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[Equipment] CPAP plus additional integrated monitoring
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m123 Offline

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Posts: 3
Joined: Sep 2012

Machine: REMstar Auto A-Flex
Mask Type: Full face mask
Mask Make & Model: ResMed Mirage Quattro
Humidifier: REMstar Heated Humidifier
CPAP Pressure: 10-12
CPAP Software: SleepyHead

Other Comments:

Sex: Male
Location: Seattle, WA

Post: #1
CPAP plus additional integrated monitoring
Hi.

I have been using a REMstar Auto A-Flex CPAP for a couple years now. I did not go for my sleep study for the typical reasons (snoring, sleepiness during the day, poor sleep). I did have a vague memory infrequently of waking up gasping for air. I went thru two complete sleep studies and was told I had severe sleep apnea. I haven't noticed a big difference how I feel using the CPAP.

About a year ago, I found the SleepyHead software and learned how to use it. What I've noticed is that I rarely have Obstructive Apneas (zero or one a night). Mine are mostly Clear Apneas. I've read on the boards here and heard from my doctor that Central Apneas are not well understood.

I'd like to see a nightly correlation of the CPAP data with my heart rate, body position and pulse ox, and went looking on the web and found the SleepScout mentioned in this interesting article:

Self-Administered Wireless Monitor for Comprehensive Evaluation of CPAP Benefit in the Home

The article makes the point that after diagnosis, the monitoring of the CPAP treatment is incomplete (compared with the sleep study during diagnosis). They gave patients the SleepScout to use at home for a few nights, which seems like a good idea to me. To see if the CPAP is really working or needs to be tweaked.

Excerpt:
The technology consists of a wearable wireless monitor (SleepScout) and a wireless compliance module (S8POD) that plugs in the back of a CPAP machine (ResMed S8). The combined system, which is called Intelligent Quantitative CPAP (IQ-CPAP), requires only three easily-placed sensors on the patient; yet, it can generate a sleep study report with ten (10) cardiorespiratory parameters: airflow, snore, mask pressure, mask leak, chest and abdominal respiratory efforts, pulse ox, body position, Heart rate and PhotoPlethysmography.

I found a link to SleepScout at [link removed]

Anyway, I'm curious if any of you have comments about this? Especially concerning using CPAP for someone like me with almost no Obstructive Apneas and mostly Clear Apneas.

Thank you.[/size]

Regards,
Michael
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Moderator Action: Link Removed
To maintain our status as an educational organization, the only commercial links allowed in this forum are to CPAP-related manufacturer websites. This is stated in the Apnea Board Rules with details given in the Commercial Links Policy section.
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07-12-2013 11:37 AM
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trish6hundred Offline

Advisory Members

Posts: 6,430
Joined: May 2012

Machine: Resmed S9 AutoSet for Her
Mask Type: Full face mask
Mask Make & Model: Fisher & Paykel Simplus
Humidifier: H5i Heated Humidifier
CPAP Pressure: 10 - 7-20 Cm H2O
CPAP Software: Not using software

Other Comments: I started CPAP in 2008. Totally blind since birth.

Sex: Female
Location: Missouri, USA

Post: #2
RE: CPAP plus additional integrated monitoring
Hi m123,
WELCOME! to the forum.!
Hang in there for answers to your question.

trish6hundred
07-12-2013 01:05 PM
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PaulaO2 Offline
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Posts: 8,065
Joined: Feb 2012

Machine: S9 Autoset
Mask Type: Full face mask
Mask Make & Model: F&P Simplus
Humidifier: H5i
CPAP Pressure: 14-20
CPAP Software: SleepyHead

Other Comments: Ehlers-Danlos Syndrome, Hypermobility Type; chronic sarcasm

Sex: Undisclosed
Location: western NC, USA

Post: #3
RE: CPAP plus additional integrated monitoring
It could be that the machine is taking care of your obstructive events but can do nothing for the Central events.

How many CA events is the machine logging? If the AHI is still lower than 5, then all is well. I think nearly all of us on CPAP experience some CA events at some point, if not every night.

Anything that connects to the S8 is going to be expensive and is going to be outdated. The S8 records data on a proprietary memory card that requires a hard to find proprietary card reader. There's several home sleep study recorders on the market that are probably cheaper and don't need to be hooked to your CPAP to work.

For Central Apnea, you really need to see a sleep doc. If your AHI stays over 5 because of central events, then you need to see your sleep doc. It's not something to mess with. Your current machine cannot treat Central Apnea.

