporting software all at my own expense. As mentioned, the Remstar EncorePro reports seem to do a better job at displaying these progressive trends so it is much easier to spot complex breathing patterns on those machines than on others. The P&B 420's Silverlining software is very good also. But I found it functions similarly to the Resmed as it relates to snores.

My opinion there is nothing better than seeing those columns of pressures listed at the top and the number of "each" event seen directly under it. You can see from my report yesterday that snores increase with pressure.

WHY? because my snores are palatal snores or snores caused by air moving over the flabby tissue of my soft palate. When I inhale air comes in the nasal passage and over the top of that palatal tissue, it vibrates and creates the snore.

Same thing happens when CPAP air moves over that tissue it only creates MORE snores. So when you use a snore killer machine like a Resmed Spirit or like your Vantage that "triggers" heavily on snore, the machine seems to concentrate all its efforts only on those snores and increases pressure to eliminate them, which only makes it worse if you have other events like hypoapneas that increase in frequency with higher pressures. As far as the autopap algorithm goes there is not much difference between a S7 Spirit and your S8 Vantage, the triggers are basically the same.

SWS can attest to this, my very first night on the Spirit it went nutso and shot up to 16cm or the limit I had set. My pressure was only 9cm. I thought the thing was broken until I learned how it functioned. Very good machine, it just didn't work for me.

Not all auto-paps are the same. There are day & night differences between ALL the available auto-paps on the market, the difference is how they respond to YOUR particular SDB events. For me, the Remstar Auto has always worked better because its algorithm for snore is DIFFERENT, basically it does informational pressure tests and if it doesn't see a reduction in the number of SDB events it backs off pressure which in my case is the right thing to do.

Glad you finally found your sweet spot, just leave it there for awhile and don't worry about too much. I know you've had a heart attack and I've had a couple strokes, most likely do to untreated OSA, that in itself can create a lot of anxiety as you want to make sure you are being treated properly. You can live life worrying about it or just live life.

My suggestion for you is to ask your cardiologist for a note to use a overnight pulse oximeter to check your levels with these new settings. This way you can see if that 8cm pressure is keeping your oxygen levels up during the night which is more critical to you than I. I suspect it is but you'll feel better knowing it. The Reslink module might be another option but it is very expensive for what you get and I doubt many use it every night. I believe that is more a diagnostic tool for home titrations than a monitoring tool. Millions of PSG titration studies have shown very low cpap pressure can restore normal oxygen levels with adequate lung and heart function.

GoofyUT · Post by **GoofyUT** » Fri Jun 30, 2006 7:39 pm

Thanks for your thougthtful post. I understand the limitations of the ResMed algorithm particularly for those that are sensitive to TOO MUCH pressure. But, i had a good night last night on a CPAP trial, and I intend to , as you suggested, JUST LEAVE WELL ENOUGH ALONE. I'm gonna stick with 8cm/noEPR/30 min ramp for awhile and just settle in. I'm not horribly worried about my MI. I was very fortunate to identify it, get to the ER and into the cath lab so that they could revascularize it within a very short time, so my EF remains very high.

I DO want to measure my oximetry more closely. I'd really like to try ResLink to correlate events and pressures with sats. But if not, then I'm going to buy one of the new SPO wrist-oximeters and use the oximetry software as best as I can with AutoScan.

Anyway, lets hope that tonight's adventure is, at least, entertaining.

Chuck

Snoredog · Post by **Snoredog** » Fri Jun 30, 2006 8:43 pm

that was my post above Chuck and in response to SWS, this site doesn't keep me logged in very long. SWS, Perry, Ted (titrator) and I go back quite a few years before this site ever started. In fact I remember when RG just started

GoofyUT · Post by **GoofyUT** » Fri Jun 30, 2006 8:56 pm

You know, I figured it was you! I don't know anyone here who knows the soul of a ResMed as well as you. So once again, thank you so much for sharing your wisdom and experience with me, and I look forward to getting to know ya better as the journey unfolds.

You have my gratitude.

Chuck

GoofyUT · Post by **GoofyUT** » Sat Jul 01, 2006 7:23 am

Second night of my 8cm CPAP trial, again, no EPR/30 min ramp.

AHI=1.9, AI=0, HI=1.9 (Personal Best!!!)

I think I'm on to something here!!!

Chuck

P.S. Thanks so much SWS, Snoredog et. al. AMAZING wisdom!

Rastaman · Post by **Rastaman** » Sat Jul 01, 2006 7:59 am

Holy cow! That's great GoofyUT! Keep up the good work. I think you ARE onto something here. And with previous heart issues I'm sure you're a bit relieved on some level. Plus feeling better. And that was the problem wasn't it? Not feeling well.

I never knew these things were called snore killers. Interesting. I'm still plodding along myself. I'd imagine once one has years of experience they start to get a much better feel for all of this. I wonder where I will be around the 6 month mark. So far, my pressures are slightly lower using the Activa than the Swift and I'm getting closer to the ever-allusive 5.0 AHI. Last night was 6.0 and pressure of 15.6 My AI was 0.6 so my HI was 5.4!

I AM starting to wonder if "I" should try a fixed pressure just to see if I can bring those numbers down. I can always go back to 8 to 17. It's easy to set.

bbeck4x4 · Post by **bbeck4x4** » Sat Jul 01, 2006 8:01 am

and to think without the software you would have most likely tossed the whole xpap in the closet and decided that "it dosen't work for me" as so many have.

Glad to hear that you have solved a major issue, keep up the good work,
My wish is that my doctor would have been as concered to my complaints as well.

oh well,

Brian

GoofyUT · Post by **GoofyUT** » Sun Jul 02, 2006 8:45 am

So, this time, I WILL proclaim it a miracle!!!

