Obstructive apnea with APAP

I m getting worst with the apnea. I dont know many things about the rules of the APAP, and the results in Sleephead.

I m very worried about if APAP ,if it´s making his work.
How can I have so long obstructive apneas . Is it normal ? APAP should open clear the vias sooner I think
How can I be 7 or 10 seg or more in obstructive apnea withe APAP working?

http://img905.imageshack.us/img905/8739/oYP6z3.jpg


http://img538.imageshack.us/img538/6987/LtbUPN.jpg

Obstructive events.

Thank you very much

I've had a look back at my own data and I see the same thing. Quite a few obstructive apnoea for between 7 & 9 seconds.

Sorry i don't know the answer but maybe it's normal and to do with the amount of time it takes the machine to recognise events and react to them.

I don't consider those long apneas. I would consider 30-seconds and higher as being long, and even a few of those would not be considered unusual.

Same here, I think it's normal.

How can I check my APAP? I exhale, keep breath for 15 seconds and the apap dont give me any overpresure.
I dont my mind to change to another apap ... i want to keep my breath. The apap dont give me overpresure even with high maximum level setting.
My apneas without apap itsnt longer than 15 sec.

Are you testing the machine by breathing while you're awake? Don't do that - it's not going to be accurate as you breathe differently when sleeping.

Do you feel good - like you're being treated enough? Do you still feel bad when you're awake?

aguaxp wrote:I m getting worst with the apnea. I dont know many things about the rules of the APAP, and the results in Sleephead.

I m very worried about if APAP ,if it´s making his work.
How can I have so long obstructive apneas . Is it normal ? APAP should open clear the vias sooner I think
How can I be 7 or 10 seg or more in obstructive apnea withe APAP working?

that's not how they work.

no pap machine tries to overpower an obstructive apnea, none.

they raise pressure after obstructives to prevent further ones from happening.

learn more and stop making assumptions.

OK then how I get a better result, increasing the minimum level?. If all APAP take the same algorithm i dont see much difference between APAP and simply CPAP.

First of all...when you hold your breath and try to fool the machine into responding, while you are awake, you might as well quit trying. When you hold your breath the airway is open and the machine won't respond at all to cessation of breathing with the airway open....that's a central (Clear Airway event) and APAP machines won't respond to centrals at all...they won't because that's the way they are supposed to react to centrals...do nothing because more pressure won't fix centrals

Second thing..PR S1 machines don't actually record event duration like the ResMed machines do..instead those numbers in parentheses that you see on PR S1 machine reports are actually marker numbers...that's why you see 7, 8 or 9 sometimes..they can't be duration in seconds because for an apnea event to meet criteria it has to be 10 seconds in duration.. It's close though. If you go zoom in real close and count seconds for an event with 8 in parentheses..it will be about 10 seconds. It's not perfectly spot on accurate though.
I don't know if you have a Respironics machine or some other brand other than ResMed but ResMed is the only machine that I know of that actually flags event duration....the rest of the brands those numbers in parentheses are NOT event duration to perfect seconds...they are close though.

Third thing....expecting the machine to respond to a single OA flagged event in apap mode...it's not going to happen.
It won't try to blow through the obstruction while the obstruction is still present. Instead it will evaluate things after the obstruction has gone and try to do a better job preventing it from happening again. RobySue has a good explanation of how APAPs work in one of her posts. I don't have that link handy at the moment though.
APAP mode pressure increases simply can't happen quickly enough to blow through an OA while it is happening.

Without seeing a full example of the detailed data I can't comment on pressure needs but if those are OAs you are seeing....then the minimum pressure is the most critical and not the maximum pressure. Set the minimum pressure more optimally and the maximum pressure will likely stabilize and not come into play nearly as much depending on what your current settings are.
Preventing is betting than trying to fix an after the fact obstruction and that means a more optimal minimum pressure setting to start with.

2 main reasons for higher pressure needs at some part of the night and not others....Sleeping on your back or REM stage sleep or maybe a combination of both.

Edit...I see PR has said essentially what I have said but I will post anyway.

Pugsy wrote:If you go zoom in real close and count seconds for an event with 8 in parentheses..it will be about 10 seconds.

they'll be *at least* 10 seconds long, since that's the minimum it takes to be flagged, but could be much more.