PaulaO2
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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.
07-12-2013 01:06 PM
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m123 Offline

New Members

Posts: 3
Joined: Sep 2012

Machine: REMstar Auto A-Flex
Mask Type: Full face mask
Mask Make & Model: ResMed Mirage Quattro
Humidifier: REMstar Heated Humidifier
CPAP Pressure: 10-12
CPAP Software: SleepyHead

Other Comments:

Sex: Male
Location: Seattle, WA

Post: #4
RE: CPAP plus additional integrated monitoring
Trish, sorry about posting the link.
Paula, thanks.

"It could be that the machine is taking care of your obstructive events but can do nothing for the Central events."

OK, this is one thing I'd like to validate. Try sleeping without the CPAP and see if I have (more) OAs. Not sure how to do that. I have a pulse ox that records during the night.

"How many CA events is the machine logging? If the AHI is still lower than 5, then all is well."

The machine is logging roughly 6-10 CAs per night (depending on the length of the time I sleep with the CPAP on - 4-8 hours). The CAs/hr is roughly 1 to 2. My overall AHI last 6 months is 1.98. On the Peak AHI graph my AHI/HR W-avg for the last 3 months ranges between 1-2 with a high of 3. My AHI/HR Max for the same period ranges around 3-5 with a high at 10. That peak, 10, I just looked at, and the during that hour I had 6 CAs, 3 OAs, 2 Hs, 1 FL, and 2 REs. An unusually bad stretch for me, not typical.

"Your current machine cannot treat Central Apnea."

Nothing does, right?
And CAs (Clear Airways) are not necessarily Central Apneas, right?

Appreciate your insight very much.

Regards,
Michael
07-12-2013 04:14 PM
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Paptillian Offline

Preferred Members-2

Posts: 474
Joined: Jun 2013

Machine: S9 AutoSet
Mask Type: Nasal pillows
Mask Make & Model: Swift FX
Humidifier: H5i
CPAP Pressure: 4 - 10, EPR x2
CPAP Software: ResScan SleepyHead

Other Comments:

Sex: Male
Location: Pennsylvania, USA

Post: #5
RE: CPAP plus additional integrated monitoring
(07-12-2013 04:14 PM)m123 Wrote:  And CAs (Clear Airways) are not necessarily Central Apneas, right?

Indeed- I can get several clear airway events each night. SleepyHead calls them "clear airway" events and ResScan just flags them as "central apnea" events. I posted about it here in another thread because I was concerned and I contacted my sleep doc. As it turns out I don't have central apneas (confirmed by the doc and my sleep study), and that it's common to get these. CPAP can induce them.

That said, it's difficult to tell a real central apnea from a CPAP-related clear airway event. It should be evaluated by a sleep doctor.
(This post was last modified: 07-12-2013 04:39 PM by Paptillian.)
07-12-2013 04:33 PM
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RonWessels Offline

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Posts: 465
Joined: Jun 2013

Machine: REMstar Auto AFlex DS560TS
Mask Type: Nasal mask
Mask Make & Model: ComfortGel Blue
Humidifier: REMstar Heated Tube DS6T
CPAP Pressure: 11 - 20
CPAP Software: SleepyHead

Other Comments: CMS50F Pulse Oximeter

Sex: Male
Location: Ontario, Canada

Post: #6
RE: CPAP plus additional integrated monitoring
(07-12-2013 04:14 PM)m123 Wrote:  "Your current machine cannot treat Central Apnea."

Nothing does, right?

Incorrect. An auto-servo machine (eg. "VPAP Adapt SV" from ResMed or "BiPAP AutoSV Advanced" from Respironics) has a built-in timer to supply pressure not just on-demand, but with a timed response as well.

