Smart Card Module for S8 Autoset Vantage?

Brent Hutto wrote:For all the warnings I've received abou the "evil DME" issue these folks couldn't have been any more helpful. I seem to be lucky that way, my doctors aren't always quacks and my first DME encounter was professional and stress-free. Kind of like the sportswriter years ago who said that Bob Gibson was overrated--the other teams just never hit worth a damn on the days he pitched.

Brent, I think you may have overlooked the irony in your statement. You are Bob Gibson against the DME, because you didn't give your DME any other option than to get you specifically what you requested. I'll bet you didn't ask for their advice on anything much. Instead, you told them what you needed in a knowledgeable and authoritarian manner (politely, of course).

Congratulations, you have been listening!

Regards,
Bill

NightHawkeye wrote:You didn't give your DME any other option than to get you specifically what you requested. I'll bet you didn't ask for their advice on anything much. Instead, you told them what you needed in a knowledgeable and authoritarian manner (politely, of course).

Actually, I faxed them a two-page memo yesterday outlining what I understood to be their point of view, my point of view and the doctor's point of view. That covered why I wanted the machine I wanted and assured them I wasn't trying to do them out of something or make an end-run around the doctor. Then I listed the issues that needed to be handled in order for everyone to get what they needed out of the deal. Then I said that they could let me know whether that would be acceptable and if not to just tell me what needs to happen differently.

I figured either they'd go along with it or run as fast as they could in the other direction and I'd have to find somebody else to do business with. Either way, we'd get it settled today Fortunately, it turned out all the details could work out splendidly.

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CPAPopedia Keywords Contained In This Post (Click For Definition): DME

Brent Hutto wrote:I figured either they'd go along with it or run as fast as they could in the other direction and I'd have to find somebody else to do business with.

And a great example you make for newcomers in how to deal with both your DME and physician to make it a win-win-win situation.

But, if I can interject a little reality back in. How many other business dealings have you had that took so much up-front preparation to make sure that everybody was working toward the same goal?

Regards,
Bill

The thing about faxing a list was a little over the top but unless it's an emergency, I always deal with doctors and such by having researched the situation as much as possible and starting out the conversation with what I think is going on and what I expect to get out of the situation. After all, they're working for me and clear communicatino is a darned sight more crucial than hiring someone to put a roof on the house.

And don't even get me started on buying a car...Oh the Humanity

I will say that one thing I consulted with the DME guy on was the mask. I had an idea that an Ultra Mirage II would be the obvious first choice but for all I know that was wrong. It turned out it was his first choice too but we also talked about the Activa as well as discussing whether I possibly needed a full-face mask based on my titration-lab experience. He was pretty sure I wasn't a mouth breather and said the Ultra/Activa decision mostly comes down to pressure (high=>Activa, low=>Ultra). So far I've rolled around on my bed with the mask on for a while and nary a leak on back, right or left side. Of course that's 7cm only.

dsm wrote: I am interested as to what you think of the transition from Inhale to Exhale on the S8 when in AUTO mode and also if you get to try the EPR feature (which turns the S8 Vantage into a mini BiLevel)

Also the noise - what does it sound like ?

OK, here's my mini-review of my first night.

I'll comment on the noise first. The machine is very, very quiet. I thought maybe there was just a very faint whistling component to the sound during inhale but my wife says all she could hear was very low-volume white noise. I think the slight whistle must have been either in my nose or in the mask. We've always run a HEPA filter thing in the bedroom at night for the white noise and she wants to start back running it tonight. It was too quiet for her last night with just the APAP machine. She said the APAP white noise changed with inhale and exhale but it reminded her of sleeping her the ocean where you can just barely hear the waves coming and going. We give it an A+ for quietness.

As for inhale to exhale, as you say it seems to have a fairly "soft" transition. My settings are 7-12 and according to the LCD this morning I averaged 10.0cm of pressure over the night. Compared to the Remstar machine they used for my titration study (5cm, 7cm, 9cm) I'd say this machine is a little easier to kind of gradually coast to a stop on the inhale and then gradually build up the exhale. That's how I normally breathe and during the titration study I felt like I had to actually start the exhale rather than it just going naturally.

I must say, though, that it may simply be me learning how to breath more naturally with the pressure. I wouldn't be surprised if I went back to the machine I used in the titration study tonight and found that my transition was much smoother. I was really struggling against the pressure that night in the sleep lab. I have no idea whether the titration machine was set with C-flex but I doubt it.

I do have a couple problems, though. First off, according to the LCD this morning I averaged 0.82L/sec of leak. That's accumulated over 8:08 of total time yesterday including a few minutes in the DME office. I actually had the mask on from 9:44PM-5:32AM minus three short bathroom breaks. So call it 7:40 of mask time last night with the other half hour being at the DME office or when I was messing around at home after supper yesterday. So there were some really big leaks during that extra half-hour but it sure looks like I was far from leak-free overnight. I wasn't aware of any leakage around my eyes but occasionally the edge along my upper lip would let a little air seep out (I have a beard and mustache).

The worse problem is I hold my breath. It's just an irresistable habit when I'm breathing against the pressure. Especially if I'm lying awake trying to fall asleep I find myself at the end of the exhale just keeping the air out and refusing to start inhaling for a few seconds, sometime longer. It's like some sort of waking central apnea. When I notice I'm doing it I make myself go ahead and breath but my body sure doesn't like the way that pressure insists on a big inhale whether I'm ready or not. Hopefully that will be better tonight.

P.S. And BTW, I did not try the EPR since I'd have to switch to CPAP mode and all that. Sorry.

