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Making sense of the numbers...
#1
I just finished my fifth night of APAP use. I use a PR 560 Auto with A Flex machine. I also use the Sleeyhead software. I really want to know if an APAP machine can my needs. Or, do I need a BiPAP or ASV machine, instead. I will see a sleep doctor in about three weeks. Here are my numbers from last night. They are typical of the previous four nights:

AHI - 6.95
Large Leak 0%
Clear Airway - 2.48
Obstructive - .30
Hypopnea - 4.17
RERA - 0%
Flow limitation - .79
Vibratory Score - 0%
Vibratory Score VS2 - .10
Pressure Pulse - 6.15
Time spent in Cheyne-Stokes Respiration - 5.36%

I am most concerned about the CSR score, along with the CAI and HI scores. My understanding is that an APAP machine doesn't target these events. If so, would a BiPAP or ASV machine be a better choice?

Any thoughts .... and thanks so much ....
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#2
(08-22-2015, 10:33 AM)xdocgx Wrote: I just finished my fifth night of APAP use. I use a PR 560 Auto with A Flex machine. I also use the Sleeyhead software. I really want to know if an APAP machine can my needs. Or, do I need a BiPAP or ASV machine, instead. I will see a sleep doctor in about three weeks. Here are my numbers from last night. They are typical of the previous four nights:

AHI - 6.95
Large Leak 0%
Clear Airway - 2.48
Obstructive - .30
Hypopnea - 4.17
RERA - 0%
Flow limitation - .79
Vibratory Score - 0%
Vibratory Score VS2 - .10
Pressure Pulse - 6.15
Time spent in Cheyne-Stokes Respiration - 5.36%

I am most concerned about the CSR score, along with the CAI and HI scores. My understanding is that an APAP machine doesn't target these events. If so, would a BiPAP or ASV machine be a better choice?

Hi xdocgx, welcome to Apnea Board.

The numbers of Clear Airway (Central Apnea) and Periodic Breathing events tend to decrease during the first few weeks or months.

Your CA Index (an Index is the average number per hour of sleep) is already small and will likely decrease further.

Your "CSR" is probably mostly Periodic Breathing without apneas, but SleepyHead lumps together PB and CSR-like breathing pattern. Looking at your Flow waveform would show this, but zoom in until vertical scale is +/- 75 Liter per minute or less, and horizontal scale is showing 5 minutes or less.

In the USA, most health insurance policies will not consider coverage for an ASV machine (or one of the other special types of non-invasive ventilator BiPAP machines with "backup" respiration rate, like an "ST" bilevel) unless the CA is at least 5.0.

Most insurance will not consider coverage for standard (non-ASV) BiPAP (neither the fixed "S" bilevel nor the "Auto" bilevel types) unless your doctor justifies it. Justifications which are usually accepted include patient discomfort/intolerance of a prescribed pressure above around 15, or a diagnosis of Upper Airway Resistance Syndrome (UARS). Standard BiPAP models usually do not decrease the number of CA or PB or CSR-like breathing - usually bilevel machines without a backup rate actually increase CA and PB and CSR-like breathing.

I think it is too early to be concerned. Give yourself another month or two to adapt to therapy.

Also, how you feel (rested and mentally clear-headed or fatigued and mentally foggy) is perhaps the most important indicator of how well your machine is working for you.

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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#3
Vaughn,

Thanks for the quick, thorough response. This forum is a great source of valuable information.

As you mention, the numbers that I posted above were taken from the Sleepyhead software. My Periodic Breathing index was 11.0, when read from the PR 560 machine's screen.

What number value should be a concern for me in three weeks or so, for Periodic Breathing and/or CSR?

Thanks again ...
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#4
(08-22-2015, 11:31 AM)xdocgx Wrote: What number value should be a concern for me in three weeks or so, for Periodic Breathing and/or CSR?

Not sure whether there is a specific threshold in number of CPAP-induced CSR-like events per hour, above which we would be concerned and below which we are fine. I think we need to pay close attention to how we feel, fatigued or refreshed, upon awakening.

If CSR is occurring without CPAP therapy, this "real" CSR is often an indicator of very serious illness. But when a similar breathing pattern is induced/caused by CPAP therapy, the same breathing pattern can be called "CSR-like" rather than "true" CSR.

When Positive Airway Pressure therapy causes smoothly-varying Periodic Breathing without CA pattern (depth of breathing gradually increases (Tidal Volume gradually increases) to a peak followed by a slow transition again into excessively shallow breathing, and the cycle slowly repeats with a period between 30 seconds to a couple minutes, without apneas occurring) I think this usually causes no problems. That is, I think blood oxygen levels usually do not drop enough to disturb sleep, and therefore little or no stress or fatigue or mental fogginess accompany this. Maybe this mild form of PB would be keeping us in shallow sleep, preventing us from reaching the deeper and more restorative sleep stages while PB is occurring, but if this is happening only during a small portion of the night I think the overall effect of the mild form of PB is nothing to worry about.

(Tidal Volume is the estimated amount of air we are breathing in or out in each breath.)

However, when Positive Airway Pressure therapy causes smoothly-varying PB with CA events (CSR-like pattern, where one or more breaths are completely skipped) I think these may be of concern, especially if accompanied by SpO2 desaturations of 4% or greater, disturbed sleep and resulting fatigue and mental fog.

Some patients sometimes have a pattern of repetitive central apneas which is not CSR-like, in which the decrease in breathing depth (Tidal Volume) is smooth and gradually transitions into central apnea but when the apnea ends the Tidal Volume restarts suddenly, jumping sharply. I think this may be a combination of central apnea plus obstructive apnea, where the apneas start as central apneas but during each apnea it transitions into obstructive apnea, in which case higher pressure may decrease the obstructive component, but higher pressure may also make worse the central component. So, to find best overall pressure settings, a small adjustment in the Min Pressure and/or the Max Pressure setting may need to be made every week or month, in order to empirically achieve lowest overall sleep quality.

For most patients, the RDI is considered a good indicator of overall sleep quality. RDI is the Respiratory Disturbance Index, which is the average number per hour of the total of apneas plus hypopneas plus RERA. RERA is Respiratory Effort Related Arousal, which is an arousal (an arousal can be an awakening but usually is merely a change into a very shallow stage of sleep in order to breath more strongly) which has been caused by the effort needed to breath when the airway has become restricted, partially obstructed.

A recording Pulse Oximeter would be able to keep a record all night of your SpO2, which is the percentage of Oxygen saturation in the blood. (The "p" in SpO2 signifies it is measured through the skin, percutaneously, using a Pulse Oximeter.) The type like a watch with separate finger sensor is less likely to fall off during sleep and is far more comfortable to wear all night once in a while (like once a week or once a month). Supplier 19 sells Pulse Oximeters and has a good reputation. A link to the Supplier List is at the top of every forum webpage.

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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