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Advice needed.
#21
(07-16-2014, 10:53 PM)diamaunt Wrote: my favorite is the vpap auto, it can act like an elite, autoset, vpap s, and vpap auto, four machines in one Smile
(07-18-2014, 10:32 AM)robysue Wrote: If PS can be set to 0, then the S9 VPAP Auto will act like the S9 AutoSet.

(07-18-2014, 10:52 AM)justMongo Wrote: S9 Autoset has a PS setting, does it not? It's limited to 3?
So, if the S9 VPAP Auto has the PS set 3 or less, then does it not act like the S9 AutoSet?

*hrmph* I said it can act like an autoset, before sleepster stuck his court jester covered head in and made snarky comments...

the autoset has an epr of 0-3, though it's effect is to lower epap, not raise pressure support over set epap.

yes, the vpap auto can set it's PS to a range of 0-10, so it can indeed pretend to be an autoset too, though it doesn't have a direct 'autoset' mode setting, (mode settings are cpap, vpap s, vpap auto).

my backup vpap auto is currently masquerading as an autoset for my bedmate.
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#22
(07-18-2014, 05:09 PM)archangle Wrote: My belief is that if an S9 or PRS1 says "clear airway" or "central," it probably IS a true central.

What if you're mouth-leaking at the time you have an obstructive apnea? Won't the forced oscillation technique, or whatever it's called, make a determination that the airway is clear?

Maybe I don't understand something about the technique. The flow response to pressure pulses is monitored. How can the response be any different with an open airway versus a mouth-leak?
Sleepster
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#23
(07-18-2014, 09:53 PM)Sleepster Wrote:
(07-18-2014, 05:09 PM)archangle Wrote: My belief is that if an S9 or PRS1 says "clear airway" or "central," it probably IS a true central.

What if you're mouth-leaking at the time you have an obstructive apnea? Won't the forced oscillation technique, or whatever it's called, make a determination that the airway is clear?

Maybe I don't understand something about the technique. The flow response to pressure pulses is monitored. How can the response be any different with an open airway versus a mouth-leak?

depends on how big a leak it is, mouth, or mask....

the resonance characteristics of the circuit change depending on whether your throat is open, thus making your lungs (sort of) like big balloons that absorb some of the pulses, or closed, thus making the pressure spike more.

if you look at a bunch of the mask pressure traces on your vpap auto, and stretch them out and compare what they look like when the machine says you have a ca vs an oa, you may see that the fot vibration shows up sharper and more defined when it says you have a OA, and more fuzzy and weaker when it says you have a CA.

PR and resmed both pulse the airflow, each in their different way, and watch what the pressure reading does when they do it.

they're already compensating for whatever mask leak there is... mouth leak is just another type, up to a point....
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#24
It looks to me like it is a matter of degree similar to flow limitation -> obstructive hypopnea -> obstructive apnea. I think that what we have is:

Obstructed airway - sharp FOT feedback
Open airway - fuzzy and weaker (like diamaunt says)
Major leak - No FOT feedback

Best Regards,

PaytonA
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#25

If the unintended Leak is greater than 30 L/minute then, instead of attempting to distinguish Central Apnea from Obstructive Apnea, ResMed will classify the apnea as UA (Unknown type Apnea).

A link to a white paper investigating the accuracy of CSAD (which is the Complex Sleep Apnea Detection method used by ResMed, also known as the Forced Oscillation Technique, or FOT):
http://www.resmed.com/fr/assets/document...-paper.pdf

The estimates of CSAD accuracy compared to polygraphy are shown on page 5, in Table 1:

Table 1. Sensitivity and specificity for CSAD
. . . . . . . . . CSAD Lower confidence interval Upper confidence interval
Sensitivity. . 0.99 0.97 1.00
Specificity. . 0.89 0.82 0.95
Accuracy. . . 0.95 0.92 0.98

Many of the unknown apneas occurred during runs of central apneas where lack of upper airway and jaw-tone neural drive caused inadvertent mask or mouth leak. Figure 2 shows a typical example. Midway through the plot the leak exceeded 30 L/min and the apneas were scored as unknown. No pressure rise was accorded in the sequence of apneas classified as unknown or central.

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. The Advisory Member group provides advice and suggestions to Apnea Board administrators and staff on matters concerning Apnea Board operation and administrative policies - not on matters concerning treatment for Sleep Apnea. I think it is now too late to change the name of the group but I think Voting Member group would perhaps have been a more descriptive name for the group.
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#26
(07-15-2014, 11:12 PM)Realtor 1 Wrote: why do people need A VPAP a part from comfort.
Price is very tempting almost the same as what I paid for my New Autoset recently.

