xpap with nightly results

Hi all
I have been on a bipap for a couple of months now. In the sleep studies I have had, the techs could not find a pressure to control my apneas. Would an autopap machine be advisable, considering that it sets its own pressure depending on the current needs of the user. Within user set limits. Are there any of the machines which display the nightly results on the screen of the machine? What can a person say to convince the doctor that self monitoring of the nightly results is in fact beneficial? The way it is I wake up several times during the night, I am very drowsy all day and can fall to sleep at any time I slow down for a minute or two. I have no idea why, pressures, leaks or what.
It seems that when I do drop off to sleep during the day, like when I try and read, that I go immediately into a dream and then my body jerks REALLY hard and I snap awake. No idea the cause. I was thinking that it took being asleep for awhile before dreams started. Any ideas??
Any comments and or help is appreciated.
Thanks
Dave

NoSleep - that sounds like me - my titration study recommended 23/23 on the bipap, but suggested that since I didn't sleep on my back at all during the study that I might need to go higher. Now I don't know how thay can cime up with these recommendations - the Respironics BiPap is the only xPAP maching I know of that goes higher than 20, and it only goes to 25.

If you have the Respironics BiPap Pro 2, I recommend investing $200 in the smart card reader and Encore software. The reports it produces for the BiPAP will give you some idea what is happening. It will show when & if the apnea events are occuring and for how long. That may help you draw some conclusions as to what things (leaks, position, etc.) make your AHI better or worse. You can order the Encore package here on cpap.com - you don't need a prescription.

I noticed the same thing you do - I am better now (the xpap treatment is working, slowly), but before, I would sit in the lobby at work, close my eyes and almost immediately begin dreaming - then I would (usually) wake up with a start. I too thought you only dreamed in REM sleep and that it only happened after you passed through all the other stages of sleep.

I'm trying an APAP now, but I think they gave me a defective unit. I was doing very well with the bipap, but wanted to try the apap. My GP was very responsive once I told him I had the Software & card reader and was monitoring and adjusting my own treatment.

Ballast, I'm trying to be careful with what I say here, but based on my own experience and my reading of (what I believe to be) the relevant Respironics patent I am growing more and more wary of the APAP algorithm used in the REMStar Auto. You may find that your unit is not "defective", just that the algorithm is not capable of handling your situation.

I've gone back to using it in CPAP mode and am getting better treatment. But that is just me, and everybody is different...

Derek, you may want to try a PB 420e Auto and see what you think.
I found it to be so much better than the ResMed Spirit for my case.

Derek

Have you ever tested the Remstar Auto for results with and without CFlex?

Jim

wary of the APAP algorithm used in the REMStar Auto. You may find that your unit is not "defective", just that the algorithm is not capable of handling your situation.

I think that there is significant value to this statement. The manufacturers of the autopap machines all use different algorithms. While MOST users will receive satisfactory treatment from all machines, ALL users will not. You might want to ask the RT people to test the Respironics Auto to see if it is functioning correctly and, if it is, be suspicious that the algorithm is not right for you.

I trialed all three machines (Respironics Autopap, ResMed Spirit, GK420E) and found that the Spirit and GK420E gave consistently good treatment such that I was awake during the day, and showed similar numbers regarding pressure delivered and AHI measured, in the data. Respironics RemStar did not treat as aggressively as I needed --> I felt tired during the day and the data showed a high AHI.

So, if at all possible, trialing the different machines really is the way to go to find the machine(s) that treat you best. If the Respironics algorithm is not right for you, no amount of "benefit" from C-FLEX will make the machine worth having.

Ballast,

I just posted regarding this same nonresponsive REMstar auto issue on another thread. I just noticed here that you were prescribed a setting of 23/23 with a bipap. What I think is happening with the auto is that because you need a pressure of 23cm to open your airway and the auto has an upper limit of 20cm it is not able to open your airway. Thanks to an earlier detailed explanation by -SWS regarding how the REMstar auto will suspend treatment after three non-responsive attempts to open the airway, I think that it is programmed to suspend treatment in your case thinking that you are experiencing central apneas. Just a guess!

Although my initial prescription was 23/23 on the bipap, I found through use and monitoring over a 2 month period that a setting of 18/16 on the bipap provided pretty consistent AHI's of under 5. My hope with the apap was that it would allow me to spend a significant part of the night at a lower pressure. I am still trying the various settings and analysing the results. Between feedback on the forum and my own observations, it appears I am probably better off with the BiPap. I have had the apap less than a week, so I do want to give it a chance. But if I can't find a good fit, then I can return the DME's rental and get my BiPAP back. I think they were considering it to be a one month test anyway.

To answer a few other questions... I seem to have a lot more leak problems with my FF mask when using the apap. That may be coincidence. I am having some allergy problems that give me massive problems with hives. To fight that I am taking some medications. I suspect the hives and the medicines are complicating the issue.

Last night I put the apap in CPAP mode with CFlex on and set the pressure to 18. That worked pretty well but a couple of time it sounded/felt like the pressure went up drastically - the smart card doesn't show any pressure changes though.

ANother thing that is sending me back towards the BiPap... When I first started using it, I noticed that a lot of my apnea events and snoring happened in the first hour of use. Looking at the smart card reports, I decided the problem was in the ramp up to full pressure. The DME had set the ramp to start at 4 (and I was going to 23 at that time) and ramp up over 30 minutes. I could look at the leaks and tell that my apneas were happening when my leaks were the lowest and that was when the pressure was lowest (ramp up). So I moved the ramp to start at 10cm and the ramp time down to 15 minutes. All the initial apnea events pretty much disappeared. I would have to conclude that even if the apap were able to adjust properly for me, it would probably spend all its time around 18 anyway.

I appreciate all the feedback - there were several good suggestions and, as usual, the forum community helps its own.

What can a person say to convince the doctor that self monitoring of the nightly results is in fact beneficial?

1. Mention that people with diabetes monitor their own sugar level
2. Say that the technology has evolved to enable self monitoring - something that was simply impossible when apnea treatements started
3. Say that though you are unconcious when asleep, you are perfectly concious and capable of looking at the data by yourself when awake.


O.