Brent Hutto wrote:Compared to the Remstar machine they used for my titration study (5cm, 7cm, 9cm) I'd say this machine is a little easier to kind of gradually coast to a stop on the inhale and then gradually build up the exhale. That's how I normally breathe and during the titration study I felt like I had to actually start the exhale rather than it just going naturally.

Very insightful, Brent. Sounds like you made a great choice in machines. I notice a similar phenomenon on my Remstar, only on inhale. When pressure gets above about 10 cm, the machine pre-emptively starts forcing air at me before I'm through exhaling. It gets progressively worse with the levels of C-flex, so I just leave C-flex turned OFF. I'd bet if you went back to your titration Remstar that you'd still notice the phenomenon. Just a difference in the algorithms between machines, I suppose.

Brent Hutto wrote:I wasn't aware of any leakage around my eyes but occasionally the edge along my upper lip would let a little air seep out (I have a beard and mustache).

LOL Good luck with taming the leaks. We all go through it I think.

Brent Hutto wrote:The worse problem is I hold my breath.

Some folks think that's natural and healthy, Brent.

Congratulations on a successful first night with xPAP.

Regards,
Bill

Brent - many thanks for your very clear summary. Of all the comments you made I am intrigued by your remark about holding your breath.

You described this activity rather well. Is this something you are aware of just before slipping into sleep ?

I am assuming you are married/partnered - does your partner have any observations or comments about your breathing just as you slip into sleep ?

Are you aware of this occurring just on waking ?

Cheers

DSM

Very interesting feedback

Bill, DSM,

The resistance to breathing I mention is any time I lie there for a while awake. I believe as I actually slip off to sleep I quit doing it. Likewise when I wake up during the night I'm not doing it but once I get awake enough to realize where I am it starts again. I have a distinct memory of at least one of my wake-ups last night where I lay there for a while just completely at peace with the mask and the air...but only until I thought "Oh, now I'm doing great" and then it was back to the little pauses and stutters.

I think it's one of those deals like trying not to think of a Christmas Tree. If you try not to think of something, you'll think of it to spite yourself. I try to not to think about breathing but as soon as I think about it I start fighting the pressure. Once I get sleepy enough I drift off thinking about something random and then I'm out. I haven't asked my wife to monitor me but I'd bet you I'm breathing steadily while I'm fully asleep.

I think the short answer is I'm just too self-aware. The down side of a few years of yoga practice combined with a compulsive urge to overcontrol. How's that for practicing Freudery without a license

Brent Hutto wrote:The resistance to breathing I mention is any time I lie there for a while awake. I believe as I actually slip off to sleep I quit doing it.

I know the feeling, Brent. While I'm sleeping the machine handles my breathing just fine, but it's a different story when I'm awake. In my case I don't think it's so much that I'm conscious of the machine as that my breathing pattern may not fit the machine's algorithm all that well. When I wake up in the morning and just lie in bed for a while before getting up, it's not unusual for my machine to start increasing pressure on me even though I'm breathing just fine. Sometimes it just runs away with the pressure increases until I have to reach over and shut it OFF. If it doesn't do that, it often registers some apneas during that time while I'm awake! They're not real though, and I don't get any oxygen desats then either.

Brent Hutto wrote:I think the short answer is I'm just too self-aware. The down side of a few years of yoga practice combined with a compulsive urge to overcontrol. How's that for practicing Freudery without a license

Hmm . . ., and how does your wife feel about that? (Never mind, just kidding.)

Regards,
Bill

Brent,

I have posted here last year extensively on an issue I became aware of in regard to breathing & slowing it down - this is observed repeatedly by my wife just as I go to sleep & as I wake.

My ever alert wife is now an expert on this as she is intently aware of breathing pattern changes that occur with me. I can change my CMS or the water level in my H/H & danged if she doesn't ask me if I have changed something.

I put my breathing slowdown to years of having practiced meditation / relaxation breathing exercises but this explanation is at best my rationalization for a process I don't fully understand.

To me you are on the path to describing a very similar pattern !

I am interested in discussing further.

Thanks

DSM

DSM,

Last night I decided to go back to first principles, just like when I was learning to do relaxation. Observe with focus on the breathing but do not judge and do not intervene. Anxiety of course comes from a reaction of "What should I do?" or an anticipation of "This is going to be a problem!" and not from focused observation per se. With my normal breathing pattern, doing relaxation at the end of yoga class for instance my breathing will get down to a breath every 20-25 seconds. I think my heart rate also gets down in the 40's (although that may be my beta blockers). I am so familiar with that slow breathing pattern than even five minutes of focusing on is very, very relaxing.

Once I quit worrying, I was able to observe my CPAP breathing pattern which is totally different than my normal one. The inhale is faster than the exhale and my overall breathing is deeper and more in my chest (I am usually almost entirely an abdominal breather). There's no pause between the end of exhale and the beginning of inhale. I did notice a couple occasions of hesitation but I observed those and let them pass by without trying to control them.

So what happened was that I was drifted off to sleep almost like normal, maybe 5-10 minutes tops. I was also able to return to sleep immediately after getting up a couple times for potty breaks. Basically, it's like now I have two different breathing patterns depending on CPAP/no-CPAP but I'm OK with that. It was a fairly restful night and I didn't get up the morning feeling like I'd been fighting for my life.

Of course there's the little problem of my machine reporting AI=3 HI=12 again for the second night in a row. My setting is 7-12cm and the reported pressure (on the LCD) was 10.0 the first night and 11.0 the second. At least my leakage is under control. It was 0.34L/sec and according to the user's manual 0.4L/sec is acceptable and 0.2L/sec is good. I sure hope once I'm accomodated to the machine it drives away those lingering apneas and hypopneas, at my diagnostic sleep study my AHI was 23.