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APAP better than CPAP for REM Apnea?
#1
Hi guys.....managed finding this new thread section-thanks!!

Have been advised to start my own thread to glean advice.

I live in the UK and have been diagnosed under the NHS. It is excruciatingly slow- its been now almost a year from the first I saw my doctor with morning headaches. However think I have had those headaches for a few years but doc thought it was due to other reasons. The sleep clinic is almost inaccessible in terms of ongoing help and advice. I have tried telephoning-line is always engaged, emailing to a general address and also a more specific address-no reply. I have resorted to turning up at the sleep centre un-announced. Whilst I was seen once, I was not entertained the second time around. So in effect I am freewheeling in this new Apnea time of my life.

Reading on this forum is a lifeline.

I have collected my cervical collar- will try it tonight-looks frightening though. Am getting a fitting for a P10 on Monday-all info gained on this site, so big thank you guys. My ffm leaks like a sieve. My pressure at 16.8 is feeling like sleeping with my face in a tornado. Messages sent by my machine says the humidifier is not being heated so air is being sent out cold. Nights are still cold here despite it being May-not much fun.

Sleep Consultant confirmed REM apnea and the overnight hospital study reported a titration of 20 cmH20!! at REM sleep although I have only an average of 7 events an hour generally. It was the further 2 weeks home study with APAP which concluded the advice of 16.8. 

Hit another hurdle- I have a MacAir with almost no inserts for anything and the SD card clearly does not fit into any of those available. I shall find a way. So can't download data just yet. Will persevere.

With 45 minutes ramp time and stopping every hour I reckon I am not sleeping for half the night and then crashing out due to severe exhaustion for another 2 hours or so. At times it is all too much at which point I rip the mask off and have another 2 hours non mask sleep and wake with a slight headache. 

So my days are a blur.

I am contemplating making a big case for changing my CPAP machine to an APAP. This is as I feel that I am being literally blown at all night long when I really only need high pressure at REM maybe?? But it will be a struggle with the NHS. I did good with the Test APAP for the 2 weeks.

I need to read and learn more about my condition before then. Sorry but I had hoped to be able to post the data with Sleepyhead by now. Problem is I do not who to make the case to in the NHS as my consultations after the first appointment was with 2 technicians and I do not know if they have the authority. But in any case, I need to be more knowledgeable about my condition.

Please help................
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#2
Glad to see you start your own thread, and I'll repeat some of what I wrote in your other post. I think you will find the use of the nasal pillows very comfortable once you become accustomed to them, and assuming you control mouth leaks. Combined with the use of a soft cervical collar, I would be very surprised if you could not not lower your CPAP pressure and get good results.

I strongly recommend that you reset the ramp to start at a higher minimum pressure and for a shorter duration of time. You should need no more than 15 minutes of ramp time, or use the Resmed Auto Ramp which detects sleep breathing and will terminate ramp. A shorter ramp time should help greatly in getting you to your therapy pressure faster, and cause less sleep disruption.

Once you are setup with data, take a look at your recent 30 days of use and compare any changes you make against that. I think it may be worthwhile to actually reduce pressure to as low as 12 cm with the nasal pillows and collar and observe the results. Only increase pressure for an obstructive index of 2.0 or more. You may end up at nearly 17 cm as you are now, but somehow I suspect not. One way your current machine can be more comfortable is to use the EPR (exhale pressure relief) function. Your machine can provide up to 3-cm pressure relief for each exhale. What are your settings for EPR? An Auto CPAP would be fantastic for you to have. Whether you go through insurance or purchase on your own, I would recommend you get the Resmed Airsense 10 Autoset, however in the meantime, we can help you to get more comfortable and effective with the machine you have.

Good luck.
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#3
Thanks Sleeprider.

My EPR is at 1.

From onset I registered with Resmed and am able to gauge my development through them. However I am beginning to think that it is all too rosy and the scores I started with was in the 90s with the home APAP trial. I certainly felt very much better in the early days. Home APAP trial started on 30th March Commenced CPAP on 12th April.

Now with my CPAP my scores are lower but still in the region of 60-80+. But I think they are deceptive as I know I am awake for about a third to half the night at times but the scores include all that under sleep. Awake, there would be no apnea so my overall events per hour would be lower.

I guess till I publish Sleepyhead data, I will be none the wiser.

I have read much of your advice to start with higher pressure than 4 in other posts. I will certainly experiment.

I have never had any problems falling asleep before I started this PAP journey. I know it is perhaps the anxiety of the onset of high air volume that is preventing me. Also rude awakenings with chipmunk cheeks isn't enticing.

Heres hoping a P10 will help to resolve some of the issues.
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#4
I am based in the UK, and went to some private sleep clinic, as I have private insurance.

I bought my own Resmed Airsense 10 autoset.

However, if I had known, I would have bought the "for her" model, sold for the same price.

