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Complex Sleep Apnea
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archangle Offline
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Post: #21
Complex Sleep Apnea
Be sure to look at the waveforms, not just the numbers, especially for the centrals. Sometimes, the machine flags something that's not all that serious, or you're having monster, long apneas, but the machine just counts it as 1 event for purposes of AHI.

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.
12-17-2013 08:48 PM
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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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Post: #22
RE: Complex Sleep Apnea
(12-17-2013 03:34 PM)Sauron Wrote:  AHI can vary considerably from night to night, but presumably the machine needs to be setup to handle your worst nights. While I have only had 3 nights on 15 cmH2O, the worst night had an AHI of 16.0 (9.0 obstructive, 1.2 central, 5.8 hypopnea). Is this enough to tell me that the pressure is insufficient, or can the apneas "settle down" once I become accustomed to the pressure settings?

I suggest leaving it at 15 for a week or two.

Also, is there any way for you to take a video of yourself sleeping, to see how often and how long you may be on your back?

(12-17-2013 03:34 PM)Sauron Wrote:  … At this point should I be asking if an APAP device might be better, as I don't know that I want a constant 16 or 17 cmH2O inflating me all night long - or is it a bit early in the game?

At this point, I think an auto bilevel machine would be worth asking for, such as ResMed model# 36026 (S9 VPAP Auto with humidifier and heated hose), or the DS760TS (PRS1 BiPAP Auto with humidifier and heated hose). When the pressure is as high as 15 a bilevel machine is usually helpful.

Most people with high pressure prefer bi-level treatment if given a trial. And you need it to be an Auto machine so it can self titrate, giving your doctor (and you) much more information, in the form of a nightly titration report.

The primary difference between the S9 AutoSet and the S9 VPAP Auto is the ability to have more than 3 cm H2O pressure difference between inhale and exhale. Most people who try bilevel therapy prefer 4 or 5, and some prefer 7 or 8. 3 or less is offered on the AutoSet.

Take care,
--- Vaughn

ADDED:
And if you are using an APAP machine, don't be hesitant to ask for a higher minimum pressure immediately if you feel like you're needing to work to get enough air during inhalation. A minimum pressure of 5 or 6 would be WAY too low for my comfort.

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: 12-18-2013 02:57 AM by vsheline.)
12-18-2013 02:34 AM
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Sauron Offline

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Post: #23
RE: Complex Sleep Apnea
Sorry for lack of updates, I've been on holiday so haven't been on the computer much (except to download my ResScan data).

We've got the pressure at 15.0 and tried lowering EPR from 3 to 2 for a week to see if it reduced the centrals.

Didn't really see much difference in centrals, but there was a marked improvement in obstructive apneas. So after a week we lowered EPR further to 1. Again, no huge difference in centrals, but less obstructives. So after a week of that we turned EPR off entirely. It's only been three days on this setting (no EPR) but obstructives are down to 0.4 per hour. I will leave it at this setting for another 4 nights to give it a week to make sure they stay this low.

But I still have centrals and hypopneas I'd like to get lower.

Current settings 15.0 cmH2O no EPR.
Obstructives 0.4 per hour (avg)
Centrals 3.8 per hour (avg)
Hypopneas 3.6 per hour (avg)

In my country I am fully funded for a CPAP, but not an APAP (not sure about bilevel device). But at this point it seems I need to try to get the most out of the CPAP machine I currently have.

I had a noted increase in aerophagia when I tried a pressure of 16 (going straight from 15), so we are planning on trying to increase the pressure weekly in increments of 0.2 to see if it has any impact on the hypopneas and/or centrals.

Does this sound like a reasonable approach?
(This post was last modified: 01-12-2014 04:31 PM by Sauron.)
01-12-2014 04:28 PM
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me50 Offline

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Post: #24
RE: Complex Sleep Apnea
(01-12-2014 04:28 PM)Sauron Wrote:  Sorry for lack of updates, I've been on holiday so haven't been on the computer much (except to download my ResScan data).

