Choosing New Machine

Bill,

That is very interesting - I had missed your earlier posts. Having SpO2 is a great additional data source (I too have a Nellcor P.O.) My SpO2 is consistently around 94-95-96 - My wife registers 2 points better than myself. I am not overly happy with the data but am looking deeper into it.

But getting back to your experiences - what really surprises me is that you are on such a low titration setting.

When I started xPAP therapy I had chest pains (really painful) for the first 3 nights but they went away - my cms being 15. I was using a RemStar AUTO but set to CFLE mode. The stomach pains came later (not sure why).

I too was experiencing nasal congestion & had to give up using my Activa mask in favor of the U-M f/f one.

But recently I successfully went back to using a Breeze but then began getting daytime nasal problems although the nights seemed ok. I will persist with trying the Breeze as I do like the freedom it offers but for pure comfort & security I find my U-M f/f/ mask the security blanket.

As of this week I have begun using nasal saline flushing to try to counter the effects of problems that showed up last week that may have begun with using the Breeze mask. Seems to be working.

I have found (& was told clearly) that using nasal decongestants is only good for about 3 days then one has to back off else they reverse their effects. Early last week I had used one for 3 nights running.

Despite having these nasal frustrations, they don't upset me these days as I have come to accept they are part of my therapy challenge.

For your therapy, you certainly have the right attitude & approach and I have no doubt you will find a pattern that works for you, but I am quite surprised at the data from your machine. In particular what made the machine go to max for both IPAP & EPAP.

Actually, I can now see a use for an APAP mode as a means of setting a base level to later switch to AUTO mode for BiPap. So this has been interesting in that I now understand better where you were coming from when saying APAP mode would be of use. The thing about AUTO with BiPap is that the two pressures (IPAP & EPAP) trck independantly (which is one reason I believe they had to set a min gap between the two).

So thanks for that data I believe I have learned from it.


Cheers

DSM

Guest DSM wrote:But getting back to your experiences - what really surprises me is that you are on such a low titration setting.

I had to start somewhere DSM since I didn't have a titration study, and for a variety of reasons, I haven't yet been successful at increasing pressure, although after my first three days with the nasal mask I think it's time to try a pressure increase again and see what happens.

Guest DSM wrote:In particular what made the machine go to max for both IPAP & EPAP.

Obviously the machine was trying to clear an obstruction. One thing I know that was happening is what I discovered last week - my jaw was getting pushed back under higher pressures with the full face mask on and this caused increased apnea. I also suspect that my sinuses were involved as well since they tend to clog up in the early morning hours. Take a look at the charts below and you can see what I mean:




The nearly constant reported snores between hours five and six were not snores at all, simply the machine registering noise from my sinus congestion. It took me a little while to put all the clues together. Leak data shows the mouth wasn't open, and oximeter data shows few desats during that time so windpipe was open. Either I was snoring with my mouth closed or the reported snores were caused by sinus congestion noise.

So, anyway, that's my current thinking about why both IPAP and EPAP went to max pressure.

Regards,
Bill (still figuring it out)

Bill, according to that top graph your machine spent the whole night
in CPAP mode while delivering only 4 cm pressure. Is that the mode and pressure you intended to set?

Yep.

Do your apnea clusters clear when your xPAP machine is allowed to go higher than 4 cm?

I hadn't thought of capturing data on a nights sleep on such a low seeting but what it more or less achieved was to provide an almost 'normal' nights sleep as a reference baseline for future comparisons.

I guess most of us who went the sleep study path have tended to stick very closely to our recommended titration figure but this strikes me as worth doing just to capture a baseline (and backed up by the PO data).

DSM

dsm wrote:I hadn't thought of capturing data on a nights sleep on such a low seeting but what it more or less achieved was to provide an almost 'normal' nights sleep as a reference baseline for future comparisons.

Ah . . ., I'm not nearly so detached as you might think, DSM. The reason I've spent most of the time since starting xPAP at 4 cm pressure is that pressure helps relieve my symptoms - a lot! If I'd found relief at 8 cm pressure on day 1, you'd better believe I'd be at that pressure instead.

Last night I let the auto pressure run up again, this time limiting it to 10 cm max and the night went well. I'm hoping this is the beginning of a new trend. Take a look at my other post for details. (No charts though, thanks to Encore Pro misbehaving. )

As for having a baseline, you're certainly right about that. And, I've now got lots of baseline data. My sleep doc was even surprised by just the few charts I brought in when I saw him last.

Regards,
Bill

Bill, I found the following information in your very first post:

NightHawkeye wrote:Interestingly enough, the new sleep study results were consistent with those obtained years ago. My AHI was only about 2.7.

If you have an AHI of 2.7 without the use of any XPAP therapy, why are you experimenting with a biPAP machine? Since an AHI under 5 doesn't constitute a diagnosis of OSA, how are you benefiting from using XPAP? Despite the lack of a clinical diagnosis, and therefore no insurance coverage, you indicated you convinced your doctor to write you a prescription for the machine because you hoped it would improve your sleep. From the data you've supplied, being on the machine has raised your AHI consistently into the teens. Doesn't that indicate XPAP therapy is making you worse instead of better? You have expressed concern about central apnea, but if you are using pressure you do not need, wouldn't that mean you are increasing the risk of pressure-induced centrals? If you are experiencing severe oxygen desats, wouldn't you benefit from oxygen therapy instead of XPAP therapy? Because you are so thorough in your treatment, I am guessing you have already considered all these possibilities, and I would like to know your opinion of how it all fits together.

Anonymous wrote:Since an AHI under 5 doesn't constitute a diagnosis of OSA, how are you benefiting from using XPAP? . . . Because you are so thorough in your treatment, I am guessing you have already considered all these possibilities, and I would like to know your opinion of how it all fits together.

