Respironics Auto CPAP vs Respironics BiPap Manual

I see the OA event graph..those 2 OAs don't present with the classic flat line for zero flow. So there was some flow but it was decreased enough to be classified as an apnea and not hyponea.
Apnea being a reduction in flow of 75 to 100% and hyponea being only a 50% reduction in flow.
Hyponeas are just as dangerous if you have enough of them and they last a long time.
So both OA and Hyponea count and event duration is important. Obviously a flat line flow reduction event is going to be more critical than a partial flow reduction but a partial flow reduction of 45 seconds is just as important as a short term flat line reduction.

It is hard to see the beginning and end of the event when you are trying to count the seconds to get event duration. When we zoom in enough to see the second demarcation lines...then the flow line gets stretched out so it is hard to see the changes and if there isn't a complete flat line with an OA...it is nearly impossible to see a change in the flow line when zoomed in. On the ResMed machine...ResMed will do the counting for you for the OAs but they don't record Hyponea duration. Respironics machines don't score event duration so if we want to know event duration we have to count the seconds and the OA flag marker isn't always in the center. To count it perfectly you have to look at the reduction (flat line event is easier) and go backward till you see the breath and forwards till you see the breath and count seconds in between. Zoomed in makes it really hard to see the beginning and ending of the flat line though. To be honest..other than satisfying curiosity, it really isn't a critical thing to know if the event is 12 seconds or really 14 seconds....or if 40 seconds vs 38 seconds. One is short and one is long and small 2 to 4 second variations with either due to us not being able to see exactly the beginning and ending of the event, is not a critical issue.

You can easily drive yourself nuts by trying to look this deeply into the wave form. I have done it to satisfy my curiosity but I don't do it often. I don't even try to count anything that isn't a flat line obstructive event. It is simply impossible to see exactly when a partial collapse starts and stops. We can get close but can't be exact.

So if you want to try to count one..pick a nice flat line one. The 2 OAs that you have isolated on the one report...the reduction is simply not enough to pick up the beginning and ending easily.
Look for something like the ones I have shown above so that the beginning and ending is more easily seen.
So you look for the start of the reduction in flow (look at prior normal flow peaks) then follow the obstruction till you see the flow return to normal and that is the ending. Like this below. I might be off by a second or 2 with my counting but I am close and that is good enough for me. I don't try to count Hyponeas because I can't see the beginning and ending nearly as clearly.

Thank you so so much Pugsy for helping me so much.

Dad has hypopneas which sometimes last long - more than 40 seconds - is that a matter of concern and can something be done about them ??

The OSA's typically are of 8-15 seconds duration.

Below is a link to a hypopnea chart.

http://www.flickr.com/photos/74904217@N ... hotostream

Love,
Deepak

Not much you can do about random Hyponeas like that long one. It is all alone and really not going to be a huge factor. I see them sometimes myself. I had one the other day that was 53 seconds long but it was all alone also..nothing else happening even remotely near the time frame for which it occurred.
Even people without the OSA diagnosis can have random events like that anyway. We can't realistically expect to prevent every possible apnea event of whatever kind. Now if we saw these long events happening several times an hour...every hour all night long...every night...then we do a pressure adjustment. For random events like your dad's...I wouldn't worry about them. His reports are really quite excellent. He would have a long way to go with things getting worse before he would have anything to worry about.

Dear Pugsy,


Dad sometimes complains of feeling as though his head is "tight" and "heavy" since he has been trying this Auto CPAP machine. Sometimes he says it feels like there is air inside his head ! Have you had similar feelings or know if this is common ?


With love,
Deepak

Morning Deepak,

Tight and heavy is not something I can think of as "common" unless it is the mask straps. I forget which mask he is using. When you look at his reports does he spend much time at the upper end of the APAP (the Auto CPAP) range? Is it possible that the mask straps are a bit too snug?

Some people do complain of some inner ear type of disturbances and that is likely from the pressure in the airway sneaking down some tiny backdoor passageways into the inner ear system. A little vertigo (dizziness) is main complaint. Not extremely common but not impossible rare either. Fairly rare is actual inner ear pain. If inner ear pain for sure..the doctor needs to be aware of it and perhaps the upper range of the Auto cpap needs to be reduced. Might also consider an over the counter decongestant if he can take those type of meds.

Also kind of hard to relate to because I don't know what he might mean by "tight" and "heavy". Is this a way of describing discomfort?

I won't be around all day today like I normally am. My own Mom is in the hospital. She is 79 years old and we first thought it was a heart attack but now it looks like something abdominal and I have to leave this morning very shortly to get to hospital and hopefully catch the general surgeon who has been called in. So if you don't see me respond quickly like I normally do you know I am gone but I will respond when I get home and back on the computer.

You might see if you can get your dad to be a little more descriptive about what he is feeling if he can.
And is this an all night every night thing...or just occasional and random???.

Right now...I guess my head feels "heavy" but it is from lack of sleep. A bit of a headache type of thing which I am pretty sure is unrelated to cpap use and very likely related to simple old broken down neck issues and the fact that for 2 nights now I haven't had enough sleep.

Brenda

Dear Pugsy,

I hope your mom will recover quickly. Were you able to ascertain the cause ?

Yes, he describes the feeling as heaviness - hangover kind and a tightness around the circumference of his head where the upper strap is tied. The readings are mostly towards the lower range, not the upper range. The charts are still on flicker if you wish to see them .

I did some googling on this and saw some posts by people saying they get this hangover kind of feeling after wearing the mask at night and think it might be due to the fact that the air is dry and dehydrates you , so the advise there is to have more liquids.


