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Can I use my ResMed A10 Autoset to test AHI?
#1
I am wondering whether I can use my ResMed A10 Autoset to roughly test whether my wife who never had a sleep study done before, has sleep apnea?

I thought of hooking up my wife on the machine for one night and see what are the machine's AHI readings the next morning. In doing so, I would switch the machine to a CPAP mode (not auto mode) and set a fixed pressure to 4 cmH2O (which is the minimum comfortable pressure allowed by the machine) and maximum EPR of 3 (which is the most comfortable level for exhalation). She could use my Philips Respironics Nuance Frabric Nasal Pillow mask so that she would not feel claustrophobic.

If indeed she has any sleep apnea, it will show up in the sleep analysis reading the next morning, won't it? She can then go for a proper sleep study after that.

What are your opinion and what would be a suitable machine setting to achieve that?
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#2
(09-20-2014, 06:05 AM)sharp56 Wrote: I am wondering whether I can use my ResMed A10 Autoset to roughly test whether my wife who never had a sleep study done before, has sleep apnea?

I thought of hooking up my wife on the machine for one night and see what are the machine's AHI readings the next morning. In doing so, I would switch the machine to a CPAP mode (not auto mode) and set a fixed pressure to 4 cmH2O (which is the minimum comfortable pressure allowed by the machine) and maximum EPR of 3 (which is the most comfortable level for exhalation). She could use my Philips Respironics Nuance Frabric Nasal Pillow mask so that she would not feel claustrophobic.

If indeed she has any sleep apnea, it will show up in the sleep analysis reading the next morning, won't it? She can then go for a proper sleep study after that.

What are your opinion and what would be a suitable machine setting to achieve that?

She might have apnea without CPAP pressure but not have apnea at 4 cmH2O pressure, so it doesn't rule out apnea if nothing shows up. Be careful you don't give her a false sense of security.

However, if it shows apnea, she presumably has it.

I think EPR won't reduce pressure below 4.
Get the free SleepyHead software here.
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#3
(09-20-2014, 06:05 AM)sharp56 Wrote: I am wondering whether I can use my ResMed A10 Autoset to roughly test whether my wife who never had a sleep study done before, has sleep apnea?

I thought of hooking up my wife on the machine for one night and see what are the machine's AHI readings the next morning. In doing so, I would switch the machine to a CPAP mode (not auto mode) and set a fixed pressure to 4 cmH2O (which is the minimum comfortable pressure allowed by the machine) and maximum EPR of 3 (which is the most comfortable level for exhalation). She could use my Philips Respironics Nuance Frabric Nasal Pillow mask so that she would not feel claustrophobic.

If indeed she has any sleep apnea, it will show up in the sleep analysis reading the next morning, won't it? She can then go for a proper sleep study after that.

What are your opinion and what would be a suitable machine setting to achieve that?
EPR makes no difference, pressure does not drop below 4 regardless of EPR level settings

I don,t think you can diagnose sleep apnea in this way but if she get some benefits using the machine than might be a possibility she has sleep apnea. For most people, the benefits are not instant
some of the benefits ... not snoring if she used to snore
Not waking up with sore throat or/and headache
Feeling better and not sleepy during the day

You can get an oximeter and check O2 levels without PAP and while on PAP

I would do the same but set the machine on auto, something like 4-7 and 45 mins ramp start at 4

From http://www.apneaboard.com/wiki/index.php...CPAP_users
While you're awake, practice by first just holding the mask up to your face without any of the other parts. Once you're comfortable with that, try wearing the mask with the straps. Next, try holding on the mask and hose, without the straps, with the hose attached to the CPAP machine at a low pressure setting (turn the ramp feature on). And, finally, wear the mask with the straps and with the air pressure machine turned on while awake. After you're comfortable with that, try sleeping with it on.


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#4
Yes, as stated by the others, epr will have no effect unless the pressure is higher. It can only drop to 4.

Also, I think a fixed 4 is a recipe for discouragement. The problem is 4 is too low for many people to breath comfortably. I think the mask will come off within a minute or two of her putting it on, and you might end up with a mask where you don't want it.

Now then, as to your theory. The autoset is often used to titrate people that have diagnosed apnea when a titration study cannot be done. Or even when there are ample reasons to believe a person has apnea, such as snoring, daytime sleepiness, etc. When they do this they usually set the min to 4 and the max to 20, which I think is not a good idea.

If it were me, I would set it to min 6 max 12. EPR off. Be sure you have Sleepyhead installed on your machine so that you can see what her results are. I would not allow the ramp to go longer than about 15 minutes because no results are analyzed during that time.

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#5
Yes you can do this roughly. retired_guy pointed out one problem, the machine won't go below 4 (even on EPR) so you can't check the "no therapy" case.

It also won't measure whether she is asleep or not, but in my opinion that 'gold standard' of sleep lab testing is vastly over-rated and pretty much everyone here proves that almost every night:

We ALL (those of us who follow our stats) use the stats from our machine to compare to our untreated pressure and decide whether we are getting effective therapy

Were the machine not at least ROUGHLY able to measure AHI and the therefore the presence of untreated sleep apnea that comparison and measurement would be totally irrelevant.

So, we ALL regularly use the machine for this purpose, and that includes sleep docs etc., whether it is admitted it or not.

Remember the caveat of the word you used, "roughly" but this still means it will give a GOOD INDICATION within the limits discussed.

Don't absolutely rule out OSA if she doesn't show any (e.g., on low pressure) and you can't be truly certain of OSA if she shows marginally high AHI for short periods (it could be mostly bogus events.)

