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[Equipment] Unclassified Apnea, S9 VPAP Auto
#1
Unclassified Apnea, S9 VPAP Auto
For the past couple of days I have switched from my Dreamstation BIPAP to a gently used S9 VPAP Auto. On my Dreamstation I rarely have an AHI over 3.0, and I average about 1.5. Both machines are set at 15-25cm and, as far as I can tell, the other settings are all the same, e.g., no ramp, etc. For the first night on the S9 I used a new Airfit P10, but for the second night I swapped it for the Airfit P10 that I was using with the Dreamstation because I was getting massive leaks, but the old mask didn't help much with the leaks. I am shocked at the AHIs from the S9 - 4.58 for the first night and 7.28 for last night. I am aware that the two machines may not be calculating the AHI the same way, for example, last night almost all of the 7.28 was 'Unclassified Apnea,' a term which I have never seen before. Here is a screenshot from OSCAR for last night:

   

I could use some suggestions! And I'm especially interested in what Unclassified Apneas are.
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#2
RE: Unclassified Apnea, S9 VPAP Auto
If I have it right, unclassified apnea means the machine detected apnea but couldn't determine if it was central or obstructive. I'd be more concerned with large leaks spread around through the 3 sleep segments than the unclassified apnea event aspect. These events did exist, it just cannot label the type.
Dave

OSCAR
Standard OSCAR Chart Order
Mask Primer
Dealing With A DME
Soft Cervical Collar Wiki
INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEBSITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
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#3
RE: Unclassified Apnea, S9 VPAP Auto
(08-16-2020, 12:39 PM)SarcasticDave94 Wrote: If I have it right, unclassified apnea means the machine detected apnea but couldn't determine if it was central or obstructive. I'd be more concerned with large leaks spread around through the 3 sleep segments than the unclassified apnea event aspect. These events did exist, it just cannot label the type.

Leaks are the bane of my PAP existence. Even with my Dreamstation I had 30-40% over the leak redline more often than not. The problem is in the mask, not the machines, although my high pressures certainly don't help. Over the years I have tried over a dozen masks, and they all leak about the same, in spite of all my efforts. And believe me, about the only thing I haven't tried is super glue.

I should have mentioned before that my machine settings vary a bit. Both are at 15-25, no ramp, but the machine settings for the Dreamstation say PS Min 2.00 cmH2O, PS Max 8.00 cmH2O, where the S9 says just PS 4.0 CmH2O. I can't find anywhere what 'PS' means.

Here is a screenshot from OSCAR from the 13th, the last night on the Dreamstation before starting on the S9:

   
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#4
RE: Unclassified Apnea, S9 VPAP Auto
JJJ, when leaks are that high the machine cannot determine what type of apneas you are having.  Have you ever tried the Breveida mask?  I also had problems with the p10 but the breveida hugs your nose and leaks are more under control.  
The other option is to try a nasal cradle mask like the n30 or the new Evora mask.
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#5
RE: Unclassified Apnea, S9 VPAP Auto
(08-16-2020, 02:22 PM)yankees123 Wrote: JJJ, when leaks are that high the machine cannot determine what type of apneas you are having.  Have you ever tried the Breveida mask?  I also had problems with the p10 but the breveida hugs your nose and leaks are more under control.  
The other option is to try a nasal cradle mask like the n30 or the new Evora mask.

Thanks for the suggestions. I haven't tried any of the above masks, but I suspect they would be even worse than the P10. Of all the masks I have tried over the years most were nasal masks, and useless. I am a side sleeper, plus I am very active. I roll over 3-4 times per hour, and every time I do a nasal masks usually slides out of position. The only way to get a nasal mask to stay in position is to tighten the headgear so much that it becomes painful. The Airfit's pillows make less skin contact, plus they can't go side to side very much. Yet they still leak a lot. Sigh.

I should add that I've used a chinstrap for a couple years, but it made no difference. My mouth is never dry either, so I don't think that is the source of the leaks.

But this thread has turned into a mask thread, which may be a good idea, but not where I started.
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#6
RE: Unclassified Apnea, S9 VPAP Auto
I am a side sleeper also and move around a lot due to neck and shoulder problems.  I was not successful with traditional nasal masks but the masks I mentioned are more nasal cradle masks. A lot of companies offer 30 day trials of masks which would be a good idea for you to try.
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#7
RE: Unclassified Apnea, S9 VPAP Auto
(08-16-2020, 03:36 PM)yankees123 Wrote: I am a side sleeper also and move around a lot due to neck and shoulder problems.  I was not successful with traditional nasal masks but the masks I mentioned are more nasal cradle masks. A lot of companies offer 30 day trials of masks which would be a good idea for you to try.

I've done some searching and I think the next mask I'm going to try is the Swift FX. I'd order it right now but I want to find out if my HMO (Kaiser Permanente) has it available, because it will be cheaper. Unfortunately, today is Sunday. Sad
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#8
RE: Unclassified Apnea, S9 VPAP Auto
Definition of PS is Pressure Support. As you're on a BPAP, PS is the difference between EPAP/exhale pressure and IPAP/inhale pressure. Example: EPAP 15 IPAP 25 then PS must be 10 assuming it's static pressure settings. By static I mean a set pressure that the machine can't change. Your first OSCAR shot says 4.0 PS so whatever the EPAP is, then the machine adds 4 for inhale. This indicates your pressures have a range of some sort and aren't static.
Dave

OSCAR
Standard OSCAR Chart Order
Mask Primer
Dealing With A DME
Soft Cervical Collar Wiki
INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEBSITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
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#9
RE: Unclassified Apnea, S9 VPAP Auto
I could be wrong but the pillows on the p10 and the swift fx are basically the same.  Headgear is obviously different.
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#10
RE: Unclassified Apnea, S9 VPAP Auto
(08-16-2020, 07:10 PM)SarcasticDave94 Wrote: Definition of PS is Pressure Support. As you're on a BPAP, PS is the difference between EPAP/exhale pressure and IPAP/inhale pressure. Example: EPAP 15 IPAP 25 then PS must be 10 assuming it's static pressure settings. By static I mean a set pressure that the machine can't change. Your first OSCAR shot says 4.0 PS so whatever the EPAP is, then the machine adds 4 for inhale. This indicates your pressures have a range of some sort and aren't static.

Thanks a bunch. That makes things a lot clearer!

I should have clarified at the beginning that I used regular APAPs for many years and they worked fine. I just went to the VPAP because the APAPs only go to 20cm, and I needed more. And I suspect that the 4.0 for PS was the factory default, and it feels fine to me. My big problem is leaks, which the Dreamstation seemed to handle better than the S9. That is what I'm going to work on next.
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