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AutoPAP vs. Auto-VPAP
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tempus Offline

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Post: #11
RE: AutoPAP vs. Auto-VPAP
Thank you all for the great information and answers. I'll have to wait till he has his doctor's appointment to see what the doctor has suggested. I think he did the titration study on a Resprionics and I'm trying to get him to visit a ResMed office just so he sees the options available. I'll post his titration results if I can get him to scan the document...

Thanks again for all the help.
07-31-2012 02:08 PM
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Tommy C Offline

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Post: #12
RE: AutoPAP vs. Auto-VPAP
(07-31-2012 04:36 AM)vsheline Wrote:  ResMed has started naming their bilevels "VPAP" machines. You can make a ResMed "VPAP Auto" act like a regular APAP simply by reducing the EPR (renamed "Pressure Relief") to 3 cm H2O or less.

This is because the main difference between a regular APAP and a ResMed VPAP Auto is the VPAP Auto allows up to 10 cm H2O of Pressure Relief between inhale versus exhale. If you wouldn't like that, I think there is not much reason to get the VPAP Auto instead of a regular APAP. But maybe many people, if they tried it, would end up just loving having more Pressure Relief between inhale versus exhale.


Why is it that we can get away with a lower pressure on exhale than inhale? Doesn't it take roughly the same CPAP pressure to hold the throat open during inhale as exhale?

For example if we found the optimum overall cm pressure to be 10, isn't this an average of what works for both inhale and exhale? Or maybe inhaling is more prone to the tongue blockage since the tongue is on the outside and can block the throat like a cork when inhaling - whereas when exhaling, the tongue gets blown forward, clearing the pathway?

I am considering a Bi-Pap too, and wondered about this potential issue.

Tommy C
08-01-2012 08:17 PM
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vsheline Offline

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Post: #13
RE: AutoPAP vs. Auto-VPAP
(08-01-2012 08:17 PM)Tommy C Wrote:  Why is it that we can get away with a lower pressure on exhale than inhale? Doesn't it take roughly the same CPAP pressure to hold the throat open during inhale as exhale?

For example if we found the optimum overall cm pressure to be 10, isn't this an average of what works for both inhale and exhale? Or maybe inhaling is more prone to the tongue blockage since the tongue is on the outside and can block the throat like a cork when inhaling - whereas when exhaling, the tongue gets blown forward, clearing the pathway?

Hi Tommy C,

Perhaps when we inhale, to some degree the suction in our lungs during inhallation is subtracting from the pressure getting delivered by the xPAP machine to the point of constriction in our airway, so the machine needs to supply more pressure so the point of constriction gets the pressure it needs.

But it makes sence that at some point we would reduce the effectiveness of our therapy if we dial in too much EPR (or Pressure Relief). I've read that most who try it prefer 4 to 6 cm H2O of Pressure Relief, but some might have problems with that much, where the excessive amount of Pressure Relief would allow a higher number of Obtructive events to occur.

If I ever get some time, I hope to read up on that subject.

If you are thinking of getting a new machine, my advice is to make sure it can distinguish Central versus Obstructive events, so you can track how your therapy parameters are affecting the incidence of both types of apnea.

Last night was my first night on my new S9 AutoSet, and I was surprised to find that all my apneas were centrals. But maybe that makes sence, since perhaps the S9 AutoSet was eliminating all the obstructive events. (My previous machine, the S8 AutoSet II, could not distinguish the two types of apnea events.)

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.
(This post was last modified: 08-02-2012 02:47 AM by vsheline.)
08-02-2012 02:45 AM
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BabyDoc Offline

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Post: #14
RE: AutoPAP vs. Auto-VPAP
For most of us, as we inhale a negative pressure is created that causes a colapse of the airway. Even normal people have some narrowing of their airway during inhalation. Those of us old enough to remember paper soda straws, remember that when the straw got wet, we could now longer suck in the soda or milk shake. The straw would colapse as we attempted to suck.
Similarly, an obstruction in airflow is going occur sooner when we inhale than when we exhale. Our airway is flexible like a wet soda staw and colapses when we breath in. When we breath out, it opens up somewhat.

If the OP's dad has mild sleep apnea and only needs low pressure settings, CPAP will probably work just fine.
Spending extra for APAP will offer more flexibility down the road if his problem worsens.
BiPAP or APAP will offer more comfort to those who need high pressure settings. Hopefully, a titration study will reveal what will work and at what he will tolerate. Unfortunately, some people have trouble sleeping in sleep labs in the way they do at home. Then AutoPAP probably works best since it autotitrates the pressures you need at home, as your pressure needs change through the night.
(This post was last modified: 08-02-2012 01:17 PM by BabyDoc.)
08-02-2012 01:16 PM
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tempus Offline

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Post: #15
RE: AutoPAP vs. Auto-VPAP
Hello Folks,

I'm back and I have data =). Attached is the Sleep Study (p1-2) and Titration study (p3-4) of my father. Overall, I think I understand the data, but there are a couple of points that I'm not sure about:

1. SWS Time (p1, Slow Wave Sleep) = 0.0mins
This seems low. Reading other member posts, it seems people generally have a non-zero value (this is equivalent to Level 3/4 sleep). Looking at the graph on p2 shows most of the sleep was between N1 and N2. Is this an indication that something is seriously wrong? i.e. very understandable that my dad is constantly tired?

2. Oximetry Summary (p1) - 91.2% time <90.
I presume normal should be around 91-100, so would it be correct to say that most of the time (91.2%) my father is receiving a sub-normal level of oxygen?

3. 95%tile pressure (p3) = 13.1mm H20.
So ~13mm is the optimal setting for the PAP machine?