I decided to visit my DME yesterday, and picked up an Activa, after reading MANY posts here from Swift users who have had good results switching off from time to time between their Swift and an Activa. Now, I started xPAP therapy with an Activa that I'm pretty sure was used and that a TERRIBLE RT from my DME threw at me when I first started and had my head spinning.But, I switched into the Swift a week later, since I was having claustrophobic fits with the Activa, which in retrospect, were just newbie growing pains. Plus, it had the "large" cushion, and didn't fit great.

Thanks to the AMAZING Rested Gal, I tried the shallow cushion at the DME's. It felt OK, didn't seem to leak much, so I took a brand new Activa in shallow home with me. I was pretty desperate for a miracle that would JUST LET ME SLEEP THROUGH THE NIGHT, fer chrissakes, and I was picking at straws that maybe this would be it.

It did. I SLEPT THROUGH THE NIGHT FOR THE FIRST TIME SINCE STARTING xPAP! AHI=0.2;AI=0.0;HI=0.2!!!!!!! BEST EVER!!!!!!

Now, I continued with my CPAP trial of 8cm/noEPR/30 min. ramp, and I'm SURE that this has a lot to do with it! But how could a mask make SUCH a difference? I mean, I've always loved my Swift. Its been plenty comfortable, and I've had no leaks or mouth-breathing problems. But in switching back to the Activa, I hit a GRAND SLAM!

Well, I for one, ain't gonna look a gift horse in the mouth, and I just pray that this continues.

Thank you all once again for your friendship and support throughout this journey!

Chuck

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CPAPopedia Keywords Contained In This Post (Click For Definition): activa, swift, newbie, CPAP, DME, AHI, Ramp

Sleepless on LI · Post by **Sleepless on LI** » Sun Jul 02, 2006 9:18 am

Chuck,

May this be the first of many nights. Congrats!

-SWS · Post by **-SWS** » Sun Jul 02, 2006 10:04 am

By Jove, Chuck, I think you've got it!

So glad to hear everything seems to be falling in place for you!

GoofyUT · Post by **GoofyUT** » Sun Jul 02, 2006 10:28 am

SWS-

I'm, needless to say, THRILLED, and I remain indebted to you for your persistence in helping me through this journey. I've also learned so much, particularly with regard to CSDB and the prospect of hypercapnic triggers.

Now, with all due respect, how could a mask change make SO MUCH difference particularly when the Swift was working so well (at least by the numbers)? I had virtually no leak with the Swift (most nights, leak stats of <0.02L/s), and no discomfort so my compliance was high (>8.5 hrs/night). But, I was sleeping poorly with the Swift, and slept wonderfully last night with the Activa. Again, no leaks. So, is there some way that 8 cmH2O through a Swift is different than 8 cmH2O through an Activa?

Chuck

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CPAPopedia Keywords Contained In This Post (Click For Definition): activa, swift

bbeck4x4 · Post by **bbeck4x4** » Sun Jul 02, 2006 10:57 am

Myself after switching back to the activa, and sleeping through the entire night, plus a 10 foot hose, I wake up in the morning with the hose wrapped around my neck or upper body, what I am doing tossing like that who knows, but I'm sleeping great. I'm glad that I have the extra length

Brian

Guest · Post by **Guest** » Sun Jul 02, 2006 11:43 am

[quote="GoofyUT"] Now, with all due respect, how could a mask change make SO MUCH difference particularly when the Swift was working so well (at least by the numbers)? I had virtually no leak with the Swift (most nights, leak stats of <0.02L/s), and no discomfort so my compliance was high (>8.5 hrs/night). But, I was sleeping poorly with the Swift, and slept wonderfully last night with the Activa. Again, no leaks. So, is there some way that 8 cmH2O through a Swift is different than 8 cmH2O through an Activa?[/url]

Chuck, that's an interesting question. At this point I am of the very strong opinion that you, indeed, manifested machine-induced CSDB. If so, that left you with diametrically opposed pressure requirements for concomitant SDB etiologies. We also know that CO2 levels can mediate the central (and machine induced in your case) SDB components. Thus in answer to your question about what a difference those two masks might make, I will yet more mad conjecture on my part. I suspect the difference between those two masks for the vast majority of xPAP patients is negligible regarding AHI deltas. However, for some CSDB patients (within a certain envelope of hypercapnic respiratory trigger), I suspect even a subtle difference on CO2 retention can be enough to mediate a slight CSDB tendency such as yours. The Activa has significantly more dead space than the Swift, and dead space can influence CO2 retention at least as much as exhaust flow through.

You just may be a very lucky CSDB patient on three counts, Chuck: 1) your machine-induced CSDB (if, indeed, you have it) seems relatively mild, 2) you were thus able to achieve an adequate therapeutic pressure with your concomitant SDB etiologies---each having diametrically opposed pressure needs, and 3) your hypercapnic respiratory trigger threshold seems to be within a range/envelope that offers at least partial mediation by a slight change in CO2-retention mask characteristics. Now this, as with everything I've speculated about in this thread regarding CSDB is purely theoretical on my own part. However, at this point there is just not adequate CSDB research for confident scientific conclusions regarding your case, Chuck. Fortunatley it seems that practical conjecture and, most importantly, trual and error has been your very good friend this summer, Chuck.

APNEA -v- HYPOPNEA

Re: Update (redux)

Thanks for your post!

Thank you

CPAP trial, 2nd night

Its a MIRACLE!!!

Thank you!

Re: Thank you!