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ResMed S9 Elite -- MANY apnea events still
#71
(06-15-2014, 12:29 AM)packardex Wrote: I was told that the S9 humidifier tank could be washed in the top drawer of a dishwasher. True????
The stainless steel bottom tank is dishwasher safe

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#72
(06-15-2014, 12:29 AM)packardex Wrote: I was told that the S9 humidifier tank could be washed in the top drawer of a dishwasher. True????
Hi packardex,
WELCOME! to the forum! best of luck to you with your CPAP therapy.
trish6hundred
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#73
Folks, this thread is not about washing machine parts.

Please refrain.

If you need to, start a separate thread on the topic.
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#74
S9 Elite, EPR off.
I need to ask the folks here a question.
With 19 days now, I think I can state a pattern with reasonable accuracy...
The strong majority of nights (16 of 19) I will have 1-2 clusters of events, marked generally as OAs, a few CAs.
Beginning the eighth night, I increased pressure from 12 to 14cm.
Number of clusters dropped, and fewer nights with 2.
(Three of the first 7 nights at 12cm, I had 3 clusters.)
Hypopneas appear scattered along the time of the cluster as well.

Of the nine nights after change to 14cm, AHI =
Mean 3.077777778
Standard Error 0.885810642
Median 2.8
Standard Deviation 2.657431927

That looks good, but mean is vastly skewed for example by 7 hours of very low AHI, but 1 to 1.5 hours of HUGE AHI during the cluster (like 75 for one bad example!!).
So, you could have hourly AHIs of [0 0 0 0 40 0 0 0] = 5.0 overall,

My question is: should I be happy with AHI < 5,
or do consistent clusters of an hour or more (16 of 19 nights) need to be "worked on?"

Here is the full run of AHIs:
7.1, 12.5, 11.3, 10.0, 5.9, 2.2 (0 clusters), 10.7,
[pressure raised to 14] 0.6 (0 clusters), 2.8, 1.6, 3.6, 0.3 (0 clusters), 7.2, 7.5, 1.2, 2.9, 4.0, 5.9, 13.3 (1 major, long, close events cluster).

One other phenomenon that concerns me is that ALWAYS during the clusters I have "periodic breathing"--a few OK breaths(2-3), then declining volume and becoming near zero, which throw an event when that part lasts more than 10 seconds. This periodic breathing pattern also shows with some frequency during times other than the cluster...but the low volume time is short enough that events are not called.

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#75
As I posed a closely worded question to my sleep doc some 4 weeks ago (it was about me hitting 10 rather than 5 or less) - his words were "numbers have a constant meaning, but our understanding of the meaning keeps changing" - he talks like that a lot. Anyhow, my gist of what he was trying to say is that numbers alone is not enough of an answer, but how do I feel, do I dream, are my blankets all mussed up, or like I didn't move all night, stuff like that.

I would say to ask your Doc, but I bet if you asked 3 or 4 different ones, you'd get 2-4 different answers.

My sleep doc said that '5' was a statistical goal (whatever that actually means) - that lower is better as long as it doesn't impact other standards of quality sleep. In other words, my 100% compliance, numbers far and away better than without my dream machine, and overall sleep quality greatly improved - make him happy. But lower AHI and a lower average leak rate (without impacts) would please him even more.

I then asked him, if I sleep much better, and wake less with a 'WISP' mask, but have worse leaks, or, use a Quattro Air FFM, but wake to adjust it, but AHI and leaks go down, which should I choose? His answer was - wear the FFM as long as you've worn a nasal mask and maybe you won't wake as often? What kind of answer is that anyhow??
*I* am not a DOCTOR or any type of Health Care Professional. My thoughts/suggestions/ideas are strictly only my opinions.

"Only two defining forces have ever offered to die for you. Jesus Christ and the American Soldier. One died for your Soul, the other for your Freedom."
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#76
(06-18-2014, 09:54 PM)jcarerra Wrote: With 19 days now, I think I can state a pattern with reasonable accuracy...

