[CPAP] Introduction

[Knitman]

In the folly of Dave, I'll put forth a parallel, a maybe OK example regarding CPAP and the therapy given by ResMed or Philips Respironics. When I worked as a parts puller at a local car salvage yard, I had to be equipped with tools to remove the car part in accordance to my order needing fulfilled.

I had to have standard and metric wenches and sockets. Standard ones mostly only fit standard hardware and metric only fit metric. Mostly is the key or highlight. There are a FEW areas they're exchangeable and are more or less equal. Examples are 5/16 and 8 mm hardware can be worked with either the standard or metric variant. And then 1/2 inch or 13 mm the same story. Note one more aspect you must consider, even if either the standard or metric fit and did the job, there's still a best choice because it fit perfect and the other choice fits almost. The light to medium difficult loosening of hardware can be done by either, unless the tasks are more difficult and demands are more exacting. The damaged bolt or screw head needs exact fit tools, and so does the task with difficult or very tight, stuck hardware. Akin to difficult Apnea needs.

Apply that to PAP, both do the designed job, but one fits better and does it better. For most, the ResMed  does it better than Respironics. Yes, there's some that Respironics fits better. We at Apnea Board deal out advice that addresses the majority first and then as needed, we deal with the needs of the few. Our answer to address the majority is ResMed, and the Respironics is delegated to address the few.

I understood all of that except the most important bit. Am I in the majority or in the few?

Kind regards

[SarcasticDave94]

Unfortunate for both you and I the folly of Dave didn't determine this needed bit of info.

However, if by example a Respironics or ResMed either answers the therapy needs, all's well. If though it fails to answer all needs, and the troubles continue, then a new brand of machine and/or new level of machine needs to be introduced and discover if it brings a better answer.

[Knitman]

Unfortunate for both you and I the folly of Dave didn't determine this needed bit of info.

However, if by example a Respironics or ResMed either answers the therapy needs, all's well. If though it fails to answer all needs, and the troubles continue, then a new brand of machine and/or new level of machine needs to be introduced and discover if it brings a better answer.

Well my my CPAP Dreamstation set to A-Trial, I am using it as an Auto. I think I understood Dave to say that in his opinion the resmed sorts our snore before they happen and the Dreamstation after. 

However, it is hard to believe that a world renowned centre of excellence such as the Royal Papworth would choose the lesser of two machines when the cost of each is basically the same.

My own preference would be the Dreamstation because I like the the machine and I know how to use it. It doesn't move easily as I have read the Resmed one does. it also has the Dreammapper app while the Resmed has no app at all.

Although the 30 trial is not over by a long way, it is apparent to even this inexperienced user that Auto is best for me as my pressures change so much.

I felt in need of a nap this afternoon and I had one which was 40mins long as far as the machine was concerned but in reality would have been about 5 mins less. I chose to be in my normal upright position, with a less steep incline. I had a score of almost 24AHI with 5 CA and 11OSA and no Hypops. 

What are central apneas?

kindest regards

[SarcasticDave94]

Ah yes the CA folly. CA flags on OSCAR called clear airway but are Central Apnea. I've got them a lot. What are they though? I'm aware of 3 flavors, and all taste bad or at least somewhat.

1 can be treatment emergent or your PAP therapy causes it because exhaling CO2 is now more efficient then in past, the body isn't caught up yet to the new being efficiency and you have CA, lowering efficiency for a while will help so you can get used to the new better efficiency, this is via dropping EPR or flex, maybe tightening pressure swings killing ramp.

2 is pre-existing CA, manifest by showing on a sleep study in through before PAP treatment stages. If CA flags appear before mask and PAP pressure are introduced, you have this one. BEST answer to treat theseb is an ASV especially the ResMed IMO.

3 is similar to number 2 but called idiopathic. This means to me medical cause unknown. Treat via ASV.

PS if your sleep study has you at equal or more CA than OA, your CA is 2 the pre-existing kind like mine. If not this then it's likely a number 1 special is what you'll get.

[Knitman]

Hi Dave-I have no idea what you mean by paragraph 1. 

I know Flex is off. I do not not what EPR is.  The rest I could not understand.

Out of interest, I attach a file which shows my AHI after an on the carbs.

Last night's reading was 10.34. It was a very disturbed night as the senile one kept groaning asking to go out. Instead of just wandering as he normally does he peed and a poo both times. Then he settled. However, I had taken a sleeping pill by then which didn't help enough. I still kept waking.

I looked at my first nights on CPAP. They were all high AHI and CA was then and still is more often lower than OA. Hypops about the same too.

I score in the 20% + range for VS2 and Variable Breathing but don't know what either are. John doesn't hear me snore. No idea what RERA is.

BTW it is possible I ask the same questions. My brain damage affects my memory.

   

[Sleeprider]

All of the terms you asked about are in our Wiki Acronyms, and searching the wiki for Periodic Breathing will bring up an article.
Acronyms: http://www.apneaboard.com/wiki/index.php/Acronyms
Variable Breathing: http://www.apneaboard.com/wiki/index.php..._Breathing

Regarding Resmed vs Philips software, the Resmed machines have MyAir which is analogous to DreamMapper.
Several members including myself has described the how and why Resmed is a superior machine, and it actually does cost more here. You are certainly welcome to take or leave that information, but with all respect to the Royal Papworth, cost is a priority. If not, you would not be on a fixed pressure CPAP when you clearly would benefit from changing pressure, depending on sleep position.

