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does ramp impact reported AHI ?
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BlueHorseshoe Offline

Members

Posts: 12
Joined: Dec 2014

Machine: Resmed Airsense 10 Elite
Mask Type: Full face mask
Mask Make & Model: Resmed Airfit F10
Humidifier: unsure
CPAP Pressure: 11
CPAP Software: SleepyHead

Other Comments:

Sex: Male
Location: Pennsylvania

Post: #11
RE: does ramp impact reported AHI ?
(12-23-2014 01:18 PM)vsheline Wrote:  
(12-23-2014 10:42 AM)surferdude2 Wrote:  Another possibility - It appears to me that you were awake during that early cluster period. I'm guessing you actually went to sleep around 23:07. Anything prior to that time looks like might be anxiety patterned breathing. If so, I would tend to throw those events out of the total count. That type of anxiety action will likely diminish as you become more comfortable with the initial pressure as therapy begins. From the later graph it appears that you are doing pretty well but eventually will need a tad more pressure. I wouldn't increase it now however but wait until you get more comfortable with your present setting of 11 cm H²O.

Hi BlueHorseshoe,

It looks like you are using the A10's new automatic Ramp mode, which stays at the Ramp Start Pressure setting until the machine decides you have fallen asleep, and then starts ramping up to your full therapy Pressure setting. So, I am assuming you were asleep by the time the pressure started increasing.

From the A10 set-up manual (Clinician Guide):
Ramp Time can be set to Off, 5 to 45 minutes or Auto. When Ramp Time is set to Auto, the device
will detect sleep onset and then gradually increase from the start pressure to the minimum
treatment pressure at a rate of 1 cm H2O per minute. However, if sleep onset is not detected, the
device will reach the target pressure within 30 minutes.

Hi surferdude2,

Notice that the zoomed-in period (the highlighted period) doesn't start until 6 or 7 minutes after the session had started, and the pressure does not start increasing until after an additional 7 minutes into the highlighted period. So, the pressure did not start increasing until 13 or 14 minutes into the session.

I am not familiar with anxiety patterned breathing. Would anxiety cause clear airway apneas or hypopneas, rather than the scored obstructive apneas?

A swallow will cause a complete obstruction for about 2 to 4 seconds, I think, but scored apneas last longer than 10 seconds and would have been verified by ResMed's Forced Oscillation Technique (FOT) as being obstructive in type. Many of the times with no Flow while the pressure is ramping up last longer than 10 seconds, so I think these are obstructive apneas which were not scored only because events are not scored until after ramping has completed. (Each minor division is one tenth of 120 seconds, or 12 seconds.)

The apneas shown (but not scored) in the Flow waveform while the pressure is actively ramping up look like obstructive apneas, which typically end with sudden hard breathing which gradually lowers to apnea again, like an arrowhead. For obstructive apneas, the amplitude envelope of the Flow is typically like an arrowhead or like a cosine, which starts at full amplitude and gradually decreases again to zero amplitude.


ADDED LATE:
The above excerpt from the A10 set-up manual has now been added.

Yes, I am using the auto-ramp feature, and from what you shared I was having apneas before falling asleep and ramping up to setting 11. I also start sleeping on my back, then roll onto my side to fall asleep, so maybe this impacts my total AHI. I'm going to try a few experiments to start out on my side and remove autoramp and see if that helps things. All this dialog makes me wonder why, given the slight cost difference in machines, my sleep doctor didn't just prescribe an APAP machine with a range more like 8 to 14, to account for this. I need more patience - I am still less than 6 weeks into cpap. Thank you.
12-23-2014 05:18 PM
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vsheline Offline

Advisory Members

Posts: 1,908
Joined: Jul 2012

Machine: S9 VPAP Adapt (USA Model# 36007, not better 36037 or 36067)
Mask Type: Full face mask
Mask Make & Model: F10 or SimPlus w/ 2Liners. MirageQuatro & Gecko gel pad
Humidifier: H5i
CPAP Pressure: 15 EPAP, PS 5-10
CPAP Software: ResScan

Other Comments: Marfan Syndrome, chronic bradycardia, occasional Cheyne-Stokes Respiration

Sex: Male
Location: California, USA

Post: #12
RE: does ramp impact reported AHI ?
(12-23-2014 05:18 PM)BlueHorseshoe Wrote:  Yes, I am using the auto-ramp feature, and from what you shared I was having apneas before falling asleep and ramping up to setting 11. I also start sleeping on my back, then roll onto my side to fall asleep, so maybe this impacts my total AHI. I'm going to try a few experiments to start out on my side and remove autoramp and see if that helps things. All this dialog makes me wonder why, given the slight cost difference in machines, my sleep doctor didn't just prescribe an APAP machine with a range more like 8 to 14, to account for this. I need more patience - I am still less than 6 weeks into cpap. Thank you.