We've got the pressure at 15.0 and tried lowering EPR from 3 to 2 for a week to see if it reduced the centrals.

Didn't really see much difference in centrals, but there was a marked improvement in obstructive apneas. So after a week we lowered EPR further to 1. Again, no huge difference in centrals, but less obstructives. So after a week of that we turned EPR off entirely. It's only been three days on this setting (no EPR) but obstructives are down to 0.4 per hour. I will leave it at this setting for another 4 nights to give it a week to make sure they stay this low.

But I still have centrals and hypopneas I'd like to get lower.

Current settings 15.0 cmH2O no EPR.
Obstructives 0.4 per hour (avg)
Centrals 3.8 per hour (avg)
Hypopneas 3.6 per hour (avg)

In my country I am fully funded for a CPAP, but not an APAP (not sure about bilevel device). But at this point it seems I need to try to get the most out of the CPAP machine I currently have.

I had a noted increase in aerophagia when I tried a pressure of 16 (going straight from 15), so we are planning on trying to increase the pressure weekly in increments of 0.2 to see if it has any impact on the hypopneas and/or centrals.

Does this sound like a reasonable approach?

what pressure was determined in your sleep study? your machine or a regular bilevel (VPAP or VPAP auto) won't TREAT centrals. Did you have centrals in your sleep study?
01-12-2014 04:34 PM
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Sauron Offline

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Post: #25
RE: Complex Sleep Apnea
It's been a bit of a trial and error approach.

Sleep study was just a take home oxygen sensor. Then they gave me a CPAP on a low pressure and have been gradually increasing it.

The centrals may be "treatment emergent", which I understand may drop in frequency on their own after a while?

But will further increases in pressure be likely to reduce hypopneas?
01-12-2014 05:03 PM
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me50 Offline

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Machine: resmed S9 VPAP Auto
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CPAP Pressure: 18/8
CPAP Software: SleepyHead

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Post: #26
RE: Complex Sleep Apnea
(01-12-2014 05:03 PM)Sauron Wrote:  But will further increases in pressure be likely to reduce hypopneas?

IMHO, it is more important to concentrate on getting your AHI below 5 rather than be concerned about which kind of event it is. I also recommend looking at your data to see what is happening during the events, i.e., waking up, leaks, etc. because if there is something like a big leak, I disregard any events that happened during that leak. Who is helping you make the adjustments, etc.? Are you still using a range of pressures or are you using a set pressure of 15?

Hope this makes sense.
(This post was last modified: 01-12-2014 05:18 PM by me50.)
01-12-2014 05:14 PM
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vsheline Offline

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Posts: 1,907
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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: #27
RE: Complex Sleep Apnea
(01-12-2014 04:28 PM)Sauron Wrote:  We've got the pressure at 15.0 and tried lowering EPR from 3 to 2 for a week to see if it reduced the centrals.

Didn't really see much difference in centrals, but there was a marked improvement in obstructive apneas. So after a week we lowered EPR further to 1. Again, no huge difference in centrals, but less obstructives. So after a week of that we turned EPR off entirely. It's only been three days on this setting (no EPR) but obstructives are down to 0.4 per hour. I will leave it at this setting for another 4 nights to give it a week to make sure they stay this low.

But I still have centrals and hypopneas I'd like to get lower.

Current settings 15.0 cmH2O no EPR.
Obstructives 0.4 per hour (avg)
Centrals 3.8 per hour (avg)
Hypopneas 3.6 per hour (avg)

In my country I am fully funded for a CPAP, but not an APAP (not sure about bilevel device). But at this point it seems I need to try to get the most out of the CPAP machine I currently have.

I had a noted increase in aerophagia when I tried a pressure of 16 (going straight from 15), so we are planning on trying to increase the pressure weekly in increments of 0.2 to see if it has any impact on the hypopneas and/or centrals.

Does this sound like a reasonable approach?

Hi Sauron,

Increasing EPR would be likely to reduce aerophagia.

If you had a bilevel machine (like the S9 VPAP S), increasing Pressure Support (PS) would be likely to improve your Hypopnea index.