[Knitman]

Dave

This is last night's chart.

The first 2hrs 51mins I was in my normal upright position. Hower, I was wearing a surgical collar. I took it off then and the rest if the night I spent laying down in the foetal position with an anti-inflammatory added to the other 6 drugs I take. 

I think, perhaps, from this chart, I ought to go a whole night with the collar. Then perhaps I can stay sleeping in the position that causes the least problems. 

I have an appointment on 7/1 to discuss this and also to discuss getting a different machine. The nurse wouldn't discuss that with me and said it would all be discussed at my review. This discussion was on the 28th so the appointment is quick. 

What do you think about the difference between the wearing the collar and not wearing it and laying down?

My preference would be to continue laying down as the pain side is much much better now But I accept this might not be possible in the long run especially as my disease progresses.

kindest regards

   

[Sleeprider]

This appears to demonstrate the efficacy of the collar to enable your upright sleep position. Your AHI was approximately equal in both positions, so you are not excluded from either, and can do whatever gives you the best comfort and sleep. Clearly this is far better than what we saw in the upright position without a collar. For now, that seems to be mission accomplished.

[SarcasticDave94]

Congrats! That looks a lot better. I'm of the opinion that with collar looks better. Now the next trick is to repeat this and that well rested state is included.

[Knitman]

I am not sure but it seems as if the sleeping sitting up with collar is better than laying in the foetal position without a collar. But this was only one night. The collar is not the most comfortable and it is going to be hard in the summer I would think, tho I could sleep with the Dyson Air thing directly blowing toward me head OR I sleep in my recliner with the air con on. 

I am going to go for the whole night tonight with the collar and sitting up. 

I had a long chat with my GP yesterday. She was unwilling to prescribe or agree to anything different until I have had my review on Thursday at 11am. Not that i asked for anything. We were just discussing my options for now. My end of life options are sorted legally but does not go as far as I would like. I may have to travel before I am ready so as not to be trapped.

We talked about me taking Melatonin. The only contra-indication she found in her book with regard to my other drugs was extra sedation which would be great. She wants to wait until the review and I tell her what the sleep Dr says. She will of course get an official letter from her.

My pain sleeping on my side has reduced significantly. If it is only a case of the intercostal inflammation going away, as it has reduced in the time I have slept on my side, on a flat bed, it may well go altogether. 

Both methods have their pros and cons. 

For a reason I have yet to find an in depth answer to, if I spend an evening overdosing
on carbs, I sleep without waking, in my sitting up position, for 12 hours and my AHI is between 0.6-1.2 on those occasions. Clearly I cannot do this on a regular basis and best not to at all as I am insulin resistant and a year ago was Type II diabetic which by low carbing and weight loss, went away by many points. (I am not normally a very fat person. I went up to 364 over the 5 year memory gap, from 175-180. It is too complicated to go into.)

Frankly I started this response hours ago. I don't know what I was addressing and seem to have lost track. I will just post it and see if it makes any sense to anyone. 

I think that it is important that since I went on A-Trial, my AHI has been below 5 most of the time, and since taking back to sleeping on my side in the foetal position, my AHI has been between 0.6 and 3, but most 1.2 ish.

If it is relevant, I have a very high tolerance to drugs. I can take 80mg of morphine on top of the 800mg gabapentin, 10 of Baclofen, the 180 mg of SR Morphine 24/7, and 30mg of valium and could, and have, done our food shopping (no driving) and not only do I not feel stoned, but no one thinks I am. The only benefit I seem to get is pain dialled right down. Needless to say this is not a regular occurance, is not part of my experiments anymore. I found other combos that work with less meds and find I can deal very well with the dial turned up some more. After all I refused all meds until 2007. I was astonished by the effect of my first dose of painkiller-Tramadol. I just thought 'how the hell did you live with that pain for 25yrs?'

After refusing to accept it, and believing it to be a BS made up condition by people who have no idea what living in a battleground all one's life since birth and escape 19yrs later did. I accepted the diagnoses I was given when in my late teens of Bi-Polar Disorder. I thought there was no such thing as a chemical imbalance in the brain, show me the proof! This was a cover for the deep shame I felt for being 'so weak' just the same as i did for having let years of 24/7 fear affect me in ways that eventually could not be hidden and the shame of that was even worse. Finally, just before turning 61 last year, I had yet another epiphany brought about by severe trauma. I accepted I had no control over this bi-polar thing and know I will be medicated for the rest of my life now. Luckily just an AD which I am weaned off of when I start to get high and go back on when the high is over. Fortunately the highs do not need medicating except sleep drugs. I don't get the sort of highs that had me dancing on a dual carriageway in my undies any more! (a dual carriageway is a road with two lanes in both directions with a central reservations which might be just a barrier or two barriers separated by tarmac or grass)

Anyway, I should shut up.