Also note one other problem related to the low pressures: Many people are VERY UNCOMFORTABLE at pressure lower than about 8 (or even 10) and just can't tolerate having this "little air flow".

Also, the masks are strange to new users (which everyone here pretty much learned the first few days or even months) so getting good readings could be difficult just due to the problem of her wearing the mask successfully.

This however is NOT a problem isolated to using an APAP machine -- the exact same effect happens in sleep labs a high percentage of the time.

My own sleep lab test was almost entirely irrelevant because even though it showed a "47 AHI" I slept very little and very poorly -- nothing like at home and not really even deep enough to QUALIFY as SLEEP in my opinion.

However, a sleep doc USED those results to make my 'initial settings' which were pretty close to irrelevant.

In truth, my first week was the REAL "sleep lab" where I used the Autoset to figure out the best pressures (but note that *I* was adjusting my own pressures from the VERY beginning, even before the first sleep.)

The doc had just set the machine wide open (4-20) and I knew from the sleep lab that it was going to take 6 or more just to make me feel comfortable.

Immediately (before using the machine) I turned it up to 6, then in the next few sessions up to 8, to make it comfortable.

The top number took me a lot longer to adjust since there is NO COMPELLING reason to reduce the top number if you machine is not making high pressure excursion that seem counter productive.

My machine never went above 15 so reducing but to a number higher than 15 was completely irrelevant.

Later, when I knew where my real effective 'top pressures' were, I nibbled that top number down to cover the 95-98% case and eliminate a few clear airway events.

I also think those Pulse Ox tests are better than they are given credit -- there are some issues with them, but when we consider that WITHOUT low saturation events, OSA would probably be pretty irrelevant.

Again, they aren't perfect but they are PROBABLY all that would ever be needed by 99% of the people out there. If you have a lot of desaturations, get a machine, if not (and your symptoms aren't noticeable) what could a machine do?

Pulse ox ($200 or less) plus trial machine, would cost MUCH LESS than a single sleep study so it's hard to understand why the insurance companies seem to insist on a sleep study. Even more of a difference if the 'trial machine' is only a RENTAL.

You could do the whole thing for 2 nights of pulse ox and 30 days of machine for less then $500 even if the DME had to SEND someone to show you how to use the machine the first night or two.

In your case, you have a machine and it's a pretty obvious thing to try. Been meaning to do that for MY wife, but never got around to it -- tonight is the night if she agrees (since I can sleep tomorrow if I get a louse night's sleep it being Saturday.)

Sweet Dreams,

HerbM
Sleep study AHI: 49 RDI: 60 -- APAP 10-11 w/AHI: 1.5 avg for 7-days (up due likely to hip replacement recovery)

"We can all breathe together or we will all suffocate alone."
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#6
Is she reluctant to go for a sleep study? That would certainly tell her if she has sleep apnea.
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#7
(09-20-2014, 04:00 PM)herbm Wrote: Pulse ox ($200 or less) plus trial machine, would cost MUCH LESS than a single sleep study so it's hard to understand why the insurance companies seem to insist on a sleep study. Even more of a difference if the 'trial machine' is only a RENTAL.

They're all part of the "Medical Mafia" and feed off of one another. Sad

My sleep study was billed at $3500. A new CPAP machine is often billed at $2400 with all the peripherals and if you add in the medical professionals that get to charge for referral and interpretation, you get somewhere around $6300 to diagnose and treat sleep apnea. There is a lot of room for improvement on that.

BTW, don't think since the insurance is picking up the tab that stuff like this doesn't hurt you any. Au contraire, it costs you and all the rest of us plenty in the long (and even short) run.
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#8
My wife is a little reluctant to spend a night being monitored in a foreign bed by people she doesn't know -- and we're not more than about 50% confident she has OSA.

My suspicion is that she does (several symptoms, light snoring, and MAYBE some breathing irregularity but difficult to tell on the last.)

Surfie is right about the insurance picking up the tab -- at best that adds to insurance premiums or taxes.

And you can RENT a machine for less than $100 per month -- figure $200 if there were little chance of selling it afterwards.

Carol is cool with using the machine tonight so we are going to see if it tells us anything along the lines of the question which started this thread.

(FYI: I also bought a Pulse Ox but had trouble with the drivers on 2012-R2 server and never bothered to put the software on Win7 etc.)
Sweet Dreams,

HerbM
Sleep study AHI: 49 RDI: 60 -- APAP 10-11 w/AHI: 1.5 avg for 7-days (up due likely to hip replacement recovery)

"We can all breathe together or we will all suffocate alone."
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#9
(09-20-2014, 08:10 PM)herbm Wrote: Carol is cool with using the machine tonight so we are going to see if it tells us anything along the lines of the question which started this thread.

I'll certainly be interested in how this turns out since I have the same wifey situation here although I dare say she's going to be much more stubborn than yours Herb. Oh-jeez

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#10
Headaches, tired all the time, fuzzy headedness, crappy sleep (sometimes) -- not a real hard sell.

She breathes well through her nose and isn't much of a mouth breather so we'll see how she does with a P10 but first nights are NOT completely easy for most people.

(However, this last is a problem that is at least as bad at the sleep lab except that they might have a choice of 2-3 masks -- though there wasn't enough time to really switch them around during my study.)
Sweet Dreams,

HerbM
Sleep study AHI: 49 RDI: 60 -- APAP 10-11 w/AHI: 1.5 avg for 7-days (up due likely to hip replacement recovery)

"We can all breathe together or we will all suffocate alone."
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