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00:59 AHI = 40.0; at 01:00 AHI = 1.0
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Sleepster Offline
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Machine: ResMed AirCurve10 VAuto
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CPAP Pressure: MaxI 13.6 | MinE 5.2 | PS 4.4
CPAP Software: ResScan SleepyHead

Other Comments: Diagnosed Nov 2011. Conquered aerophagia.

Sex: Male
Location: Houston, Texas

Post: #21
RE: 00:59 AHI = 40.0; at 01:00 AHI = 1.0
(07-06-2014 05:20 PM)jcarerra Wrote:  The events are somewhat within my pattern. I have nights of two clusters, one cluster, zero clusters--approximately 1/3 of nights each, roughly. That cluster beginning about 2330 is longer and earlier than I usually see. Clock is set correctly.

A likely cause here is sleeping position. These clusters could be occurring simply because you're sleeping on your back.

Sew a tennis ball into the back of your night shirt. Big Grin

I see from your profile that you've raised your pressure from 12 to 14. I take it that you were titrated at 12 during your sleep study and you've since raised it to 14 to try to lower your AHI?

Do your sleep study results have any mention of sleeping in the supine position? The reason I ask is because if you never slept on your back during your sleep study and you're doing so now that might explain why a pressure of 12 is too low for you.

Anyway, you could try raising the pressure a bit more. Also, if you can afford it try and get a S9 Autoset or equivalent. Or better yet, a S9 VPAP Auto. It takes patience to find them, but there are a lot of people out there selling used machines at a fraction of the cost of a new machine.

Sleepster
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INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED AS MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEB SITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
07-07-2014 02:57 PM
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jcarerra Offline

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Machine: ResMed S9 Adapt SV
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Post: #22
RE: 00:59 AHI = 40.0; at 01:00 AHI = 1.0
As noted, and just from my mind, I think I have about 1/3 nights with 0 clusters (few events here and there), 1/3 with 1 cluster, 1/3 with 2 clusters--maybe a bit less than 1/3 with 2.

Pressure actually now is 15 --and was when that one occurred.

Did take some charts to my PCP, who thinks it needs to be looked at, thinks they look like centrals, and left for long trip to S. America.

I have in hand a used Respironics Auto Bipap 750p, but am still in insurance compliance )6 weeeks) on my Resmed Elite, and don't have a new filter for the used 750p, so have not used it. Am concerned about initial settings to put in it too.
07-07-2014 03:18 PM
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Sleepster Offline
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Posts: 4,991
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Machine: ResMed AirCurve10 VAuto
Mask Type: Full face mask
Mask Make & Model: F&P Simplus
Humidifier: HumidAir and SlimLine Hose
CPAP Pressure: MaxI 13.6 | MinE 5.2 | PS 4.4
CPAP Software: ResScan SleepyHead

Other Comments: Diagnosed Nov 2011. Conquered aerophagia.

Sex: Male
Location: Houston, Texas

Post: #23
RE: 00:59 AHI = 40.0; at 01:00 AHI = 1.0
PM me your postal address and I'll send you some new filters for the PRS1. I have lots of extras that I'll probably never use.

I would set it at a Max IPAP of 16, see how often you hit 16, and see if the clusters are occurring when the pressure maxes out at 16.

As for the rest of the settings, well, that should be easy enough to figure out. I would start with a small PS because when I went from CPAP to BiPAP it induced a lot of centrals. But that faded away with time.

I wonder why your doctor thinks those clusters are centrals? It makes sense and if it's true they should fade away with time. But you're not seeing that. If he's right, raising the pressure is the wrong thing to do.

Sleepster
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www.ApneaBoard.com


INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED AS MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEB SITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
07-07-2014 03:25 PM
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jcarerra Offline

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Machine: ResMed S9 Adapt SV
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CPAP Software: ResScan

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Post: #24
RE: 00:59 AHI = 40.0; at 01:00 AHI = 1.0
Thanks. PM coming.
07-07-2014 03:58 PM
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robysue Offline
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Machine: PR Dreamstation BiPAP Auto
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Post: #25
RE: 00:59 AHI = 40.0; at 01:00 AHI = 1.0
(07-07-2014 03:18 PM)jcarerra Wrote:  As noted, and just from my mind, I think I have about 1/3 nights with 0 clusters (few events here and there), 1/3 with 1 cluster, 1/3 with 2 clusters--maybe a bit less than 1/3 with 2.

