What's REMStar Auto Really Doing? - new thread

derek · Post by **derek** » Fri Mar 18, 2005 9:34 am

Loonlvr has asked me to post some more of his Encore Pro sleep data. Rather than add to the previous thread:
What is the REMStar Auto really doing?,
I thought I would start anew (the old one was getting VERY long).

Here are a couple of links to the two apap sessions from loonlvr that were posted in the old thread:
Session1
Session2

Loonlvr's new session is with staright cpap at his titrated pressure of 11 cm H2O. Note the OA Index!!

Note that because this is a CPAP report there are no NRA events reported - loonlvr's previous charts showed non-responsive apneas.

In his email to me loonlvr said:
"I had a lot of requests after last thread to try using my machine at a straight pressure, which I did. Its 11, as prescribed. Well looked what happened. Please post if you would. I m very shocked that this was happening for over a year that I had my cpap. It may be a good lesson for newbies to push for an auto and get encore."

derek

mommaw · Post by **mommaw** » Fri Mar 18, 2005 10:24 am

Derek,

For those of us that don't have the software, can you explain to us what this report means? I would really like to know what the difference was between the auto and straight. Help!

Gilda

P.s. In simple terms please. Thanks

loonlvr · Post by **loonlvr** » Fri Mar 18, 2005 10:24 am

maybe I should try Zero huh Thanxs derek.

Sleeping With The Enemy · Post by **Sleeping With The Enemy** » Fri Mar 18, 2005 10:57 am

So what do we conclude from Loonlvr's report? What should he do?

derek · Post by **derek** » Fri Mar 18, 2005 11:01 am

Gilda,
On this chart there a three rows of data. The top rows shows the occurence of obstructive apneas (OA), the second shows hypopneas, and the third snores. Every little bar on the chart represents an event. The horizontal scale is the time into the sleep session. So we see crom the chart that loonlvr had an intense set of apneas about an hour and three quarters into the sleep session, and that the burst lasted almost two hours. He had another burst at about five and a quarter hours into the session. He had three or four hypopneas that night, and a few snores.

This is just a portion of the detailed report from Encore Pro - see my review for the full page. In APAP mode there is more information shown.

Loonlvr usually uses APAP, and the pressure will normally rise to help prevent apneas/hypopneas during an attack such as we see here. On this particular night he set his machine to a constant pressure of 11 cm H2O, ie it was acting as a CPAP machine. I believe that his point is that he was titrated at this pressure, and spent over a year at this pressure on a CPAP before switching to APAP. But, looking at this chart he is showing that CPAP as titrated for him is not treating his condition.

Hope this helps,

derek

loonlvr · Post by **loonlvr** » Fri Mar 18, 2005 11:21 am

Yes, Derek is correct. My old machine was a cpap(straight pressure) set at 11. I have my new auto set at 9-19 now. I did this as a 1 nite test to see what was going on for the year I was on it. Scary huh. I will send my sleep SPECIALIST who refused me the auto a copy once my insurance re-emburses me.

littlebaddow · Post by **littlebaddow** » Fri Mar 18, 2005 12:15 pm

I guess the answer to my question is that everyone is different, but do you think this experience is more usual than the opposite?

By the opposite, I mean finding that an APAP generally delivers a lower pressure than a fixed machine, yet is still an effective treatment.

In my case, I was originally given a fixed machine set at 10cm, having been presribed at 11cm. Now that I've switched to the remstar auto, my pressure range typically stays in the range 5cm to 8cm and only very rarely goes to 9cm, yet I now have an AHI of between 1 and 2.
This happened within 3 months of the original sleep study and there have been no other signifcant factors in between time, eg my weight hasn't changed much.

wading thru the muck! · Post by **wading thru the muck!** » Fri Mar 18, 2005 12:24 pm

Very interesting post!