Apparently, a pressure support (difference between inhale and exhale pressures) of 10 is sufficient to "force" respiration against a relaxed diaphram (ie. you are not actively trying to hold your breath).
(This post was last modified: 07-12-2013 05:24 PM by RonWessels.)
07-12-2013 05:23 PM
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buran Offline

Members

Posts: 5
Joined: Feb 2013

Machine: ResMed S9 Autoset
Mask Type: Hybrid
Mask Make & Model: Innomed hybrid
Humidifier: H5i
CPAP Pressure: 8-15
CPAP Software: ResScan SleepyHead Other Software

Other Comments:

Sex: Male
Location:

Post: #7
RE: CPAP plus additional integrated monitoring
The paper is very interesting but somewhat outdated. All the needed technology and devices for additional monitoring already exist, but in practice it is never done. There are several reasons. First, many doctors do not have time, knowledge or both to look even on the flow waveforms that top CPAP machines already record now (all what they care about is your AHI). It is very difficult to find a really good doctor. Second, it is not covered by insurance. Even pulse oximeter is not (usually) covered. So patients and doctors do not know if the treatment really works (and again most of the doctors do not care).
In fact, almost any home sleep test device would work. However, patients are not allowed to buy them (please correct me if I'm wrong - I really wanted to buy one but could not find. The only solution I found was to buy a small multi-sensor monitor from China for about $600 - they do not care about FDA regulation).

If you want to know about current DIY home sleep monitoring done by CPAP users, read these two blogs:

wiredapneic.blogspot.com
hypnagogia.squarespace.com/index/

DIY systems, however, are not integrated and you need to integrate all the signals yourself.
(This post was last modified: 07-12-2013 11:06 PM by buran.)
07-12-2013 11:04 PM
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PaulaO2 Offline
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Moderators

Posts: 8,065
Joined: Feb 2012

Machine: S9 Autoset
Mask Type: Full face mask
Mask Make & Model: F&P Simplus
Humidifier: H5i
CPAP Pressure: 14-20
CPAP Software: SleepyHead

Other Comments: Ehlers-Danlos Syndrome, Hypermobility Type; chronic sarcasm

Sex: Undisclosed
Location: western NC, USA

Post: #8
RE: CPAP plus additional integrated monitoring
Your older REMstar probably does not have a sophisticated enough software package to be able to accurately detect true Central Apnea events.

The newer S9s and the PRS1s however, are much better at accurately detecting and reporting them. They are still referred to as "clear airway" events probably for the sue-ability of the thing. They can only go by airflow and some other stuff (such as the vibration of snoring) but it has no clue as to what your body position is or if you are struggling (obstructive event) or just laying there (central event). It can't tell the depth of sleep (REM stages) or if you twitch (PLSD) in response to an event.

You are not having enough clear airway events to be of any concern. The apnea index is the number of events added together then divided by the time. So if you slept 4hrs and had 10 events, that's an AHI of just 2.5, well below the threshold. These are nothing to worry about.

Look at your data. You say the range is 10-12. That's a fairly tight range. How often do you stay at the bottom of that ten? How often do you reach the 12? If you stay near 10 most of the night, you could easily drop that lower number down to 9 then monitor for at least ten days, preferably longer. If it stays near the bottom again, lower another point. Rinse, repeat. That's the safest way to tell if the CPAP is actually doing anything for you. You want to go slowly, not making too big a change and not more than one change at a time. Keep a log of what you do, how you feel, what the numbers were, etc.

Or, for a faster response, put on the oximeter and take a short nap without your CPAP. Note when you lay down and when you wake up. How you feel, quality of nap, if you woke up at any point but fell asleep, etc. Then look at the data. This is just one little slice of your sleep picture but it should show some events, some dropping of blood O2. I did this once accidentally and got to see just how much my CPAP was working for me!

PaulaO2
Apnea Board Moderator
www.ApneaBoard.com


Breathe deeply and count to zen.

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.
07-13-2013 12:29 AM
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m123 Offline

New Members

Posts: 3
Joined: Sep 2012

Machine: REMstar Auto A-Flex
Mask Type: Full face mask
Mask Make & Model: ResMed Mirage Quattro
Humidifier: REMstar Heated Humidifier
CPAP Pressure: 10-12
CPAP Software: SleepyHead

Other Comments:

Sex: Male
Location: Seattle, WA

Post: #9
RE: CPAP plus additional integrated monitoring
PaulaO2
"If you stay near 10 most of the night, you could easily drop that lower number down to 9 then monitor for at least ten days, preferably longer."

I checked and, yes, most of the night it's at 10 with little short peaks up to 11 a few times. I'll try this. Sounds like an interesting experiment. I downloaded the info on how to change the pressure a while ago, but haven't tried it yet. Thanks.

buran
Thanks for the blogs, interesting. Looks like there's a whole world of DIY sleep improvement to explore. I guess I'm not surprised to hear how making money comes into conflict with patient benefit. Seems like the general rule for our economic system.
07-13-2013 10:55 AM
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