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First night on new VPAP Auto
#1
Just completed my first night on a ResMed S9 VPAP Auto and also downloaded the ResMed Software. Was on CPAP for over 5 years without much quality of sleep in the last 6 months, so I had a study in December.

I realize that not much information can be gathered from only one day, but one portion of the statistics have me worried:

AHI: 45.6

Obstructive: 6.4
Central: 39.2

Should I be concerned? Is it possible that I should have been prescribed the SV model with the servo ventillator to even out my episodes. Much thanks for any feedback.
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#2
I would suggest getting the full report of your sleep study, including data points, etc. Take a look at what it says and if you need to, post it here so we can help you better. I can see your concern but there is a whole lot of info that isn't included that would help us help you a lot better.
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#3
Hi rickresmed,
WELCOME! to the forum.!
Hang in there for more answers to your questions and much success to you as you continue your CPAP therapy and with getting used to your new machine.
trish6hundred
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#4
What me50 said.
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#5
not familiar with your set, but have heard CAs can be a reaction to new therapy and especially if it widely differs from past settings. beyond that, I would watch a couple more days, and then consider reducing the IPAP pressure and increasing the lower EPAP slightly. I have seen some posts that also point out the past equipment might not have provided the pressure it was supposed to.

better advice is coming, though. post tonight's scores in the morning. Smile
Dedicated to QALity sleep.
You'll note I am listed as an Advisory Member. I am honored to be listed as such. See the fine print - Advisory Members as a group provide advice and suggestions to Apnea Board administrators and staff concerning Apnea Board operation and administrative policies. 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.
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#6
(01-10-2015, 02:08 PM)me50 Wrote: I would suggest getting the full report of your sleep study, including data points, etc. Take a look at what it says and if you need to, post it here so we can help you better. I can see your concern but there is a whole lot of info that isn't included that would help us help you a lot better.


Hi rickresmed, welcome to the forum.

What me50 said, but you might need to make a few more posts before your membership status will be upgraded and you will be able to post an attachment or a link to a file.

What therapy mode is your machine in (Auto or S?), and what is the PS set to? (PS, Pressure Support, is the difference between the exhale pressure setting versus the inhale pressure setting.)

It is true that the CAI (average number of central apnea events per hour) may improve as you gradually become accustomed to the high pressures, especially if your earlier CPAP pressures were lower. Also, the OAI (average number of obstructive apnea events per hour) may improve as we learn to minimize mask leaks and mouth leaks.

But, of course, I would be concerned if my CAI was as high as 39.2, and perhaps I would call my doctor right away so he could look at the data in the SD card as soon as possible.

The two things which usually lower the CAI are (1) lowering the PS and (2) lowering the Max IPAP.

One of the things which often allows the pressure settings to be lowered is if we can ensure that we are never sleeping flat on our back.

During overnight lab titrations, we are usually asked to sleep at least part of the night flat on our back, because that is usually the worst case sleep position for causing Obstructive Sleep Apnea.

If we can ensure that we will never be sleeping flat on our back, then it is likely our pressure needs will be lower. And the lower pressure may significantly lower the CAI.

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.
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#7
Good question by vsheline -- what mode are you in?
That machine can be set to CPAP, S mode (straight biLevel) or Auto.
Also, your profile should reflect 3 numbers in Auto mode (see my profile -- same machine.)
In auto mode, the IPAP max, EPAP min and a PS number define the pressure limits of therapy.
PS is the constant split between inhalation and expiration. IPAP max is the top of the permitted inhalation pressure.
IPAP min is the bottom of the expiration pressure, A PS split greater than 6 is not advised by ResMed as "it may reduce effectiveness of therapy."


Was your Rx pressure increased after the recent study? Increased pressure can induce CAs.
And somethings they abate with time.

Perhaps you will need an ASV machine -- but, your insurance makes you step through bilevel first --
They save pennies while wasting dollars.

Do you have any other respiratory conditions other that sleep apnea? Like COPD?
Are you taking sleep aids or pain meds?
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#8
Thank you all for the quick replies. I am currently 18 IPAPmax-11 EPAPmin and will find out what my PS= is. No I do not have COPD, nor am I on sleep meds or pain meds. I know I jumped the gun in worrying about a CA value so soon. I will spend more time on this site to educate myself. I was on the CPAP for over 10 years but was not diligent in it's use. When I had the sleep study in December it also revealed some Atrial Fibrillatioon during sleep. This gave me the scare that I needed to be more serious about my OSA/CSA. Hope I didn't take some quality years (I am soon to be 60 years old) away from being so cavalier in the CPAP usage.
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#9
(01-11-2015, 09:07 AM)rickresmed Wrote: Thank you all for the quick replies. I am currently 18 IPAPmax-11 EPAPmin and will find out what my PS= is. No I do not have COPD, nor am I on sleep meds or pain meds. I know I jumped the gun in worrying about a CA value so soon. I will spend more time on this site to educate myself. I was on the CPAP for over 10 years but was not diligent in it's use. When I had the sleep study in December it also revealed some Atrial Fibrillatioon during sleep. This gave me the scare that I needed to be more serious about my OSA/CSA. Hope I didn't take some quality years (I am soon to be 60 years old) away from being so cavalier in the CPAP usage.

Sleep apnea and A-Fib often go together in us older folks. Likely they can control A-Fib with a simple Beta blocker. If not already, you might ask your cardiologist about taking a low-dose aspirin.

Your CA may just be pressure induced CA that may abate with a little time. Report it to your sleep doc; and that doc may back off on the IPAP pressure a little.

Kindest Regards,

Mongo
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#10
(01-11-2015, 09:07 AM)rickresmed Wrote: I am currently 18 IPAPmax-11 EPAPmin and will find out what my PS= is. No I do not have COPD, nor am I on sleep meds or pain meds. I know I jumped the gun in worrying about a CA value so soon.

Hi rickresmed,

I think a CAI of 39.2 is severe enough to warrant calling the doctor right away (first thing on Monday) and requesting a Max IPAP pressure reduction and/or Pressure Support reduction, with the aim of gradually increasing the pressure later, as your system gradually becomes accustomed to the therapy changes.

The doc may (hopefully, will) want you to drop off the SD card first, so he can review the first 3 days of data. Or, perhaps much better, you could simply email the doc (or drop off hard copies of) full reports for each day, created using ResScan which can save full reports in pdf format.

Before creating the full report for each day, if there are any clusters of central apneas then I suggest you use the lower ResScan screen to zoom in on a 10 minute or 30 minute portion showing a cluster.

If after a few weeks or months the CAI is still over 5.0 and is larger than the OAI, then I think you may want to ask your doctor to obtain pre-authorization for an ASV titration.

Or, for now, if you are feeling worse (more fatigued) using the new machine, you may want to return to using your old machine tonight, until the doctor has determined what lower pressure settings should be tried using the new machine.

The doctor may recommend returning the new machine to the Durable Medical Equipment supplier and using your old machine until an ASV titration can be performed.

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.
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