Need Help w/Sleep Study Results

Question:

> say about was the fact that "The patient had alpha-wave intrusion > throughout his sleep."  I suspect that this Alpha wave stuff might be > important – for the past year I have had problems with achyness and > have had chronically high CK or CPK test results (@ 400).  Related – I > would love to know?

The alpha wave intrusions along with your comment of achyness could indicate you have fibromyalgia I don’t think your sleep center was very good if they couldn’t titrate you with any machine – they should know how to adjust your machine and should have been able to make at least some periodic adjustments without disturbing you too much….. I have no idea what CK or CPK refers to — Beth in Australia ————————– Unless stated otherwise, anything I say here is my opinion only – I am not a medically trained professional FAQ for alt.support.sleep-disorder can be found here http://talhost.net/sleep Newsgroup Archives http://talhost.net/sleep/archives.htm this site is a work in progress – feel free to submit info/articles _________________________________________ Usenet Zone Free Binaries Usenet Server More than 120,000 groups Unlimited download http://www.usenetzone.com to open account

Response:

Thanks Beth – my MD mentioned the FMS connection, but I looked at its description and it sounds more specific than what I think I have – I dont really have trigger points – other than in my feet – I just ache, kind of down to the bones.  Possibly connected, the CK is, I believe, Creatinine PhosphoKinese(?) – as I understand it, it is a muscle enzyme that is released when muscles degenerate…

Response:

I had a semi-successful sleep study three days ago – due to a study center CPAP malfunction, I had to use my own CPAP.  So they got all the readings, but no titration!  Anyway – with my CPAP at 12, I still had an RDI of 16, compared to my previous pre-CPAP study when my RDI was 99.  Since they couldnt titrate, their recommendation was for me to self titrate…According to the results of the study, I had no "apnea" events, but I had 81 "obstructive hypopnea" events.  Further, my MD marveled at the fact that all these events were in "nonREM" states.  I only had two REM stages for the night, my sleep efficiency was 88%, even though I felt like crap in the am, Oxygen avg was 93%.  He also marveled, with no comment on the significance, that all my "respiratory events" were in nonREM states as well – or maybe that is the same thing…Finally, another anomaly that he noted but had nothing more to say about was the fact that "The patient had alpha-wave intrusion throughout his sleep."  I suspect that this Alpha wave stuff might be important – for the past year I have had problems with achyness and have had chronically high CK or CPK test results (@ 400).  Related – I would love to know? Can someone please help me interpret these results???? Thanks

Response:

V.A. policy on sleep studies? Other ways to detect apnea?

Question:

On Thu, 03 Mar 2005 13:28:12 -0500, Tom Devlin <tomdev…@ameritech.net> wrote: >Well sure, this sort of thing is a moving target. Kate, who had a >thoroughly botched UPPP, seems to be doing fine with an AutoSet >Spirit. >But I’m still going to obstinately continue to suggest that people >who’ve had a UPPP might not be the best candidates for AutoPAPs.

That could well be true, but considering that one of the bad outcomes of UPPP is tissue damage in certain locations, I suspect that problems could happen with any form of xPAP. >We >can argue about the reasons, you seem to have your own theories, but I >simply can’t ignore the fact that a night in the sleep lab would be a >good idea for anyone who doesn’t seem to be getting the expected >results from an AutoPAP. Especially if they’ve had a UPPP.

I don’t disagree with the concept of getting another study done, but I don’t necessarily think that one can jump to the conclusion of blaming the type of equipment >And I’m going to continue to mention snoring until I find something >better to blame this on. Feel free to continue to correct me. <g> >Tom

– .andy To email, substitute .nospam with .gl

Response:

"Tiger Lily" <m…@privacy.com> wrote: >> I would, especially if it’s been a while since your last titration. My >> pressure’s gone up about 1Cm/year. >interesting…….. i have to say the same thing as well……. that’s why >i’m so thrilled with my AutoPAP………… it makes the changes for me

I’m doing my own adjusting. My DeVilbiss 9001D lets you go in .5Cm steps, it’s nice for fine tuning. >occassionally the setting drops back down to the first Rx’d level, but that >doesn’t stay for very long………

That might be due to body position or depth of sleep, it would be interesting to try to figure out which (if either). Tom

Response:

Andy Hall <an…@hall.nospam> wrote: >>That may be cause and effect. A UPPP eliminates snoring, a major >>trigger for any AutoPAP. >It’s one of the triggers, and in the past a significant one on some >early autotitrating machines.

There used to be a well-conected poster on sleepnet named Perry, he was a "tough case" for AutoPAPs and manufacturers used to send him equipment to test. He said that, once you got past all the "patent language", snoring was still the primary trigger for most AutoPAPs. IIRC, He also said the unit most likely to work for people who’d had a UPPP was the DeVilbviss AutoAdjust LT. According to someone here, Joe Guilford (the cpapman), said that Respironics had hired the fellow who’d developed that machine to design the REMstar Auto, that could very well explain Quick’s findings. >On the newer ones, and as algorithms have been updated, the major >sensing is based on flow limitation detected from the change in shape >of the flow/pressure curve over a period of time.

Well sure, this sort of thing is a moving target. Kate, who had a thoroughly botched UPPP, seems to be doing fine with an AutoSet Spirit. But I’m still going to obstinately continue to suggest that people who’ve had a UPPP might not be the best candidates for AutoPAPs. We can argue about the reasons, you seem to have your own theories, but I simply can’t ignore the fact that a night in the sleep lab would be a good idea for anyone who doesn’t seem to be getting the expected results from an AutoPAP. Especially if they’ve had a UPPP. And I’m going to continue to mention snoring until I find something better to blame this on. Feel free to continue to correct me. <g> Tom

Response:

>Dan: >I’m a bit confused by your closing statement.  First, Norm basically said >Andy was incorrect in his comments because of his generalizations. You >sternly took Norm to task for that. Now you say "it is not possible to >generalise." You can’t have it both ways.

No, this is another case of people reading what they wanted to read rather that what was actually said. I was very careful not to make generalisations but to point out there are geographical differences in  diagnosis and treatment for reasons that are clinical, fashionable, economic and so on.    The important things are the rates of effective diagnosis and outcomes of treatment. >You are also wrong in your generalization about BiPAP being described only >for OSA patients who also have cardiac or respiratory problems. Despite your >"contacts with six CPAP companies you are incorrect.  I was prescribed BiPAP >treatment and I do not have cardiac or respiratory problems.

Yes and that’s fine.  It’s common practice in the U.S.  The point being made that this is not considered to be a medically necessary reason in many countries in Europe. Equally, you might argue that use of autotitrating equipment is not considered medically appropriate in certain healthcare environments in the U.S.   Nobody has an issue with that. THe point is that treatment approaches do vary and there are lots of factors involved. As far as I am aware, Americans are not genetically different to Europeans, so there is no basis to assume that different regimes are more or less appropriate either way.  They are simply different. >You and Andy >may be informed on OSA treatment in the UK and Ireland.  But that >"expertise" does not extend to OSA therapy in the U.S.

Nobody has discussed this in terms of expertise at all.  The point has simply been that there are different methods of treatment and diagnosis in use in different parts of the world and that clinical and other arguments can be made for all of them. — .andy To email, substitute .nospam with .gl

Response:

On Tue, 01 Mar 2005 12:06:36 GMT, normc <no…@socal.rr.com> wrote: >> It’s amazing how attitudes differ. >Sometimes one’s attitude results from the availability, or >lack thereof, of appropriate medical services.

Of course, and that was part of my point. – Hide quoted text — Show quoted text ->> I was talking to my specialist recently about this as well as reading >> the clinical guidelines that are supposed to be operated in the public >> sector.  I also found an insurance company guideline (IIRC from >> Cigna?) >> It appears that generally the first option both here in the UK, and >> from what I see, the U.S. is to go for a single fixed pressure >> machine.   Cost appears to be a big factor in that whether it be the >> government or the insurance company paying, they want the cheapest. >Your statement here is incomplete and, as a result, very >misleading.  You make it sound like the cheapest equipment >is provided, without regard to its medical appropriateness. >  That just isn’t so in the US, except for HMOs.

No, I haven’t made misleading statements at all.   I did look at  the policies of some insurance companies in the U.S. for some of the comments, but I haven’t suggested that this becomes a policy thing for all cases.  I’m certainly aware that HMOs look on a cost basis, so in that sense may be looking for economies that don’t offer thje clinically best options. My point was that cost is a big issue wherever you are and with whatever scheme.  It may be that the higher tier insurance companies appear to offer things without regard to cost, but ultimately nobody is writing bland cheques and it would be naive to assume that they are.   I don’t think that we fundamentally disagree here, I am simply making the point that no medical care is given without some regard to cost.  it may be buried, but it’s certainly there. >Medicare and insurance companies will pay for what is >medically required.  Since an autopap is not usually >medically required, they won’t normally pay for it.

That is not a valid assumption at all.  You describe the flow chart of certain clinical practise in parts of the U.S.   In Europe it is quite common to prescribe autotitrating equipment as the next step if fixed pressure equipment causes the user problems of compliance.   In that sense it is a medical choice and would be funded by public healthcare. I am well aware that the common view in the U.S is different, but that does not mean that one can make a sweeping statement that a given treatment technique is not medically necessary.  The furthest that you can go is to say that it is typically not deemed medically necessary in a certain geography. >> Here in the UK in the public sector, the second step, if the patient >> has compliance difficulties but not any  respiratory problems beyond >> OSA, an autotitrating machine is used. >This is an interesting qualification…. no respiratory >problems.  Are you saying that some sort of respiratory >problems would keep you from using apap?  If so, why?

No, it’s the opposite way around.  Patients can have compliance issues if they have a single high fixed pressure set in an attempt to eliminate apnoea and hypopnoea events in as many scenarios as possible.   In reality, they may well not need the high level of pressure all the time at all and there is plenty of evidence to suggest that improved compliance can be achieved if a lower pressure is used for a greater proportion of the time. The qualifier about respiratory issues needs to be added because there can be instances where either fixed or autoitration equipment is not appropriate and the patient medically needs bilevel equipment. My point was that here at least, bilevel equipment is typically not prescribed if the only issue that the patient has is compliance difficulties with a fixed pressure machine run at high pressure.   It might be used if the issue is related to another respiratory condition. >What kind of compliance problem does an autopap eliminate?

Already described. >> Private patients can opt for >> this at the outset, since they will be paying for the equipment >> anyway.  The public sector doesn’t look beyond the end of its nose in >> terms of the saving that can be made through not requiring titration >> studies or as many followups; but purely at the equipment cost. >That model fits your view, but it doesn’t fit mine or many >others.  If I am having a sleep related problem, I have no >expectation of being able to solve it with an apap machine. >   Too many possible variables.

That’s really your issue.   For many people, this is a good solution and is in wide use in other geographies.   One of the points is that the technology can deal with some of the large number of variables. If you aren’t comfortable with that, then it’s no problem. Go with what works for you. >I have every expectation of a far better opportunity of >solving the problem with a PSG.  And that’s why insurance >companies and Medicare in the US pay for PSGs.  AAMOF, >Medicate requires a two night study. >But I’ll have to say, if I couldn’t get the best, I’d take >whatever I could get. >HMOs in the US are notorious for not providing adequate and >appropriate medical services, for many things, including >apnea.  They are the ones that promote autopaps, in order to >increase their profits, or as you say, "..the savings that >can be made.."  I don’t want any cost cutting.  I want the best.

This is all fine and if you are able to get that kind of treatment, good luck.  Ultimately somebody pays and that ends up being you and others. There are different approaches to diagnosis.  For example, here the common practice in all sectors is to screen and diagnose SDBs first on the simple basis that they need treating anyway.  Then if there are other issues, other tests including PSGs can be done.   One of the points about this is that if a PSG is done with a severe apnoea patient and they are then treated for it, the sleep architecture and information from a PSG are going to change anyway, necessitating repeat of the test. It’s a matter of clinical opinion and methodology and the important thing is the outcome. There are certainly savings that can be made by using technology, but there is no basis for treating them as a second best approach when the outcome is the same.   I don’t like cost cutting in medicine either, but I do look carefully at diagnostic and treatment methods.   If there are methods to achieve the same outcome at lower cost or with less patient inconvenience, then it’s reasonable to consider them. >> In continental Europe, it is much more common to start with >> autotitrating equipment because there is a longer term view taken of >> the budget aspects and in any case such a machine can always be set to >> a fixed pressure. >Are we supposed to take your word for all the statements you >make without any support.  For all I know, you may have a >vivid imagination, or just a great urge to get people to see >things your way.

It’s up to you.  I don’t really care.   If you would like clinical references, I will happily post them for you. I have no urge  to persuade people to think one way or another.  It doesn’t matter to me. I am simply poionting out that there are geographical variations in treatments and approaches to diagnosis and that one can’t really say that one is better than the other without looking at the outcome. >> Bilevel machines are quite rarely used here, and usually only when >> medically indicated, e.g. the patient has some additional respiratory >> disease, heart failure and so on; very rarely because of CPAP >> compliance issues due to pressure. >I won’t believe this without something other than your >casual statement.  Exactly how does a bipap affect >respiratory disease, heart failure, and so on.

That’s up to you.  I tend not to make casual statements unless I make it clear that that’s what it is. Take a look at http://www.sign.ac.uk/pdf/sign73.pdf sections 4.3.1 to 4.3.3 >> AIUI, and comment here, in the U.S. a bilevel machine is usually the >> second choice after fixed pressure even for compliance issues? >Indeed.  At least you got that right.

I get many things right and can provide references as appropriate. The issue is one of having an open mind that there are different approaches to diagnosis and treatment and that part of this is based on standardised clinical practices which vary by geography/ — .andy To email, substitute .nospam with .gl

Response:

"normc" <com> wrote in message com… > Let’s see… how much did your apap cost you <g>? > Unfortunately they are pretty tough to get on Medicare or > other insurance here in the U.S.  There has to be a medical > necessity/reason.  TTBOMK, not having to make doctor and > clinic visits for further tests and machine adjustments > don’t quality for these requirements.  So you mostly have to > pay for them yourself, which I certainly can’t afford. > I suppose if you live in the boonies, doctor and clinic > visits could be a problem, but it sure isn’t a problem for me.

you get sleep studies done!!! it takes me 2 years as a non-urgent to get a sleep study done….. and once they have done ONE sleep study………… well, good luck on getting another sleep study………. i did go back to the sleep Dr for a referral for a sleep study then there was my insurance….. they wouldn’t pay for a mask and hose but they would pay for a complete XPAP up to $2,000 i got the AutoPAP with 2 masks for $2,180 …………. looks like the DME supplier knows how to play the game too……….. sigh……… at least it was paid for…… i won’t go back though…… i will stick with it and pay the extra that is needed to have it…………… kate

Response:

