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John, thanks for your interest. I will post my numbers over the weekend. Of course, the dentist thinks I'm an excellent candidate for the oral appliance(Somnodent) I slept with it last night. No difficulty but I realize it's only the beginning. I missed my cpap! I may use both for a while cause who really knows if the Somnodent is effective.

chicagocard wrote:John, thanks for your interest. I will post my numbers over the weekend. Of course, the dentist thinks I'm an excellent candidate for the oral appliance(Somnodent) I slept with it last night. No difficulty but I realize it's only the beginning. I missed my cpap! I may use both for a while cause who really knows if the Somnodent is effective.

I keep thinking to buy an oral appliance someday if only to use as an adjunct to CPAP (or an expensive paperweight, John). My plans would be to start out using it exclusively with CPAP. If I can tolerate it and it seems to be working well, I would begin dropping my pressure settings in 0.5 cm increments and following the data closely.

If my AHI stays acceptably low, at some point in lowering the pressure, I would have to think about a home sleep study using the oral appliance only.

But that is more of a daydream, because I have a gut feeling that my airway is so narrow that CPAP will always be required.

Good morning, well I was amazed to discover that I haven't used Encore Pro and My Encore since November 2008! I have forgotten how to maneuver everything and so will have to work on it. Encore Pro tells me I have had an average of .7 AHI since the start of 2010. Thanks for suggesting the gradual lowering of pressure and checking the results. I'll report back.

chicagocard wrote:Good morning, well I was amazed to discover that I haven't used Encore Pro and My Encore since November 2008! I have forgotten how to maneuver everything and so will have to work on it. Encore Pro tells me I have had an average of .7 AHI since the start of 2010. Thanks for suggesting the gradual lowering of pressure and checking the results. I'll report back.

Did your insurance cover the appliance??

I know I was partly responsible for this thread diverging from 10-sec apneas to oral appliances. The update I wanted to add today was about 10-sec apneas. I could also make a story about oral appliances, as since my last post here I have obtained and am using intermittently an oral appliance. However, what I have to say about oral appliances is not as interesting to me at this stage as what I have to say about 10-sec apneas. So here it goes.
I had a long talk yesterday with someone from ResMed. I shared with her some of my recent data from a portable monitor which showed central apneas and also some of my ResScan data. What she noted was that my plethora of 10-sec apneas tended to correspond with no change in ResMed 8 Autoset Pressure. She explained that the device checks the resistance in the airway before increasing pressure after an apnea. If the airway is not offering resistance, then the device does not increase pressure (and a central exists). If the airway is offering resistance, as in obstructive apnea, then the device increases pressure. Ipso facto, when a patient is having a 10-sec apnea and no change in pressure, the patient is having centrals. For centrals, the APAP is not optimal -- a VPAP Adapt might be more appropriate.
I asked her how it could be that some nights I had many, many 10-sec apneas but almost no apneas of other duration. She replied that my pathophysiology might be such that after 10 seconds of no breathing that the O2 or CO2 balances stimulate a breath. In other words, my brainstem has first detected some O2 or CO2 level that made the brain think that no breathing was appropriate but after 10 seconds the loss of O2 gets serious enough to stimulate a breath.
I found this very interesting for 3 reasons:
1. For one, I had wanted to get a ResMed 9 to see the central versus obstructive distinction explicitly. Now I realize that I can more or less compute for myself whether or not I am having central or obstructive airway events from the ResMed 8 data -- to the extent that a PAP device can know.
2. For another, I now want to consider another type of 'respirator'.
3. Finally, I am yet further drawn to wanting a portable monitor that would allow me to definitively detect centrals versus obstructive events. I borrowed from my dentist a portable monitor for sleep apnea (a Nox Medical T3) for a weekend and found the data very helpful. However, the dentist wanted the portable monitor returned. Does anyone know how and where I can buy a portable monitor with associated software?
Is anybody else having apneas on ResMed 8 with no increase in pressure and wondering what that means?
Yours,
Roy

rada wrote:...Is anybody else having apneas on ResMed 8 with no increase in pressure and wondering what that means?

