Resmed VPAP Adapt SV - for Central Sleep Apnea

Snoredog wrote:I ran across this note from a Respiratory lecture I once saved to disk

The net response to the high CO2 will be an increase in respiratory rate and depth.

Interesting point there, Dog. Is what you're saying that if you increase those parameters, and consequently minute ventilation, by using an enhanced CO2 system, and then utilize a machine that is triggered by changes in minute ventilation, then a potential conflict could develop?
SAG

SAG...initial sleep study said about REM:
Stage 1 17.7%, Stage 2 52%, Stage 3&4 19.5% and Stage REM 10.8%

0 ob apneas, 0 mixed, 22 CA, and 82 hyp with REM RDI of 24 per hr, and NON-REM RDI 24.6 per hr.
28 leg movement arousal with 1 in REM

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CPAP study did say "the patient spent all study time in a supine position with a positional RDI of 1.6 events per hour."
Latencies:
from light off (min) sleep onset 18.0, S1 18.0, S2 26.5, Delta 63.5
from sleep onset (min) S1 0.0, S2 8.5, Delta 45.5
REM was blank

that's all I know about REM

previous post made by bluegrassfan not a BOT...sorry

So I read -SWS's quote of RG who is advising someone to change their pressures in various ways, with various rationales. Shall we say she is encouraging unknown hordes of people to take their lives in their hands and start changing their pap pressures at will. Hey, some of those people don't even know what AHI means, and most don't have a machine that will show it to them so they can know if the pressure change made an improvement or a dangerous problem.

Then there are the people who use tape on their mouths. RG and others have posted extensively on types of tape, silicone dams etc. These people could kill themselves from this advice.....possibly.... No one can control everything, and these desperate people seem to be willing to try anything...maybe we shouldn't have any open sharing of thoughts and ideas and personal experiences and technical information. Yeah...that way we don't have to worry that somebody who is a dim bulb won't take something we say and screw themselves up with it......

Sorry, I happen to think there are many here who have enough intelligence to think and act appropriately. And those who do not are not likely to read complicated topics, or to do things they don't understand. I have faith in humans. More in this area than I do for say those who ride their motorcycles with no helmuts (gaaahhh )

There are large numbers of people who feel way worse on cpap, like me, and they need to know the possibilities they and their doctor could explore. No one else is telling them, no other information is right out there about it. If they were uncomfortable with pressures or masks, there are hundreds of ways for them to be encouraged to ask for bipap or autopap or certain kinds of masks. The information that their pap could be making them sick and it could be remedied with the proper equipment and titration should be right out there with all the other basic toolbox for users and for their doctors too.

Until then, I may well appear incessant, because they are not getting it from anywhere else. How is that anywhere less than a positive contribution.

Now I ask you, with all your explanation of why it wouldn't work, how come my (dreaded desperate maneuver which shall go unnamed) made me (and maybe others) feel much better, and continues to do so with the "official medical" setup I use now? (I am not talking placebo effect so don't haul that one out on me.)

Let's speculate about that - maybe it (the maneuver) produces a pressure alteration that helps some people who have a history of asthma, like I do.
Although I had CO2 measurements that guided my team about my EERS setup, I am willing to consider the actual mechanism might be different than rebreathing, it might be like a back pressure just to throw out an alternative idea.

BTW I also wanted to say, I get my REM related apneas (those are the big awful backpain ones for me) no matter if I am supine or sidelying...

Back to topic: SAG, do you use cpap yourself? Do you know firsthand how we tend to pull off our masks even when asleep when something isn't right, like nasal congestion?

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CPAPopedia Keywords Contained In This Post (Click For Definition): bipap, Titration, CPAP, AHI

ah let it go frequen, had it been me over on TAS I probably would have given mango a loaded 45 spun the cylinder and told him it only had one bullet

frequie wrote:So I read -SWS's quote of RG who is advising someone to change their pressures in various ways, with various rationales. Shall we say she is encouraging unknown hordes of people to take their lives in their hands and start changing their pap pressures at will.

With apologies to Lloyd Bentsen:

Frequie, I PSG'ed with RG. I know RG. RG is a friend of mine. Frequie, you're no RG.

At the risk of being presumptuous in speaking for RG, the obvious answer is that in addition to the various disclaimers, any of RG's opinions that I have seen fall within accepted, mainstream SBD management. (OK, the tape thing makes me a little nervous, especially for someone who tossed down a 12-pack of Molsons before they went to bed). There is no basis whatsoever for saying that changing mask exhaust rates does anything except leave the door open for an untoward event.

frequie wrote:Now I ask you, with all your explanation of why it wouldn't work, how come my (dreaded desperate maneuver which shall go unnamed) made me (and maybe others) feel much better, and continues to do so with the "official medical" setup I use now? (I am not talking placebo effect so don't haul that one out on me.)