"h.sanders" <h.sand…@comcast.net> wrote in message

news:Qc-dnZt5Aav8ILnfRVn-3A@comcast.com… – Hide quoted text — Show quoted text -> "D. Smyth" <dannospa…@eircom.net> wrote in message > news:d02d7k$4l0$1@reader01.news.esat.net… >> (SNIP) >> I may be able to help here. Although in Ireland I am somewhat familiar > with >> what happens in the UK. >> >> It’s amazing how attitudes differ. >> > Sometimes one’s attitude results from the availability, or lack >> > thereof, >> > of appropriate medical services. >> >> I was talking to my specialist recently about this as well as reading >> >> the clinical guidelines that are supposed to be operated in the public >> >> sector.  I also found an insurance company guideline (IIRC from >> >> Cigna?) >> >> It appears that generally the first option both here in the UK, and >> >> from what I see, the U.S. is to go for a single fixed pressure >> >> machine.   Cost appears to be a big factor in that whether it be the >> >> government or the insurance company paying, they want the cheapest. >> > Your statement here is incomplete and, as a result, very misleading. > You >> > make it sound like the cheapest equipment is provided, without regard >> > to >> > its medical appropriateness. That just isn’t so in the US, except for >> > HMOs. >> Must agree with Andy here. First choice for a public patient in either >> the >> UK or Ireland is a fixed pressure machine. Absolutelt no doubt about >> that. >> > Medicare and insurance companies will pay for what is medically > required. >> > Since an autopap is not usually medically required, they won’t normally >> > pay for it. >> >> Here in the UK in the public sector, the second step, if the patient >> >> has compliance difficulties but not any  respiratory problems beyond >> >> OSA, an autotitrating machine is used. >> > This is an interesting qualification…. no respiratory problems.  Are > you >> > saying that some sort of respiratory problems would keep you from using >> > apap?  If so, why? >> Problems such as COPD or similar, heart failure etc will stop a patient >> using a fixed pressure machine. They will be unable to exhale against the >> fixed pressure. There can also be problems with the force of a fixed >> pressure machine, relating directly to their condition. >> > What kind of compliance problem does an autopap eliminate? >> As above. Also with patient requiring high pressure. >> >> Private patients can opt for >> >> this at the outset, since they will be paying for the equipment >> >> anyway.  The public sector doesn’t look beyond the end of its nose in >> >> terms of the saving that can be made through not requiring titration >> >> studies or as many followups; but purely at the equipment cost. >> > That model fits your view, but it doesn’t fit mine or many others.  If >> > I >> > am having a sleep related problem, I have no expectation of being able > to >> > solve it with an apap machine. Too many possible variables. >> I am also one of many who can solve my OSA problem with a fixed pressure >> machine., >> > I have every expectation of a far better opportunity of solving the >> > problem with a PSG.  And that’s why insurance companies and Medicare in >> > the US pay for PSGs.  AAMOF, Medicate requires a two night study. >> > But I’ll have to say, if I couldn’t get the best, I’d take whatever I >> > could get. >> The introduction of auto titrating machines is having a major effect on >> hopital stay times on this side of the pond. It’s really a case of using >> technology to minimise hospital stays. >> > HMOs in the US are notorious for not providing adequate and appropriate >> > medical services, for many things, including apnea.  They are the ones >> > that promote autopaps, in order to increase their profits, or as you > say, >> > "..the savings that can be made.."  I don’t want any cost cutting.  I > want >> > the best. >> What is the best ? A recent study reported on the NAPS site showed that >> three forms of titration, the traditional overnight hospital stay (with >> monitoring etc), the use of a formula (in the past used by technicians, > with >> data from the original sleep study) and an autotitrating machine used in > the >> patients home produced, pretty much, the same result. >> >> In continental Europe, it is much more common to start with >> >> autotitrating equipment because there is a longer term view taken of >> >> the budget aspects and in any case such a machine can always be set to >> >> a fixed pressure. >> > Are we supposed to take your word for all the statements you make > without >> > any support.  For all I know, you may have a vivid imagination, or just > a >> > great urge to get people to see things your way. >> Again, I side with Andy. Figures from Belgium (2001) indicate a 2 month > wait >> from referral to commencement of treatment for OSA. This compares to >> anything up to 3 years in the UK, and up to 2 years in Ireland. The > Belgians >> use auto titrating machines in the main, usually in the patients home for >> titration purposes. >> >> Bilevel machines are quite rarely used here, and usually only when >> >> medically indicated, e.g. the patient has some additional respiratory >> >> disease, heart failure and so on; very rarely because of CPAP >> >> compliance issues due to pressure. >> > I won’t believe this without something other than your casual >> > statement. >> > Exactly how does a bipap affect respiratory disease, heart failure, and > so >> > on. >> Not a casual statement by any means. I am in regular contact with 6 >> different CPAP companies. Bi Level PAP comes under the heading of non >> invasive ventillation (rather than OSA PAP). The companies (all of them) >> tell me that Bi Level PAP is only prescribed for patients with other >> respiratory or cardiac problems in addition yo OSA. My own sleep > specialist >> also confirmed this. >> >> AIUI, and comment here, in the U.S. a bilevel machine is usually the >> >> second choice after fixed pressure even for compliance issues? >> In Ireland auto titrating machines are the second choice for compliance >> issues. Bi Level is not prescribed for OSA alone. >> > Indeed.  At least you got that right. >> I think he got pretty much everything right. >> In the UK, the National Health Trust (for public patients) grant an >> amount >> of funds to each sleep clinic on an annual basis. This is to cover >> running >> costs, also the cost of purchasing all PAP machines, masks, filters, >> hoses >> etc. They are then responsible for ‘maintaining’ their existing and new >> patients, not the CPAP company. The ongoing maintenence cost can knock a > big >> hole in any new funding received, so a clinic that is very efficient and >> treats a lot of patients is actually penalised by ’short funding’. Not a >> very fair system, which is why the clinics look for ‘value’ when > purchasing >> machines. There are many cases of patients being diagnosed with OSA, >> being >> titrated, and then being told to come back in 6 months time when the > clinic >> hope to have machines available. There are also cases of non compliant >> patients having their CPAP machine taken back by the clinic, >> reconditioned >> and given to a new patient. >> In Ireland, whether you are a public or private patient you must either >> purchase or rent your machine. One exception are patients who hold >> Medical >> Cards which come under 2 categories. Those who have low incomes (and I > mean >> low) and those over 70 years of age. In these cases the Health Services >> Executive pick up the tab for whatever machine is prescribed, also all >> maintenence costs (the CPAP companies handle the paperwork on behalf of > the >> patient). For everyone else the choice is to purchase or rent. In the >> case >> of rental, the cost (or part of it) can be recouped from the state. If > your >> medical (drugs etc) plus CPAP rental exceeds ?85 ($96 or

OSA score

Question:

newsuser <newsuser1…@sometimes.yahoo.com> wrote: >I asked my referring doctor (an ENT)  for an objective score when I >was diagnosed with OSA. He said mine was 14 (point something,) which I >believe related to events per hour when I had my sleep test.  Can >someone point me to a source that might discusses this number, its >meaning, severity, etc?

That’s the Apnea/Hypopnea Index (AHI), here’s a good overview of OSA’s cause(s) and treatment(s).  http://www.emedicine.com/med/topic2697.htm The AHI rankings are … Mild – Five to 15 episodes per hour Moderate – Fifteen to 30 episodes per hour Severe – More than 30 episodes per hour …. so you’re right on edge of Moderate, and really should get treatment. (But you probably knew that.) Note that the 40% success rate quoted for a Uvulopalatopharyngoplasty (UPPP around here) is only in the short term. The actual long term cure rate seems to be no better than one person in six. (The figures are inflated by counting a 50% reduction in AHI as successful, even when the patient still suffers from the effects of OSA.) Nasal CPAP is the current Gold Standard in OSA treatment and it’s what almost everyone here is using. Please try it before anything else, we can help you through the initial teething period. Please keep us posted, and feel free to ask as many questions as you like. We’re a generally friendly bunch, and we _love_ to help. Tom

Response:

I asked my referring doctor (an ENT)  for an objective score when I was diagnosed with OSA. He said mine was 14 (point something,) which I believe related to events per hour when I had my sleep test.  Can someone point me to a source that might discusses this number, its meaning, severity, etc? Thanks in advance

Response:

On Wed, 26 Jan 2005 09:09:16 -0800, newsuser <newsuser1…@sometimes.yahoo.com> wrote: >I asked my referring doctor (an ENT)  for an objective score when I >was diagnosed with OSA. He said mine was 14 (point something,) which I >believe related to events per hour when I had my sleep test.  Can >someone point me to a source that might discusses this number, its >meaning, severity, etc? >Thanks in advance

There is a fairly standard statistically based measure called Apnoea/Hypopnoea Index or AHI. There are then Apnoea and Hypopnoea Indices which are taken together to give the AHI figure. These are both measured in terms of events per hour.  An apnoea event is normally defined as being a greater than 75% decrease in ventilation, while a hypopnoea is normally defined as 50-75%. They are an attempt to apply a standardised measurement to a biological system (i.e. you), and of course people vary.  However, the measurements can be done quite effectively.   The numbers chosen are somewhat arbitrary (i.e. it could just as reasonably been 53 to 78.5% and so on) – the point is consistency of measurement criteria. An AHI of 14 is neither the worst case nor the least in the global scheme of things.   The top end can be tens of events per hour. Treatment criteria vary from place to place, but generally reducing AHI to under 10 or under 5 are the most commonly used. You mention involvement with an ENT.   Please take a look through previous threads on this.   There have been numerous ENT procedures (UPPP being the most well known).  Unfortunately they have a poor success rate and in some countries have been all but abandoned as an OSA treatment.   One problem is that the effectiveness in reduction of AHI is not often good.  THe ENT surgeon might say 2:1 but this may not be achieved.  Secondly, the effectiveness is often not maintained in the long term.  Thirdly, it may leave the patient with an inability to use other treatments such as CPAP. Generally CPAP is considered to be the gold standard in OSA treatment and has the advantage of being non invasive and non permanent.   In the unlikely event of it not working, the patient is not going to be permanently damaged. I would suggest seeking a referral to a sleep specialist or pulmonologist.  Much safer option. — .andy To email, substitute .nospam with .gl

Response:

Snoring and sleepy.

Question:

i use an AutoPAP as do you i have the bottom pressure set to the pressure that the sleep study called for….. and i allow the machine to go up to 5 pts above the pressure from the sleep study this told me that i needed a higher pressure setting overall and i have again moved the ‘bottom line’ pressure to meet the study results i know…. it’s not how the machines are designed to work, but it works for me…. kate – Hide quoted text — Show quoted text -"Bob West" <net> wrote in message webtv.net… > I have been diagnosed with sleep apnea for over 11 years. I did not want > to go on cpap so I had the dreaded UPPP. As we all know now this > procedure did not work out. It was a good thermometer for checking > throat pain though.  I have been on xpap for 8 plus years now. About a > year ago I bought a Respironics Remstar Auto with a heated humidifier > and card reader. Prior to the Remstar Auto I was on a Sullivan IV with a > setting of 12.  My wife told me that I snore like a freight train and I > am very sleepy during the day. > The latest compliance detail printout reads total AHI at 7.3 and a > pressure of 9 at 90% of the time. > My question is should I chuck the Remstar Auto or set it at a constant > pressure instead of running it on auto? Or do you recommend a new sleep > study in order to find out the problem? Thank you.

Response:

- Hide quoted text — Show quoted text -> "Bob West" <net> wrote in message webtv.net… >> I have been diagnosed with sleep apnea for over 11 >> years. I did not want to go on cpap so I had the dreaded >> UPPP. As we all know now this procedure did not work >> out. It was a good thermometer for checking throat pain >> though.  I have been on xpap for 8 plus years now. About >> a year ago I bought a Respironics Remstar Auto with a >> heated humidifier and card reader. Prior to the Remstar >> Auto I was on a Sullivan IV with a setting of 12.  My >> wife told me that I snore like a freight train and I am >> very sleepy during the day. >> The latest compliance detail printout reads total AHI at >> 7.3 and a pressure of 9 at 90% of the time. >> My question is should I chuck the Remstar Auto or set it >> at a constant pressure instead of running it on auto? Or >> do you recommend a new sleep study in order to find out >> the problem? Thank you.

What are the other readings? OSA Hypopnea Flow Limitation Snore and mask leak. What interface are you using with it? Is it at a pressure of 9, 90% of the time or is 9 the 90% reading? The 90% figure the machine produces is the pressure you were at *or under* 90% of the time.  The machine constantly samples the pressure reading. If you take all the samples, 90% of them were 9 or under. What was the average pressure? Any unresponsive apneas? If you have a prescribed pressure of 12 cm you could set the upper and lower limits of the Auto to 12 cm (turning it into a CPAP) and see if there is a marked improvement. -Quick

Response:

The report lists all pressures accross the top from 4 thru 20  The pressure of 9 is highlighted. I use the Activa mask. Obstructive Apnea    7.2 Hypopnea                 1.3 Snore                        2.4 Flow Limitation          8.1 AHI                            8.1 Average Leak            41.4 lpm Average max leak     92.5 lpm Average 90% leak     59.5 lpm

Response:

"Quick" <quick7135-n…@NOSPAMyahoo.com> wrote: >If you have a prescribed pressure of 12 cm you could set the >upper and lower limits of the Auto to 12 cm (turning it into a >CPAP) and see if there is a marked improvement.

I used Kate’s trick when I tried the Virtuoso. It came at the default, 4(?) and 20Cm, pressures and I felt like I couldn’t get enough air at the lower level. I moved the lower level up to 10Cm, my "official" titration pressure at the time, and let the machine boost as needed. I slept just fine until my next (in lab) titration. Tom

Response:

- Hide quoted text — Show quoted text -Bob West wrote: > I have been diagnosed with sleep apnea for over 11 years. I did not want > to go on cpap so I had the dreaded UPPP. As we all know now this > procedure did not work out. It was a good thermometer for checking > throat pain though.  I have been on xpap for 8 plus years now. About a > year ago I bought a Respironics Remstar Auto with a heated humidifier > and card reader. Prior to the Remstar Auto I was on a Sullivan IV with a > setting of 12.  My wife told me that I snore like a freight train and I > am very sleepy during the day. > The latest compliance detail printout reads total AHI at 7.3 and a > pressure of 9 at 90% of the time. > My question is should I chuck the Remstar Auto or set it at a constant > pressure instead of running it on auto? Or do you recommend a new sleep > study in order to find out the problem? Thank you.

bob wrote Re:   I use the Remstar auto  I had surgery for Apnea.   The Remstar auto is a terrific machine. I use it I am not a doctor and I do not play doctor.  However, I do have a suggestion.  You had a upper uppp.  It is my belief that most xpaps will not work well for you.    Your operation has modified your normal breathing pattern.  all or most xpaps computers algorithms are designed to interact with a natural breathing cycle.  There is a xpap machine,the Auto Adjust Lt, that might be of interest to you. reference: http://www.sleepnet.com/apnea32/messages/662.html http://www.sleepnet.com/apnea86/messages/561.html     Perry use to test xpaps he has aparrently retired from doing this. He has a good reputation and I have a lot of respect for him.  He has written many e-mails on xpaps. Go to sleepnet.com  or go to goggle and do a search on perry.  He uses the Auto adjust Lt.  You might be able to communicate with him at Perry…@lakefield.net. Also call the cpapman and talk to him -(do not e-mail him} 1-877-272-7626 x-201.  He is a "large Internet DME" and a certified Res. Tech.  Tell him you were referred by Grumpy bob.  His personal xpap is the remstar auto. Best wishes go to cpapman.com and look at his online catalog.

Response:

I have been diagnosed with sleep apnea for over 11 years. I did not want to go on cpap so I had the dreaded UPPP. As we all know now this procedure did not work out. It was a good thermometer for checking throat pain though.  I have been on xpap for 8 plus years now. About a year ago I bought a Respironics Remstar Auto with a heated humidifier and card reader. Prior to the Remstar Auto I was on a Sullivan IV with a setting of 12.  My wife told me that I snore like a freight train and I am very sleepy during the day. The latest compliance detail printout reads total AHI at 7.3 and a pressure of 9 at 90% of the time. My question is should I chuck the Remstar Auto or set it at a constant pressure instead of running it on auto? Or do you recommend a new sleep study in order to find out the problem? Thank you.

Response:

RemStar Pro w/Cflex

Question:

Nashville obviously hasn’t read up on central apnea and how it can be CAUSED by over pressure on the CPAP oh well….. it’s his brain that will go without oxygen for longer……….. "*Bob Gootee" <goo…@comcast.net> wrote in message

news:4127316B.8080001@comcast.net… – Hide quoted text — Show quoted text -> Nashville Pete wrote: > > Yeh, right. And you’re telling me that the exact, correct pressure is > > determined during a sleep lab test over one arbitrarily selected night > > ignoring variations due to weather (barometric pressure and humidity) and > > the patient’s allergy situation. > > Bob, your message is strikingly similar the that of the FDA’s in regards the > > prescription Meds from Canada. You don’t have much credibility in my view. > Hey, go ahead and spin the cylinder, pull the trigger and see what happens. > I’ve had 2 Dr’s certified in sleep medicine from sleep labs accredited > by the American Sleep Apnea Association and 3 sleep lab tech’s tell me > this plus seeing it here over the last 8-9 years. > What’s your qualifications, some dislike for the FDA? > — > Bob Gootee

Response:

"Tiger Lily" <m…@privacy.com> wrote in message

news:2oosgqFd3tbtU1@uni-berlin.de… > Nashville obviously hasn’t read up on central apnea and how it can be CAUSED > by over pressure on the CPAP > oh well….. it’s his brain that will go without oxygen for > longer………..

I never mentioned adjusting to an over pressure. Au Contraire…I attempt to get the facts which allow me to take informed decisions as regards to to my health and life. My CPAP Titration Results indicate a wide range of effective pressure yielding 0 apnea and hypopnea events with a measured range of 91 -93% SaO2. Are you two suggesting I risk central apnea using a CPAP adjusted to a pressure within that range?

