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your change in pressure... is due to the EPR being set (from what I've read)

failing can mean different things to different doctors... from what I've seen even aerophagia can come under failing (I think)

Uncle_Bob wrote:...Have you considered neurofeedback training for treatment of panic and anxiety? ... I swear by it. ...

I have considered it, but with anxiety comes a feeling of being "overwhelmed" which is starting to go away little by little as I use my xPAP. Right now I'm dealing with starting xPAP therapy and regular therapy, so I don't want to do too much at once. I will definitely put that on my back burner!

Thanks!

cflame1 wrote:your change in pressure... is due to the EPR being set (from what I've read) ... failing can mean different things to different doctors... from what I've seen even aerophagia can come under failing (I think)

Why would the pressure setting read differently in the clinical menu rather than in the SmartData menu? They must mean different things, but I couldn't find that in the clinical manual.

I will do whatever I can not to fail. That I am determined. My aerophagia is beginning to go away!

tattooyu wrote:What do you think would be considered "failing"? I'm NOT giving up that's for damn sure!

Failing "cpap" is maybe....

Can't use it because pressure is so high.
Difficulty using it because pressure is so high.
Keep waking up unable to breathe out against the pressure.
Can't go to sleep because unable to breathe out against pressure and ramp doesn't help.
Keep waking up with painful bloating -- seems like high pressure shoving air into stomach and gut.
"I really want to stick with this treatment, but I have to keep taking the mask off -- this high pressure is unbearable to try to breathe out against. I don't want to quit, but I just can't keep doing this. I can't sleep."
Telling the doctor any/all of those things during the first month of cpap use.

tattooyu wrote:Last night I switched to APAP with a range of 10.0-14.0cm. The PRESSURE setting in RESULTS showed 11.0cm

That's the 95% number. Means that the machine used that pressure AND pressures below that pressure 95% of the time. Doesn't mean the machine used that one pressure 90% of the time.

tattooyu wrote:Why didn't the machine ramp up the pressure to try and prevent more apnea events?

ResMed machines use the "A10" algorithm. If an apnea is sensed, and the machine is already using a pressure of 10 or more, it will not increase the pressure. It will wait it out, and when the apnea ends, the machine will resume varying the pressure as needed in response to flow limitations and snores, to try to prevent further occurrences.

At this site:
http://www.resmed.com/en-au/assets/html ... edica.html
The last link at the bottom of that page goes to an interview with Dr Berthon-Jones who patented the A10 algorithm. On page 5, he answers the question, Why doesn’t ResMed's AutoSet respond to apnea above 10 cmH2O in pressure? (Thanks to ozij and dsm for bringing "resmedica" to the board's attention.)

Before anyone says, "WHAT???!! ResMed autopaps won't increase the pressure higher than 10 if there's an apnea???!! It takes more than that to handle my apneas..."
It's not just ResMed that won't keep increasing pressure if there's an apnea. EVERY autopap manufacturer builds in safeguards against raising pressure unnecessarily, in case an apnea happens to be a central apnea (throat is already open) rather than an obstructive apnea.

All the more reason, in my humble non-medical opinion, why most people should set the minimum pressure of an autopap up high enough to prevent most apneas right from the start.

tattooyu wrote:Why is the PRESSURE listed as 11.0 in the clinical menu but 8.8 (below the minimum?) in the SmartData section of the patient menu?

I'm not sure. My guess is that the 8.8 is figuring in the drop of pressure you get with EPR turned on (as cflame1 mentioned), and maybe the 11.0 figure does not take EPR into consideration. But, I'm so math challenged...perhaps someone else knows for sure. It ain't me when it comes to math!

Dr. Michael Berthon-Jones wrote:Why doesn’t ResMed's AutoSet respond to hypopnoea?

When you are lying quietly awake, or when you first go to sleep, or when you are dreaming, you can have hypopneas (reductions in the depth of breathing) which are nothing to do with the state of the airway. For example if you sigh, which you do every few minutes, you usually have a hypopnea immediately afterwards. This can also happen if you have just rolled over and are getting settled, or if you are dreaming. And the annoying thing is that when you are on CPAP, this tendency to have what are called central hypopneas - hypopneas that are nothing to do with the state of the airway - is increased. If you make an automatic CPAP device that responds to hypopneas, you will put the pressure up to the maximum while the patient is awake.

Do you think there is a misconception clinically that all hypopneas should be treated ?

For simple obstructive sleep apnea, central hypopneas should not be treated. They are not a disease. Everyone has them. And they don’t go away with CPAP.There is a rare and important exception: central hypopneas due to heart disease. This is called Cheyne-Stokes breathing. CPAP does help with that.

Thanks for the info RestedGal. It seems from that article that hypopneas really shouldn't be treated unless they are central hypopneas due to heart failure. Am I reading that right? If so, we should definitely take stock more in the AI number than the HI number, especially (as you say) if you have ResMed which is more sensitive to hypopneas. I know when I am falling asleep I sigh and toss/turn a lot, which is probably why my HI number is so much higher than my AI.

