My snoring and flow limitation events and min pressure

RRL wrote:Good point about the doctor. I was thinking (if he noticed the changes) he would be pleased that a patient was compliant and trying to optimize their treatment, but I guess he could be very 'by the book' and have the 'I'm the doctor;not you' attitude. If he does have that response, I agree it makes sense to find one who likes having patients involved in their care. It's not like I'm doubling my dose of medications or making drastic changes here, and what I've done was based on my therapy data and has helped - so I don't see it like I was acting recklessly or putting myself at risk.

I get what you mean about the pressure spikes being insignificant. My (very limited) understanding is that this machine consistently creates these spikes in APAP mode to 'check' for any issues that need to be addressed. Is this accurate? If not, please share your knowledge about this topic so that I understand it properly. Thank you for your comments!

there's not a whole lot you can do with a regular cpap that *CAN* put yourself at risk, other than not using it. bipaps are a different story, in that you can hyperventilate yourself if you crank the pressure support up to uncomfortable levels.

the spikes are 1.5cm increases in pressure, and the respironics auto machines do them, perversely, when everything is really calm, quiet and you're sleeping very calmly. they don't do it if your sleep is disturbed and uneven, it's kinda weird. the commonly held idea is that they do those probes to see if the pressure increase helps.... but weirdly, they only do it when there's nothing wrong! it would make sense to do the probes if your sleep is a bit restless, "hey, let's see if things can be made better"... it's almost as if they got the test in the coding backwards.. just another of the weird little things that the respironics machines do

Thank you for your comments Den and palerider. It makes sense that the spikes/probes would be considered significant if they are disrupting my sleep. Like you say, I'll have to decide that for myself. I do know I'm not experiencing any of the common health or wellness improvements many notice after starting CPAP therapy, but I'm also being patient because I know it can vary widely how long it takes for someone to feel better, if at all. I haven't been awakened by the pressure probes (that I know of) but it seems like it could still be disrupting the quality of my sleep without being conscious of it. Thanks to the suggestions here I've been able to at least get closer to optimizing my therapy, and for that I am grateful.

As a next step, I believe I should try nasal pillows and determine the comfort and effectiveness compared to my current Wisp. If the DME supplier resists, I'll insist. I have another 15 days of "trial period" so I have every right to try more than one mask - even if my numbers are fine and leaks are minimal. Then, after my appointment with the doctor later this month, I could stop by the DME supplier located in the same building (hospital). The PR machine's spikes in pressure/probing does seem weird and may be disrupting my sleep, so I'm going to ask them if they supply (non-brick) ResMed machines. If they do, I'll let them know I'm interested in changing DMEs and becoming their patient if I can get a good ResMed machine and take it from there.

Another option is just calling the hospital DME tomorrow with my inquiries, i.e. do they supply ResMed Auto machines and AirFit P10 pillows. If I like what I hear and they can get me started within 15 days (so I can try a new mask), I can continue with my current DME until the day before my appt. with the hospital DME and just drop off everything to my current DME and say adios! I've asked my insurance and they said I can change DMEs at any time as long as they are in my network. My compliance/efficacy data would obviously come from two different machines/DMEs, but I don't foresee that being a severe problem. Hard to know how well any of this would work out, but I think it makes sense to try. I does seem like ResMed machines and masks are well liked around the forum, so perhaps seeking out that equipment would be beneficial.

RRL wrote: I haven't been awakened by the pressure probes (that I know of) but it seems like it could still be disrupting the quality of my sleep without being conscious of it.

you could be getting disturbances and not know. the easy way to tell, as mentioned, is to zoom in on your sleepyhead report, and look for changes in your breathing patterns when the spikes happen.

it's better than guessing

palerider wrote: you could be getting disturbances and not know. the easy way to tell, as mentioned, is to zoom in on your sleepyhead report, and look for changes in your breathing patterns when the spikes happen.

Thanks, I'll do that and look for breathing changes.