Sorry back. Let's not blend changing exhaust rates with EERS to try to gain credibility. Further, the subjective improvement in a patient following the administration of inert therapy is the very definition of placebo effect. If you think it does do something, then I would suggest that you share "peer-reviewed data" or your own prima facie evidence. That is science. What you propose is "screwing around"-- throwing out untried ideas and hoping that something good might happen.

Incessant? Here's incessant:

Are you ready to accept responsibility and culpability for your actions?

Are you ready to accept responsibility and culpability for your actions?

Are you ready to accept responsibility and culpability for your actions?

That's the difference between a "scientist" and "screwing around". Witness this exchange:

sleepyjane wrote:I am not sure what that test is, but someone told me the symptoms I had were also symptoms of copd and I have had a new development in the last two months of wheezing, tightness around chest, shortness of breathe and coughing but I related it to allergies.

sleepyjane wrote:Doctor was recommending a bi-pap at 18/14 as he told me about high pressures causing central sleep apnea and I guess that is why he settled on 18 and 14 on exhale due to this carbon dioxide thing.

rested gal wrote:I'm sorry, I really have no idea what to suggest given the constellation of health issues you're having to work through, Jane.
I hope your doctor is able to get your treatment going well for you very soon. My heart does go out to you.

Put that line into -SWS' book of RG's greatest quotes. That whole case is an iceberg, with 90% of the information still under the water, and I'm sure more thought went into that RG post than most of the posts that are 5 times as long.

frequie wrote:Do you know firsthand how we tend to pull off our masks even when asleep when something isn't right, like nasal congestion?

Not the same thing. Obstructed airway is sudden and acute. Increasing pCO2 is gradual, insidious and self-sedating.

dsm wrote:Your post to Frequie ( ) did seem a bit harsh. I greatly respect your general insights & experience and usually enjoy your posts.

Like I said, I'm not trying to win any popularity contests. I believe the potential for a Sentinel Event is so great here any means justifies the end.

However, in re: in the aforementioned case, I do note your post

dsm wrote:"people here thought it might be better" ? - were 'these people' respiratory professionals or merely ordinary xpapers here merely expressing a best guess opinion based on what they have been told ?

What Are We Fixing?

Right, that's definitely not a "let's try these settings and see how you feel" kind of case, and my guess is that simply tracking respiratory events may not be sufficient if a (the) primary goal is pCO2 control.
SAG

SAG, you have gone to alot of trouble to sidestep the real questions in my previous posts and continue attacking me personally.

You have used alot of apace that will make this topic probably too cumbersome for anyone to get much usefulness out of it.

When I was able to get medical help to address my needs I did so and reported about it. It was helpful and it had published research behind it.

Now I pass that information along when it is relevant: that CO2 levels and the CSDB possibility should be included in a cpap assessment/prescription. Yes, I affirm that this is a responsible action.

I believe there are many for whom conventional cpap does not work well. I have personally known a number of them who have given up altogether and are having their health damaged by sleep apnea as a result. This is deplorable, and all medical information should be made available, properly organized and accurately applied. The whole field of SDB therapy sorely needs to come up to this standard.

If you disagree about the recommendations that the doctors at Beth Israel are making, please stick to the topic and provide objective information for alternative constructive considerations.

SAG, FrequenSeeker,

As a way to bring this issue to a compatible end, can we get down to the core issue & see if we can get agreement. Lets not dwell on the negative peripheral remarks as hopefully they will drop away if the core issue is resolved.

SAG, is the core issue for you, your serious concern over FrequenSeeker discussing/suggesting modifications to masks and suggestions that CO2 issues may be at the cause of some formum members xpap therapy problems ?

FrequenSeeker, are you interpreting the core trigger for all of SAG's comments, as being his concern over your good intentions re CO2 washout & other effects & offering complex advice to people in this area ?

If CO2 experimenting is the heart of this, do both of you see a way this issue can be resolved. SAG is there a polite & purposeful brief suggestion you would like to offer to FrequenSeeker
e.g. (just a guess)
Please don't make suggestions to people to modify their masks in ways that may for some, end up causing serious complications to the recipient.

For frequenseeker, if SAG can produce a polite, sensible & brief suggestion that gets to the heart of the matter, would you consider it and agree to give a yay or nay ?.

My intent here is to try to get the topic away from the unproductive negative elements that are present. You both have friends here.

DSM

dsm wrote:As a way to bring this issue to a compatible end, can we get down to the core issue & see if we can get agreement.

Well, that's somewhat of a problem in that today's column was still in the "acerbic" format, but I suppose I could temper it down somewhat.

Regardless, my intent was to make sure that a strong counterpoint exists to discourage any attempt to control inspired CO2 levels by occluding exhaust ports on masks. In most cases it will do nothing, the possibility for a catastrophe is very real, and no matter how slick you think you are, the results are at the very least unpredictable. Just look at the leak/pressure relationship of any mask and that should tell you why. And anyone who is a CO2 retainer is at particular risk under all circumstances.