4. AHI on p3 (titration) 4.3 vs. AHI on p1 (sleep study) 65.
This means that the machine did cut down the number of Apnea events significantly right?

5. Total Leak (p3)
The values show on the table ranging from 14L/min at low pressure, to 47L/min at the higher pressures. Is that a "normal" level of leakage or does this suggest the fitting overall was not particularly good for my father?

6. Oximetry on p3 (95%) vs. Oximetry on p1 (<90).
Is this also an indicator that the PAP increased the oxygen levels to my father?

Thank you for looking into this, and if there is anything unusual/strange about the report, please let me know. For me, the thing that stood out the most was that no time was spent in "Deep" (SWS) sleep.
08-02-2012 02:09 PM
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archangle Offline
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Post: #16
RE: AutoPAP vs. Auto-VPAP
I think if airflow stops during exhale, the pressure drop of EPR, Flex, or bilevel goes away, so you should get back up to the correct pressure to stop the apnea if the lower pressure does allow your airway to collapse. Of course, you'd rather not have the airway collapse happen at all.

I've heard some talk that once "inflated," it does take a while for your airway to collapse again.

I wonder if EPR, Flex, and bilevel increase your tidal volume.

Get the free SleepyHead software here.
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If it's midnight and a DME tells you it's dark outside, go and check it yourself.
08-02-2012 03:33 PM
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Sleepster Offline
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Post: #17
RE: AutoPAP vs. Auto-VPAP
(08-02-2012 02:09 PM)tempus Wrote:  I'm back and I have data =).

Your conclusions seem reasonable to me. I don't understand the titration data in that chart. It looks like he spent by far the most time with pressures between 11 and 13. Does this mean he was titrated with a APAP?

Also, he had 78 arousals per hour. To me, that would explain why he spent zero time in deep sleep. And I agree it would explain why he's so tired all the time.

It seems there should be another report with the prescribed pressure?

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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.
08-02-2012 09:37 PM
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Sleepster Offline
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Post: #18
RE: AutoPAP vs. Auto-VPAP
(08-02-2012 03:33 PM)archangle Wrote:  I think if airflow stops during exhale, the pressure drop of EPR, Flex, or bilevel goes away, so you should get back up to the correct pressure to stop the apnea if the lower pressure does allow your airway to collapse.

The EPR or Flex goes away. But the bilevel doesn't.

For example I have my BiPAP set with a IPAP of 10.5 and a EPAP of 7.5. I have Bi-Flex set to 3, so this presumably lowers the pressure to 4.5 when exhaling. When I inhale the pressure is 10.5. When I stop inhaling the pressure drops to 7.5, then when I exhale it drops further to 4.5. If I were exhaling and stopped, the pressure would rise from 4.5 to 7.5. It wouldn't kick all the way back up to 10.5 until I started inhaling.

So I think BabyDoc's analogy with the wet paper straw is correct. The airway won't collapse when exhaling. If it did a little extra muscle effort in the diaphram would raise the pressure in the lungs and open it back up again. But if it collapses on inhaling, muscle effort in the diaphram won't work because you need to raise the pressure on the outside of the lungs.

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.
(This post was last modified: 08-02-2012 09:51 PM by Sleepster.)
08-02-2012 09:48 PM
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EyesWideOpen Offline

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Post: #19
RE: AutoPAP vs. Auto-VPAP
I would suggest going for the ResMed S9 Auto-set. I have had both the Respironics and ResMed machines , and I prefer the ResMed. Auto-set machines provide versatility that the standard CPAP machine cannot match. In my case, my CPAP prescribed pressure was 12. However with both of my Auto-Set machines, I have never been higher than 12 and most of the time I was between 9 and 11. The machine automatically adjusts the pressure for optimal apnea protection balanced with comfort in a very effective way. These machines adjust to you. If you're really tired, have a cold, drank too much, gained/lost weight, or travel to different elevations, these machine auto-adjust to you.

Your choice is really limited to CPAP or Auto-Set CPAP. The other variants are very specialized, and are only prescribed in very specific circumstances. FYI, an AHI of 30 is considered severe sleep Apnea. Your Dad had 60 which is double that, and I had 87, so I know where he is coming from.

Good luck with your choice, and your Dad's therapy.
08-03-2012 06:33 AM
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tempus Offline

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Post: #20
RE: AutoPAP vs. Auto-VPAP
Thanks for looking through the report.

Sleepster - Yes, I think the titration was done with an APAP. On p3 (p1 of titration study) in the top right corner under device it says "PR RemStar Auto" which I guess is probably a Philips Respironics RemStar Auto? Aren't Titration studies usually done by an APAP as oppose to having someone dial the settings constantly? BTW - the study was done at home as oppose to in a hospital. There was no other document that I'm aware of with the prescribed pressure... I thought that number at the bottom right of p3 (13.1mmH2O) was it.

EyesWideOpen - Based on my research/forum reading etc. I was hoping that my dad would try a ResMed S9 AutoSet with the H5i and Climaline and then which ever mask worked best for him. I've asked him a number of times whether he had issues exhaling during the titration and he said it was pretty okay. If he did, I would lean towards the VPAP although I don't think I have a full understanding as to when you go VPAP vs. APAP... The main difference being the ability to set a different exhalation pressure, I thought it's mostly to do with breathing out issues, but various places, including a rep from ResMed suggest that it's "rarely" used to treat apnea, and more for pulmonary disease and other stuff.

So are the mask leakage numbers on p3 (ranging from 14L/min- 47L/min) are "ok"?
08-03-2012 01:17 PM
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