Some DME fun today. I decided to just stick with my current DME and ask to try new masks. I was able to get in today to see the RT, who was not particularly thrilled to see me to say the least. I was interested in the P10 and Nuance pillows. I noticed on the door coat hook the headgear for the P10, so I was optimistic they would have both types of mask. I was wrong. Regarding the P10, he said "we don't have that." I pointed out the P10 headgear. He said, "Oh, we can get it if ordered." So I took that to mean the Dr. would have to write a script for the P10. Okay, onto the Nuance then. After I mentioned the Nuance, he had me try on the Dreamwear. Really? So I agreed it seemed like a decent set-up but I wanted to try the Nuance. He went away and came back with the Nuance. It appeared to be a new package and I put the medium pillow up to my nose and it seemed to fit. I said I still wanted to have all three sizes of pillows just in case. He agreed.

He wrote up the ticket thing and I handed over the Wisp. I get home and opened the package to find a small pillow in a baggie with an S on it, the medium pillow attached to the mask, and another medium pillow in a baggie with an L on it that had obviously been opened. The medium seemed to fit fine and I'm pretty sure it will when I try it tonight, but I just wanted to have the normal package with S, M and L pillows in case I need to size up or down. I kicked myself for not checking the box before I left their office. I didn't check when I got the Wisp and they left me with just the L and XL cushion - no S/M. I should have learned my lesson. So I called to ask them if they could send me the L pillow and they insisted the M would fit and I agreed but said I thought I was being given a new package with the standard offering of S, M, and L. They said it is "brand new" even after I mentioned the extra M size in a baggie labeled L that had clearly been opened. They said "sometimes that happens", which seems to be their favorite way to lie because that's what they said when I asked about the System One Resistance Control feature - "doesn't have that....the manuals vary....sometimes that happens." False. That makes lie #3 (or is it #4?). I wonder if they have a sick game in the office where they see how many different lies/shady practices they can pull off and have the stupid customer be none-the-wiser. Lies and shady dealings. Not surprising, but still aggravating. Oh, another thing I just remembered - they messed up the billing when I first started. When I called my insurance, the agent seemed kind of upset about it and called the DME with me on hold to straighten them out, which was nice of them. Of note: I will be contacting the main supply center to notify them of my mask change because I would not be one bit surprised if they started sending me replacement Wisp gear. Good times.

Thanks for listening to my DME supplier rant. I know many of you can relate. So I guess if the Nuance works out I won't have to deal with this DME office again until I'm due for/need a new machine. I will likely end up changing DMEs anyway after the rental period ends, which seems like a good time to do so.

Tonight I'll be using the Nuance gel pillows mask and with the "X2" System One Resistance control setting as indicated on the pillow. This will be the third mask I've tried. In 2009 the PR Nasal Blue gel for a month or so and the Wisp during the past 2 weeks. Last night at 10.5 min pressure I had some notable mouth leakage issues so I'm just going to stay at 10 for a week to keep that variable constant as I get used to the Nuance. Will post updates, observations and experiences. Thank you for listening and for all of your support!

First night with Nuance. AHI 1.81 which is the highest it has been in the past two weeks. Quite a bit more clear airway events than usual. Flow limitation and snores still relatively low. No pressure increases at all. Numerous "pressure pulses" at over twice the average. Some air leaking through mouth - leak levels/rate OK. Mask was quite comfortable. No change in how I feel compared to before starting therapy.

I'm reading forum posts about clear airway events and pressure pulses. Will keep min. pressure at 10 again tonight. Information, suggestions etc. are welcome.

RRL wrote:First night with Nuance. AHI 1.81 which is the highest it has been in the past two weeks. Quite a bit more clear airway events than usual. Flow limitation and snores still relatively low. No pressure increases at all. Numerous "pressure pulses" at over twice the average. Some air leaking through mouth - leak levels/rate OK. Mask was quite comfortable. No change in how I feel compared to before starting therapy.