It deeply concerns me that people are still attempting this. But I realize that's going to be an ongoing problem. That I might offer a strong word of caution is primarily for selfish reasons. It improves my sleep architecture.

frequenseeker wrote:You have used alot of apace that will make this topic probably too cumbersome for anyone to get much usefulness out of it.

Maybe, maybe not. But this thread is now averaging about 600 views/day, and it's apparent that every now and then, "Black Bart" needs to post.
SAG

I would propose that we attack underlying concepts, principals and even methods without actually attacking those who share opposite views. I would also propose that we attack those ideas with vehemence, if vehemence is an absolutely necessity.

SAG, was that "Black Bart the pirate", "Black Bart the gun slinger", or "Bart Simpson" with our television color circuitry gone kaput? You did mention thread-view subtotals, which sure reminds me an awful lot of those Nielson ratings. Enter the third Bart to round out the list of suspects. Absolutely no vehemence in my own Bart-induced wondering. Just wondering who the great Bart might be.

-SWS wrote:I would propose that we attack underlying concepts, principals and even methods without actually attacking those who share opposite views. I would also propose that we attack those ideas with vehemence, if vehemence is an absolutely necessity.

I appreciate your position.

bluegrassfan wrote:...initial sleep study...

Oh yeah, BGF. Let's review that:

Diagnostic sleep study
Stage 1 17.7%
Stage 2 52%
Stage 3&4 19.5%
Stage REM 10.8%

22 central apnea
82 hypopnea
REM RDI 24.0
NREM RDI 24.6

What was the diagnostic REM latency?

To review sleep architecture, getting a look at the graphs (the ones that have everything on them) will be useful. They (get both studies) may help to identify the cause of the centrals in the diagnostic (sleep-onset, post-arousal, intermittent, in a cyclic heap, maybe really obstructive cause they disappeared with treatment, etc.) but again, that you were able to get down to 2 in titration makes that almost academic. I'll get my post-arousal central to demonstrate that phenomenon if it looks like that's what it is.
SAG

Thanks to all who are encouraging a positive resolution.

FrequenSeeker, are you interpreting the core trigger for all of SAG's comments, as being his concern over your good intentions re CO2 washout & other effects & offering complex advice to people in this area ?

I don't think so. I hope not. I have asked for him to be specific about that.
He is more focused on this:

to discourage any attempt to control inspired CO2 levels by occluding exhaust ports on masks

I believe I said it a number of times above, but I can understand if it is hard to find in all the posts:

I do not advocate anyone plugging vent holes in their masks.

So, SAG and Frequenseeker have no disagreement here...I hope we have laid that one to rest now...please.

I do think CSDB and CO2 issues should be in the current lexicon of pap therapy and considered by all involved, especially by those who investigate and prescribe for people with sleep apnea.

Can we work together to build awareness of these resources so those who would benefit can access them in their care.

If there is disagreement with my statement, please give us facts and data so we can understand the alternative viewpoint.

My doctors at Beth Israel are now back from being away, and are considering the ASV issues in advance of my upcoming PSG with them.
I would be happy to relay any further questions, ideas, or suggestions that could make good use of the opportunity to clarify the ASV operation and indications as well as their CO2 regulation strategies.

Yesterday, saw my respiratory specialist & although in an earlier post I said he would probably tell me I didn't need a Bilevel etc:, the report from the sleep clinic actually advised sticking with my existing setup including my existing 10/13 epap/ipap.

Basically he said 'You are a good boy, take a lollipop for the jar & pat yourself on the head, you are doing fine'

Seriously, he was very happy with the results & agreed I stay with my own choice of machine & pressures & come back in 18 months.

He was even happier when I gave him this copy of a doc I have been working on. He promised to have some of his postgrad associates review it & come back with any suggestions.

http://www.internetage.com/cpapinfo/cpa ... ar2007.htm

MS Word hardcopy ...
http://www.internetage.com/cpapinfo/cpa ... ar2007.doc

Next version should have photos of machines & masks to flesh it out.

DSM

dsm - good start!

A few other topics come to mind: mouthleaks, rainout, heated tubes, aerophagia, sleep stages, REM. Complications if apnea is not treated such as right sided heart failure, kidney failure, hypertension, stroke. Sleep walking and other concurrent disorders.
You are welcome to include or link to my DIY mouthleak preventer oral appliance.

Another apnea category: Complex Sleep Disordered Breathing - similar to Cheynes-Stokes. The patient does not have heart failure and can be basically healthy but has cyclic breathing fluctuations; also may have a need for higher levels of retained CO2.

I just saw research that found that 50% of people with pacemakers had sleep apnea..