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[CPAP] Go from CPAP to APAP?
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vsheline Offline

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Machine: S9 VPAP Adapt (USA Model# 36007, not better 36037 or 36067)
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CPAP Pressure: 15 EPAP, PS 5-10
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Other Comments: Marfan Syndrome, chronic bradycardia, occasional Cheyne-Stokes Respiration

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Location: California, USA

Post: #11
RE: Go from CPAP to APAP?
(03-15-2015 08:11 PM)TyroneShoes Wrote:  Many major xPAP manufacturers do not even pay attention to RERA as a separate issue. Possibly they assume that if you have an apnea that is severe enough to arouse you, that this has already been counted, and flagging an arousal is splitting hairs because any apnea long enough to be flagged as an apnea is already associated with a partial arousal. I don't know. Some think its important; some ignore it altogether. I guess if it were really important certain manufacturers would not ignore it.

Hi TyroneShoes,

Actually, counting RERA events would never be double counting, because by definition RERAs are the arousals caused by respiratory effort which were not counted as apneas or hypopneas.

RERAs are arousals from sleep, so they are important.

I think it's just that RERAs are harder to detect than Apneas and Hypopneas, and most manufacturers have not yet developed algorithms which attempt to detect RERAs.

The Phillips Respironics System One machines (the ones which are fully data-capable, such as the PRS1 Remstar Auto with A-Flex) report a conservative estimate of the number of RERA events, meaning that the true number of RERA events is likely to be at least the amount which is reported.

Regarding ResMed machines, so far only the AirSense 10 AutoSet For Her model reports RERA events, I think. In my view it is extremely regrettable that ResMed omitted RERA reporting from the other data-capable AirSense 10 models (and AirCurve 10 models).

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: 03-15-2015 09:51 PM by vsheline.)
03-15-2015 09:08 PM
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TyroneShoes Offline

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Machine: Resmed S9 Autoset
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Post: #12
RE: Go from CPAP to APAP?
(03-15-2015 08:34 PM)vsheline Wrote:  ...
If 191 events represented an RDI of 43 events per hour, then you would have slept about 4.44 hrs. 7 CA events in 4.44 hrs would have represented about 1.6 CA events per hour, which is regarded in the medical community as an insignificant amount...

I'm glad you posted, Vaughn, because you understand RDI better than most of us.

What is somewhat new information (at least to me) is that rather than a simple hourly index, they noted the increase during REM (which if the sleep hours are correct, means a lower than 43 AHI during non-REM).

But I am most curious about the large number of hypops, and what that means for the therapy, and for which sort of machine AirSign should be getting.

I have to admit it is a little hard to read between the lines and give a good assessment of what might be going on here; AirSign seems to be pointed in the right direction, but I question whether the sleep doc is really on the ball here according to other things reported. There seems to be a disconnect: there was a full titration done, but only part of that was reported to the patient, for instance. AirSign is left in the dark. Maybe I am too concerned, but the feeling I get is that the red tape with the PSG might just be the tip of the iceberg here; there are other indicators supporting a disconnect between doc and patient and the understanding that they should be providing to AirSign.

If I had the elevated hypops, I would be wanting to know exactly why the doc is recommending what he is recommending, both for the therapy and choice of new machine. I would be waterboarding someone for better answers. And the ONLY reason why is because I now know, from coming here, that elevated hypops are not a normal or common SA diagnosis, and might need a particular therapy a little different from classic CPAP or APAP. The scary part about that is that if I did not know this, I would be whistling right through the graveyard thinking everything was fine, and if the doc drops the ball, I'd never know.

It sort of bothers me when docs treat patients in a way that seems to want to motivate the patient to find the answers on their own. True, patients should indeed be trying to learn all they can, but the docs should be the first, best resource for that education, not some entity-on-high that makes them feel like they have to get a plier and pull their fingernails out to get the answers they deserve.