I am, in fact every one of the few I have is not associated with a pressure increase! Interesting info from ResMed. I wore a CMS 50D handheld recording oximeter for about 2 wks; some nights I was bumping up against 100% for some period of time...will have to see if I had any apneas then and if they occurred when I might have been fully oxygenated. Will post when I get some time to check this out.

Thanks Rada! I had a bad night with 2 back to back apneas, short 10 & 12 sec, surround by several hypops and felt really lousy the next day. Was also beginning to wonder why my AutoSet II didn't increase pressure under 10 while reporting an apnea...artifact or a possible defect was flitting through my brain.

According to the ResMed expert, I would interpret your apneas not associated with a pressure increase as central apneas. Is that what you are thinking? They should reduce your SpO2 too, although being short in duration the SpO2 impact might be slight. Did those short apneas plus perhaps longer hyponeas disrupt your sleep? Sometimes when I have the short apneas with no pressure response, I sleep through them. I somehow imagine that the short-duration central apneas are less phsyiologically disruptive than the short-duration obstructive apneas. What is your experience?
Your 'signature' says that you have the S8 Autoset. So do I. I wonder how different the data would be with the S9 which explicitly records the central versus obstructive. I read an interesting 2010 journal paper today by Ueno et al titled "Evaluation of the apnea-hyponea index determined by the S8 Autoset ... " which claims the S8 gives AHI similar to PSG. I am considering to respond to the authors about what the S8 misses. But Ueno et al removed patients with centrals from their study. Are you interested in that kind of paper?
Roy

rada wrote:...Are you interested in that kind of paper?

Yes! I was also considering centrals...while I had none in my PSG, my sleep length, quality, & architecture were so poor (1.5 mins of SWS & no REM) that I wonder if they might not have shown up if I'd had deeper sleep. I typically have been waking up 5-6 times/night. Finally went back to using my topical progesterone and I get deeper sleep...seemingly with more events but it's hard to say because the weather's extremely hot (I don't breathe well in heat), I have more congestion from 'bad air' (code orange) days & just plain feel lousy, and am feeling esp stressed-rushed. The last 4 nights I've had short apneas, only one followed nby increased pressure...sure seems like centrals. Sometimes events terminate in a wakeup...flush, pulse up, increased/deeper breathing & sometimes not...very frustrating as I know these interruptions make restful sleep more a hope than a reality.

I'd get the S9 Auto in a heartbeat if I had the funds to buy it...the reported data is soooo seductive for those of us for whom restful sleep is a challenge (the data might reveal the answer as to how to get that restful sleep I used to have...)

I sympathize with you. I also have been having some difficulties in the heat, feel that my last sleep study at my doctor's clinic was not reflecting my typical sleep, and have been waking several times during the night and feeling tired throughout the next day. I was not aware that progesterone might be a treatment for sleep apnea but in now reading http://www.aeron.com/volume_2_number_12.htm can see the connection. I was visiting family in Denver for the first two weeks of June, forgot the cable for my pulse oximeter, and have now spent most of June relying only on APAP data for numeric, machine monitored data of my sleep. I have, however, been experimenting with three treatments (APAP, oral appliance, and sleep position (supine, lateral, or prone)) and various combinations thereof, such APAP + oral appliance + lateral position. Regardless of my approach, I have interrupted sleep, and thus I can sympathize with your frustration. While I think the S9 would give me better, more useful data, I don't think it's not the ultimate answer as regards data. I would like the oximetry and brain wave data synched with the air flow. I don't know how to get such a portable monitor, even though I pay from my own pocket for it. Even the portable monitor that adds synchronized oximetry and plethsymography but no EEG, I don't know where to buy. What is the etiology of your sleep apnea? I seem to recall your mentioning something about losing weight in a message and that that helped you. By the way, on closing and keeping with the title of the thread, my 2 hours of APAP last night showed a AHI about 30 and apnea index about 10 with almost all apneas of 10-second duration and corresponding with unchanged APAP pressure.
Yours, Roy