UARS just starting VPAP adapt

Hello,

I've found this forum to be a great help to me in discovering and starting to treat my UARS. I'll start with an overview of my story because I found it helpful to read about others experiences. I'm 26 years old, 6'00" 155 lbs. Discovering that my proplem was breathing related was a long journey. I had my first sleep study done at national jewish hospital in denver when I was 20 years old. The report indicated I didn't have sleep apnea or rls and my doc concluded it must be physcological. I was put on sleep meds including ambien and lunesta and zoloft for depression. I few years ago I moved to the mountains and realized in the heart of the winter my symptoms would almost go away only to return with a vengence in the spring. This is what propted me to look into UARS which I was diagnosed with just a couple months ago.

A sleep study indicated my RDI was 22.3 events per hour. I also didn't respond well to Bipap (central apneas) so I was put on a resmed vpap adapt. I've been on the machine now for 24 days and I can't seem to wear it for more than 5 hours. I wake up after about 4 hours typically and the pressure seems like its a lot to handle (max 12, epap , and I never can seem to go back to sleep. My machine also doesn't have a ramp feature which I feel would help a lot. Is this normal for people in the beginnig of therapy? How long does it typically take to adjust to sleeping 8 hours with a cpap? Any tips or suggestions would be greatly appreciated. Thank you.

Hey, SC, I can't answer any of your questions, but I look forward to the responses of others. I, too have UARS.

sleepycyclist wrote: I few years ago I moved to the mountains and realized in the heart of the winter my symptoms would almost go away only to return with a vengence in the spring. This is what propted me to look into UARS which I was diagnosed with just a couple months ago.

I wonder what the connection was between your symptoms being worse in the spring and UARS. Is it allergies?

What does a VPAP adapt offer that an APAP doesn't?

Does anyone know if a pressure of 12 is too high for a person with an RDI of 22? SC, was your titration different on the BiPAP?

I wonder what the connection was between your symptoms being worse in the spring and UARS. Is it allergies?

Yes I believe this is due to my allergies (hay fever). I have recently started allergy shots to see if they help.

was your titration different on the BiPAP?

I have only had one titration done where they found that I was having central apneas on the bipap, they switched me over to a asv machine and I responded very well. My perscription says to set to:

max ps: 12
eep: 10
min ps: 6

I have mine set up like this to help me adjust:
max ps : 12
eep: 8
min ps: 3

I'm not sure the difference between eep and epap on my machine it says epap and on my perscription it says eep.


Thanks for the response.

sleepycyclist wrote:

I wonder what the connection was between your symptoms being worse in the spring and UARS. Is it allergies?

Yes I believe this is due to my allergies (hay fever). I have recently started allergy shots to see if they help.

was your titration different on the BiPAP?

Hi and welcome to the forum. I can't add much to your question but it will now bump up to the top and perhaps get some attention.
My allergies have been bad and I, too start having problems about 4 am.. initially blamed it on the mask, but I read where others wake up around that time. My allergist told me a few years ago that the allergy concentration goes up around early morning, hence to limit my early morning exposure then. So that may be a connection. Also, we may be going in to a more busy -restless? time with moving around in our sleep, I'm not sure.
Hopefully someone with a better answer will pick up on the thread. Best wishes, sleepycyclist.

napstress wrote:... What does a VPAP adapt offer that an APAP doesn't? ... Does anyone know if a pressure of 12 is too high for a person with an RDI of 22? ...

I will tackle these questions first.

First a Resmed S9 VPAP Adapt unit is an ASV unit. This is a very special BiPAP unit that acts as a ventilator to sustain breathing during central apneas. These units are VERY expensive due to the adaptive servo-ventilator function built into them. There are several members in the forum who use these units, including myself. They are a LOT different than an Auto PAP (APAP) or a BiPAP or even an Auto BiPAP unit.

Second, I suspect the original poster did not know how to read the detail from the ASV unit. The pressure that (at least my older) VPAP Adapt SV unit presents is the "average" pressure from the previous night. Depending on the posters titration study, that actual max pressure may be as high as 25cm H2O. But that is what is needed to sustain breathing. That is how the unit acts as a ventilator when needed.

sleepycyclist wrote:Hello,

I've found this forum to be a great help to me in discovering and starting to treat my UARS. I'll start with an overview of my story because I found it helpful to read about others experiences. I'm 26 years old, 6'00" 155 lbs. Discovering that my proplem was breathing related was a long journey. I had my first sleep study done at national jewish hospital in denver when I was 20 years old. The report indicated I didn't have sleep apnea or rls and my doc concluded it must be physcological. I was put on sleep meds including ambien and lunesta and zoloft for depression. I few years ago I moved to the mountains and realized in the heart of the winter my symptoms would almost go away only to return with a vengence in the spring. This is what propted me to look into UARS which I was diagnosed with just a couple months ago.

A sleep study indicated my RDI was 22.3 events per hour. I also didn't respond well to Bipap (central apneas) so I was put on a resmed vpap adapt. I've been on the machine now for 24 days and I can't seem to wear it for more than 5 hours. I wake up after about 4 hours typically and the pressure seems like its a lot to handle (max 12, epap , and I never can seem to go back to sleep. My machine also doesn't have a ramp feature which I feel would help a lot. Is this normal for people in the beginnig of therapy? How long does it typically take to adjust to sleeping 8 hours with a cpap? Any tips or suggestions would be greatly appreciated. Thank you.