Response:

On Sat, 21 Aug 2004 16:34:30 -0500, Nashville Pete wrote: >"Tiger Lily" wrote: >> Nashville obviously hasn’t read up on central apnea and how it can be >>CAUSED by over pressure on the CPAP >> oh well….. it’s his brain that will go without oxygen for >> longer……….. >I never mentioned adjusting to an over pressure. >Au Contraire…I attempt to get the facts which allow me to take informed >decisions as regards to to my health and life. >My CPAP Titration Results indicate a wide range of effective pressure >yielding 0 apnea and hypopnea events with a measured range of 91 -93% SaO2. >Are you two suggesting I risk central apnea using a CPAP adjusted to a >pressure within that range?

Well, within your titration range, you’re OK. The concern is more with putting people for the first time on CPAP.

Response:

Nashville Pete wrote: > Yeh, right. And you’re telling me that the exact, correct pressure is > determined during a sleep lab test over one arbitrarily selected night > ignoring variations due to weather (barometric pressure and humidity) and > the patient’s allergy situation. > Bob, your message is strikingly similar the that of the FDA’s in regards the > prescription Meds from Canada. You don’t have much credibility in my view.

Hey, go ahead and spin the cylinder, pull the trigger and see what happens. I’ve had 2 Dr’s certified in sleep medicine from sleep labs accredited by the American Sleep Apnea Association and 3 sleep lab tech’s tell me this plus seeing it here over the last 8-9 years. What’s your qualifications, some dislike for the FDA? — Bob Gootee

Response:

On Thu, 19 Aug 2004 17:51:53 -0400, superkite <nob…@hotmail.com> wrote: >There are studies showing that self-titrations are about as >efficacious as sleep lab titrations.  I do remember reading one study >that indicated that self-titraters sometimes set their pressure on the >low side (which is worse than setting it too high).  OTOH, lab >titrations are sometimes set too high, (e.g., side sleepers, those who >lose wieght while on CPAP, those w/ congestion, others).  I doubt the >funeral homes are much better off as a result of these overpressurized >CPAPs.

There was a recent study from an eminent doctor at Radcliffe in Oxford making this very point. http://tinyurl.com/638w7 >Unfortunately, it is tough to self-titrate, as most events occur >unnoticed and unremembered during sleep or the fog of night.  It took >me a while to get dialed in.  FWIW, while I would love to see where a >proper lab titration would put me, if the outcome was not improved >sleep I would go right back to my self-derived setting. >All that said, I would not advocate self-titrating without the >guidance of a good sleep m.d.

Certainly.    One should also keep in mind that there are warnings in the documentation of at least two flow generators of different brands that I have seen that warn that under fault conditions the flow generator could raise the pressure to and uncontrolled 30cm. Undoubtedly the manufacturers go out of their way to avoid this, but have identified that theoretically it could happen.     They go on to advise that if this is believed to be a potential problem for the patient that the product should not be used. .andy To email, substitute .nospam with .gl

Response:

On Thu, 19 Aug 2004 15:34:31 -0700, "Quick" – Hide quoted text — Show quoted text -<quick7135-n…@NOSPAMyahoo.com> wrote: >This peaked my technical curiosity on a couple of points: >1) Central Apneas >With OSA, as your O2 drops, your brain wakes you up >and you start breathing again.  What about Central Apnea? >I’m assuming that "normal" CA events are temporary? and >something clicks and you start breathing again? >With too high of a pressure the external condition causing >the reflex persists.  Does your brain still wake you up in >the same way?  Do you still feel like you have to gasp >for air once you’re concious? Is there some marginal >pressure where you wake up and realize that you need >to exhale in order to inhale and well above that it’s simply >fatal and you pass away quietly?

I looked at this in respect of flow generators and pressure setting in general, whether it be fixed pressure or automatic control. I can try to find the references in my notes if you like, but at least one of the mechanisms is the Hering Breuer reflex, which is essentially associated with the receptors in the lungs that "inform" the brain that inhalation has reached its maximum. The suggestion in the articles that I read was that excessively high CPAP pressure could trigger this reflex and effectively fool the brain into thinking that breathing is happening when it is not. >2) Barometric pressure >Do the Cflex machines have pressure transducers? I was under >the impression that they were "fixed speed" machines (unlike >APAPs) with a different *fixed* inhale pressure and exhale pressure. >2 or 3 fixed settings with different deltas and timing.  Certainly >my CPAP doesn’t have any pressure transducers and the pressure >is determined by a fixed fan motor speed.  I have 3 settings for >altitude adjustment.  This is to compensate for the density of >the air which in turn is effected by pressure (of the atmosphere >above). >I just assumed that barometric pressure changes at a particular >altitude were small relative to the barometric pressure change >from changing altitude (like going up a few thousand feet)?

This would all suggest a situation where there is a single pressure sensor and assumptions being made about air density and flow, much as they are with simple blower units – hence the need to set the altitude setting. I know for at least ResMed’s Autoset series machines, there are two pressure sensors, being at ends of a path of known resistance.  From this it is possible to deduce flow and pressure with no need to make altitude settings.    However, there are assumptions about deliberate mask leak, making it necessary to tell the machine about the mask. There are some quite complex formulae that tie these factors together, which no doubt are handled by the machine algorithms. I haven’t looked at the CFLEX machines in a lot of detail, but the Remstar information suggests that the machine detects commencement of exhalation and simply drops the motor power by a user settable amount, increasing it again when inhalation begins again or after a timeout. It did not appear that the machine does an accurate lower setting – for one thing, that ought not then to be in the user’s hands. I did look at the patents and technical details on a couple of Bilevel machines some while ago, and these certainly manage the pressure as accurately as possible between two levels.    This implies being able to control and accelerate/decelerate the motor very quickly, and is a whole different engineering challenge to CPAP and aPAP equipment; and is one reason for the higher price tag. – Hide quoted text — Show quoted text ->-Quick >ronlin wrote: >> Actually humidity and barometric pressure have noe effect on the units >> pressure. Pressure transducers measure and causes the equipment to >> control the pressure relative to atmospheric pressure. One leg of the >> transducer is vented to air. The only thing the relative humidity >> affects is the amount of water the air can pick up from the >> humidifier. >> Nashville Pete wrote: >>> Yeh, right. And you’re telling me that the exact, correct pressure is >>> determined during a sleep lab test over one arbitrarily selected >>> night ignoring variations due to weather (barometric pressure and >>> humidity) and the patient’s allergy situation. >>> Bob, your message is strikingly similar the that of the FDA’s in >>> regards the prescription Meds from Canada. You don’t have much >>> credibility in my view. >>> "*Bob Gootee" <goo…@comcast.net> wrote in message >>> news:412432D4.9040107@comcast.net… >>>> Pete, >>>> While adjusting your machine if you set it too low, you will just >>>> have a hose hanging off your face with annoying air blowing up your >>>> nose all night long doing no good. >>>> If you set it too high you will induce central apneas and may need >>>> one of these – >>>> http://www.countrylogcaskets.com/ >>>> — >>>> Bob Gootee

.andy To email, substitute .nospam with .gl

Response:

This peaked my technical curiosity on a couple of points: 1) Central Apneas With OSA, as your O2 drops, your brain wakes you up and you start breathing again.  What about Central Apnea? I’m assuming that "normal" CA events are temporary? and something clicks and you start breathing again? With too high of a pressure the external condition causing the reflex persists.  Does your brain still wake you up in the same way?  Do you still feel like you have to gasp for air once you’re concious? Is there some marginal pressure where you wake up and realize that you need to exhale in order to inhale and well above that it’s simply fatal and you pass away quietly? 2) Barometric pressure Do the Cflex machines have pressure transducers? I was under the impression that they were "fixed speed" machines (unlike APAPs) with a different *fixed* inhale pressure and exhale pressure. 2 or 3 fixed settings with different deltas and timing.  Certainly my CPAP doesn’t have any pressure transducers and the pressure is determined by a fixed fan motor speed.  I have 3 settings for altitude adjustment.  This is to compensate for the density of the air which in turn is effected by pressure (of the atmosphere above). I just assumed that barometric pressure changes at a particular altitude were small relative to the barometric pressure change from changing altitude (like going up a few thousand feet)? -Quick – Hide quoted text — Show quoted text -ronlin wrote: > Actually humidity and barometric pressure have noe effect on the units > pressure. Pressure transducers measure and causes the equipment to > control the pressure relative to atmospheric pressure. One leg of the > transducer is vented to air. The only thing the relative humidity > affects is the amount of water the air can pick up from the > humidifier. > Nashville Pete wrote: >> Yeh, right. And you’re telling me that the exact, correct pressure is >> determined during a sleep lab test over one arbitrarily selected >> night ignoring variations due to weather (barometric pressure and >> humidity) and the patient’s allergy situation. >> Bob, your message is strikingly similar the that of the FDA’s in >> regards the prescription Meds from Canada. You don’t have much >> credibility in my view. >> "*Bob Gootee" <goo…@comcast.net> wrote in message >> news:412432D4.9040107@comcast.net… >>> Pete, >>> While adjusting your machine if you set it too low, you will just >>> have a hose hanging off your face with annoying air blowing up your >>> nose all night long doing no good. >>> If you set it too high you will induce central apneas and may need >>> one of these – >>> http://www.countrylogcaskets.com/ >>> — >>> Bob Gootee

Response:

- Hide quoted text — Show quoted text -Still Lurking wrote: > x-no-archive: yes > Quick wrote: >> This peaked my technical curiosity on a couple of points: >> 1) Central Apneas >> With OSA, as your O2 drops, your brain wakes you up >> and you start breathing again.  What about Central Apnea? >> I’m assuming that "normal" CA events are temporary? and >> something clicks and you start breathing again? > I am not going to get "into it" again with you. I just want folks to > know that the breathing reflex in the brain is triggered not by > dropping O2 levels, but by raising CO2 levels in the blood supplied > to the brain.

Heh, I want to know too -:). My understanding of OSA is that the breathing reflex is not interrupted. It’s because your airway is physically blocked that the physical action of breathing (in?) doesn’t happen. Then chemical changes tell your brain that something else needs to happen for preservation.  That would include an arrousal to a conscious or more conscious state. Is this correct? If so, is this different in this respect than central apnea events? When your brain suspends the breathing (inhale?) reflex (due to the HB reflex) does it respond in the same way to the resulting blood chemistry changes? Are your O2 levels independent (in this context) of your CO2 levels? -Quick – Hide quoted text — Show quoted text ->> With too high of a pressure the external condition causing >> the reflex persists.  Does your brain still wake you up in >> the same way?  Do you still feel like you have to gasp >> for air once you’re concious? Is there some marginal >> pressure where you wake up and realize that you need >> to exhale in order to inhale and well above that it’s simply >> fatal and you pass away quietly? >> 2) Barometric pressure >> Do the Cflex machines have pressure transducers? I was under >> the impression that they were "fixed speed" machines (unlike >> APAPs) with a different *fixed* inhale pressure and exhale pressure. >> 2 or 3 fixed settings with different deltas and timing.  Certainly >> my CPAP doesn’t have any pressure transducers and the pressure >> is determined by a fixed fan motor speed.  I have 3 settings for >> altitude adjustment.  This is to compensate for the density of >> the air which in turn is effected by pressure (of the atmosphere >> above). >> I just assumed that barometric pressure changes at a particular >> altitude were small relative to the barometric pressure change >> from changing altitude (like going up a few thousand feet)? >> -Quick >> ronlin wrote: >>> Actually humidity and barometric pressure have noe effect on the >>> units pressure. Pressure transducers measure and causes the >>> equipment to control the pressure relative to atmospheric pressure. >>> One leg of the transducer is vented to air. The only thing the >>> relative humidity affects is the amount of water the air can pick >>> up from the humidifier. >>> Nashville Pete wrote: >>>> Yeh, right. And you’re telling me that the exact, correct pressure >>>> is determined during a sleep lab test over one arbitrarily selected >>>> night ignoring variations due to weather (barometric pressure and >>>> humidity) and the patient’s allergy situation. >>>> Bob, your message is strikingly similar the that of the FDA’s in >>>> regards the prescription Meds from Canada. You don’t have much >>>> credibility in my view. >>>> "*Bob Gootee" <goo…@comcast.net> wrote in message >>>> news:412432D4.9040107@comcast.net… >>>>> Pete, >>>>> While adjusting your machine if you set it too low, you will just >>>>> have a hose hanging off your face with annoying air blowing up >>>>> your nose all night long doing no good. >>>>> If you set it too high you will induce central apneas and may need >>>>> one of these – >>>>> http://www.countrylogcaskets.com/ >>>>> — >>>>> Bob Gootee

Response:

I just read my own message and wanted to kick in that I self-titrated w/ the blessing and the assistance of my (diplomated) sleep doc…. – Hide quoted text — Show quoted text -superkite wrote: > On Thu, 19 Aug 2004 00:55:48 -0400, *Bob Gootee <goo…@comcast.net> > wrote: > [De-lurkage and snippage] > Bob, while I agree that there are risks involved, I can’t agree with > your dire admonition against having people fine tune their pressure > settings.  I have seen group posters warn that if you mess w/ your > pressure, you’re going to *die* of central apnea.  Perhaps it is taken > as true because it is repeated so frequently and so forcefully within > this very ng.   > Setting pressure too high, while not completely without risk, is not > exactly playing Russian Roulette (but then again I have been known to > pop 4 Motrin when the bottle says to eat 1).  Many in the profession > advocate for self-titration.  I doubt their goal is to court death > (maybe the folks at http://www.countrylogcaskets.com/ are putting them > up to it?).   > There are studies showing that self-titrations are about as > efficacious as sleep lab titrations.  I do remember reading one study > that indicated that self-titraters sometimes set their pressure on the > low side (which is worse than setting it too high).  OTOH, lab > titrations are sometimes set too high, (e.g., side sleepers, those who > lose wieght while on CPAP, those w/ congestion, others).  I doubt the > funeral homes are much better off as a result of these overpressurized > CPAPs. > Unfortunately, it is tough to self-titrate, as most events occur > unnoticed and unremembered during sleep or the fog of night.  It took > me a while to get dialed in.  FWIW, while I would love to see where a > proper lab titration would put me, if the outcome was not improved > sleep I would go right back to my self-derived setting. > All that said, I would not advocate self-titrating without the > guidance of a good sleep m.d. > You are now possessed of my too sense. > moq >>Pete, >>While adjusting your machine if you set it too low, you will just have a >>hose hanging off your face with annoying air blowing up your nose all >>night long doing no good. >>If you set it too high you will induce central apneas and may need one >>of these – >>http://www.countrylogcaskets.com/

Response:

1) Unplug the unit. 2) While holding down the two "right and left" buttons (I ain’t near the machine so I can’t describe this in more detail), plug the unit back in. 3) You will now see the setup screens.  Press the right and left buttons to navigate through the various options.  One of them will be your pressure.  You can change the settings using the ramp and heat buttons. Good luck! ps I am not Grumpstone! – Hide quoted text — Show quoted text -"Nashville Pete" <poremskinos…@comcast.net> wrote in message <news:hc-dnW1IG7VJ_r7cRVn-sg@comcast.com>… > Thanks, I have tried combinations and permutations of the five buttons and > have not been successful. I will need the procedure. > "Dan" <d…@nospam.com> wrote in message > news:vFzUc.5658$3O3.3828@newsread2.news.pas.earthlink.net… > > Nashville Pete wrote: > > > Does anyone know how to adjust the pressure on the Respironics >  RemStarPro > > > w/CFlex? The Lab Tech at the Sleep Lab said that 14 Cm looked right > > > according to the test but two weeks later the distributor’s tech showed >  me > > > the prescription calling for 11 Cm and adjusted the machine for 11 Cm >  per > > > the prescription. > > > I would like to adjust the machine to a level that works best for me. > > As a child of the 60’s, I have no problem with self medication. On my > > Bi-flex Pro unit you hold down the buttons on the face of the machine > > while turning on the power. Same procedure as doing a self test on a > > printer.