Pressure actually now is 15 --and was when that one occurred.

Did take some charts to my PCP, who thinks it needs to be looked at, thinks they look like centrals, and left for long trip to S. America.
I think your PCP is onto something when s/he suggested that these clusters look like they may be centrals. And the possibility that these clusters may be centrals NEEDS to be investigated further: If those clusters ARE central in nature, then repeatedly increasing the pressure is NOT going to solve the problem. And, in fact, more pressure may make the problem worse in the long run.

In my well-educated patient opinion, if you are seeing at least one 40+minute cluster of events on roughly 2/3 of your nights, it's time to call in a specialist and have a sleep doc look at your some of your daily data.

Quote:I have in hand a used Respironics Auto Bipap 750p, but am still in insurance compliance )6 weeeks) on my Resmed Elite, and don't have a new filter for the used 750p, so have not used it. Am concerned about initial settings to put in it too.
It's not at all clear what starting pressure settings to suggest on that PR System One BiPAP Auto because of the very real possibility that what's being scored might be central events. Out of curiosity, can you zoom in on a 10 minute piece of that cluster of events so we can see what's going on in a breath-by-breath fashion? How regular is the pattern during the cluster: Is there a OA being scored every minute or two like clockwork?

Here's the thing: The Resmed FOT algorithm is far from perfect when it comes to distinguishing between CAs and OAs. The algorithm is much more likely to score an real CA as an OA than it is to score a real OA as a CA. So the CAs scored by the FOT algorithm are very likely to be CAs (if they occur when you're actually asleep.) But the way the FOT algorithm works, it's quite possible for a whole string of CAs occurring at moderately high pressures to be mis-scored as OAs. Unstable breathing can trigger and unstable airway and the FOT algorithm may pick up "upper airway resistance" and score an OA when the problem is actually unstable breathing due to a CO2 overshoot/undershoot cycle (i.e. the problem is central in nature). When this happens and the machine is running in Auto mode, the machine can inappropriately increase the pressure and make matters worse.

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(This post was last modified: 07-07-2014 05:31 PM by robysue.)
07-07-2014 05:30 PM
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robysue Offline
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Machine: PR Dreamstation BiPAP Auto
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Post: #26
RE: 00:59 AHI = 40.0; at 01:00 AHI = 1.0
(07-07-2014 03:25 PM)Sleepster Wrote:  I wonder why your doctor thinks those clusters are centrals?
The length of the cluster combined with the wild variations in MV raise the question of whether a CO2 overshoot/undershoot cycle has developed. If the doc has had a chance to examine the wave flow in a ten-minute window, extreme regularity in a breathing pattern that repeats every 1-3 minutes is more evidence that these might be centrals. And add to that the fact that things have NOT gotten any better with a 3cm increase in pressure. There's good reason to worry that these might be long chains of centrals that are being mis-scored as OAs.

Quote:It makes sense and if it's true they should fade away with time. But you're not seeing that.
For most new PAPers, the CAs fade with time. But for some new PAPers, the pressure induced CAs do NOT fade with time. And if they stick around long enough, or are severe enough, the PAPer ends up with a diagnosis of Complex Sleep Apnea (CompSA).

The first approach in treating CompSA seems to be prudent waiting and vigilant monitoring of PAP therapy for a while. But at some point if the CAs don't start to fade on CPAP, the patient gets moved to bi-level, and then to either bi-level ST or and ASV machine if the CAs persist with bi-level PAP therapy.

Quote:If he's right, raising the pressure is the wrong thing to do.
Exactly. That's why I think it is prudent to NOT increase the pressure any further. Jcarerra has already increased the pressure from 12cm (titrated level) to 15cm and the 3cm increase in pressure has not done anything to reduce the frequency of nights with really bad clusters. It's time to investigate whether those events really are OAs or CAs rather than just assuming the S9's FOT is correct and continuing to increase the pressure.

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07-07-2014 05:43 PM
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jcarerra Offline

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CPAP Software: ResScan

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Post: #27
RE: 00:59 AHI = 40.0; at 01:00 AHI = 1.0
Here is 10 minute capture from that cluster.
The individual breath pattern here is quite similar to all my clusters, though this one lasted longer than usual when I have one.

