CPAPtalk.com

Hi! I go back for my titration study results on Friday. I want to be armed with info on the best machine/s so I can have some input. I know that masks are more individual ( I am leaning toward Activa). As for machines which would be better as a first machine, straight CPAP or APAP? I thought maybe APAP as the ones I am considering can all be turned to CPAP. The only info that I have now that would be pertinent is my pulmo said that I have more apnea events on my back than on my side. I tend to start on my side, but may end up on my back. I know I want the exhale pressure relief option and an integrated heated humidifier and a good software program so I can take charge of my treatment.It also need to travel well although I only travel 3-4 times a year. Here are the machines I have compared and gotten down too, any input would be great!
CPAP- Respironics M series Pro, Resmed S8 Elite, Resp. M Series Remstar Plus, or Resp. Remstar Pro 2 Cflex
APAP- Resp. Remstar Auto Cflex, Resmed S8 Vantage, or Resp. Remstar M Series Auto cflex
Thanks for any advice!

Welcome, you can see what I prefer below, in fact, I have two and a Pro 2 CPAP. Never can have too many. I don't travel much, but would have no problem taking my "Tank", in fact it's going on a overnight tomorrow, taking it with me is the least of my worries for sure. The softwate is a important item, if you don't know what's going on it's hard to correct it. Jim

You've got a good list there, but I would eliminate the Resp. M Series Remstar Plus. It doesn't record statistics other than compliance.

I've only used the Respironics machines, so I can't give any personal experience on the ResMed machines. After using the machines I have, I wouldn't want to switch to any others.

Give just as much time (if not more) to the mask selection, too.

Best wishes,

Den

If your titrated pressure is over 14 or 15, consider a bilevel machine. Since you seem to have other lung problems anyway (I am guessing this from your remark about your pulmonary specialist) the doctor might want you to have lower pressure for exhale even with a lower pressure.

IF you need a bipap, the only auto bipap with biflex (similar to cflex) is the Respironics Auto Bipap.

BTW, the ResMed auto machines cannot use the EPR setting (similar to cflex) when used in auto mode. If you are sure you want cflex or biflex AND auto, then you might want to stick with Respironics Auto CPAP or Respironics Auto Bipap.

Regardless, be sure your pulmonary and sleep doctors coordinate on this prescription.

Just my opinion,

Moogy

I would suggest learning about the Sleep Disordered Breathing (SDB) events that will be seen on your report, then you can better understand the results and ask questions.

The SDB events seen on that report will be:

Sleep Architecture: This will show how well you sleep as determined by the amount of time you spend at each stageX of non-REM and REM sleep. Most of the restorative effects of sleep are thought to be obtained in Stages 3/4 (together considered deep sleep) and REM which is where you dream. If you never reach deep sleep and/or it is fragmented sleep you may never reach REM. So it may look similar to:

Wake
Stage1: 25%
Stage2: 60%
Stage3/4: 15%
REM: 0%

In the above example Stage2 is higher than the others because that is where most people "land" after experiencing a SDB event, but a person can be aroused all the way back to a Wake state. But you can see from the zero that they never actually reached REM sleep. This person may never remember their dreams. You may NOT go in specific numerical order as shown, you can bounce around from Stage1/2/4 to REM and from other stages but most of us would land at Stage2 before heading back towards the sleep goal of non-REM deep sleep or REM.

The SDB item(s) that keep you from reaching REM are seen as arousals and can be made up of the following events:

Spontaneous arousals:
Flow Limitation:

Except for snore, these 'obstructive" items are generally associated with oxygen desaturations making them more critical than the less severe items above (see legend below for meaning of each):

Hypopnea:
Snore:
Apnea:

The above obstructive events have to do with blockages and partial blockages to your airway. If there was a fire hose on the ground and you stepped on it collapsing it halfway, that is a good example of what happens to your airway with a hypopnea. If you stood on the hose blocking all water flow, that would be similar to a apnea.

These central events are thought to be caused by an interruption of the signal traveling from the brain stem to trigger respiratory breathing:

Central Apnea (CA): (cessation of breathing)
Mixed Apnea (CA & OA): (combination of central apnea and obstructive apnea at the same time).

You can also have other disorders such as PLMS which causes an arousal to and interrupts your sleep enough to kick you back from reaching REM.

There used to be some pretty good diagrams on the net showing how you breathe during sleep and what happens to the airway when you have one of the above events. Resmed's website may have this diagram.

Here is a legend for what the above items mean:

DEFINITIONS:
APNEA = cessation of airflow for 10 seconds or greater.
HYPOPNEA =>50% decrease in airflow for 10 seconds or greater with a decrease in oxygen saturation of >3%.
APNEA/HYPOPNEA INDEX (AHI) = apnea plus (+) HYPOPNEA/hour of sleep.
RESPIRATORY AROUSAL INDEX (RAI) = AHI +snoring related EEG arousals/hour of sleep.
AHI/RAI** Scale =<5 events /hour = (none); 5-15 events/hour = (mild); 15-30 events/hour = (moderate); >30 events/hour = (severe).
Respiratory related sleep fragmentation: Sleep arousals due to respiratory events or snoring.
Desaturation = Drop in O2 oximetry distribution saturation by 3% below average saturation.
SaO2 scale: >89%=(none); 85-89%=(mild);80-84%=(moderate); <80% (severe).
EPWORTH SLEEPINESS SCALE =<10=(does not indicate EDS (Excessive Daytime Somnolence));10-15=(indicates daytime somnolence-not excessive);>16 (indicates EDS).
RESPIRATORY EFFORT RELATED AROUSALS (RERAs)=Sleep Arousals due to respiratory events characterized by pressure flow limitations in the airflow indicator channel without significant O2 desaturations.
StageIII and StageIV are combined and referred to as Deep Sleep.
Sleep Efficiency = Normal is >80%

The good thing about APAPs is that you can use them as a cpap and there are times when that might be desirable.

All the apaps you have listed are great for recording data and the data is without doubt what you want to track your progress.

The Remstar Auto is probably the most popular here & thus you will find lots of help & support. Personally I dislike the EncorePro software but that is my opinion (am a software/hardware engineer)


Try to make sure the DME does not leave you with an Auto set more than 4-5 cms between max & min. To use one otherwise may cause some problems.

Good luck

DSM

Thanks for the help! Hopefully all will go well and I will at least get my prescrition for a machine. I am so tired, I can't wait to start therapy!

Snoredog wrote:(snip)

There used to be some pretty good diagrams on the net showing how you breathe during sleep and what happens to the airway when you have one of the above events. Resmed's website may have this diagram.

(snip)

It isn't exactly a diagram, but this is a multi-media presentation on Sleep Disordered Breathing at the ResMed site:

Link to ResMed SDB MultiMedia Presentation

One may have to choose the link to download the MacroMedia Flash Player.

Thanks for the link! Very helpful!

You are so welcome! I used this multimedia (video) to show to friends and family when I first started CPAP. It really helped to explain things well and thoroughly.

I just now sent it to my parents. They have been so concerned about my health for years. We were all so happy when I was diagnosed with OSA ( weird, huh?!) It could explain what has been plaguing me for 20 years or so ( being tired no matter how long I slept, weight gain, high blood pressure Gerd, night sweating, morning headaches, general achiness, depression) I actually have an improved attitude already and haven't even started CPAP. It is just great to know I am not just fat and lazy and not alone!