You need about 30 days worth of data to draw conclusions when your numbers are this low.

Those clusters are probably a REM sleep stage. I have them, too, and so do a lot of other people.

Quote:My question is: should I be happy with AHI < 5,

Very much so, yes. If you are tolerating the pressure at 14 just leave it there until you have 30 days worth of data. Then lower it back to 12 for another 30 days and compare averages.
Sleepster
Apnea Board Moderator
www.ApneaBoard.com


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.
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#77
(06-18-2014, 11:17 PM)Sleepster Wrote: Those clusters are probably a REM sleep stage. I have them, too, and so do a lot of other people.

Now that is interesting to me...so having a one hour cluster of 20+ OSAs and 20+ hypopneas almost every night, and two clusters some nights, is common and not something to "work on?"

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#78
I don't know if it's common. I just see people on this forum reporting it, and I experience it.

You might want to see if your doctor wants to do anything about it.

About the only thing I know to do about it is to raise the pressure. This is where a auto-CPAP would come in handy as you could see if the pressure goes up and treats these clusters of events.
Sleepster
Apnea Board Moderator
www.ApneaBoard.com


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.
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#79
(06-19-2014, 10:03 AM)Sleepster Wrote: About the only thing I know to do about it is to raise the pressure. This is where a auto-CPAP would come in handy as you could see if the pressure goes up and treats these clusters of events.

Yes. After I started seeing my data, I was very disappointed that they had set me up with the Elite instead of the Autoset.

A contradiction is that I see here all the time that you need many days to see what is going on--often 30 is recommended--yet the sleep study, from which *major* decisions are made, is ONE NIGHT. Granted, they have the leg, respiration, and brain data which offsets that some, but if you have an abnormal night, no amount of equipment is going to give them representative data.

I am beginning to think I had one of my nights with no clusters during the study. In fact, since I always feel very "unslept" after no-cluster nights, and that is how I felt after the study, I believe there is a high probability I did not have one that night. Also, many of them have occurred between 5-7 AM, and they got me up at 5AM.

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#80
(06-19-2014, 09:05 AM)jcarerra Wrote:
(06-18-2014, 11:17 PM)Sleepster Wrote: Those clusters are probably a REM sleep stage. I have them, too, and so do a lot of other people.

Now that is interesting to me...so having a one hour cluster of 20+ OSAs and 20+ hypopneas almost every night, and two clusters some nights, is common and not something to "work on?"
The short answer is: It depends.

As sleepster points out, until you get about 30 days of data, you're still in the gathering data stage.

But the lengths of those residual clusters do seem to be a bit troubling. And while a lot of people continue to have REM-related clusters, they're usually not this long and they usually don't have this many events. AND the really long clusters are usually not present on most nights.

But where to go from here is not completely clear. I'd start with consulting the sleep doc even though there's a high probability that he'll look at the overall AHI data and say things are fine ... You could try to get a more reasoned approach by handing him the detailed data that shows the clusters FIRST and ask him what he thinks about those long, dense clusters of events before you show him the summary data.

As for dial winging on your own: I'd be cautious about just bumping up your pressure by a whole lot more. While almost all of your events are being labeled as "OAs", the breathing itself when we examine it on a much closer level has some periodicity and it could be that for whatever reason, the machine is mis-classifying some of those events. In other words, when one of the very long clusters gets started, the breathing simply does not stabilize and there's some data that points to the unstable breathing as having some characteristics of a long hypoventilation/hyperventilation cycle. And these kinds of cycles are not always driven by collapsing airways; rather they can be caused by the PAP pressure leading to too much CO2 being blown off, which can start the hypoventilation part of the cycle ...

In other words, if you really feel like you must do something in terms of increasing the pressure, I'd suggest that you only increase it by 0.5cm and that you leave it at new setting for at least 7 days (30 days would be better) before you think about increasing the pressure again.


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