Response:

Thanks for your help. I appreciate it very much! "Grumpstone" <grumpst…@yahoo.com> wrote in message

news:9868910b.0408180927.69e7e297@posting.google.com… – Hide quoted text — Show quoted text -> 1) Unplug the unit. > 2) While holding down the two "right and left" buttons (I ain’t near > the machine so I can’t describe this in more detail), plug the unit > back in. > 3) You will now see the setup screens.  Press the right and left > buttons to navigate through the various options.  One of them will be > your pressure.  You can change the settings using the ramp and heat > buttons. > Good luck! > ps I am not Grumpstone! > "Nashville Pete" <poremskinos…@comcast.net> wrote in message

<news:hc-dnW1IG7VJ_r7cRVn-sg@comcast.com>… – Hide quoted text — Show quoted text -> > Thanks, I have tried combinations and permutations of the five buttons and > > have not been successful. I will need the procedure. > > "Dan" <d…@nospam.com> wrote in message > > news:vFzUc.5658$3O3.3828@newsread2.news.pas.earthlink.net… > > > Nashville Pete wrote: > > > > Does anyone know how to adjust the pressure on the Respironics > >  RemStarPro > > > > w/CFlex? The Lab Tech at the Sleep Lab said that 14 Cm looked right > > > > according to the test but two weeks later the distributor’s tech showed > >  me > > > > the prescription calling for 11 Cm and adjusted the machine for 11 Cm > >  per > > > > the prescription. > > > > I would like to adjust the machine to a level that works best for me. > > > As a child of the 60’s, I have no problem with self medication. On my > > > Bi-flex Pro unit you hold down the buttons on the face of the machine > > > while turning on the power. Same procedure as doing a self test on a > > > printer.

Response:

Actually humidity and barometric pressure have noe effect on the units pressure. Pressure transducers measure and causes the equipment to control the pressure relative to atmospheric pressure. One leg of the transducer is vented to air. The only thing the relative humidity affects is the amount of water the air can pick up from the humidifier. – Hide quoted text — Show quoted text -Nashville Pete wrote: > Yeh, right. And you’re telling me that the exact, correct pressure is > determined during a sleep lab test over one arbitrarily selected night > ignoring variations due to weather (barometric pressure and humidity) and > the patient’s allergy situation. > Bob, your message is strikingly similar the that of the FDA’s in regards the > prescription Meds from Canada. You don’t have much credibility in my view. > "*Bob Gootee" <goo…@comcast.net> wrote in message > news:412432D4.9040107@comcast.net… >>Pete, >>While adjusting your machine if you set it too low, you will just have a >>hose hanging off your face with annoying air blowing up your nose all >>night long doing no good. >>If you set it too high you will induce central apneas and may need one >>of these – >>http://www.countrylogcaskets.com/ >>– >>Bob Gootee

Response:

Nashville Pete wrote: > Oh hum…more unsolicited advice. Does anyone know how to change the > pressure on a RemStar Pro w/Cflex?

Yes. — michael No matter how cynical I get, I’m unable to keep up.  :^>

Response:

On Thu, 19 Aug 2004 00:55:48 -0400, *Bob Gootee <goo…@comcast.net> wrote: [De-lurkage and snippage] Bob, while I agree that there are risks involved, I can’t agree with your dire admonition against having people fine tune their pressure settings.  I have seen group posters warn that if you mess w/ your pressure, you’re going to *die* of central apnea.  Perhaps it is taken as true because it is repeated so frequently and so forcefully within this very ng.   Setting pressure too high, while not completely without risk, is not exactly playing Russian Roulette (but then again I have been known to pop 4 Motrin when the bottle says to eat 1).  Many in the profession advocate for self-titration.  I doubt their goal is to court death (maybe the folks at http://www.countrylogcaskets.com/ are putting them up to it?).   There are studies showing that self-titrations are about as efficacious as sleep lab titrations.  I do remember reading one study that indicated that self-titraters sometimes set their pressure on the low side (which is worse than setting it too high).  OTOH, lab titrations are sometimes set too high, (e.g., side sleepers, those who lose wieght while on CPAP, those w/ congestion, others).  I doubt the funeral homes are much better off as a result of these overpressurized CPAPs. Unfortunately, it is tough to self-titrate, as most events occur unnoticed and unremembered during sleep or the fog of night.  It took me a while to get dialed in.  FWIW, while I would love to see where a proper lab titration would put me, if the outcome was not improved sleep I would go right back to my self-derived setting. All that said, I would not advocate self-titrating without the guidance of a good sleep m.d. You are now possessed of my too sense. moq – Hide quoted text — Show quoted text ->Pete, >While adjusting your machine if you set it too low, you will just have a >hose hanging off your face with annoying air blowing up your nose all >night long doing no good. >If you set it too high you will induce central apneas and may need one >of these – >http://www.countrylogcaskets.com/

Response:

Yeh, right. And you’re telling me that the exact, correct pressure is determined during a sleep lab test over one arbitrarily selected night ignoring variations due to weather (barometric pressure and humidity) and the patient’s allergy situation. Bob, your message is strikingly similar the that of the FDA’s in regards the prescription Meds from Canada. You don’t have much credibility in my view. "*Bob Gootee" <goo…@comcast.net> wrote in message

news:412432D4.9040107@comcast.net… – Hide quoted text — Show quoted text -> Pete, > While adjusting your machine if you set it too low, you will just have a > hose hanging off your face with annoying air blowing up your nose all > night long doing no good. > If you set it too high you will induce central apneas and may need one > of these – > http://www.countrylogcaskets.com/ > — > Bob Gootee

Response:

- Hide quoted text — Show quoted text -Nashville Pete wrote: > Thanks, but I didn’t ask for advice…I asked how to adjust the pressure. If > it doesn’t work better I can always adjust it back…no big deal. > If there was a plan then someone should have advised me. I have made it > clear to all my providers that I want to be fully informed and I ask > questions at every juncture. I am already investigating the discrepancy > between the report and the prescription. >>"Nashville Pete" <poremskinos…@comcast.net> wrote in message >>news:SN2dnSzSANQP2b_cRVn-jg@comcast.com… >>>Does anyone know how to adjust the pressure on the Respironics > RemStarPro >>>w/CFlex? The Lab Tech at the Sleep Lab said that 14 Cm looked right >>>according to the test but two weeks later the distributor’s tech showed > me >>>the prescription calling for 11 Cm and adjusted the machine for 11 Cm > per >>>the prescription. >>>I would like to adjust the machine to a level that works best for me.

Pete, While adjusting your machine if you set it too low, you will just have a hose hanging off your face with annoying air blowing up your nose all night long doing no good. If you set it too high you will induce central apneas and may need one of these – http://www.countrylogcaskets.com/ — Bob Gootee

Response:

Thanks, I have tried combinations and permutations of the five buttons and have not been successful. I will need the procedure. "Dan" <d…@nospam.com> wrote in message

news:vFzUc.5658$3O3.3828@newsread2.news.pas.earthlink.net… – Hide quoted text — Show quoted text -> Nashville Pete wrote: > > Does anyone know how to adjust the pressure on the Respironics RemStarPro > > w/CFlex? The Lab Tech at the Sleep Lab said that 14 Cm looked right > > according to the test but two weeks later the distributor’s tech showed me > > the prescription calling for 11 Cm and adjusted the machine for 11 Cm per > > the prescription. > > I would like to adjust the machine to a level that works best for me. > As a child of the 60’s, I have no problem with self medication. On my > Bi-flex Pro unit you hold down the buttons on the face of the machine > while turning on the power. Same procedure as doing a self test on a > printer.

Response:

yes I do – Hide quoted text — Show quoted text -Nashville Pete wrote: > Oh hum…more unsolicited advice. Does anyone know how to change the > pressure on a RemStar Pro w/Cflex?

Response:

And, pray tell, how does one do it on this model? "paula" <nom…@lspam.net> wrote in message

news:4122D5C1.79AE9857@lspam.net… – Hide quoted text — Show quoted text -> yes I do > Nashville Pete wrote: > > Oh hum…more unsolicited advice. Does anyone know how to change the > > pressure on a RemStar Pro w/Cflex?

Response:

Nashville Pete wrote: > Does anyone know how to adjust the pressure on the Respironics RemStarPro > w/CFlex? The Lab Tech at the Sleep Lab said that 14 Cm looked right > according to the test but two weeks later the distributor’s tech showed me > the prescription calling for 11 Cm and adjusted the machine for 11 Cm per > the prescription. > I would like to adjust the machine to a level that works best for me.

As a child of the 60’s, I have no problem with self medication. On my Bi-flex Pro unit you hold down the buttons on the face of the machine while turning on the power. Same procedure as doing a self test on a printer.

Response:

Does anyone know how to adjust the pressure on the Respironics RemStarPro w/CFlex? The Lab Tech at the Sleep Lab said that 14 Cm looked right according to the test but two weeks later the distributor’s tech showed me the prescription calling for 11 Cm and adjusted the machine for 11 Cm per the prescription. I would like to adjust the machine to a level that works best for me.

Response:

Your best bet is to go back to "They who write prescriptions" and ask why the difference. Things have been known to be copied down incorrectly, and it is quite possible "They who write prescriptions" wanted you start at a lower pressure for a reason. Ask … — The personal opinion of Gary G. Little "Nashville Pete" <poremskinos…@comcast.net> wrote in message

news:SN2dnSzSANQP2b_cRVn-jg@comcast.com… – Hide quoted text — Show quoted text -> Does anyone know how to adjust the pressure on the Respironics RemStarPro > w/CFlex? The Lab Tech at the Sleep Lab said that 14 Cm looked right > according to the test but two weeks later the distributor’s tech showed me > the prescription calling for 11 Cm and adjusted the machine for 11 Cm per > the prescription. > I would like to adjust the machine to a level that works best for me.

Response:

Thanks, but I didn’t ask for advice…I asked how to adjust the pressure. If it doesn’t work better I can always adjust it back…no big deal. If there was a plan then someone should have advised me. I have made it clear to all my providers that I want to be fully informed and I ask questions at every juncture. I am already investigating the discrepancy between the report and the prescription. "Gary G. Little" <gglittle.nos…@sbcglobal.net> wrote in message news:EbsUc.8214$GN2.6842@newssvr22.news.prodigy.com… – Hide quoted text — Show quoted text -> Your best bet is to go back to "They who write prescriptions" and ask why > the difference. Things have been known to be copied down incorrectly, and it > is quite possible "They who write prescriptions" wanted you start at a lower > pressure for a reason. Ask … > — > The personal opinion of > Gary G. Little > "Nashville Pete" <poremskinos…@comcast.net> wrote in message > news:SN2dnSzSANQP2b_cRVn-jg@comcast.com… > > Does anyone know how to adjust the pressure on the Respironics RemStarPro > > w/CFlex? The Lab Tech at the Sleep Lab said that 14 Cm looked right > > according to the test but two weeks later the distributor’s tech showed me > > the prescription calling for 11 Cm and adjusted the machine for 11 Cm per > > the prescription. > > I would like to adjust the machine to a level that works best for me.

Response:

When you had your last study done, they varied the pressure during the night and determined the optimum pressure, based on the recorded data. You may not feel the difference between 11 and 14cm, but the data may indicate otherwise. Would you change the prescribed dosage of any medication you are taking, based on how you feel? – Hide quoted text — Show quoted text -Nashville Pete wrote: > Thanks, but I didn’t ask for advice…I asked how to adjust the pressure. If > it doesn’t work better I can always adjust it back…no big deal. > If there was a plan then someone should have advised me. I have made it > clear to all my providers that I want to be fully informed and I ask > questions at every juncture. I am already investigating the discrepancy > between the report and the prescription. > "Gary G. Little" <gglittle.nos…@sbcglobal.net> wrote in message > news:EbsUc.8214$GN2.6842@newssvr22.news.prodigy.com… >>Your best bet is to go back to "They who write prescriptions" and ask why >>the difference. Things have been known to be copied down incorrectly, and > it >>is quite possible "They who write prescriptions" wanted you start at a > lower >>pressure for a reason. Ask … >>– >>The personal opinion of >>Gary G. Little >>"Nashville Pete" <poremskinos…@comcast.net> wrote in message >>news:SN2dnSzSANQP2b_cRVn-jg@comcast.com… >>>Does anyone know how to adjust the pressure on the Respironics > RemStarPro >>>w/CFlex? The Lab Tech at the Sleep Lab said that 14 Cm looked right >>>according to the test but two weeks later the distributor’s tech showed > me >>>the prescription calling for 11 Cm and adjusted the machine for 11 Cm > per >>>the prescription. >>>I would like to adjust the machine to a level that works best for me.

Response:

Oh hum…more unsolicited advice. Does anyone know how to change the pressure on a RemStar Pro w/Cflex? "ronlin" <ron…@verizon.net> wrote in message

news:3CuUc.10116$Zh3.7237@trndny02… – Hide quoted text — Show quoted text -> When you had your last study done, they varied the pressure during the > night and determined the optimum pressure, based on the recorded data. > You may not feel the difference between 11 and 14cm, but the data may > indicate otherwise. > Would you change the prescribed dosage of any medication you are taking, > based on how you feel? > Nashville Pete wrote: > > Thanks, but I didn’t ask for advice…I asked how to adjust the pressure. If > > it doesn’t work better I can always adjust it back…no big deal. > > If there was a plan then someone should have advised me. I have made it > > clear to all my providers that I want to be fully informed and I ask > > questions at every juncture. I am already investigating the discrepancy > > between the report and the prescription. > > "Gary G. Little" <gglittle.nos…@sbcglobal.net> wrote in message > > news:EbsUc.8214$GN2.6842@newssvr22.news.prodigy.com… > >>Your best bet is to go back to "They who write prescriptions" and ask why > >>the difference. Things have been known to be copied down incorrectly, and > > it > >>is quite possible "They who write prescriptions" wanted you start at a > > lower > >>pressure for a reason. Ask … > >>– > >>The personal opinion of > >>Gary G. Little > >>"Nashville Pete" <poremskinos…@comcast.net> wrote in message > >>news:SN2dnSzSANQP2b_cRVn-jg@comcast.com… > >>>Does anyone know how to adjust the pressure on the Respironics > > RemStarPro > >>>w/CFlex? The Lab Tech at the Sleep Lab said that 14 Cm looked right > >>>according to the test but two weeks later the distributor’s tech showed > > me > >>>the prescription calling for 11 Cm and adjusted the machine for 11 Cm > > per > >>>the prescription. > >>>I would like to adjust the machine to a level that works best for me.

Response:

One month on CPAP–better, but could use some suggestions…

Question:

"Jo" <jo…@stopit.yahoo.com> wrote in message

news:ENKdnf47Ib4hv2bdRVn-hg@suscom.com… > That chin strap sounds interesting, can you post a manufacturer or official > name for it so I can look it up?

There’s no marking on it whatsoever. I got mine from the Royal North Shore hospital, Sydney, Australia. You could try calling them – the main number for the hospital is +61 2 9926 7111. Ask for the Sleep Investigation Unit. It cost me $15.00. I made a small typo (as you probably realise) – it’s called a Butterfly Chinstrap. The reason for the word "butterfly" is, I think, simply because of the overall shape of it, when it’s laid flat – there are two sections, which are joined in the middle, and it narrows a lot where the join is, making it look butterfly-like. It looks like it would be very easy to make oneself. For a woman, anyway. ;^) Greg.

Response:

Hello all! This is my first post on this newsgroup. I admit that I feel a whole lot better after reading your messages because I am a "new" user of CPAP and I am having a lot of trouble sleeping with it. In fact, I have only slept a few minutes in a week and I rarely have the mask on more than 2-3 hours each night. It just becomes too painful. When I first put it on, it’s OK, but after I have it on awhile the mask seems to screw itself into my face somehow, if that’s possible! I have a ResMed S7 Elite CPAP and I am using the Ultra Mirage Full Face Mask which covers the nose and mouth. It seems to work OK at first and I have dozed off some nights, but most of the time I am awake. But I’m happy to have read on here that most of you struggle with your masks and have trouble getting to sleep, too. So I will keep on trying. I go back for my checkup on July 28. I started with this setup on July 8. So that’s 20-days of trial. Maybe they might suggest a different mask. Have any of you heard of a nose mask with a strap that fits around your head to keep your mouth shut? My brother wears that one and says it works great for him. Bertrand Macpherson — Outgoing mail is certified Virus Free. Checked by AVG anti-virus system (http://www.grisoft.com). Version: 6.0.719 / Virus Database: 475 – Release Date: 07/12/2004

Response:

On Fri, 16 Jul 2004 15:03:44 GMT, "Bertrand K. Macpherson" <bmacpherson…@woh.rr.com> wrote: >Hello all! >This is my first post on this newsgroup. I admit that I feel a whole lot >better after reading your messages because I am a "new" user of CPAP and I >am having a lot of trouble sleeping with it. >In fact, I have only slept a few minutes in a week and I rarely have the >mask on more than 2-3 hours each night. It just becomes too painful. When I >first put it on, it’s OK, but after I have it on awhile the mask seems to >screw itself into my face somehow, if that’s possible!