Pugsy wrote: APAP mode pressure increases simply can't happen quickly enough to blow through an OA while it is happening.

even the epap varying ASV machines don't increase pressure during an obstructive... they wait till after. it may not be possible, depending on how the airway blocks, to pressure through and event. (having seen some 'hidden camera' stuff on youtube of airway collapses, I can see why)

Pugsy wrote: Edit...I see PR has said essentially what I have said but I will post anyway.

your greater level of explanation is always welcome by me

aguaxp wrote:OK then how I get a better result, increasing the minimum level?. If all APAP take the same algorithm i dont see much difference between APAP and simply CPAP.

the difference between APAP and CPAP is huge.

My APAP is a REMSTAR AUTO A-Flex.
Anyway i can see more pressure before the obstructive apnea of 15 sec. Stay in min 10,5.
There must a be a check buttom or service buttom to check in the good working service I suppose. I dont know if i could be a firmware upgrade, also.

My last night:

Obstructive Apnea time 15 sec - 20 sec.
pressure setting: min 10,5 max 16
min 8,5 to start the ramp

Last night:
Average Pressure
10.59

Min Pressure
8.50

Max Pressure
12.50

90% Pressure
11.50

palerider wrote:they'll be *at least* 10 seconds long, since that's the minimum it takes to be flagged, but could be much more.

The flagged events that show single digits (less than 10) are most always going to be right around 10 second duration..maybe 12 at most if someone were to go in and manually count the seconds. I manually counted probably a hundred or so events to get an idea how those markers were running (using my PR S1 machine reports) quite a while back and the duration was probably within 2 or 3 seconds on all of them. I had events with below 10 that I counted along with a lot in the teens and a few in the 30 to 45 range and they all were within 2 or 3 seconds using manual second counting. It's a bit difficult to spot the beginning and end of an event when zoomed in close enough to count the second hash marks so allowing for some user error in spotting the exact beginning and ending of a reduction in flow...they were all within 2 or 3 seconds one way or the other. Hyponeas were harder to count because not always working on a totally flat air flow line.
So while there is a bit of a difference...I never could find one where the difference was a huge difference...like a 10 in parenthesis and the event when manually counted was 25 to 30 seconds. Those numbers in parentheses are going to be real close and close enough for government work IMHO.

Pugsy wrote:

palerider wrote:they'll be *at least* 10 seconds long, since that's the minimum it takes to be flagged, but could be much more.

The flagged events that show single digits (less than 10) are most always going to be right around 10 second duration..

ah, yes, I was just referring to flagged events in general as being at least, but possibly much more than, 10 seconds, not just those with small numbers on the PRS1 machines

I agree that the numbers are usually close (are they always less?) than the actual duration of the events.

palerider wrote:I agree that the numbers are usually close (are they always less?) than the actual duration of the events.

I found it not always to be the case that the number in parentheses was less than actual second count (when I tried the manual counting of longer events).
I didn't have a lot of "longer" events to manually evaluate...those 30 and above events and most were hyponeas in my case and it's difficult to see the beginning and ending of hyponeas when zoomed in at the level needed to count the seconds.
Some of them appeared to be spot on accurate....especially the longer duration events.

So while the short duration events were usually less (by 2 or 3 seconds) the longer duration events seemed to be more spot on in terms of accuracy as best as I could tell. I never found one that was more than 5 seconds difference (plus or minus) though...and I don't think I found many that were more than 4 seconds off and that was likely more from my own inability to clearly define the ending and beginning. It seemed to me that the higher the number in parentheses the more likely it was to be more spot on in terms of manually counting.
Pretty much every single digit (in parentheses) event was at most 12 seconds when manually counting and most often barely made 10 seconds.

You know that Encore will actually report "time in apnea" so it has to have some sort of event duration to calculate from...and I suspect (but can't prove) that it is related to the "markers" that Mark has to use as the number in parentheses from the Respironics machines. There's a reason for those markers to even be there and I think it relates to the "time in apnea" thing.
It's not official and obviously with single digit markers it isn't exact but I think it is really close and I think that it gets closer the longer the event lasts.