It's the responsibility of the doc, not the patient, to get the therapy right. God help those who do not take the level of interest that AirSign is taking, or don't know any better that they should.

Maybe my reaction is misplaced and I'm way off base. Or maybe my reaction is a universal reaction to universal poor treatment of patients by the med community. Maybe it hits home. Maybe a little of each. Probably not fair to use AirSign as the poster-child example of treatment practice that irks me here, but this hits what I think might be a common nerve ending. (stepping off soapbox, for now...back to the main issue).Thinking-about
03-15-2015 09:22 PM
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trish6hundred Offline

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Post: #13
RE: Go from CPAP to APAP?
Hi AirSign,
WELCOME! to the forum.!
Much success to you as you continue your CPAP therapy.
Good luck to you with your new machine when you get it.

trish6hundred
03-15-2015 09:28 PM
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AirSign Offline

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Post: #14
RE: Go from CPAP to APAP?
Thanks, trish, certainly committed to continue Smile

Tyrone, I'm hoping that I'll get more insight when I actually see the titration session results.

I'll report back when I have that information.

Yes, I think that sleep apnea needs more attention. Am especially blessed that my sister-in-law and brother noticed my sleep disturbance 6 years ago when I thought I was watching TV in a recliner but they said I was talking in my sleep, snoring, and gasping. They knew that meant it was likely I had SA, and fortunately I had just started on Medicare and got the care I needed.

I'm often amazed how many people really don't know about it, and how many doctors don't consider it a life-threatening condition.
03-15-2015 09:47 PM
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vsheline Offline

Advisory Members

Posts: 1,907
Joined: Jul 2012

Machine: S9 VPAP Adapt (USA Model# 36007, not better 36037 or 36067)
Mask Type: Full face mask
Mask Make & Model: F10 or SimPlus w/ 2Liners. MirageQuatro & Gecko gel pad
Humidifier: H5i
CPAP Pressure: 15 EPAP, PS 5-10
CPAP Software: ResScan

Other Comments: Marfan Syndrome, chronic bradycardia, occasional Cheyne-Stokes Respiration

Sex: Male
Location: California, USA

Post: #15
RE: Go from CPAP to APAP?
(03-15-2015 09:22 PM)TyroneShoes Wrote:  But I am most curious about the large number of hypops, and what that means for the therapy, and for which sort of machine AirSign should be getting.

The high number of hypopneas when not being treated with CPAP does not in itself tell us much except that hers is a severe case of Sleep Apnea.

If the hypops all clear up under standard CPAP treatment, then a standard APAP machine would be appropriate.

If the number of hypops continue to be excessive with standard CPAP/APAP treatment despite attempts to fine tune the machine's settings, then I would think a standard Auto bilevel machine should be tried, which would help the patient to inhale/exhale more fully.

If with CPAP treatment an excessive number of the hypops appear to be central in cause (such as Periodic Breathing) rather than being obstructive in cause, then I think perhaps an ASV machine would be indicated (needed). Or, if with CPAP treatment there are an excessive amount of outright central apneas, then I think an ASV machine would be indicated.

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: 03-15-2015 10:23 PM by vsheline.)
03-15-2015 10:10 PM
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archangle Offline
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Post: #16
RE: Go from CPAP to APAP?
Essentially all APAP machines can be set to do CPAP, so from the patient's point of view, APAP is always a better choice than CPAP.

Be sure you get a good data capable CPAP machine. There is information on which ones are best in the Useful Links in my signature line at the bottom of this post.

The medical mafia has a bias against APAP machines, so you might get some resistance. Realize that just because you have an APAP, you don't want to set it to run through the full pressure range. Most people do better if you start the machine at something fairly close to the pressure you usually need.

Get the free SleepyHead software here.
Useful links.
Click here for information on the main alternative to CPAP.
If it's midnight and a DME tells you it's dark outside, go and check it yourself.
03-15-2015 11:26 PM
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