Is there an APAP set-up that's best for hypopnea/no desats

Trying to inform myself about APAPs so I can visit the DME with lots of information.

My initial sleep study showed 181 respiratory arousals (index=47.1) with no desaturations and no snoring. They were all hypopneas (though sleepydave at sleepapnea.org explained there's room for interpretation there).

Is there an APAP set up that works best for someone in my situation...which is a bit unusual? Or does it not matter if you don't snore or have no desats?

Jenny

...what you are asking about is an APAP that works well with flow issues, because, since you don't snore, you won't have a snore index.

I can't speak for any APAP other than the Respironics, since that is the only one I've ever used, but I believe that it works fine to reduce hypopnea when you have no SI or a SI that is unrelated to the pressure.

Did you have a titration study too? Were they able to successfully address the arousals with CPAP?

A hypopnea, by definition, is flow limitation accompanied by oxygen desats. Maybe you are referring to UARS (Upper Airway Resistance Syndrome) or RERAs (Respiratory Effort Related Arousals) as defined in 1999 by the AASM Task Force:

A sequence of breaths characterized by increasing respiratory effort leading to an arousal from sleep, but which does not meet criteria for an apnea or hypopnea. These events must fulfill both of the following criteria:

1. Pattern of progressively more negative esophageal pressure, terminated by a sudden change in pressure to a less negative level and an arousal

2. The event lasts 10 seconds or longer

RERA is a type of arousal, not a respiratory event.

The bad news is some UARS/RERAs respond to pressure and some don't.

Here are excerpts from posts by -SWS regarding this.

-SWS wrote:UARS/RERA events manifest as flow limitations. However, flow limitations are not exclusive to UARS/RERA events. Flow limitations can also happen because of simple allergic rhinitis, bronchial swelling, incipient hypopneas, etc.

-SWS wrote:...of all the obstructive airway sleep-event types or conditions, these are perhaps the least predictable and the least understood by sleep medicine. There is much disagreement within the medical community about the classification of this sleep disordered breathing condition (my hunch is that it is actually several), let alone proper pressure treatment for this type of patient as well. Some of these UARS/RERA patients seem to respond favorably to more air pressure, some respond favorably to less air pressure, while others are completely air pressure unresponsive. Patients falling in this diagnostic category are a genuine "predictive wildcard," so to speak, regarding the best pressure treatment to offer in my view. Disappointingly, AHI and other simple obstructive sleep indices do not always help to reveal exactly how well these patients sleep/feel...

As to which machine best treats UARS/RERAs, that's up for debate too. Here's an interesting thread discussing this issue as it pertains to the Puritan Bennett 420e Auto:

viewtopic.php?p=4420#4420

I didn't have a titration study. I had a terrible lab effect for the initial study and my doc is just setting me up with an APAP that I should get next week.

I'm re-reading my study now after your description of hypopneas and all I can figure is the lab used a different definition. They count 180 hypopneas but all the desaturation stats are zero. Did they not measure desats or did I simply not have any?

Average Saturation was 97.5. Lowest Saturation was 94. They counted 181 respiratory arousals and zero RERAs.

I don't know what the difference his. My symptoms are more like some of the UARS studies show (ie. fibromyalgia, migraines, etc.) so I've been reading up on that.

Now I'm wondering if home titration is really the best for me. Thanks for the info and also Brasshopper That's helpful. Jenny

Anonymous wrote:Did you have a titration study too? Were they able to successfully address the arousals with CPAP?

A hypopnea, by definition, is flow limitation accompanied by oxygen desats. Maybe you are referring to UARS (Upper Airway Resistance Syndrome) or RERAs (Respiratory Effort Related Arousals)
RERA is a type of arousal, not a respiratory event.

I'm a strong proponent of APAPs and a great believer in home titration studies, but in this case, I think you might benefit from a lab titration (provided you can actually sleep while you're there). Theoretically, they will be able to tell if CPAP has an effect on your arousals. It seems like RERAs are an enigma and combining the information you'd get from a lab titration with your own at-home study with an APAP (and the accompanying software) could only increase your odds of getting a handle on this. (If you had garden-variety OSA, I personally would skip the lab titration. If that were the case, home-titration would be a no-brainer.) But you're special! I'd give the lab a go. If you sleep, it could be very revealing. If not, at least you gave it a shot. Just my opinion.

I just noticed you said you had a terrible lab effect during the initial PSG. I'm not sure what that means exactly, but if the thought of going through it all again for the titration portion is too overwhelming, then don't do it. It isn't worth the anxiety and if you won't be able to sleep, it isn't worth your time. You're the best judge of whether or not you should try it.

So back to the APAP question. Unfortunately, this isn't an exact science, so it's not possible to say, "You need _______ machine. It will be the most effective for you." Your particular breathing patterns might be better treated by one machine over another, but you wouldn't know until you tried them all. I guess if I was going to throw out a suggestion, I'd say try the PB420e because there are some adjustable variables that might be of use to you. I'm sure others will chime in with different opinions.

Did your sleep doctor make any suggestions?

Patterns, smattererns, you need your APAP set to 3 CM under and 3 CM higher than your titration pressure. Then get the software and read the results. Then you can decide if you are good enough or you can narrow the range to 2 under and 2 over your 90 % rate.

The closer to can control the pressure of your APAP the faster it can respond to your needs. Their is a slight difference in the way the different machines respond to you, but unless you try both machines and decide for yourself it doesn't matter. It's likely that either machine will work good for you.

People here tend sometimes to go off into the abstract. Just remember Your Star Trek training. "There's three kinds of Matter in the universe, Matter, Anti-Matter, and Don't Matter." All things are composed of one or the other. Jim

I just heard from the DME and my doctor prescribed a Resmed Advantage and they are coming Tuesday to set me up.

It's just as well because I don't have the energy to make an informed choice for myself at this time. So trial and error may be the way to go.

Funny though, I talked to my insurance and they had no record of any claim being submitted, so I called my doctor's and then the DME just to find out what was going on. I was very concerned my insurance would reject the APAP claim. 10 minutes later the DME calls to set up an appointment, insurance okayed everything. Alrighty then. I guess I worried for nothing (knock on wood).

Thanks for your ideas everyone. Much appreciated. Jenny