First, welcome to the forum, sleepycyclist. I recommend that you register as a user and register your equipment. Here are some instructions on registering your equipment:

wiki/index.php/Registering_Equipment_in_User_Profile

Second, you will probably want to become familiar with Central Sleep Apnea. Rested Gal maintains a list of "Links to Central Apnea" discussion, which has a LOT of background information:

viewtopic.php?p=22702

Third, please understand that your VPAP Adapt (I assume an S9 unit) is a LOT different than a BiPAP unit. As I noted in the previous post, this is an ASV unit. That is, it is an Adaptive Servo-Ventilator. When you have a central apnea - simply fail to breathe - your unit shifts into ventilator mode and helps sustain your breathing. At this point, it ramps the pressure WAY up. Your specific unit has a maximum pressure of 25cm H2O. That is a lot higher than most CPAP and BiPAP units. It is also what is needed to help you breathe when your body fails to do so.

As I noted, an ASV unit is a lot different than a CPAP or BiPAP unit. You have a LOT more settings on your unit. It would be a good idea to request your prescription for your unit. It can help if you travel - I keep mine in my ASV case when I travel. That way, if anyone asks, the prescription (often written as a Letter of Medical Necessity) is right there. I never get any hassle about it, since CPAPs are so common these days.

Oh, since it is so different, in the future, you might want to add "ASV" into the subject of the post. Those of us with ASV units will then quickly chime in and see what we can do to help.

Now onto your specific questions:

sleepycyclist wrote:... I wake up after about 4 hours typically and the pressure seems like its a lot to handle (max 12, epap , and I never can seem to go back to sleep. ...

Sounds as if your central sleep apnea starts to surface during deep sleep. You would start to reach and stay in deep sleep after a few hours of sleep. This is actually pretty normal. For example, I tend to have more central apneas during Non-REM sleep than during REM sleep. During lighter levels of sleep and during REM sleep there is more brain activity that helps reinforce normal breathing. During very deep sleep the brain activity decreases, and the tendency to have central apneas increases.

If you have problems with getting to sleep after one of these events, you might want to chat with your doctor about it. A fast acting sleep agent (Lunesta, Ambien, etc) might help.

Or you might get up, read a little and then see if you can go back to sleep. Often getting away from it a bit helps. The idea that we should sleep 8 hours through the night is actually a very modern (post industrial revolution) idea. Prior to that it was not unusual to have an early session of sleep and then a second (or third) session of sleep. See the Segmented Sleep article in Wikipedia.

sleepycyclist wrote:... My machine also doesn't have a ramp feature which I feel would help a lot. ...

Nope. That's because a lot of folks with central apneas stop breathing as they fall asleep. The ramp feature would not be able to sustain their breathing should they fail to breathe as they fall asleep. By the way, that is very normal. Anytime we fall asleep, our bodies shift from one method of regulating and controlling breathing to another. During this transition to and from sleep we often have central apneas. These are normally discounted during sleep studies - unless they are VERY long in duration. Prior to being put on an ASV unit, I would stop breathing so long that the "Auto OFF" feature of my BiPAP would activate. That is, I would stop breathing for more than a minute at a time. Not good.

So, for those of us with ASV units, a ramp feature is simply not an option. Sorry.

sleepycyclist wrote:... Is this normal for people in the beginnig of therapy? How long does it typically take to adjust to sleeping 8 hours with a cpap? Any tips or suggestions would be greatly appreciated. ...

At the beginning of CPAP or BiPAP therapy no. But you have an ASV unit. And I fear it is pretty normal for someone with an ASV unit. Some of us never get to sleep the full 8 hours through the night. I rarely do. Sometimes, but maybe only once a week or less. But I am DEFINITELY doing much better than I was prior to ASV therapy.

Depending on the type of mask that you have, you might want to investigate a mask liner. That will help quiet the mask when the pressure gets really high. You can find some at:

http://www.remzzzs.com/Default.asp
http://quietusliners.com/
http://padacheek.com/PAC_Maskliners.html

You may also find that a full face mask is needed at the high pressures. (Or you might have one already ... that's why we need you to register and register your equipment).

Hope that helps.

John,

Thank you so much for taking the time to respond.

Sounds as if your central sleep apnea starts to surface during deep sleep. You would start to reach and stay in deep sleep after a few hours of sleep. This is actually pretty normal. For example, I tend to have more central apneas during Non-REM sleep than during REM sleep. During lighter levels of sleep and during REM sleep there is more brain activity that helps reinforce normal breathing. During very deep sleep the brain activity decreases, and the tendency to have central apneas increases.

I think your right on with this comment because when I do wake up during the night my machine is at a very high pressure 18 or 19 cm. When I wake up I turn off the machine then turn it back on hoping that it will go down to a lower pressure but it just starts back again with a very high pressure that I find hard to fall asleep with.

You may also find that a full face mask is needed at the high pressures. (Or you might have one already ... that's why we need you to register and register your equipment).

I actually started my therapy with a full face mask (mirage quattro) but I was having bad aerophagia that was causing me quite a bit of discomfort. I switched to a nasal pillow system and am now taping my mouth shut to avoid leaking air out of my mouth. The chin strap I found to be very uncomfortable and caused some tmj pain. I seem to be doing good with the tape system, definatly less aerophagia. Maybe I will try the quattro again with a chin strap or tape.

Thanks again!

sleepycyclist wrote:... I actually started my therapy with a full face mask (mirage quattro) but I was having bad aerophagia that was causing me quite a bit of discomfort. I switched to a nasal pillow system and am now taping my mouth shut to avoid leaking air out of my mouth. The chin strap I found to be very uncomfortable and caused some tmj pain. I seem to be doing good with the tape system, definatly less aerophagia. Maybe I will try the quattro again with a chin strap or tape. ...

No, no. You found something that works. And if it works and helps decrease the side symptoms, great!

As you can see from my avatar, taping my mouth is not an option. I also panic when I try something like that. But most importantly, my wife threatened, no PROMISED, all sorts of torture if I shave my mustache.

So, a full face mask is my only real option. But if you've found something that works, great!