I'm reading forum posts about clear airway events and pressure pulses. Will keep min. pressure at 10 again tonight. Information, suggestions etc. are welcome.

Well, you know how to fix that if you decide to.


Den

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Wulfman wrote:Well, you know how to fix that if you decide to.

I do, thanks to your advice regarding setting min and max to the same value or going to straight CPAP I could eliminate the continuous spikes/probes that PR machines do. When I say pressure pulses I don't mean the continuous spikes/probes. According to Sleepyhead they are "Small test probes or puffs of air to help the machine decide if the apnea event is obstructive in nature or clear airway in nature. This number can vary widely and is of no real critical consequence to therapy." So in this case there were 28 pressure pulses and there were 24 total events (CAs, FLs, OAs and Hs) that the pressure pulses were 'assessing.' I'm not worried about it, just see the CAs as another form of disrupted sleep which I'm obviously trying to minimize. Thanks for your assistance!

Wulfman... wrote:

RRL wrote:Numerous "pressure pulses" at over twice the average.

Well, you know how to fix that if you decide to.

what? switch to a resmed?

No, still the same machine. In the past two weeks the number of pressure pulses per night has ranged from 3 to 21. I didn't add them up and calculate an average, but the majority were under 15 and I was guessing an average of 12. So 28 was the highest yet and so was CA events at 9 (most under five and many zero or 1.) Not worried, just an interesting change in the numbers - especially the first time the machine has not increased pressure to address an event; only the standard spikes/probes.

RRL wrote:No, still the same machine..

I know, I, like you, think that wulfman was suggesting you start using plain cpap mode, to get rid of the pressure spikes... but even in cpap mode, it'll do the PPs when you have an apnea. the older machines don't do that.

palerider wrote: even in cpap mode, it'll do the PPs when you have an apnea. the older machines don't do that.

Exactly. Didn't know that about the older machines.

palerider wrote:

RRL wrote:No, still the same machine..

I know, I, like you, think that wulfman was suggesting you start using plain cpap mode, to get rid of the pressure spikes... but even in cpap mode, it'll do the PPs when you have an apnea. the older machines don't do that.

I don't think so. (but I'm talking about the 1.5 cm pressure probes, not the "puffs")
If there is no way for it to increase pressure, how could it? It needs a couple of centimeters of pressure spread.
But, you're right in that the old Autos would do the pressure bumps when a range was used but not in straight pressure or when the min and max were set to the same pressure.
In fact, in the OLD Autos (Pre-C-Flex) the way you set them to CPAP mode was to set the minimum and maximum to the same setting.


Den

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Wulfman... wrote:

palerider wrote:

RRL wrote:No, still the same machine..

I know, I, like you, think that wulfman was suggesting you start using plain cpap mode, to get rid of the pressure spikes... but even in cpap mode, it'll do the PPs when you have an apnea. the older machines don't do that.

I don't think so. (but I'm talking about the 1.5 cm pressure probes, not the "puffs")

RRL was clearly talking about Pressure Pulses, as he even clarified, which the machine does in cpap mode to report on what type of apnea is being experienced.

you're the only one going on about the auto machine pressure probes.

palerider wrote:

Wulfman... wrote:

palerider wrote:

RRL wrote:No, still the same machine..

I know, I, like you, think that wulfman was suggesting you start using plain cpap mode, to get rid of the pressure spikes... but even in cpap mode, it'll do the PPs when you have an apnea. the older machines don't do that.

I don't think so. (but I'm talking about the 1.5 cm pressure probes, not the "puffs")

RRL was clearly talking about Pressure Pulses, as he even clarified, which the machine does in cpap mode to report on what type of apnea is being experienced.

you're the only one going on about the auto machine pressure probes.

No, he clearly mentioned the "pressure spikes" which are the sawtooth patterns on his reports......1.5cm pressure "spikes", "probes", whatever you want to call them.......which you DID.

palerider wrote: the spikes are 1.5cm increases in pressure......

If they're NOT bothering him, then FINE.


Den

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