Do keep trying!  I’m not familiar with the case with full face masks, but I’m convinced there is a tendency among new CPAPers to adjust the headgear so the mask is too tight. Try backing off on the adjustment until you feel the mask is just barely hanging on. Don’t make this adjustment while sitting up – you’ll for sure get it too tight that way. Most masks depend on the air pressure inflating the flexible section that fits your face to maintain a seal. Adjusting too tight defeats that process. good luck and keep trying!

Response:

That chin strap sounds interesting, can you post a manufacturer or official name for it so I can look it up? Thanks! Joanne "Greg" <REMOVEaeratedT…@hotmail.com> wrote in message

news:40f88438$1@duster.adelaide.on.net… – Hide quoted text — Show quoted text -> "Bertrand K. Macpherson" <bmacpherson…@woh.rr.com> wrote in message > news:k7SJc.218743$DG4.217357@fe2.columbus.rr.com… > > Have any of you heard of a nose mask with a strap > > that fits around your head to keep your mouth shut? My brother wears that > > one and says it works great for him. > I use a seperate "buttefly chin-strap" (which I bought from the sleep > investigation unit where I had my tests > done)  and it works very well indeed. I find that I have to have > the part which goes over my lips done up reasonably tight, but that the part > which goes under > my chin can be done up just gently. I was skeptical at first – I didn’t > think this would prevent > my lips from parting and air leaking out – but it works. The leaflet > mentions that a further improvement > in seal can be realised by using a "combination dressing" over the mouth (in > conjunction with the chinstrap > proper), but I haven’t had to do anything like that – the chinstrap alone > seems to be sufficient for me. > Regarding masks, I have recently switched to a Resmed Mirage Activa mask, > and boy, what an improvement > over my previous mask!! This mask is fantastic. I note that others here are > also happy with this mask. > Greg.

Response:

 I haven’t had any experience with nasal pillows,but I’m a very restless sleeper and after trying several masks,have found the resmed activa to be very good,as the extra cushion seal ,and flexible extension hose lets you toss and turn without leaks.It is a bigger mask,but I find it quite comfortable because of the extra flotation bit.it doesn’t leave any red marks on my face next day,despite its extra size and weight.Don’t know if its an option for you,but might be worth  try.If you buy it on ebay you will save heaps. "Joe Ahearn" <jo…@mail.airmail.net> wrote in message

news:up3bf0tju0gi6le8fccfmu9b07ooiloj50@4ax.com… – Hide quoted text — Show quoted text -> Hi, > As some of you may remember, I was diagnosed with hypopnea (index=62), > RLS, and insomnia about a month ago after two sleep studies. > The  good news is that on most days I am fuctional again, I have been > able to start reading for pleasure again, I am working better, and on > almost all days I have at least a few hours of feeling "normal": > rested, and alert, and productive. > My pressure seems to be ranging from the high 8s to the low 12s (I > check it every morning first thing when I wake up, before I turn the > machine off.) > The bad news is that about one day out of three I still feel > "trainwrecked." And I still need about 11 hours of sleep a night > (though that’s down from 16-18). I figure I am still in a transitional > state, getting more and more deeply rested after at least ten years of > severe sleep disruption. > Here’s the stuff I could use some help with: > 1. I am using nasal pillows that are held in place with nylon straps > and velcro. (Sorry I don’t have the product name or number.) Despite > using every combination of strapping I can think of, and using both > Carmex and Ayr gel, I still find that the pillows cause me a lot of > pain in my nose–enough to wake me up frequently. Does anyone have any > suggestions for sleeping more comfortably? > 2. This headset doesn’t work well if you turn in your sleep. I often > awake because the pillows have come out of my nose and are > leaking–the head straps don’t really hold things in place if I move > AT ALL off my back. I am quite  restless sleeper and so quite often I > am waking in the middle of the night and trying to put the headset > back together. Again, I have read the manual, consululted several > times with my DME, and have used many different combinations of hard > and soft pressure to hold this damned thing together. Can anyone > suggest anything that might help here? > 3. Finally, in the last two days I have woken three times to find I’ve > taken the headset off while asleep. I have no memory of this, yet I > wake to find the headset off and on my night stand. Tres bizarre. > Again, if anyone has any suggestions here, I’d really appreciate them. > I’d like to thank everyone who posts here for their advice and > encouragement. I’ve learned more here than I have from my doctor and > DME. I read this group every day, and while I generally have no wisdom > to share (yet), I learn something from every post. > TIA, > Joe Ahearn > Dallas

Response:

Follow the suggestion about loosening the mask. I hve just gotten a ResMed Mirage Activa mask and I think it is really going to be a major improvement on the standard Ultra Mirage (not ful face). I, also, am using the S7 Elite.  Talk to you CPAP supplier and make sure they know you are unhappy. ResMed do have a chin strap – I use one. Pleasant dreams Dave

Response:

Many thanks to everyone who has written in. I have printed this entire thread and will work through all of these suggestions. Thank Jah for this group–otherwise, I’d be left with just the advice of my supplier, and that’s worthless. Just coincidentally, I slept terrifically well last night and I feel great this morning. Being able to sleep so well, even if only on occasion, keeps me motivated to fine-tune this machine. Best, Joe Ahearn On Wed, 14 Jul 2004 20:06:58 GMT, Joe Ahearn <jo…@mail.airmail.net> wrote: – Hide quoted text — Show quoted text ->Hi, >As some of you may remember, I was diagnosed with hypopnea (index=62), >RLS, and insomnia about a month ago after two sleep studies. >The  good news is that on most days I am fuctional again, I have been >able to start reading for pleasure again, I am working better, and on >almost all days I have at least a few hours of feeling "normal": >rested, and alert, and productive. >My pressure seems to be ranging from the high 8s to the low 12s (I >check it every morning first thing when I wake up, before I turn the >machine off.) >The bad news is that about one day out of three I still feel >"trainwrecked." And I still need about 11 hours of sleep a night >(though that’s down from 16-18). I figure I am still in a transitional >state, getting more and more deeply rested after at least ten years of >severe sleep disruption. >Here’s the stuff I could use some help with: >1. I am using nasal pillows that are held in place with nylon straps >and velcro. (Sorry I don’t have the product name or number.) Despite >using every combination of strapping I can think of, and using both >Carmex and Ayr gel, I still find that the pillows cause me a lot of >pain in my nose–enough to wake me up frequently. Does anyone have any >suggestions for sleeping more comfortably? >2. This headset doesn’t work well if you turn in your sleep. I often >awake because the pillows have come out of my nose and are >leaking–the head straps don’t really hold things in place if I move >AT ALL off my back. I am quite  restless sleeper and so quite often I >am waking in the middle of the night and trying to put the headset >back together. Again, I have read the manual, consululted several >times with my DME, and have used many different combinations of hard >and soft pressure to hold this damned thing together. Can anyone >suggest anything that might help here? >3. Finally, in the last two days I have woken three times to find I’ve >taken the headset off while asleep. I have no memory of this, yet I >wake to find the headset off and on my night stand. Tres bizarre. >Again, if anyone has any suggestions here, I’d really appreciate them. >I’d like to thank everyone who posts here for their advice and >encouragement. I’ve learned more here than I have from my doctor and >DME. I read this group every day, and while I generally have no wisdom >to share (yet), I learn something from every post. >TIA, >Joe Ahearn >Dallas

Response:

You probably have your mask too tight. 1) Wash face with a non-oily astringent to reduce skin/mask leaks 2) Loosen the straps. The mask should ‘float’. Don’t feel stupid. Very many folks (most) tighten this mask too much in the beginning. regards, eric pearson nonono.ericp1.non…@nonono.fuse.net On Fri, 16 Jul 2004 15:03:44 GMT, "Bertrand K. Macpherson" – Hide quoted text — Show quoted text -<bmacpherson…@woh.rr.com> wrote: >Hello all! >This is my first post on this newsgroup. I admit that I feel a whole lot >better after reading your messages because I am a "new" user of CPAP and I >am having a lot of trouble sleeping with it. >In fact, I have only slept a few minutes in a week and I rarely have the >mask on more than 2-3 hours each night. It just becomes too painful. When I >first put it on, it’s OK, but after I have it on awhile the mask seems to >screw itself into my face somehow, if that’s possible! >I have a ResMed S7 Elite CPAP and I am using the Ultra Mirage Full Face Mask >which covers the nose and mouth. It seems to work OK at first and I have >dozed off some nights, but most of the time I am awake. But I’m happy to >have read on here that most of you struggle with your masks and have trouble >getting to sleep, too. >So I will keep on trying. I go back for my checkup on July 28. I started >with this setup on July 8. So that’s 20-days of trial. Maybe they might >suggest a different mask. Have any of you heard of a nose mask with a strap >that fits around your head to keep your mouth shut? My brother wears that >one and says it works great for him. >Bertrand Macpherson >— >Outgoing mail is certified Virus Free. >Checked by AVG anti-virus system (http://www.grisoft.com). >Version: 6.0.719 / Virus Database: 475 – Release Date: 07/12/2004

Response:

"Bertrand K. Macpherson" <bmacpherson…@woh.rr.com> wrote in message news:k7SJc.218743$DG4.217357@fe2.columbus.rr.com… > Have any of you heard of a nose mask with a strap > that fits around your head to keep your mouth shut? My brother wears that > one and says it works great for him.

I use a seperate "buttefly chin-strap" (which I bought from the sleep investigation unit where I had my tests done)  and it works very well indeed. I find that I have to have the part which goes over my lips done up reasonably tight, but that the part which goes under my chin can be done up just gently. I was skeptical at first – I didn’t think this would prevent my lips from parting and air leaking out – but it works. The leaflet mentions that a further improvement in seal can be realised by using a "combination dressing" over the mouth (in conjunction with the chinstrap proper), but I haven’t had to do anything like that – the chinstrap alone seems to be sufficient for me. Regarding masks, I have recently switched to a Resmed Mirage Activa mask, and boy, what an improvement over my previous mask!! This mask is fantastic. I note that others here are also happy with this mask. Greg.

Response:

Hi, As some of you may remember, I was diagnosed with hypopnea (index=62), RLS, and insomnia about a month ago after two sleep studies. The  good news is that on most days I am fuctional again, I have been able to start reading for pleasure again, I am working better, and on almost all days I have at least a few hours of feeling "normal": rested, and alert, and productive. My pressure seems to be ranging from the high 8s to the low 12s (I check it every morning first thing when I wake up, before I turn the machine off.) The bad news is that about one day out of three I still feel "trainwrecked." And I still need about 11 hours of sleep a night (though that’s down from 16-18). I figure I am still in a transitional state, getting more and more deeply rested after at least ten years of severe sleep disruption. Here’s the stuff I could use some help with: 1. I am using nasal pillows that are held in place with nylon straps and velcro. (Sorry I don’t have the product name or number.) Despite using every combination of strapping I can think of, and using both Carmex and Ayr gel, I still find that the pillows cause me a lot of pain in my nose–enough to wake me up frequently. Does anyone have any suggestions for sleeping more comfortably? 2. This headset doesn’t work well if you turn in your sleep. I often awake because the pillows have come out of my nose and are leaking–the head straps don’t really hold things in place if I move AT ALL off my back. I am quite  restless sleeper and so quite often I am waking in the middle of the night and trying to put the headset back together. Again, I have read the manual, consululted several times with my DME, and have used many different combinations of hard and soft pressure to hold this damned thing together. Can anyone suggest anything that might help here? 3. Finally, in the last two days I have woken three times to find I’ve taken the headset off while asleep. I have no memory of this, yet I wake to find the headset off and on my night stand. Tres bizarre. Again, if anyone has any suggestions here, I’d really appreciate them. I’d like to thank everyone who posts here for their advice and encouragement. I’ve learned more here than I have from my doctor and DME. I read this group every day, and while I generally have no wisdom to share (yet), I learn something from every post. TIA, Joe Ahearn Dallas

Response:

- Hide quoted text — Show quoted text -Joe Ahearn wrote: > Hi, > As some of you may remember, I was diagnosed with hypopnea (index=62), > RLS, and insomnia about a month ago after two sleep studies. > The  good news is that on most days I am fuctional again, I have been > able to start reading for pleasure again, I am working better, and on > almost all days I have at least a few hours of feeling "normal": > rested, and alert, and productive. > My pressure seems to be ranging from the high 8s to the low 12s (I > check it every morning first thing when I wake up, before I turn the > machine off.) > The bad news is that about one day out of three I still feel > "trainwrecked." And I still need about 11 hours of sleep a night > (though that’s down from 16-18). I figure I am still in a transitional > state, getting more and more deeply rested after at least ten years of > severe sleep disruption. > Here’s the stuff I could use some help with: > 1. I am using nasal pillows that are held in place with nylon straps > and velcro. (Sorry I don’t have the product name or number.) Despite > using every combination of strapping I can think of, and using both > Carmex and Ayr gel, I still find that the pillows cause me a lot of > pain in my nose–enough to wake me up frequently. Does anyone have any > suggestions for sleeping more comfortably?

Go to www.cpapman.com and look at the pictures of the ADAMS to see if that is the one you have. If so, then the Conjo Custom headgear (on the same site) is a huge improvement over the stock ADAMs headgear.  If you order it there is a slightly involved measurement process to do first (I had no idea where exactly where one’s occipital bump might be located and mine is not very prominent). The angle adaptor with the additional swivel is a must have even if you don’t get the custom headgear. The angle of the pillows to your nares is important for a comfortable fit and seal. The pillows should seal without having to be squashed completely flat.  I put mine on and center the pillows in my nares. It feels very loose until I turn on the machine which expands the pillows. A slight wiggle to seat the pillows and I’m good to go. My struggle is a bit different. I have a short mustache.  The shell that holds the pillows contacts my upper lip which has the effect of driving the mustache hairs into the skin.  I try to adjust things so that the shell doesn’t contact my upper lip. Completely off the lip results in a "pig snout" effect where the top of the shell/pillows pulls up on my nose.  Too much pull and my nose hurts. Too little pull and my lip hurts.  It’s a fine balance which takes a night to adjust every time I drop my head gear into the washing machine. Are you sure you have the right size pillows? Can you talk your DME into letting you try a size larger? maybe even smaller but most people who are misfitted are fitted too small. Have you tried the dilator style. Goes into the nose further but contacts at a different point. They are a bit more rigid too which may not be good. > 2. This headset doesn’t work well if you turn in your sleep. I often > awake because the pillows have come out of my nose and are > leaking–the head straps don’t really hold things in place if I move > AT ALL off my back. I am quite  restless sleeper and so quite often I > am waking in the middle of the night and trying to put the headset > back together. Again, I have read the manual, consululted several > times with my DME, and have used many different combinations of hard > and soft pressure to hold this damned thing together. Can anyone > suggest anything that might help here?

See above. I find that I can turn from back to side to side with little, if any, disturbance of the pillows. Do you have your hose suspended behind and above your head (headboard)?  This makes a large difference. > 3. Finally, in the last two days I have woken three times to find I’ve > taken the headset off while asleep. I have no memory of this, yet I > wake to find the headset off and on my night stand. Tres bizarre. > Again, if anyone has any suggestions here, I’d really appreciate them.