In the UK, the standard autoset does not have the same functionality as the "for her" model, for instance to detect RERAs.
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#5
Apnea Infant, you state that "with 45 minutes ramp time and stopping every hour" - what do you mean?
The machine stops every hour?
I had the same problem with the ramping and huge leaks; with sleeprider's advice I turned off the ramp; the machine was set on "smart start";
My mask was leaking so bad - that when the ramping got up to full pressure (19-23 at that time for me) the machine thought I took it off and stopped because it couldn't sense my breathing.
So all night long, I was ramping up, and the machine would turn off, then start again - the entire night of this;
turning ramp off and turning smart start off really solved alot of problems.
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#6
I am waking up almost every hour for the first 3 hours of my sleep time, so with a ramp time of 45 minutes, what I am trying to say is that I was not having much therapy. I also think I might have been awake for the whole hour before stopping the machine to start again at 4 cmH2O as it is more relieving. It is cheating, I know.

16.8 is quite powerful to tolerate awake, so after a while I find I have to switch it off. I reckon I might have been doing that for about 3 hours till I drop off, usually about 4 am in the morning. I would then wake at about 6 am and then sleep without the mask for another hour or so. It all is a mess, I know. And I started off this journey so well.

I need to get back on track. Think my problems are the cold air leaks as the tube heating is not working; extremely dry mouth irritating me despite the humidifier and the chipmunk cheeks with the high pressure. Need to find resolution item by item which am hoping the good people on this forum will help me with.
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#7
you need to learn how to make adjustments to your treatment. you also need to be able to give us data that will help us suggest things.

if you can adjust your machine by now, you might take some shot-in-the-dark suggestions and see how you sleep with those settings.

it doesn't really do you much good to sleep without the machine. so lets get you so you can use it all night long and still sleep.

if I had same situation, I would set my minimum pressure to 8, maximum to 17, and EPR to 2.

please record your AHI for a couple nights and whether you able to sleep. post these in any way you can.

good luck,

QAL
Dedicated to QALity sleep.
You'll note I am listed as an Advisory Member. I am honored to be listed as such. See the fine print - Advisory Members as a group provide advice and suggestions to Apnea Board administrators and staff concerning Apnea Board operation and administrative policies. Membership in the Advisory Member group should not be understood as in any way implying medical expertise or qualification for advising Sleep Apnea patients concerning their treatment.
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#8
I set up auto ramp with a min. pressure of 6-thought I would adjust slowly, will change to 8 tonight.

I WAS able fall asleep I think very quickly but still awoke after 30mins for a sip of water. Then fell asleep quickly again and awoke after another hour. Think beyond that it may have been another 2 hours. So much better with auto ramp. All in all had 6.5 hours of CPAP sleep. But as I was very cold upon awakening and also with a headache, I took the mask off and unfortunately fell asleep for 2 further hours sleep without air therapy. Only possible it being sunday.

Cold blown air is still causing headaches and a cold-y feeling. I do need to contact the Sleep Clinic at Guys Hospital to discover why and if a heater tube would get rid. Think it would as it did before.

From Resmed My-Air I got a total score of 81, 6.49 hours use - 68/70, AHI 0.7 - 5/5, Good mask seal - 8/20, 7 mask on/off - 0/0 So I must have woken up more than I remember.

As I know I slept mostly last night, I feel the above scores are realistic compared to when I know I am awake half the night. BUT I have a slight headache now-so still a problem to resolve which I think is due to the cold air on my face. My system does not take well to this.

In the early days I did try EPR of 3 but reduced to 1 as did not have good night with it. In the early days, I felt I was changing settings too quickly.

QAL, I shall try EPR 2 tonight with start pressure of 8 on auto ramp. I would have to wake for work tomorrow so will not be tempted to snooze on.

On another note, does anyone have any suggestion of which multi card reader works with a Macbook Air with OS 10 El Capitan version 10.11.4?
This was present from my son. I am more used to PCs at work.
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#9
If you look at post #5 by Gramato10, notice she said her prescription was 19-23 cm pressure, but her profile shows 11-19. We worked together to find a more effective therapy pressure and found using the cervical collar and other optimization, it was possible to get good results on much lower pressure. I earlier suggested we might be able to try the same for you...let me know if you're interested. 16.8 is not too bad for pressure, and apparently your AHI was 0.7 which is excellent; however it is equally important to have more continuous. undisrupted sleep. My suggestion of a pressure of 12, would do that, and you can compare AHI recorded by the machine to see what the trade-off is for that lower pressure.
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#10
Hi Sleeprider

There are a few things going on today. I had been nauseous all morning after breakfast and threw up an hour or so ago. I do feel better for it. So maybe down with a virus. There are lots of potential to catch anything in London-all you have to do is breathe.

I am getting a fitting for P10 tomorrow and anticipate to have it for tomorrow nights sleep. Do you think that would be a better time to reduce the pressure to 12. Do you think that would help with using the P10 initially? Or would it be too much changes all at once.

I know I have to help myself but I am being monitored by Guys Hospital for the first 3 months. That said-they are inaccessible and even when possible, the discussions are never as in depth as the ones on this forum. Reason I came here was I felt I was treated like a child with kids gloves at Guys which I don't enjoy.

Tell me what you think about my plans.

Thanks...........
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