Hi Realtor 1,

The S9 VPAP Adapt, if it is truly a couple years old, will be model 36007, not the current model 36037 which is described on ResMed's website and replaced the 36007 in November 2012. On the back of the USA model blower unit (not humidifier) will be REF# 36007 or 36037.

The difference is kinda like between the Elite and the AutoSet, inasmuch as model 36007 (which I use) does not have ASVauto mode, in which EPAP is automatically adjusted to minimize Flow Limitation and Snore, much like the AutoSet adjusts EPAP automatically and the Elite does not. I think neither model of S9 Adapt distinguishes between central versus obstructive apneas.

S9 VPAP Adapt model 36007 uses a fixed EPAP all night, and it adjusts PS as needed to maintain a target of at least 90% of our recent Minute Volume, which is the amount of air inhaled (or exhaled) in one minute.

So if we fairly quickly slow down or pause in our breathing, the machine will kick in within a few seconds to keep us ventilated by raising Pressure Support sky high. (Actually, it will likely only increase PS up to about 8 or 10, but that can feel like it is sky high.)

If our EPAP is 12 and if PS is currently 10 because the machine estimates we are in the middle of an apnea, then the pressure will cycle between 12 and 22 to maintain our recent breath rate.

Using model 36007 would be like using an Elite which will keep EPAP fixed but the IPAP pressure will be boosted a whole lot whenever we pause to swallow some saliva or to think or whatever. It has no Ramp feature, and some patients find they unable to fall asleep using the machine. Also, those who are susceptible to Aerophagia (air swallowing) may find the much higher IPAP pressures may make their aerophagia much worse and perhaps painful. Also, some patients may react badly to the higher pressures and may develop eye problems or balance problems or hearing problems triggered by the higher pressures.

If you did not have insomnia, which obviously may be the explanation for your continued tiredness, a VPAP Auto or its "equivalent" (but actually more capable) Philips Respironics System One BiPAP Auto might be more helpful than the AutoSet. For example, a VPAP Auto might be better than an AutoSet if a patient feels better when using an EPR of 3 than when using a lower value for EPR, and would like to try using Pressure Support of 4 or higher. This may improve sleep quality if the higher pressure does not cause excessive aerophagia or otter problems and if UARS (Upper Airway Resistance Syndrome) was the major remaining problem. UARS is usually helped by increasing Pressure Support above 3.

But in your own case, I suggest (as did Zonk) that the logical place to focus on for now is the insomnia, and to work on getting that fixed. Hey, don't give up. It is amazing what great difference a change in doctors can sometimes make.

Take care,
--- Vaughn
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. The Advisory Member group provides advice and suggestions to Apnea Board administrators and staff on matters concerning Apnea Board operation and administrative policies - not on matters concerning treatment for Sleep Apnea. I think it is now too late to change the name of the group but I think Voting Member group would perhaps have been a more descriptive name for the group.
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#27
Thanks everyone for some great advice & Information.

I went back to my doctor for the follow up.
The Sleep test with the Autopap showed better results then previous ones. Still no Slow wave sleep at all but improved REM sleep of 22% & 68% in Phase 2 of sleep. AHI of under 1.

He has prescribed me Modinifil to cope with the excess Fatigue & Focus issues. Anyone here has anything to share about this Medicine ?
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#28
The Doc knows best I guess, but when I see the what is on the list of side effects I think I would rather go without that medication...... As always do what is best for you.
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#29
Modafinil appears to be the generic name for Provigil. It is a wakefulness promoting drug that is often prescribed for narcolepsy and is sometimes prescribed for OSA sufferers who are compliant with PAP therapy, but who continue to have serious problems with daytime sleepiness.

In other words, it should help a lot with the "Focus" issues.

But it probably won't help much with fatigue unless you are using "fatigue" and "sleepiness" interchangeably. Note: Fatigue is NOT the same as sleepiness, and if you are really dealing with fatigue issues instead of daytime sleepiness issues, the Modafinil may not do much to relieve the fatigue.
Questions about SleepyHead?
See my Guide to SleepyHead
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#30
Thanks.
Provigil is Known as Alertec in Canada & Modinifil is the generic version of it.
I took my first dose of 100mg in the morning & took the 2nd one at around noon.
Still feeling very sleepy & fatigued (Hard for me to differentiate between the 2 ). Focus is definitely better but have been encountering side effects like Muscle Cramps. pretty serious within 30 mins of taking the first dose but have improved since then & do have a bad headache along with a lot of pressure on the eyes. Lets hope that things will improve .

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