Good data but bad sleep?

FreeLancer74 · Post by **FreeLancer74** » Mon Dec 03, 2007 8:21 am

I notice you guys are all talking about Resmed machines and masks. How does the conversion work for the Respironics M-series machines? Is the LCD number the same l/m as the graph, or do I have to convert as well? The M-series does not have a mask input section of its firmware.

DreamStalker · Post by **DreamStalker** » Mon Dec 03, 2007 8:31 am

No conversion needed for Respironics machines and no math needed to adjust for leak rates as they do not have mask setting.

BarryKrakowMD · Post by **BarryKrakowMD** » Wed Dec 05, 2007 12:54 am

At our sleep center, http://www.sleeptreatment.com, we have noted this problem for several years now, and we came to the conclusion some time ago that most of these cases, assuming all other factors have been properly managed, reflect the persistence of flow limitation (aka upper airway resistance syndrome).

As a reminder, AHI is not the current standard for measuring the severity of a sleep breathing disorder. The new and more accurate metric is RDI (respiratory disturbance index), which means that you measure apneas, hypopneas and flow limitations (also known as RERAs or UARS).

So, many people with low AHIs actually suffer from persisting or residual breathing events that typically equate to an RDI greater than 15 and often greater then 30 events/hr.

We have found that many of the APAP machines do not resolve this problem fully. In fact, I used to use APAP a few years back, and while I got a good response, I never got a great one. About 3 years ago, I switched to bilevel, and we now titrate most of our patients with bilevel and prescribe bilevel for more than 90% of cases. Specifically, we find that it is must easier to lower the RDI to less than 10 events/hr when we use bilevel.

If you are interested in learning more about our approach, I encourage you to check out my new book, Sound Sleep, Sound Mind, available at any bookstore or on our site. Also, for those of you interested in blogging about sleep, you might find some interesting opportunities at our new site http://www.snoozebusters.com

Good Night and Sweet Dreams!

Barry Krakow, MD, blogging at http://www.sleepdynamictherapy.com

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CPAPopedia Keywords Contained In This Post (Click For Definition): AHI, RDI, APAP

GumbyCT · Post by **GumbyCT** » Sun Dec 16, 2007 3:10 am

Dr. Krakow - Welcome aboard.

How can we tell if our therapy is effective? Can reading the events from the software be used to make that determination?
If not what is the accepted or preferred way to determine therapy effectiveness?
Thanks,
GumbyCT

Slinky · Post by **Slinky** » Mon Dec 17, 2007 7:42 am

One of the problems I see or anticipate is air escaping from our lips thru out the night. Its not enough to wake us but it is causing a loss of therapy. So unless one resorts to either a full face mask or lip sealing of some sort whether taping or "gluing" w/PoliGrip denture gel one isn't getting an accurate picture of what is going on w/our CPAP therapy.

I realize that the sleep tech can compensate for this type of leak during titration but how many of us end up using the mask we wore during our titration? So the tech compensates for the leaks we encounter during titration and our pressure is determined based on that data then we go home and end up using a different mask most likely changing our leaks and who is to say whether the selected pressure is then accurate for our needs?

I don't know of any RT, sleep doctor or sleep tech who recommends sealing our lips. Yet how many are able to comfortably and effectively use a full face mask? Yet again, the darn mask holds the key. *sigh*

Good data but bad sleep?

Low AHI, Low Leak, Yet Poor Response