Derek, thanks for making the effort to post this very instructive info on the hazzards of long term use of a fixed pressure machine.

loonlvr, would you be interested in trying a fixed pressure at the 12.5cm (90%) pressure the auto data reported?

loonlvr · Post by **loonlvr** » Fri Mar 18, 2005 12:45 pm

Thats not probelm. I ll try 12.5 tonite. One great thing I FINALLY learned was making the changes to pressures thru the card instead of machine. Very ez.

mommaw · Post by **mommaw** » Fri Mar 18, 2005 3:05 pm

Derek thanks for the explanation. I did not know how to read the graph. So it would appear that the straight cpap might not be the best route to go. Wednesday night I started a similar experience and I will let the board know how it goes. I went to my sleep doctor Wednesday and we discussed my interest in an autopap. He agreed to me trying one for a month and said he would be interested to see the results. I have been on a bilevel at 18/14 and the auto is set at 6/20. I dont have the software to check my numbers nightly, but I am to take the card in each week to my DME and she will print a report for me and my doctor. I will do this for a month and then we will decide which machine is best for me. One interesting thing I noticed on my PSG was that my apnea episodes were almost identical at the 10/6 level as the prescribed 18/14 level. When I asked him why he choose the 18/14 over the 10/6 he said because I was only titrated for 7 minutes at that pressure and at 61.5 minutes at the 18/14. When I ask why I was not titrated longer at the 10/6, he had no answer. Thus the auto. Will let all know how my numbers turn out.

Gilda

-SWS · Post by **-SWS** » Fri Mar 18, 2005 3:24 pm

Loonlver, thanks for sharing your data once again! The big burning question is whether 11 cm fixed pressure is no longer adequate to maintain a patent airway for your obstructions, or whether you are experiencing bursts of central apneas----or even some combination of those two event types. Wader's suggestion of setting a higher fixed pressure goes along with what your data suggests---assuming that those are obstructive apneas.

If you cannot address those bursts of apneas with higher fixed pressure and/or a "higher and narrower" AutoPAP pressure range, then you may very well be looking at a central apnea problem---in which case you need to get with a responsive sleep doctor quick (maybe not your current doctor).

Here's the catch: the sleep-medicine industry is all too often reproachful when we try to proactively take our own health into our hands using AutoPAP technology----presumably so that we don't "hurt ourselves" out of our own ignorance. Yet, they refuse to proactively treat our changing physiological needs. You maintain your doctor was adamantly against AutoPAP. Meister's doctor is adamantly against his patients ever getting a glimpse of their ongoing sleep data. Yet, so many of these doctors seem to prefer that our physiology haphazardously migrate away from optimum treatment under their neglectful supervision (or lack of supervision really). There's something wrong with this picture...

loonlvr · Post by **loonlvr** » Fri Mar 18, 2005 3:36 pm

No probelm sws with posting my data. We should be thanking derek, because I could never figure how to get this stuff up. I think that I m a exception in here in the sense that I m having lots more apneas than most ppl. Thats why I think its a good case study. I was about to say that the graph was only one nite , but then thats what happens at sleep study!!!! I will be surprised if raising the pressure only 1.5 makes a big differnce but we will see. If after all is said and done and I am having centrals, or a mixture of both, whats answer.? How do you prevent centrals.?

-SWS · Post by **-SWS** » Fri Mar 18, 2005 4:09 pm

Loonlvr, I agree with you about thanking Derek! So thanks Derek for everything you have done for us lately----so much!

Re: the central apneas. My understanding is that central apnea treatment is nowhere near as straight forward as treatment of purely obstructive events. I believe the doctor would try to discern the nature or origins of your central apneas and RX accordingly. Sometimes adequate central sleep event treatment is achieved with supplemental oxygen, sometimes with BiLevel therapy, sometimes with medication, etc. Admittedly modern medicine is still at a loss to adequately explain and treat all cases of central apnea. I honestly think a follow up PSG sleep study right about now is a good thing for someone in your shoes.

I will say that it is clear that you were better off being treated by AutoPAP than you were fixed pressure of 11 cm. Yet, those results still fall short and could probably be improved upon with the correct therapy. It should also be noted that some patients do not get their AHI down below 5 for a variety of reasons.

Sleeping With The Enemy · Post by **Sleeping With The Enemy** » Fri Mar 18, 2005 4:25 pm

Loonlvr,

When I was up at your house and we looked at your reports, now correct me if I am wrong, you were having lots of apneas even while on the auto.

Your AHI was pretty bad even when the auto was trying to help you, am I right?

Sleeping with the Enemy

-SWS · Post by **-SWS** » Fri Mar 18, 2005 4:31 pm

Heidi raises a good question, loonlvr. How representative were those two AutoPAP charts? In any event I think you should get with a responsive sleep doctor very soon.

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