This is a not so uncommon problem that some people have while they adapt to treatment.  I’m sure others will reply with what worked for them. -Quick – Hide quoted text — Show quoted text -> I’d like to thank everyone who posts here for their advice and > encouragement. I’ve learned more here than I have from my doctor and > DME. I read this group every day, and while I generally have no wisdom > to share (yet), I learn something from every post. > TIA, > Joe Ahearn > Dallas

Response:

I use the breeze setup and find the same difficulties in that if I want to lie on my back I usually have to adjust the sliders on the thing to stop leakage. I now usually avoid back sleeping because of this. However for all it’s problems I still prefer this system as it allows me to sleep in other positions without any leakage. Any masks I have tried leaked as soon as I rolled over. I don’t know what setup you have but if it is a ’strapped’ version  I suggest that once you get the right fit mark the straps with indelible ink. That way when it comes to washing the headgear (mask or pillows) you shouldn’t have much difficulty in getting the right fit again. — Frankie I used to be normal but didn’t like it. To Reply By E-Mail Remove  ’MY SPLEEN’ http://uk.msnusers.com/LivingWithSleepApnea ————————————————————————- FIGHT BACK AGAINST SPAM! Download Spam Inspector, the Award Winning Anti-Spam Filter http://mail.giantcompany.com " Joe Ahearn" <jo…@mail.airmail.net> wrote in message

news:up3bf0tju0gi6le8fccfmu9b07ooiloj50@4ax.com… – Hide quoted text — Show quoted text -> Hi, > As some of you may remember, I was diagnosed with hypopnea (index=62), > RLS, and insomnia about a month ago after two sleep studies. > The  good news is that on most days I am fuctional again, I have been > able to start reading for pleasure again, I am working better, and on > almost all days I have at least a few hours of feeling "normal": > rested, and alert, and productive. > My pressure seems to be ranging from the high 8s to the low 12s (I > check it every morning first thing when I wake up, before I turn the > machine off.) > The bad news is that about one day out of three I still feel > "trainwrecked." And I still need about 11 hours of sleep a night > (though that’s down from 16-18). I figure I am still in a transitional > state, getting more and more deeply rested after at least ten years of > severe sleep disruption. > Here’s the stuff I could use some help with: > 1. I am using nasal pillows that are held in place with nylon straps > and velcro. (Sorry I don’t have the product name or number.) Despite > using every combination of strapping I can think of, and using both > Carmex and Ayr gel, I still find that the pillows cause me a lot of > pain in my nose–enough to wake me up frequently. Does anyone have any > suggestions for sleeping more comfortably? > 2. This headset doesn’t work well if you turn in your sleep. I often > awake because the pillows have come out of my nose and are > leaking–the head straps don’t really hold things in place if I move > AT ALL off my back. I am quite  restless sleeper and so quite often I > am waking in the middle of the night and trying to put the headset > back together. Again, I have read the manual, consululted several > times with my DME, and have used many different combinations of hard > and soft pressure to hold this damned thing together. Can anyone > suggest anything that might help here? > 3. Finally, in the last two days I have woken three times to find I’ve > taken the headset off while asleep. I have no memory of this, yet I > wake to find the headset off and on my night stand. Tres bizarre. > Again, if anyone has any suggestions here, I’d really appreciate them. > I’d like to thank everyone who posts here for their advice and > encouragement. I’ve learned more here than I have from my doctor and > DME. I read this group every day, and while I generally have no wisdom > to share (yet), I learn something from every post. > TIA, > Joe Ahearn > Dallas

Response:

I’ve been on APAP for a couple of months and I’m also waking up and finding my mask’s been tossed towards the far wall and having no memory of doing it.   I think part of my problem is I need to get the humidifier and work on mouth leaks. I have an Activa and I agree with previous posters that it’s fairly comfortable and mostly leak proof.  I still get evidence that I’m getting eye leaks in the night though (extreme dry and red eyes when I wake up). Two new masks that I’m thinking about trying are: The new InnoMed "Freestyle" (looks like it would give Burglars a pretty good laugh).    http://www.innomedinc.com/products/shoot6.html And the new FP FlexiFit Full Face Mask (tried the resmed full face. Leaked like a sieve).    http://www.fphcare.com/osa/HC431%20Brochure.pdf Good Luck Todd – Hide quoted text — Show quoted text -Joe Ahearn <jo…@mail.airmail.net> wrote in message <news:up3bf0tju0gi6le8fccfmu9b07ooiloj50@4ax.com>… > Hi, > As some of you may remember, I was diagnosed with hypopnea (index=62), > RLS, and insomnia about a month ago after two sleep studies. > The  good news is that on most days I am fuctional again, I have been > able to start reading for pleasure again, I am working better, and on > almost all days I have at least a few hours of feeling "normal": > rested, and alert, and productive. > My pressure seems to be ranging from the high 8s to the low 12s (I > check it every morning first thing when I wake up, before I turn the > machine off.) > The bad news is that about one day out of three I still feel > "trainwrecked." And I still need about 11 hours of sleep a night > (though that’s down from 16-18). I figure I am still in a transitional > state, getting more and more deeply rested after at least ten years of > severe sleep disruption. > Here’s the stuff I could use some help with: > 1. I am using nasal pillows that are held in place with nylon straps > and velcro. (Sorry I don’t have the product name or number.) Despite > using every combination of strapping I can think of, and using both > Carmex and Ayr gel, I still find that the pillows cause me a lot of > pain in my nose–enough to wake me up frequently. Does anyone have any > suggestions for sleeping more comfortably? > 2. This headset doesn’t work well if you turn in your sleep. I often > awake because the pillows have come out of my nose and are > leaking–the head straps don’t really hold things in place if I move > AT ALL off my back. I am quite  restless sleeper and so quite often I > am waking in the middle of the night and trying to put the headset > back together. Again, I have read the manual, consululted several > times with my DME, and have used many different combinations of hard > and soft pressure to hold this damned thing together. Can anyone > suggest anything that might help here? > 3. Finally, in the last two days I have woken three times to find I’ve > taken the headset off while asleep. I have no memory of this, yet I > wake to find the headset off and on my night stand. Tres bizarre. > Again, if anyone has any suggestions here, I’d really appreciate them. > I’d like to thank everyone who posts here for their advice and > encouragement. I’ve learned more here than I have from my doctor and > DME. I read this group every day, and while I generally have no wisdom > to share (yet), I learn something from every post. > TIA, > Joe Ahearn > Dallas

Response:

Joe Ahearn <jo…@mail.airmail.net> wrote: > The  good news is that on most days I am fuctional again, I have been > able to start reading for pleasure again, I am working better, and on > almost all days I have at least a few hours of feeling "normal": > rested, and alert, and productive.

I found that it took at least six months before I really started feeling a lot better. > The bad news is that about one day out of three I still feel > "trainwrecked." And I still need about 11 hours of sleep a night > (though that’s down from 16-18). I figure I am still in a transitional > state, getting more and more deeply rested after at least ten years of > severe sleep disruption.

Exactly. > 1. I am using nasal pillows that are held in place with nylon straps > and velcro. (Sorry I don’t have the product name or number.) Despite > using every combination of strapping I can think of, and using both > Carmex and Ayr gel, I still find that the pillows cause me a lot of > pain in my nose–enough to wake me up frequently. Does anyone have any > suggestions for sleeping more comfortably?

You may be using the wrong size? > 2. This headset doesn’t work well if you turn in your sleep. > 3. Finally, in the last two days I have woken three times to find I’ve > taken the headset off while asleep.

Both of these things were problems I had in the first few months, but don’t have any more. Dunno why. — _Deirdre                                             http://deirdre.net "Memes are a hoax! Pass it on!"

Response:

Hi Joe; I don’t use pillows, I tried them at the DME and didn’t like them. I used to have an Aclaim mask which was adequate but prone to leaks and not particularly comfortable. I recently bought a Resmed Activa and quite like it. The best things about it are that it really is virtually leak proof, comfortable (as can be ), allows you to move around (though I haven’t been able to sleep on my stomach for a year now) and the straps are worn quite loosely. The mask does weigh a little more and hose management is a bit of  an issue. The Aclaim puts the hose over your head so there was little fuss. The exhaust port does expel a lot more air than the Aclaim which could be a problem with your partner. If you use the ramp feature on your CPAP it doesn’t seem to work well with the Activa as the cushion does not inflate enough. I think that most people don’t use the ramp after getting used to CPAP. Overall, it is quite a improvement and well worth the money. For the first few months, I also took my mask off every night and I never remembered doing it. It drove me crazy . It seems to take a bit of determination but over time you’ll get used to it and be using it all night. Just keep putting it on every night and put it back on if you wake up. I felt better the first week of using CPAP and then for about three months I felt significantly worse than pre-CPAP. The funny thing is that   I never knew I felt bad before starting CPAP. After I knew the difference, I realized that I felt pretty crappy pre-CPAP. It does get better and well worth the hassles of adjustment. The most important part is the interface between you and the machine. Make sure that you get something that your comfortable with and get your DME to help you find something that works for you. If it hurts, its bad. I hope this helps! Steve – Hide quoted text — Show quoted text -Joe Ahearn wrote: > Hi, > As some of you may remember, I was diagnosed with hypopnea (index=62), > RLS, and insomnia about a month ago after two sleep studies. > The  good news is that on most days I am fuctional again, I have been > able to start reading for pleasure again, I am working better, and on > almost all days I have at least a few hours of feeling "normal": > rested, and alert, and productive. > My pressure seems to be ranging from the high 8s to the low 12s (I > check it every morning first thing when I wake up, before I turn the > machine off.) > The bad news is that about one day out of three I still feel > "trainwrecked." And I still need about 11 hours of sleep a night > (though that’s down from 16-18). I figure I am still in a transitional > state, getting more and more deeply rested after at least ten years of > severe sleep disruption. > Here’s the stuff I could use some help with: > 1. I am using nasal pillows that are held in place with nylon straps > and velcro. (Sorry I don’t have the product name or number.) Despite > using every combination of strapping I can think of, and using both > Carmex and Ayr gel, I still find that the pillows cause me a lot of > pain in my nose–enough to wake me up frequently. Does anyone have any > suggestions for sleeping more comfortably? > 2. This headset doesn’t work well if you turn in your sleep. I often > awake because the pillows have come out of my nose and are > leaking–the head straps don’t really hold things in place if I move > AT ALL off my back. I am quite  restless sleeper and so quite often I > am waking in the middle of the night and trying to put the headset > back together. Again, I have read the manual, consululted several > times with my DME, and have used many different combinations of hard > and soft pressure to hold this damned thing together. Can anyone > suggest anything that might help here? > 3. Finally, in the last two days I have woken three times to find I’ve > taken the headset off while asleep. I have no memory of this, yet I > wake to find the headset off and on my night stand. Tres bizarre. > Again, if anyone has any suggestions here, I’d really appreciate them. > I’d like to thank everyone who posts here for their advice and > encouragement. I’ve learned more here than I have from my doctor and > DME. I read this group every day, and while I generally have no wisdom > to share (yet), I learn something from every post. > TIA, > Joe Ahearn > Dallas

Response:

Joe Ahearn <jo…@mail.airmail.net> wrote: > 1. I am using nasal pillows that are held in place with nylon straps > and velcro. (Sorry I don’t have the product name or number.) Despite > using every combination of strapping I can think of, and using both > Carmex and Ayr gel, I still find that the pillows cause me a lot of > pain in my nose–enough to wake me up frequently. Does anyone have any > suggestions for sleeping more comfortably?

My DME shorted me the flexible pleated 18 inch hose that is supposed to run from the swivel at the end of the six foot hose from the CPAP to the interface. As a result, there was a lot of pressure trying to pull forwad on my nose. The other problem was I was given the standard normal size pillows. They fit too far up into my nose and irritated my nares. A shift to the large pillows, (a mint green color), solved that problem. The nares should rest atop the pillows not have the pillows push up into the nares. > 2. This headset doesn’t work well if you turn in your sleep. I often > awake because the pillows have come out of my nose and are > leaking–the head straps don’t really hold things in place if I move > AT ALL off my back. I am quite  restless sleeper and so quite often I > am waking in the middle of the night and trying to put the headset > back together. Again, I have read the manual, consululted several > times with my DME, and have used many different combinations of hard > and soft pressure to hold this damned thing together. Can anyone > suggest anything that might help here?

It takes a while to get adjusted properly. It is adjust, try, adjust some more, try again, and so on. One thing that helped was to get the straps that go around the head as low down on the head as I could, then adjust the large strap that goes over the top of the head. Then adjust the hose and pillows, finally adjust the straps from the pillow shell to the strap around the head. Ross Bernheim

Response:

Are RDI's important when AHI is low?

Question:

On my recent sleep study, my RDI was 18 per hour.  I had only one Apnea.  Do RDI’s cause arrousals that disrupt sleep?  I never got beyond sleep stage 2 and have no REM sleep.  The test collected only an hour of data because I could not sleep. ~snoozy~

Response:

Yes they do, RDI means ‘respiratory disturbance index’.  Did they list how many hypopneas you had? "Snoozy" <sno…@nowhere.net> wrote in message

news:40DA0EA6.E9205716@nowhere.net… – Hide quoted text — Show quoted text -> On my recent sleep study, my RDI was 18 per hour.  I had only one > Apnea.  Do RDI’s cause arrousals that disrupt sleep?  I never got beyond > sleep stage 2 and have no REM sleep.  The test collected only an hour of > data because I could not sleep. > ~snoozy~

Response:

Snoozy, Please clarify your question. As best I understand it, RDI = AHI. RDI and AHI are both equal to: (total number of apneas + total number of hypopneas) / hours. The most common definition of ‘apnea’ is a cessation of respiratory airflow for 10 or more seconds. The most common definition of ‘hypopnea’ is a 50% or more reduction in respiratory airflow for 10 or more seconds. Hypopneas are a ’superset’ of apneas, and apneas are a ’subset’ of apneas by that definition. The way the two most widely sold auto-titrating machines report is: Apnea index = Apneas / hours Hypopnea index = ‘non-apnea’ Hypopneas/hours AHI = RDI = Apnea index plus hypopnea index. Both apneas and hypopneas are important since if they occur frequently enough (two common measures of ‘frequently enough’ are 5 and 10 events per hour), they disrupt sleep architecture in a fashion which reduces the percentage of time spent in REM (to oversimplify, ‘dreaming’) sleep which helps heal the mind and Delta (stage 3 and 4, or ‘very deep’  sleep) which helps the body heal the damage caused by daily physical stresses. I hope this gives you some clarification. If not, please supply this group with the summary results of your poly test. I am certain there will be several (I am one) folks who will help you understand that report in non-medical (and in some cases, pedantically medical) terms. On Wed, 23 Jun 2004 23:13:34 GMT, Snoozy <sno…@nowhere.net> wrote: >On my recent sleep study, my RDI was 18 per hour.  I had only one >Apnea.  Do RDI’s cause arrousals that disrupt sleep?  I never got beyond >sleep stage 2 and have no REM sleep.  The test collected only an hour of >data because I could not sleep. >~snoozy~

regards, eric pearson nonono.ericp1.non…@nonono.fuse.net

Response:

My test said AHI = 1, RDI = 18 Apnea/Hpopnea means event ten seconds or greater. So AHI does not necessarily = RDI No REM sleep.  Only got to stage 2 sleep.  Only one hour of sleep when the lab awoke me and the test was terminated. – Hide quoted text — Show quoted text -eric pearson wrote: > Snoozy, > Please clarify your question. > As best I understand it, RDI = AHI. > RDI and AHI are both equal to: > (total number of apneas + total number of hypopneas) / hours. > The most common definition of ‘apnea’ is a cessation of respiratory > airflow for 10 or more seconds. > The most common definition of ‘hypopnea’ is a 50% or more reduction in > respiratory airflow for 10 or more seconds. > Hypopneas are a ’superset’ of apneas, and apneas are a ’subset’ of > apneas by that definition. > The way the two most widely sold auto-titrating machines report is: > Apnea index = Apneas / hours > Hypopnea index = ‘non-apnea’ Hypopneas/hours > AHI = RDI = Apnea index plus hypopnea index. > Both apneas and hypopneas are important since if they occur frequently > enough (two common measures of ‘frequently enough’ are 5 and 10 events > per hour), they disrupt sleep architecture in a fashion which reduces > the percentage of time spent in REM (to oversimplify, ‘dreaming’) > sleep which helps heal the mind and Delta (stage 3 and 4, or ‘very > deep’  sleep) which helps the body heal the damage caused by daily > physical stresses. > I hope this gives you some clarification. If not, please supply this > group with the summary results of your poly test. I am certain there > will be several (I am one) folks who will help you understand that > report in non-medical (and in some cases, pedantically medical) terms. > On Wed, 23 Jun 2004 23:13:34 GMT, Snoozy <sno…@nowhere.net> wrote: > >On my recent sleep study, my RDI was 18 per hour.  I had only one > >Apnea.  Do RDI’s cause arrousals that disrupt sleep?  I never got beyond > >sleep stage 2 and have no REM sleep.  The test collected only an hour of > >data because I could not sleep. > >~snoozy~ > regards, > eric pearson > nonono.ericp1.non…@nonono.fuse.net

Response:

In article <40E34EC0.83BB6…@nowhere.net>, snoozy <sno…@nowhere.net> wrote: > My test said AHI = 1, RDI = 18 > Apnea/Hpopnea means event ten seconds or greater. > So AHI does not necessarily = RDI > No REM sleep.  Only got to stage 2 sleep.  Only one hour of sleep when the > lab awoke me and the test was terminated.

