I believe it was Wader who suggested he do this...
derek
What's REMStar Auto Really Doing? - new thread
Loonlvr's cpap response at 12.5 cm.
Here is Loonlvr's Encore Pro chart at 12.5 cm cpap from last night:
I believe it was Wader who suggested he do this...
derek
I believe it was Wader who suggested he do this...
derek
Loonlover, what is your take on your 12.5 cm experiment? Does Wader or anybody else have any comments or observations on this 12.5 cm experiment?
Loonlover, I think you're still at two possibilities: 1) central apneas, 2) "fast and heavy" apneic closures that outstrip the RemStar Auto's three-pressure-increment limit. In that second case the RemStar Auto wouldn't be able to climb quickly enough to address those obstructions in three-pressure-increment limits. You could theoretically test for that case by getting your AutoPAP pressure range both narrow and high. I still edge central apneas as being the more probable case, however.
Anybody else have opinions?
Loonlover, I think you're still at two possibilities: 1) central apneas, 2) "fast and heavy" apneic closures that outstrip the RemStar Auto's three-pressure-increment limit. In that second case the RemStar Auto wouldn't be able to climb quickly enough to address those obstructions in three-pressure-increment limits. You could theoretically test for that case by getting your AutoPAP pressure range both narrow and high. I still edge central apneas as being the more probable case, however.
Anybody else have opinions?
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wading thru the muck!
- Posts: 2799
- Joined: Tue Oct 19, 2004 11:42 am
My take on your night at a fixed 12.5cm is that 12.5cm is too low. I'm not going to suggest another pressure to try. Show the data to your Doc and see if he/she wants to just up it a notch or do another sleep study. If you do another sleep study make sure you take you data sheets along to show the tech. He/she may not want to see the data but it may give the tech a heads-up that you are a difficult case.
Sincerely,
wading thru the muck of the sleep study/DME/Insurance money pit!
wading thru the muck of the sleep study/DME/Insurance money pit!
I think it's interesting that loonlvr had an AutoPAP maximum pressure of 19 cm set, but never hit that top end. If 12.5 cm is still too low for loonlvr (implying obstructions versus central events), and a top-end AutoPAP range of 19 cm was never realized, then that hints at AutoPAP incompatibility for loonlvr. That is unless a narrower and higher AutoPAP pressure range suffices for loonlvr.
Alternately, if those were prolific central apneas (on the 1st and 2nd charts) causing the Remstar Auto to "take a pass" on treating so many subsequent apneas, then that too hints at AutoPAP incompatibility for loonlvr.
Alternately, if those were prolific central apneas (on the 1st and 2nd charts) causing the Remstar Auto to "take a pass" on treating so many subsequent apneas, then that too hints at AutoPAP incompatibility for loonlvr.
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rested gal
- Posts: 12881
- Joined: Thu Sep 09, 2004 10:14 pm
- Location: Tennessee
I agree with Rested Gal. Additionally, he would be able to determine whether or not these are actually Central Apnea's.
I've found something interesting about myself using the 420E for the last several weeks:
I am convinced now that the pressure runaways that I was having were caused by nasal obstruction. You can only get so much air through small openings quickly enough. This caused the 420E to trigger on flow restriction very aggressively, and when the pressure got to a certain point, I would get gross mask leaks or intermittant mouth leaks.
I have adjusted my machine accordingly and plan to experiment with Afrin and other allergy medications and will change to a full face mask, if necessary. (Perhaps pillows might be a good compromise because all the pressure is on the inside of the nares, which would help to keep the nasal passages open--if only I could get used to those "booger pushers". . .)
I wonder if Loonlvr might be having similar nasal restrictions?
Loonlvr, what kind of mask are you using? Do you have trouble breathing through your nose. Also, do you ever wake up in the middle of any of these excessive apnea periods finding it hard to take in air through your nose?
-John
I've found something interesting about myself using the 420E for the last several weeks:
I am convinced now that the pressure runaways that I was having were caused by nasal obstruction. You can only get so much air through small openings quickly enough. This caused the 420E to trigger on flow restriction very aggressively, and when the pressure got to a certain point, I would get gross mask leaks or intermittant mouth leaks.
I have adjusted my machine accordingly and plan to experiment with Afrin and other allergy medications and will change to a full face mask, if necessary. (Perhaps pillows might be a good compromise because all the pressure is on the inside of the nares, which would help to keep the nasal passages open--if only I could get used to those "booger pushers". . .)
I wonder if Loonlvr might be having similar nasal restrictions?
Loonlvr, what kind of mask are you using? Do you have trouble breathing through your nose. Also, do you ever wake up in the middle of any of these excessive apnea periods finding it hard to take in air through your nose?
-John
Another possibility:
On the first two charts (in Auto mode), in both cases, the highly concentrated string of apneas occurs somewhere in the middle of the night. In both charts, the pressure at the time of these apneas was exactly at the first pressure increase of the evening to equal or exceed 10 or 11 cmH20. Could this simply be a case of runaway central apneas triggered by pressures in excess of 10 cmH20?
I noticed that although the REMstar's algorythm tries to determine whether an apnea might be central by determining whether it they are responsive to pressure increases, it does not seem to lower the pressure enough to see whether they can be eliminated once they are detected. Judging from loonlvr's charts, the machine just stayed at the elevated pressures and even continued to raise it based on other events until the string of NR's finally ended before lowering the pressure.
Also note that loonlvr's string of concentrated apneas occured much earlier in the evening when the pressure was set at 11 and 12-1/2, respectively. This makes sense, because those pressures were not reached until later in the evening when the machine was set to "auto".
Perhaps you could try to put the machine in Auto mode and limit the max pressure to 9-1/2 or 10 cmH20 to see what happens? At least you could discuss this with your sleep doc. . .
If the total AHI is unacceptable at the lower pressure, then perhaps a bi-level machine might be indicated.
-John
On the first two charts (in Auto mode), in both cases, the highly concentrated string of apneas occurs somewhere in the middle of the night. In both charts, the pressure at the time of these apneas was exactly at the first pressure increase of the evening to equal or exceed 10 or 11 cmH20. Could this simply be a case of runaway central apneas triggered by pressures in excess of 10 cmH20?
I noticed that although the REMstar's algorythm tries to determine whether an apnea might be central by determining whether it they are responsive to pressure increases, it does not seem to lower the pressure enough to see whether they can be eliminated once they are detected. Judging from loonlvr's charts, the machine just stayed at the elevated pressures and even continued to raise it based on other events until the string of NR's finally ended before lowering the pressure.
Also note that loonlvr's string of concentrated apneas occured much earlier in the evening when the pressure was set at 11 and 12-1/2, respectively. This makes sense, because those pressures were not reached until later in the evening when the machine was set to "auto".
Perhaps you could try to put the machine in Auto mode and limit the max pressure to 9-1/2 or 10 cmH20 to see what happens? At least you could discuss this with your sleep doc. . .
If the total AHI is unacceptable at the lower pressure, then perhaps a bi-level machine might be indicated.
-John
I use an ultra mirage full face mask. Can t use a nasal mask. I m gonna try a new pressure, 12-19 and see what happens. After this i ll let you know what happened. maybe derek can post the results.Seems like its real hard to get under a 10 ahi consistently. So far it seems I have two strings of intense apneas every nite.