Hi BlueHorseshoe,

I think you were having obstructive apneas as soon as you fell asleep, but perhaps not before you fell asleep.

Seems to indicate your pressure is too low whenever sleeping on your back, so probably would be good to either increase the therapy pressure higher than 11 (which could cause problems like excessive and eventually painful air-swallowing, or worse problems), or, instead, you could simply make sure you are never sleeping flat on your back.

A foam wedge may help a little by keeping the shoulders and neck and head aligned but elevated. Or, some sleep in a reclining lounge chair. Or, some use strategically-placed pillows to keep themselves at least partly off their back. Or, some wear a small light backpack with something light but bulky inside. I wear a snug teeshirt with one or two tennis balls in pockets sewn between my shoulder blades and higher, so that when I roll onto my back while sleeping I wake up enough to keep on rolling until I am positioned on my other side.

Having an APAP machine gives us more data (in the form of a nightly auto-titration by the machine), and this makes it easier to zero in on optimal settings, but I think the most important thing is to have a fully data capable machine, which, thankfully, yours is.

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.
(This post was last modified: 12-23-2014 08:26 PM by vsheline.)
12-23-2014 07:53 PM
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BlueHorseshoe Offline

Members

Posts: 12
Joined: Dec 2014

Machine: Resmed Airsense 10 Elite
Mask Type: Full face mask
Mask Make & Model: Resmed Airfit F10
Humidifier: unsure
CPAP Pressure: 11
CPAP Software: SleepyHead

Other Comments:

Sex: Male
Location: Pennsylvania

Post: #13
RE: does ramp impact reported AHI ?
(12-23-2014 10:42 AM)surferdude2 Wrote:  Another possibility - It appears to me that you were awake during that early cluster period. I'm guessing you actually went to sleep around 23:07. Anything prior to that time looks like might be anxiety patterned breathing. If so, I would tend to throw those events out of the total count. That type of anxiety action will likely diminish as you become more comfortable with the initial pressure as therapy begins. From the later graph it appears that you are doing pretty well but eventually will need a tad more pressure. I wouldn't increase it now however but wait until you get more comfortable with your present setting of 11 cm H²O.

BTW, I don't think your 7 minute ramp time is doing you any good whatsoever. Increasing it to a higher setting that will allow you to get to sleep before getting the higher pressure could help you get over the early anxiety events. That's the normal way that the ramp is used. Eventually most users quit using the ramp once they get more comfortable with CPAP and manage to fall asleep with the pressure right from the start.

The above are just my own opinions. I will add that if you have any doubt about which course to follow, I'd suggest you stick with vsheline since he has much more insight into this therapy whereas I'm practically a newbie in comparison.

(12-23-2014 07:53 PM)vsheline Wrote:  
(12-23-2014 05:18 PM)BlueHorseshoe Wrote:  Yes, I am using the auto-ramp feature, and from what you shared I was having apneas before falling asleep and ramping up to setting 11. I also start sleeping on my back, then roll onto my side to fall asleep, so maybe this impacts my total AHI. I'm going to try a few experiments to start out on my side and remove autoramp and see if that helps things. All this dialog makes me wonder why, given the slight cost difference in machines, my sleep doctor didn't just prescribe an APAP machine with a range more like 8 to 14, to account for this. I need more patience - I am still less than 6 weeks into cpap. Thank you.

Hi BlueHorseshoe,

I think you were having obstructive apneas as soon as you fell asleep, but perhaps not before you fell asleep.

Seems to indicate your pressure is too low whenever sleeping on your back, so probably would be good to either increase the therapy pressure higher than 11 (which could cause problems like excessive and eventually painful air-swallowing, or worse problems), or, instead, you could simply make sure you are never sleeping flat on your back.

A foam wedge may help a little by keeping the shoulders and neck and head aligned but elevated. Or, some sleep in a reclining lounge chair. Or, some use strategically-placed pillows to keep themselves at least partly off their back. Or, some wear a small light backpack with something light but bulky inside. I wear a snug teeshirt with one or two tennis balls in pockets sewn between my shoulder blades and higher, so that when I roll onto my back while sleeping I wake up enough to keep on rolling until I am positioned on my other side.

Having an APAP machine gives us more data (in the form of a nightly auto-titration by the machine), and this makes it easier to zero in on optimal settings, but I think the most important thing is to have a fully data capable machine, which, thankfully, yours is.

Take care,
--- Vaughn

Thank you for the follow-up and good council, I appreciate the time you and others took here to communicate and address my situation. Last night I tried going to sleep on my side and not sleeping on my back or stomach anytime during the night, with no ramp ( started at 11 setting ), and my total AHI was 3.7 for the night. My OA and CA events were sporatic, and I am very happy with this number and best of all I woke refreshed and ready to tackle the holiday events now Smile I will watch and see now..... of course, Happy Holidays to all. Dan
12-24-2014 08:28 AM
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