Is it possible that the RDI includes snoring arousals? Apparently some people have gotten CPAP treatment because of enough snoring arousals to cause daytime sleepiness, even with few Apneas and/or Hyopneas. Dan

Response:

Rapid Shallow Breathing Using CPAP

Question:

To reduce the amount of CFlex exhalation relief you get on your RemStar Plus, first make sure the power (pressure) switch is turned off, then press the ramp button and hold it until the unit beeps to go into patient setup mode. Press the right arrow button under the LCD display repeatedly until you see the icon that looks like a horsheshoe with a tiny down-arrow in the center (I think it’s three presses).  In your case, next to the icon you will probably see the number 3, meaning the maximum pressure drop on exhale.  Use the heat and ramp buttons to adjust the number up and down between 0 and 3.   To exit setup mode, press the On/Off button.  My DME said to keep the number as low as was comfortable.   If you’d like to read further instructions, a user manual is online at http:\www.respironicsremstar.compdfPlus w_C-Flex User Instr.pdf

Response:

I believe if you hold down the ramp key for several seconds, you can change it yourself. "Harry Gerapetritis" <gerapetrit…@charter.net> wrote in message

news:10cm3f123hoqsc3@corp.supernews.com… : Yes!  I am using a Respironics Remstar Plus with CFLEX, and I have the CFLEX : turned all the way up!  I was having trouble exhaling against my initial : pressure of 9, so the CFLEX was set at three.  Maybe I should get the DME to : bump that back to 1 or 2 on the lower pressure. : : Thanks.

Response:

Yes!  I am using a Respironics Remstar Plus with CFLEX, and I have the CFLEX turned all the way up!  I was having trouble exhaling against my initial pressure of 9, so the CFLEX was set at three.  Maybe I should get the DME to bump that back to 1 or 2 on the lower pressure. Thanks. "David Ruether" <r…@no-junk.cornell.edu> wrote in message

news:l2iyc.10054$Xw3.8414@nwrdny03.gnilink.net… – Hide quoted text — Show quoted text -> "Harry Gerapetritis" <gerapetrit…@charter.net> wrote in message > news:10chvfq9kmq7eb@corp.supernews.com… > > I’ve been using CPAP since the beginning of the year, and my prescribed > > pressure has been changed several times as we try to strike a balance to > > minimize obstructive and central apneas. On a pressure of 9, I was having > > frequent centrals, while on a pressure of 7 I was having more obstructive > > apneas, so we settled on a pressure of 8.  I have since recorded about an > > hour of my sleeping on a number of occasions and I was shocked to hear how > > rapidly (and I guess shallowly) I was breathing. The faster than normal pace > > continued throughout the hour until the tape ended. Has anyone else observed > > this? Any idea what causes such shallow rapid breathing? > Just a guess (Mark’s comment is much more likely > relevant), but are you using a Respironics machine > with "C-Flex"? I used to catch myself doing short > rapid breaths "synching" with the C-Flex pressure > changes. This stopped long ago for me (I think…), > but it is possible it may be an issue for you (the > feature can be reduced to nearly "0" on the > machine, if this is what is happening). > — >  David Ruether >  r…@cornell.edu >  http://www.ferrario.com/ruether

Response:

I have this.  My shallow breathing is actually hypopneas. Hypopnea is partial obstruction of the airway.   "Harry Gerapetritis" <gerapetrit…@charter.net> wrote in message news:10chvfq9kmq7eb@corp.supernews.com…

: I’ve been using CPAP since the beginning of the year, and my prescribed : pressure has been changed several times as we try to strike a balance to : minimize obstructive and central apneas. On a pressure of 9, I was having : frequent centrals, while on a pressure of 7 I was having more obstructive : apneas, so we settled on a pressure of 8.  I have since recorded about an : hour of my sleeping on a number of occasions and I was shocked to hear how : rapidly (and I guess shallowly) I was breathing. The faster than normal pace : continued throughout the hour until the tape ended. Has anyone else observed : this? Any idea what causes such shallow rapid breathing? : :

Response:

"Harry Gerapetritis" <gerapetrit…@charter.net> wrote in message

news:10chvfq9kmq7eb@corp.supernews.com… > I’ve been using CPAP since the beginning of the year, and my prescribed > pressure has been changed several times as we try to strike a balance to > minimize obstructive and central apneas. On a pressure of 9, I was having > frequent centrals, while on a pressure of 7 I was having more obstructive > apneas, so we settled on a pressure of 8.  I have since recorded about an > hour of my sleeping on a number of occasions and I was shocked to hear how > rapidly (and I guess shallowly) I was breathing. The faster than normal pace > continued throughout the hour until the tape ended. Has anyone else observed > this? Any idea what causes such shallow rapid breathing?

Just a guess (Mark’s comment is much more likely relevant), but are you using a Respironics machine with "C-Flex"? I used to catch myself doing short rapid breaths "synching" with the C-Flex pressure changes. This stopped long ago for me (I think…), but it is possible it may be an issue for you (the feature can be reduced to nearly "0" on the machine, if this is what is happening). —  David Ruether  r…@cornell.edu  http://www.ferrario.com/ruether

Response:

I’ve been using CPAP since the beginning of the year, and my prescribed pressure has been changed several times as we try to strike a balance to minimize obstructive and central apneas. On a pressure of 9, I was having frequent centrals, while on a pressure of 7 I was having more obstructive apneas, so we settled on a pressure of 8.  I have since recorded about an hour of my sleeping on a number of occasions and I was shocked to hear how rapidly (and I guess shallowly) I was breathing. The faster than normal pace continued throughout the hour until the tape ended. Has anyone else observed this? Any idea what causes such shallow rapid breathing?

Response:

Titration Study Results

Question:

On Sat, 22 May 2004 09:02:03 -0400, eric pearson – Hide quoted text — Show quoted text -<nonono.ericp1.non…@nonono.fuse.net> wrote: >On Sat, 22 May 2004 09:44:43 +0100, Andy Hall <an…@hall.nospam> >wrote: >>>3) Bottom limit set too low. Bottom should be no lower than >>>about 3-4cm below actual 90th percentile. >>Where did you get that from?   It isn’t in any ResMed documentation >>that I have read, including the clinical manual. >There has been muchn discussion of this on Sleepnet. Some of the best >info comes from a fellow named Perry.

OK, but I think that I’d rather stick with the manufacturer’s recommendation…… .andy To email, substitute .nospam with .gl

Response:

On Sat, 22 May 2004 09:44:43 +0100, Andy Hall <an…@hall.nospam> wrote: >>3) Bottom limit set too low. Bottom should be no lower than >>about 3-4cm below actual 90th percentile. >Where did you get that from?   It isn’t in any ResMed documentation >that I have read, including the clinical manual.

There has been muchn discussion of this on Sleepnet. Some of the best info comes from a fellow named Perry. – Hide quoted text — Show quoted text ->>regards, >>eric pearson >>nonono.ericp1.non…@nonono.fuse.net >>On Fri, 21 May 2004 23:43:58 +0100, Andy Hall <an…@hall.nospam> >>wrote: >>>On Fri, 21 May 2004 21:45:57 GMT, "Sam" <newsgro…@hotmail.com> >>>wrote: >>>>"Andy Hall" <an…@hall.nospam> wrote in message news:93cra0t76ttasr10t9q2kamccohgptlcte@4ax.com… >>>>: >>>>: >The data at home over a one month period shows that I never exceed 12cm.   >>>>: >>>>: Is this from the software or the menu on the display? >>>>Yes. >>>>: >>>>: What are the leak values?   Can you look at a few days of this? >>>>: Generally with this mask, I would expect it to be below about 0.3 >>>>: l/sec but < 0.4  is OK.    More than 0.5 should be checked out. >>>>Yes, the leak values are low.  Around 3, but always less than 4. >>>That should be OK. >>>>: >>>>: What is the AHI and HI now looked at for a week and a month? >>>>: >>>>: Is it still at 11.6? >>>>Yes, it’s around 9-12.  The HI is around 5-7. >>>OK, so this is putting apnoea events at 4 – 5. >>>When you did the sleep test, do you know if they screened for central >>>apnoea events?    This could be an explanation for some of this. >>>This is a less common form of apnoea where the cause is related to the >>>brain "believing" that breathing is happening when it isn’t. Some >>>people have both forms. >>>The Autoset algorithm (described if you look on Resmed’s web site) >>>has a conservative approach whereby it gradually ramps the pressure up >>>due to flow limitation (associated with obstructive hypopnoea and >>>apnoea normally), but limits the pressure to 10cm in the case of >>>apnoea without associated flow limitation – i.e. central apnoeas. >>>Basically it is working by looking at the flow limitation >>>characteristics, which for obstructive events almost always precede >>>apnoea and dealing with those.     >>>However, the machine does record apnoeas and if downloaded using the >>>software >>>Go to http://www.resmed.co.uk/1006744953780.html and click on Night >>>Profile. >>>The bottom graph is of hypopnoea and apnoea.      Hypopnoea is shown >>>as an accumulating graph over the course of each hour, while apnoeas >>>are shown as events (red lollipops) where the height represents the >>>length of time of the event. >>>I would contact the sleep doctor or pulmonologist, get the machine >>>downloaded and ask them to look at the data – the machine records 5 >>>days worth of this level of detail and then summarises the results >>>after that. >>>I’m not a doctor, but something should explain why this is happening. >>>The doctor ought to be able to figure out whether there is a central >>>element to what you’re experiencing.   It is said that  even people >>>without sleep disorders at all, have a small number of central events >>>per night…… >>>>:   >>>>: FWIW, I have a virtually zero AI but HI is average around 4 as >>>>: described before. >>>>That’s really good. Even with the HI <10, my memory and concentration is noticably impaired. >>>OK. Is this your general feeling or do you have something to compare >>>it with?      One obvious question is are you doing the basic sleep >>>hygiene stuff?    Even so, the results could be better perhaps. >>>>: Some doctors do consider an AHI reduction to <10 to be a success as I >>>>: mentioned before. >>>>I know, some doctors also recommend laser uvula surgery too for apnea.  I don’t agree with either. >>>>: >>>>: If you are concerned, ask to borrow an oximeter for a couple of nights >>>>: to check oxygen levels.    That is a pretty good test of effectiveness >>>>: of treatment. >>>>What kind of results should I look for with the oximeter? >>>It does vary  from person to person.     IIRC, a satisfactory score is >>>if the oxygen level remains in the high 90s percent for most of the >>>time. >>>Again it’s something to discuss with the doctor.    It’s possible that >>>the clinic has the gear which allows an oximeter to be hooked up to >>>the Spirit – then all parameters are recorded together.   Look at the >>>link above but click on detailed data.   You can see how oxygen >>>saturation (SpO2) and pulse rate are correlated with pressure and >>>apnoea/hypopnoea.    You can also see that there is a correlation in >>>the example of when apnoea events are happening, oxygen desaturation >>>(dips in the graph) and rises in pressure. >>>Of course, a separate instrument is fine as well and typically they >>>have a PC hookup as well so that the charts can be compared. >>>AIUI from when I went through this exercise with my specialist, they >>>are looking for extended periods of oxygen desaturation if there is a >>>suspicion that therapy is not as effective as it could be. >>>At any rate, the results you are getting are not horrendous, but I >>>think if it were me, I would want to pursue it with the doctor and >>>find out why.     >>>.andy >>>To email, substitute .nospam with .gl >.andy >To email, substitute .nospam with .gl

regards, eric pearson nonono.ericp1.non…@nonono.fuse.net

Response:

On Fri, 21 May 2004 21:23:25 -0400, eric pearson <nonono.ericp1.non…@nonono.fuse.net> wrote: >Do you mean 3-4 on leaks or 0.3-0.4? >IIRC this is a ResMed unit. ResMed states that the sensing and >reaction of their APAPs is suboptimal if leak > 0.4. My testing of >a ResMed unit confirms this.

In the context, it would have to be 0.3 to 0.4 because the machine reports high leak and switches off at not much over 1 litre/sec. FWIW, there is a margin here.   In the clinical documentation, they say that treatment will be effective at up to 0.7.   The aim should be to reduce leak to below 0.4 for most of the time. – Hide quoted text — Show quoted text ->regards, >eric pearson >nonono.ericp1.non…@nonono.fuse.net >On Fri, 21 May 2004 21:45:57 GMT, "Sam" <newsgro…@hotmail.com> >wrote: >>"Andy Hall" <an…@hall.nospam> wrote in message news:93cra0t76ttasr10t9q2kamccohgptlcte@4ax.com… >>: >>: >The data at home over a one month period shows that I never exceed 12cm.   >>: >>: Is this from the software or the menu on the display? >>Yes. >>: >>: What are the leak values?   Can you look at a few days of this? >>: Generally with this mask, I would expect it to be below about 0.3 >>: l/sec but < 0.4  is OK.    More than 0.5 should be checked out. >>Yes, the leak values are low.  Around 3, but always less than 4. >>: >>: What is the AHI and HI now looked at for a week and a month? >>: >>: Is it still at 11.6? >>Yes, it’s around 9-12.  The HI is around 5-7. >>:   >>: FWIW, I have a virtually zero AI but HI is average around 4 as >>: described before. >>That’s really good. Even with the HI <10, my memory and concentration is noticably impaired. >>: Some doctors do consider an AHI reduction to <10 to be a success as I >>: mentioned before. >>I know, some doctors also recommend laser uvula surgery too for apnea.  I don’t agree with either. >>: >>: If you are concerned, ask to borrow an oximeter for a couple of nights >>: to check oxygen levels.    That is a pretty good test of effectiveness >>: of treatment. >>What kind of results should I look for with the oximeter?

.andy To email, substitute .nospam with .gl

Response:

On Fri, 21 May 2004 21:37:37 -0400, eric pearson <nonono.ericp1.non…@nonono.fuse.net> wrote: >Apnea  5? >AHI sometimes > 10? >You should expect better results >Sounds to me that one of several things is happening: >1) Central Apnea is happening. Go to BiPAP and/or appropriate CNS >medications.

Could be, which was a point I raised.  But BiPap is not always the option for central apnoea, and may not be at all where there is a mix of central and obstructive events. >2) This APAP does not respond well to patient’s signals. >Leaks could cause this, or in the case of ResMed, the use of anything >other than a narrowly defined set of facial interfaces and humidifiers >could cause this. Even the generally well-regarded Breeze rig reduces >the effectiveness of ResMed sensing.

They do make that clear in their documentation and the reason, which is the pressure/flow characteristics through the blow off vent of the interface are also clear.     Resmed adopt the general position of saying that only their interfaces are tested for use with their machines.   In fact others will work provided that they have a vent with characteristics comparable to one of ResMed’s mask types that are settable on the machine.    For example the F&P HC45 has very similar vent properties to the ResMed standard setting.   The Adam circuit is also known to work.  The Breeze doesn’t because the vent is out of range of one of the settings.   THe manufacturers of the Breeze have the issue there because they should design their interface more sensibly to work with more machines.   That would be a lot easier than changing a flow generator algorithm. In this case it doesn’t matter anyway because the mask is an Activa. >3) Bottom limit set too low. Bottom should be no lower than >about 3-4cm below actual 90th percentile.

Where did you get that from?   It isn’t in any ResMed documentation that I have read, including the clinical manual. >4) Wrong APAP for the patient. The ResMed ‘do not react to >hypopnea if current pressure > 10cm’ part of the algorithm may be >questionable for patients who have pressure needs > 10 and >a high Hyopnea/Apnea ratio.

That isn’t how ResMed describe that their algorithm works. Hypopnoea is almost always associated with flow limitations unless central hypopnoea is involved. I think you mean hypopnoea to apnoea ratio? >The algorithm will work if the patient’s >flow limitation behavior fits within the behavior patterns programmed >into the algorithm. If the ‘breath profile’ does not match what is >expected by the algorithm, reaction to potential hypopneas at pressure > > 10 cm could be compromised.