By the way, here are the results for last night, which makes me very happy, even though it's only one night. I think my body is really starting to get used to my APAP buddy. I felt like I had really slept. My dreaming has started as well! Not as intensely as I've read on here (yet), but at least I'm dreaming more. YAY!

I even woke up a half hour earlier than usual after sleeping for 7.5 hours.

Results for 2/25/2009:
Pressure: 10.6
Leakage: 0.24
AHI: 10.3 (Adjusted = 5.3)
AI: 0.9
HI: 9.4 (Resmed/2 = 4.7)


This weekend, I think I'm going to bump up my minimum pressure to 12.0 since I'm almost at 11.0 anyway to see if I can improve my HI number a bit. The leak rate is getting lower, and I know why. I'm not opening my mouth up as much. Last night I only woke up once to drink some water because of dry mouth (mouth breathing), and I haven't even gotten my chinstrap yet!

Results for 2/26/2009:
Pressure (95%): 11.2
Leakage: 0.5 L/s
Usage: 7:06 hrs
AHI: 10.6 (Adjusted = 5.4)
AI: 0.2
HI: 10.4 (Resmed/2 = 5.2)


Except for the leakage, which was atrocious, my best numbers yet at least for AI. I think I actually slept through the night and woke up at 5:30 am. ME? 5:30 am? You betcha. I don't really feel tired!

Another thing I noticed is that I'm not edgy/panicky any more. I even just got off a bad tech support call (that's what I do for a living) that would have sent me through the roof prior to CPAP therapy. I did get hot under the collar, but NO PANIC ATTACK!

Way to go, Kenny!! Getting rid of the ramp and upping your pressure has helped improve your AHI. You have got it figured out and you are helping others. That is what this is all about.

Bev

It's working, Kenny. Isn't that great?
O.

OutaSync wrote:Way to go, Kenny!! Getting rid of the ramp and upping your pressure has helped improve your AHI. You have got it figured out and you are helping others. That is what this is all about. Bev

THANKS! I agree with Wulfman's comment in another post of thinking of Ramp like "training wheels". That's very true. I wouldn't have been able to be compliant at the beginning without it. Now, I don't need it.

My doctor's final prescription is for 16.0 cm, but I'm skeptical about that pressure because: the machine they had sucked, it wasn't my bed, I was already anxious from the apnea and diagnosis, etc. This weekend I'm going to try the minimum at 12.0 to see what happens to my AHI and leakage; I'll keep the maximum at 18.0 cm in case I need it. Oh, and my "Hozer" is arriving today hopefully!

ozij wrote:It's working, Kenny. Isn't that great?O.

Yes, ma'am indeed! I feel so much better, and I haven't even hit two weeks yet.

birdshell wrote:Kenny, determination pays off.

With a bit of input, you seem to be managing to take good care of yourself. What an idea...if you take good care of yourself, all KINDS of other benefits fall into place. I'm glad that they are falling into line for you.

Sincerely,
Karen,
Who continues to tweak...

Thanks Karen. You ain't just whistlin' Dixie there either. I walked with my co-workers to the mall; about 0.5 mi one way (down hill). I made that walk once in the past pre-CPAP. Breathless, palpitations, lightheaded, etc. The uphill trek was even worse. Today? It was like nothing. The uphill part was still a little rough only because I'm fat. Other than that? It was a breeze!

What was waiting for me back at the office? My HOZER ARRIVED!

Kenny, thank you so much for sharing your progress. I think you've got us all smiling and shouting"YES!). Just think of all the encouragement you're giving to other newbies.

DoriC wrote:Kenny, thank you so much for sharing your progress. I think you've got us all smiling and shouting"YES!). Just think of all the encouragement you're giving to other newbies.

My pleasure. Thank you (all) for being here for me. Between my anxiety-ridden initial posts, and my progress posts, I can't believe I've managed to rack up 9 pages worth of posts! LOL.

GooooooooooOOOOOOOOOOOOOOO NEWBIES!

This is a TEST for Kenny.

Beeeeeeeep.

This has been a test of the emergency CPAP-board broadcast system. If this had been an actual emergency, you would have been instructed where and in which thread to look for further instructions. Repeat: This has only been a test.

We will now take you back to your original programming.

Thank you.

tattooyu wrote:Would somebody be so kind as to try and post a reply on my post "Kenny's CPAP Thread"? I'm just curious to see if you can do it. I can't.

viewtopic.php?f=1&t=38502&p=342913&hilit=kenny#p342913

First night with The Hozer management system, and it's great. I wish I had a longer hose, as it stretches the slack to the very limits, but I slept much more soundly not having to adjust the hose every time I move.

Results for 2/26/2009:
Pressure: 11.0
Leakage: 0.44 L/s
Usage: 7:06 hours
AHI: 6.2 (Adjusted: 3.3)
AI: 0.4
HI: 5.8 (ResMed/2: 2.9)


For some reason I couldn't post a reply if my text had an equals sign in it!