Looks NOT like Chenye-Stokes (sp) because they lack the front end sine wave entry into the breathing (lower into higher breaths followed by declining breaths). Mine jump straight away into strong breaths.
[attachment=923]
07-07-2014 05:55 PM
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archangle Offline
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Post: #28
RE: 00:59 AHI = 40.0; at 01:00 AHI = 1.0
(07-07-2014 05:55 PM)jcarerra Wrote:  Here is 10 minute capture from that cluster.
The individual breath pattern here is quite similar to all my clusters, though this one lasted longer than usual when I have one.

Looks NOT like Chenye-Stokes (sp) because they lack the front end sine wave entry into the breathing (lower into higher breaths followed by declining breaths). Mine jump straight away into strong breaths.

Central is the first thing that comes to my mind when I see that pattern of regular waxing and waning, but ResScan seems to think they're obstructive. The pattern of flow limitation might mean something, but I'm not quite sure what.

I do think that sometimes the CPAP will not indicate a central even if actually is a central. It's hard to "feel" out the open airway through a humidifier, 6 feet of hose, a mask, and your nose and mouth.

There are sometimes apneas that are "central" in the sense that there's no respiratory effort shown with a chest effort belt, but the airway actually collapses, which doesn't show up in a "clear airway" measuring device like a CPAP. That's one of the legitimate limitations of CPAP generated data.

They usually show Cheyne Stokes/periodic breathing as sort of a slow waxing and waning of a sine wave, but I don't know if that's just the simplest case they use to illustrate it, or if it's sometimes not so "clean," especially if your airway is collapsing during a central apnea event.

Get the free SleepyHead software here.
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07-07-2014 06:23 PM
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Sleepster Offline
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Posts: 4,991
Joined: Feb 2012

Machine: ResMed AirCurve10 VAuto
Mask Type: Full face mask
Mask Make & Model: F&P Simplus
Humidifier: HumidAir and SlimLine Hose
CPAP Pressure: MaxI 13.6 | MinE 5.2 | PS 4.4
CPAP Software: ResScan SleepyHead

Other Comments: Diagnosed Nov 2011. Conquered aerophagia.

Sex: Male
Location: Houston, Texas

Post: #29
RE: 00:59 AHI = 40.0; at 01:00 AHI = 1.0
(07-07-2014 05:43 PM)robysue Wrote:  The first approach in treating CompSA seems to be prudent waiting and vigilant monitoring of PAP therapy for a while. But at some point if the CAs don't start to fade on CPAP, the patient gets moved to bi-level, and then to either bi-level ST or and ASV machine if the CAs persist with bi-level PAP therapy.

All of that makes sense except for the plain vanilla bi-level. Is it because less oxygen is delivered during EPAP?

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INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED AS MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEB SITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
07-07-2014 06:47 PM
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robysue Offline
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Machine: PR Dreamstation BiPAP Auto
Mask Type: Nasal pillows
Mask Make & Model: Swift FX
Humidifier: PR Dreamstation humidfier
CPAP Pressure: min EPAP = 4; max IPAP = 9;
CPAP Software: SleepyHead EncoreBasic EncorePro

Other Comments: Papping since September 2010

Sex: Female
Location: Buffalo, NY

Post: #30
RE: 00:59 AHI = 40.0; at 01:00 AHI = 1.0
(07-07-2014 06:47 PM)Sleepster Wrote:  
(07-07-2014 05:43 PM)robysue Wrote:  The first approach in treating CompSA seems to be prudent waiting and vigilant monitoring of PAP therapy for a while. But at some point if the CAs don't start to fade on CPAP, the patient gets moved to bi-level, and then to either bi-level ST or and ASV machine if the CAs persist with bi-level PAP therapy.

All of that makes sense except for the plain vanilla bi-level. Is it because less oxygen is delivered during EPAP?
Not "less oxygen" during EPAP. Less AIR, so you're a bit less likely to blow off too much CO2. Or at least that's what I think the theory is.

And for some people, breathing with a bilevel just plain feels more "normal" so there's less inclination to overbreath in the first place.

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See my Guide to SleepyHead
(This post was last modified: 07-07-2014 10:04 PM by robysue.)
07-07-2014 09:59 PM
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