You should work for a sleep lab, Anonymous. Some of those guys really do think they have all the answers. .

While I'm tempted to blow off the condescending nature of your post, I'll instead state what I've posted here before: The sleep study got it wrong. My sleep doctor doesn't dispute that, nor did he when I initially brought in the oximeter data which indicated a more significant problem.

The main cause of failure during the sleep study was, I believe, the fact that I often don't experience significant apneas until the later, and longer, segments of REM sleep. I've recorded lengths of up to five hours after going to sleep before ever having any apneas, but usually it's only two or three hours. So, consider the fact of the sleep study being in an unfamiliar environment, my likely sleeping lighter than usual, and what result do you suppose one should expect to see?

So, Anonymous, thank you very much for your questions. I believe I've covered them sufficiently in prior posts, with the exception of the supplemental oxygen question, and honestly, I don't know where you dredged that one up from cause I've never said anything about my oxygen level being low, except as the result of apneic events.

To summarize:
1) The sleep study got it wrong
2) Sleep doc agrees and is pleased with progress
3) I'm doing very well now, thank you very much

Regards,
Bill

Bill,
I read no condescension in the guest's questions. He/She sounded very polite to me.

Many of us use this forum to learn, and those question seemed to me to be in the spirit on enquiry - I was glad to have them asked, and glad to read your explanation.
O.

ozij wrote:I read no condescension in the guest's questions. He/She sounded very polite to me.

Thank you ozij. You're probably right. I have to remind myself from time to time that most questioners are, in fact, serious. I suppose it may just have been the combination of the questioner being anonymous coupled with the daunting prospect of trying to answer all the questions in one fell swoop. My apologies for offending anyone.

Regards,
Bill

Bill,

Don't feel bad about reacting that way. It was very human. We have had some heated debates here on the issue of anon posts. I took the position that it was like being grilled by someone with a hood over their head.

And the questions were somewhat blunt. It is interesting that Ozij didn't feel they were 'interagoratory' - I leaned toward my above definition.

Cheers

DSM

#2 - IMHO a common cause of frustration with anonymous unsigned posts is that one can't PM the originator to seek clarifications nor guess at who the person may be - this forces the responder onto the defensive and running the risk that other anons will join in and if their posts 'seem' negative that can seem like swordfighting with multiple (or is it one) opponents - all with bags over their heads

I do apologize, Bill. Far from being condescending, my questions were written because I have a sincere interest in learning what led you to insist on XPAP therapy despite the fact OSA was not indicated. More so, I wanted to learn what went into your thought process to continue with XPAP treatment despite the fact it resulted in a higher AHI than was obtained without it. Your posts have always been open and honest as you give detailed accounts of your Encore Pro and My Encore statistics, and it never occurred to me you would find my questions offensive.

I have learned a great deal from this forum. I am accustomed to seeing individuals conduct self-titration experiments in an effort to lower their AHI below 5. It was puzzling to me that this was not your intent and I didn't understand why. Currently you are using an extremely low pressure and your AHI is in the teens. If you raised your pressure, would your AHI drop to a level where therapy would be deemed to be effectively treating your OSA? If you are not raising your pressure for fear of pressure-induced centrals, what is your next course of action? The reason I asked about supplemental oxygen, is because I thought perhaps that would be a logical solution to the desat problem you mention in your posts.

This is an ongoing education for all of us and your case is of particular interest because it is so different from the norm. Because you have shared your charts and graphs and thought processes so freely in the past, I felt no hesitation in asking questions and, in fact, assumed you would welcome them. My apologies for making such an assumption.

DSM, my questions are indeed straight-forward and succinct. I have always viewed this as a positive trait and admire it in others. When I read information, no matter what the source, I check the facts, I verify the conclusions, and I ask questions. I place a high value on factual and accurate content, as well as the intelligence with which a post is written, and if it is concise, all the better. I care not a whit about the name of the person who wrote it. My apologies for offending you as well.

Thank you Guest for explaining yourself. It does take longer to compose a considered and respectful inquiry, yes?

I'll try not to be too blunt, but I am short for time here and I do like my sleep these days. AHI to me is just a number, one of many different measures for sleep apnea. My real concerns are the real physical symptoms I've experienced and described in detail. The oximeter results provide an interesting and objective comparison between pre and post xPAP. The oximeter results on average are somewhat better now than before starting xPAP. That's one objective measure, besides my symptoms, to indicate that the sleep lab got it wrong.

To your pressure questions, we'll see what happens. Multiple effects have occurred. Anyone who's ever done troubleshooting for a living can tell you that sometimes you just have to work through multiple problems, or peel back the layers of the onion as it were. If you're interested you can go back through some of my prior posts where I've detailed some of these effects.

As to the uniqueness of my case, maybe, maybe not so unique. So far, the specifics I've uncovered relating to my situation are not particularly unique. Jaw position, apnea during REM only, sinus problems, and sweats/chills are all phenomena experienced by others on this forum. (By the way, I've read that central apneas are almost never manifested during REM sleep, assuaging my concern there somewhat as well.)

Now, it's off to sleep for me. And, Guest, I'd encourage you to sign up as a member so that the rest of us can judge you as well by the history of your participation here.

Regards,
Bill

NightHawkeye wrote:Thank you Guest for explaining yourself. It does take longer to compose a considered and respectful inquiry, yes?

Now that was condescending.

NightHawkeye wrote:And, Guest, I'd encourage you to sign up as a member so that the rest of us can judge you as well by the history of your participation here.

Your comment smacks of arrogance, and if ever there was an invitation made which will deter an anonymous poster from wanting to "sign up", that was it. We are all members here. Some of us choose to post our questions and answers with a registered username and some of us do not. Making judgments about other members may be your personal objective, but thankfully it is not the objective of this forum.