PS is a lot like EPR, except PS increases the pressure during inhalation, and EPR decreases the pressure during exhalation.

On the S9 Elite, EPR decreases the pressure during exhalation, so EPAP = Pressure - EPR. On the Elite, Presure = IPAP.

On the bilevel S9 VPAP S, PS increases the pressure during inhalation, so IPAP = EPAP + PS.

On your S9 Elite, increasing both Pressure and EPR by 1 would set your EPAP to 15 and your IPAP to 16 and therefore would be like having a bilevel machine adjusted for EPAP=15 and PS = 1.

Your obstructive apnea index is so low that I would suggest increasing EPR to 1 again before gradually increasing Pressure to 16, and paying close attention to hypopneas to see if the hypopnea index gets lower without too much aerophagia.

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: 01-12-2014 06:09 PM by vsheline.)
01-12-2014 05:46 PM
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Sauron Offline

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Post: #28
RE: Complex Sleep Apnea
(01-12-2014 05:14 PM)me50 Wrote:  IMHO, it is more important to concentrate on getting your AHI below 5 rather than be concerned about which kind of event it is. I also recommend looking at your data to see what is happening during the events, i.e., waking up, leaks, etc. because if there is something like a big leak, I disregard any events that happened during that leak. Who is helping you make the adjustments, etc.? Are you still using a range of pressures or are you using a set pressure of 15?

Hope this makes sense.

I agree about looking at the overall AHI, but since the obstructives seem to be sorted, and not much a CPAP can do for centrals, I figured the only thing i can potentially do anything more about on my current machine is the hypopneas.

I'm doing the changes myself and checking in with the sleep technician as to what is going on.

Set pressure of 15 for last several weeks, CPAP machine so can't do a range.

(01-12-2014 05:46 PM)vsheline Wrote:  Hi Sauron,

Increasing EPR would be likely to reduce aerophagia.

If you had a bilevel machine (like the S9 VPAP S), increasing Pressure Support (PS) would be likely to improve your Hypopnea index.

PS is a lot like EPR, except PS increases the pressure during inhalation, and EPR decreases the pressure during exhalation.

On the S9 Elite, EPR decreases the pressure during exhalation, so EPAP = Pressure - EPR. On the Elite, Presure = IPAP.

On the bilevel S9 VPAP S, PS increases the pressure during inhalation, so IPAP = EPAP + PS.

On your S9 Elite, increasing both Pressure and EPR by 1 would set your EPAP to 15 and your IPAP to 16 and therefore would be like having a bilevel machine adjusted for EPAP=15 and PS = 1.

Your obstructive apnea index is so low that I would suggest increasing EPR to 1 again before gradually increasing Pressure to 16, and paying close attention to hypopneas to see if the hypopnea index gets lower without too much aerophagia.

Take care,
--- Vaughn

Why would I increase the EPR? Just for comfort?
01-12-2014 06:25 PM
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Sauron Offline

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Post: #29
RE: Complex Sleep Apnea
(01-12-2014 05:14 PM)me50 Wrote:  I also recommend looking at your data to see what is happening during the events, i.e., waking up, leaks, etc. because if there is something like a big leak, I disregard any events that happened during that leak.

Forgot to mention, never seem to have any real leak issues, which is good so I don't believe that's a factor.

Centrals do happen throughout the night but are a lot more prevalent while I am falling asleep rather than while I am completely asleep.

Hypopneas are just scattered throughout the entire night.
01-12-2014 06:33 PM
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vsheline Offline

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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: #30
RE: Complex Sleep Apnea
(01-12-2014 06:25 PM)Sauron Wrote:  Why would I increase the EPR? Just for comfort?

It may do that, too, but you had mentioned aerophagia was excessive when Pressure was 16 and EPR was 0.

When gradually increasing the Pressure up to 16, having EPR set to 1 would likely be reducing aerophagia, at least a bit.

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: 01-12-2014 06:38 PM by vsheline.)
01-12-2014 06:34 PM
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