I am going to try him on the BIPAP from today and see how that goes. Am thinking of 8 and 12 settings. One the auto he ocassionaly seems to go to 12.5- 13 , but am thinking to try 12 and see the readings. Is it ok you think ?

Am also making another general post about the heaviness thing on this forum and seeing if others have any input.

With love,
Deepak

One more thing Pugsy

I notice you use the nasal pillow mask. Have you found this to be more comfortable than the other designs ? He did try one nasal pillow mask and did not like it as he said it seemed to stretch his nose and dry it.

Love,
Deepak

Hi DeePak,
My Mom has pancreatitis. She is pretty sick. Looks like maybe from a bad gallbladder and when she get stable enough they plan to remove the gallbladder. Thank you for asking. It is pretty rough on her right now. She is 79 years old and this sort of illness is very painful and very scarey.

I think BiPap at 8 and 12 would be a good place to start with for your dad.

You might increase the humidifier setting a little and see if that helps your dad be more comfortable. The heaviness in the head sure sounds like the straps might be just a little too tight. I really doubt that it is pressure or actual therapy related. I suspect mask strap issues.

Nasal pillows shouldn't make a person feel like their nose is being stretched unless some one has the pillows inserted to far into the nostrils and too tight. They should just barely sit against the nostrils. Seems like a lot of people want to try to make masks much tighter than they need to be and perhaps also the nasal pillow size was wrong for your dad. I love the nasal pillows. I wouldn't use anything else and in fact...don't own any other type of mask.
Dryness....again likely needed the humidifier increased just a bit.

Dear Pugsy,

I will keep your mom in my prayers and hope she recovers real soon

As of now he has not been using any humidifier. Is it necessary? Will ask the tech to give me a humidifier then too. Maybe this could be the reason its dehydrating ??


Love,
Deepak

Dear Pugsy,

Were you using the Respironics nasal pillow mask too at anytime ? That is the one he tried. Would you recommend another ??

Love,
Deepak

heartchakra wrote:As of now he has not been using any humidifier. Is it necessary? Will ask the tech to give me a humidifier then too. Maybe this could be the reason its dehydrating ??

Humidifiers are completely necessary for some people and others can get by without them.
Definitely lack of humidifier would be number one suspect for the dehydrating.

If my humidifier died....I simply wouldn't use the machine. I have let it run dry by accident and the dryness created horrible sinus symptoms. Pressure, congestion, runny nose, pain....horrible issues.

Hmmm...I just said pressure...is your dad complaining of pressure or fullness in the top of his head...or frontal area (above eyes) and cheeks?
Might want to add the humidifier and see if it helps...sure wouldn't hurt.

Gotta go to bed. Need to start my day early tomorrow and get back to the hospital.
Night.

The Respironics Optilife Nasal Pillow? I have used it. I hated it. Too much stuff on my face and not comfortable at all. The one I use now so much easier and more comfortable.
The Swift FX or the Swift LT (both ResMed models of nasal pillows) are so much better...in my opinion.

Dear Pugsy,

Does the need or not for a humidifier depend on the climate one is in ? I am in Mumbai and right next to the sea so we have quite a bit of humidity.

Also, is the difference of 4 in a BIPAP machine between IPAP and EPAP have some significance or can it be more too? For example can I also try 7 and 12 or 6 and 12 if that could be more comfy ?


With love,
Deepak

Climate will make a bit of a difference in the need for a humidifier but not a total "no need" thing.
We have our deep south which typically has a very high humidity level and even some people on our sea coasts in Florida prefer to use added moisture. It is more up to the person's own preference.
Even people living in the rain forest might want or need a humidifier.

Then there are the others which blows my mind..those people who live in the high desert arid areas who don't need or want added humidity.

BiPap pressure...you need the EPAP pressure to be sufficient to be effective just like a minimum pressure on the APAP machine.

4 cm just happens to be a common use spread and very comfortable spread. You can use more if there seems to be a need but the EPAP can't be too low. Example...if you used EPAP of 6 and IPAP of 12...the AHI might show more events because the 6 cm minimum lets some events sneak past the defenses. So the larger spread between EPAP and IPAP can be used and for some people it may even be preferable but we still have to watch the EPAP and make sure it is effective. My EPAP is 9....I did try EPAP of 8 but my AHI more than doubled and they were all obstructives. So with EPAP of 9..the machine can deal with things better.

In general we do EPAP adjustments for obstructive apneas and IPAP adjustments for Hyponeas.
If your dad used BiPap and had minimal to none obstructive apneas but a lot of Hyponeas then we would raise IPAP. If no hyponeas but too many Obstructive apneas then we adjust the EPAP.

If you had a BiPAP Auto machine we would have some room for the EPAP and IPAP to adjust like the APAP machine but since the BiPap machine you have is a fixed bilevel machine with to auto adjusting properties...we have to dial the pressure in a bit more strictly. Not a bad thing though. Fixed BiPap can do just as good of a job and be hugely comfortable in the process.

Dear Pugsy,

Thanks

When I go into settings on the BiPAP machine , it has something called BIPAP and options 1 2 or 3 - can I choose any one ?


With love,
Deepak

heartchakra wrote:When I go into settings on the BiPAP machine , it has something called BIPAP and options 1 2 or 3 - can I choose any one ?

Hmm.. are you talking about BiFlex setting choices? That is the exhale relief and strictly a comfort setting. I would suggest middle of the road with "2". The difference is really very minor and best way I can tell you is that it is sort of a rhythm with a person's respiration. I found a setting of 3 seemed to be just a bit too fast...like it was wanting me to breathe a bit faster than I wanted to. There is a BiFlex demo in the BiFlex screen on the machine.. you can test each one quickly and easily and ask your dad if one "Feels" better than the other.