Not quite.  That is only true if there is not associated flow limitation which in the case of obstructive behaviour there is. – Hide quoted text — Show quoted text ->regards, >eric pearson >nonono.ericp1.non…@nonono.fuse.net >On Fri, 21 May 2004 23:43:58 +0100, Andy Hall <an…@hall.nospam> >wrote: >>On Fri, 21 May 2004 21:45:57 GMT, "Sam" <newsgro…@hotmail.com> >>wrote: >>>"Andy Hall" <an…@hall.nospam> wrote in message news:93cra0t76ttasr10t9q2kamccohgptlcte@4ax.com… >>>: >>>: >The data at home over a one month period shows that I never exceed 12cm.   >>>: >>>: Is this from the software or the menu on the display? >>>Yes. >>>: >>>: What are the leak values?   Can you look at a few days of this? >>>: Generally with this mask, I would expect it to be below about 0.3 >>>: l/sec but < 0.4  is OK.    More than 0.5 should be checked out. >>>Yes, the leak values are low.  Around 3, but always less than 4. >>That should be OK. >>>: >>>: What is the AHI and HI now looked at for a week and a month? >>>: >>>: Is it still at 11.6? >>>Yes, it’s around 9-12.  The HI is around 5-7. >>OK, so this is putting apnoea events at 4 – 5. >>When you did the sleep test, do you know if they screened for central >>apnoea events?    This could be an explanation for some of this. >>This is a less common form of apnoea where the cause is related to the >>brain "believing" that breathing is happening when it isn’t. Some >>people have both forms. >>The Autoset algorithm (described if you look on Resmed’s web site) >>has a conservative approach whereby it gradually ramps the pressure up >>due to flow limitation (associated with obstructive hypopnoea and >>apnoea normally), but limits the pressure to 10cm in the case of >>apnoea without associated flow limitation – i.e. central apnoeas. >>Basically it is working by looking at the flow limitation >>characteristics, which for obstructive events almost always precede >>apnoea and dealing with those.     >>However, the machine does record apnoeas and if downloaded using the >>software >>Go to http://www.resmed.co.uk/1006744953780.html and click on Night >>Profile. >>The bottom graph is of hypopnoea and apnoea.      Hypopnoea is shown >>as an accumulating graph over the course of each hour, while apnoeas >>are shown as events (red lollipops) where the height represents the >>length of time of the event. >>I would contact the sleep doctor or pulmonologist, get the machine >>downloaded and ask them to look at the data – the machine records 5 >>days worth of this level of detail and then summarises the results >>after that. >>I’m not a doctor, but something should explain why this is happening. >>The doctor ought to be able to figure out whether there is a central >>element to what you’re experiencing.   It is said that  even people >>without sleep disorders at all, have a small number of central events >>per night…… >>>:   >>>: FWIW, I have a virtually zero AI but HI is average around 4 as >>>: described before. >>>That’s really good. Even with the HI <10, my memory and concentration is noticably impaired. >>OK. Is this your general feeling or do you have something to compare >>it with?      One obvious question is are you doing the basic sleep >>hygiene stuff?    Even so, the results could be better perhaps. >>>: Some doctors do consider an AHI reduction to <10 to be a success as I >>>: mentioned before. >>>I know, some doctors also recommend laser uvula surgery too for apnea.  I don’t agree with either. >>>: >>>: If you are concerned, ask to borrow an oximeter for a couple of nights >>>: to check oxygen levels.    That is a pretty good test of effectiveness >>>: of treatment. >>>What kind of results should I look for with the oximeter? >>It does vary  from person to person.     IIRC, a satisfactory score is >>if the oxygen level remains in the high 90s percent for most of the >>time. >>Again it’s something to discuss with the doctor.    It’s possible that >>the clinic has the gear which allows an oximeter to be hooked up to >>the Spirit – then all parameters are recorded together.   Look at the >>link above but click on detailed data.   You can see how oxygen >>saturation (SpO2) and pulse rate are correlated with pressure and >>apnoea/hypopnoea.    You can also see that there is a correlation in >>the example of when apnoea events are happening, oxygen desaturation >>(dips in the graph) and rises in pressure. >>Of course, a separate instrument is fine as well and typically they >>have a PC hookup as well so that the charts can be compared. >>AIUI from when I went through this exercise with my specialist, they >>are looking for extended periods of oxygen desaturation if there is a >>suspicion that therapy is not as effective as it could be. >>At any rate, the results you are getting are not horrendous, but I >>think if it were me, I would want to pursue it with the doctor and >>find out why.     >>.andy >>To email, substitute .nospam with .gl

.andy To email, substitute .nospam with .gl

Response:

Apnea  5? AHI sometimes > 10? You should expect better results Sounds to me that one of several things is happening: 1) Central Apnea is happening. Go to BiPAP and/or appropriate CNS medications. 2) This APAP does not respond well to patient’s signals. Leaks could cause this, or in the case of ResMed, the use of anything other than a narrowly defined set of facial interfaces and humidifiers could cause this. Even the generally well-regarded Breeze rig reduces the effectiveness of ResMed sensing. 3) Bottom limit set too low. Bottom should be no lower than about 3-4cm below actual 90th percentile. 4) Wrong APAP for the patient. The ResMed ‘do not react to hypopnea if current pressure > 10cm’ part of the algorithm may be questionable for patients who have pressure needs > 10 and a high Hyopnea/Apnea ratio. The algorithm will work if the patient’s flow limitation behavior fits within the behavior patterns programmed into the algorithm. If the ‘breath profile’ does not match what is expected by the algorithm, reaction to potential hypopneas at pressure  > 10 cm could be compromised. regards, eric pearson nonono.ericp1.non…@nonono.fuse.net On Fri, 21 May 2004 23:43:58 +0100, Andy Hall <an…@hall.nospam> wrote: – Hide quoted text — Show quoted text ->On Fri, 21 May 2004 21:45:57 GMT, "Sam" <newsgro…@hotmail.com> >wrote: >>"Andy Hall" <an…@hall.nospam> wrote in message news:93cra0t76ttasr10t9q2kamccohgptlcte@4ax.com… >>: >>: >The data at home over a one month period shows that I never exceed 12cm.   >>: >>: Is this from the software or the menu on the display? >>Yes. >>: >>: What are the leak values?   Can you look at a few days of this? >>: Generally with this mask, I would expect it to be below about 0.3 >>: l/sec but < 0.4  is OK.    More than 0.5 should be checked out. >>Yes, the leak values are low.  Around 3, but always less than 4. >That should be OK. >>: >>: What is the AHI and HI now looked at for a week and a month? >>: >>: Is it still at 11.6? >>Yes, it’s around 9-12.  The HI is around 5-7. >OK, so this is putting apnoea events at 4 – 5. >When you did the sleep test, do you know if they screened for central >apnoea events?    This could be an explanation for some of this. >This is a less common form of apnoea where the cause is related to the >brain "believing" that breathing is happening when it isn’t. Some >people have both forms. >The Autoset algorithm (described if you look on Resmed’s web site) >has a conservative approach whereby it gradually ramps the pressure up >due to flow limitation (associated with obstructive hypopnoea and >apnoea normally), but limits the pressure to 10cm in the case of >apnoea without associated flow limitation – i.e. central apnoeas. >Basically it is working by looking at the flow limitation >characteristics, which for obstructive events almost always precede >apnoea and dealing with those.     >However, the machine does record apnoeas and if downloaded using the >software >Go to http://www.resmed.co.uk/1006744953780.html and click on Night >Profile. >The bottom graph is of hypopnoea and apnoea.      Hypopnoea is shown >as an accumulating graph over the course of each hour, while apnoeas >are shown as events (red lollipops) where the height represents the >length of time of the event. >I would contact the sleep doctor or pulmonologist, get the machine >downloaded and ask them to look at the data – the machine records 5 >days worth of this level of detail and then summarises the results >after that. >I’m not a doctor, but something should explain why this is happening. >The doctor ought to be able to figure out whether there is a central >element to what you’re experiencing.   It is said that  even people >without sleep disorders at all, have a small number of central events >per night…… >>:   >>: FWIW, I have a virtually zero AI but HI is average around 4 as >>: described before. >>That’s really good. Even with the HI <10, my memory and concentration is noticably impaired. >OK. Is this your general feeling or do you have something to compare >it with?      One obvious question is are you doing the basic sleep >hygiene stuff?    Even so, the results could be better perhaps. >>: Some doctors do consider an AHI reduction to <10 to be a success as I >>: mentioned before. >>I know, some doctors also recommend laser uvula surgery too for apnea.  I don’t agree with either. >>: >>: If you are concerned, ask to borrow an oximeter for a couple of nights >>: to check oxygen levels.    That is a pretty good test of effectiveness >>: of treatment. >>What kind of results should I look for with the oximeter? >It does vary  from person to person.     IIRC, a satisfactory score is >if the oxygen level remains in the high 90s percent for most of the >time. >Again it’s something to discuss with the doctor.    It’s possible that >the clinic has the gear which allows an oximeter to be hooked up to >the Spirit – then all parameters are recorded together.   Look at the >link above but click on detailed data.   You can see how oxygen >saturation (SpO2) and pulse rate are correlated with pressure and >apnoea/hypopnoea.    You can also see that there is a correlation in >the example of when apnoea events are happening, oxygen desaturation >(dips in the graph) and rises in pressure. >Of course, a separate instrument is fine as well and typically they >have a PC hookup as well so that the charts can be compared. >AIUI from when I went through this exercise with my specialist, they >are looking for extended periods of oxygen desaturation if there is a >suspicion that therapy is not as effective as it could be. >At any rate, the results you are getting are not horrendous, but I >think if it were me, I would want to pursue it with the doctor and >find out why.     >.andy >To email, substitute .nospam with .gl

Response:

On Fri, 21 May 2004 21:45:57 GMT, "Sam" <newsgro…@hotmail.com> wrote: >"Andy Hall" <an…@hall.nospam> wrote in message news:93cra0t76ttasr10t9q2kamccohgptlcte@4ax.com… >: >: >The data at home over a one month period shows that I never exceed 12cm.   >: >: Is this from the software or the menu on the display? >Yes. >: >: What are the leak values?   Can you look at a few days of this? >: Generally with this mask, I would expect it to be below about 0.3 >: l/sec but < 0.4  is OK.    More than 0.5 should be checked out. >Yes, the leak values are low.  Around 3, but always less than 4.

That should be OK. >: >: What is the AHI and HI now looked at for a week and a month? >: >: Is it still at 11.6? >Yes, it’s around 9-12.  The HI is around 5-7.

OK, so this is putting apnoea events at 4 – 5. When you did the sleep test, do you know if they screened for central apnoea events?    This could be an explanation for some of this. This is a less common form of apnoea where the cause is related to the brain "believing" that breathing is happening when it isn’t. Some people have both forms. The Autoset algorithm (described if you look on Resmed’s web site) has a conservative approach whereby it gradually ramps the pressure up due to flow limitation (associated with obstructive hypopnoea and apnoea normally), but limits the pressure to 10cm in the case of apnoea without associated flow limitation – i.e. central apnoeas. Basically it is working by looking at the flow limitation characteristics, which for obstructive events almost always precede apnoea and dealing with those.     However, the machine does record apnoeas and if downloaded using the software Go to http://www.resmed.co.uk/1006744953780.html and click on Night Profile. The bottom graph is of hypopnoea and apnoea.      Hypopnoea is shown as an accumulating graph over the course of each hour, while apnoeas are shown as events (red lollipops) where the height represents the length of time of the event. I would contact the sleep doctor or pulmonologist, get the machine downloaded and ask them to look at the data – the machine records 5 days worth of this level of detail and then summarises the results after that. I’m not a doctor, but something should explain why this is happening. The doctor ought to be able to figure out whether there is a central element to what you’re experiencing.   It is said that  even people without sleep disorders at all, have a small number of central events per night…… >:   >: FWIW, I have a virtually zero AI but HI is average around 4 as >: described before. >That’s really good. Even with the HI <10, my memory and concentration is noticably impaired.

OK. Is this your general feeling or do you have something to compare it with?      One obvious question is are you doing the basic sleep hygiene stuff?    Even so, the results could be better perhaps. >: Some doctors do consider an AHI reduction to <10 to be a success as I >: mentioned before. >I know, some doctors also recommend laser uvula surgery too for apnea.  I don’t agree with either. >: >: If you are concerned, ask to borrow an oximeter for a couple of nights >: to check oxygen levels.    That is a pretty good test of effectiveness >: of treatment. >What kind of results should I look for with the oximeter?

It does vary  from person to person.     IIRC, a satisfactory score is if the oxygen level remains in the high 90s percent for most of the time. Again it’s something to discuss with the doctor.    It’s possible that the clinic has the gear which allows an oximeter to be hooked up to the Spirit – then all parameters are recorded together.   Look at the link above but click on detailed data.   You can see how oxygen saturation (SpO2) and pulse rate are correlated with pressure and apnoea/hypopnoea.    You can also see that there is a correlation in the example of when apnoea events are happening, oxygen desaturation (dips in the graph) and rises in pressure. Of course, a separate instrument is fine as well and typically they have a PC hookup as well so that the charts can be compared. AIUI from when I went through this exercise with my specialist, they are looking for extended periods of oxygen desaturation if there is a suspicion that therapy is not as effective as it could be. At any rate, the results you are getting are not horrendous, but I think if it were me, I would want to pursue it with the doctor and find out why.     .andy To email, substitute .nospam with .gl

Response:

Do you mean 3-4 on leaks or 0.3-0.4? IIRC this is a ResMed unit. ResMed states that the sensing and reaction of their APAPs is suboptimal if leak > 0.4. My testing of a ResMed unit confirms this. regards, eric pearson nonono.ericp1.non…@nonono.fuse.net On Fri, 21 May 2004 21:45:57 GMT, "Sam" <newsgro…@hotmail.com> wrote: – Hide quoted text — Show quoted text ->"Andy Hall" <an…@hall.nospam> wrote in message news:93cra0t76ttasr10t9q2kamccohgptlcte@4ax.com… >: >: >The data at home over a one month period shows that I never exceed 12cm.   >: >: Is this from the software or the menu on the display? >Yes. >: >: What are the leak values?   Can you look at a few days of this? >: Generally with this mask, I would expect it to be below about 0.3 >: l/sec but < 0.4  is OK.    More than 0.5 should be checked out. >Yes, the leak values are low.  Around 3, but always less than 4. >: >: What is the AHI and HI now looked at for a week and a month? >: >: Is it still at 11.6? >Yes, it’s around 9-12.  The HI is around 5-7. >:   >: FWIW, I have a virtually zero AI but HI is average around 4 as >: described before. >That’s really good. Even with the HI <10, my memory and concentration is noticably impaired. >: Some doctors do consider an AHI reduction to <10 to be a success as I >: mentioned before. >I know, some doctors also recommend laser uvula surgery too for apnea.  I don’t agree with either. >: >: If you are concerned, ask to borrow an oximeter for a couple of nights >: to check oxygen levels.    That is a pretty good test of effectiveness >: of treatment. >What kind of results should I look for with the oximeter?

Response:

"Andy Hall" <an…@hall.nospam> wrote in message news:93cra0t76ttasr10t9q2kamccohgptlcte@4ax.com…

: : >The data at home over a one month period shows that I never exceed 12cm.   : : Is this from the software or the menu on the display? Yes. : : What are the leak values?   Can you look at a few days of this? : Generally with this mask, I would expect it to be below about 0.3 : l/sec but < 0.4  is OK.    More than 0.5 should be checked out. Yes, the leak values are low.  Around 3, but always less than 4. : : What is the AHI and HI now looked at for a week and a month? : : Is it still at 11.6? Yes, it’s around 9-12.  The HI is around 5-7. :   : FWIW, I have a virtually zero AI but HI is average around 4 as : described before. That’s really good. Even with the HI <10, my memory and concentration is noticably impaired. : Some doctors do consider an AHI reduction to <10 to be a success as I : mentioned before. I know, some doctors also recommend laser uvula surgery too for apnea.  I don’t agree with either. : : If you are concerned, ask to borrow an oximeter for a couple of nights : to check oxygen levels.    That is a pretty good test of effectiveness : of treatment. What kind of results should I look for with the oximeter?

Response:

On Fri, 21 May 2004 05:22:22 GMT, "Sam" <newsgro…@hotmail.com> wrote: >I am not sure if this is directed at me, but in any case, I will respond. >The machine at home is the Resmed Autospirit, while at the lab it was a Respironics brand.   >The mask is a Mirage Activa. >The target range is 6-15cm.

I have the same equipment with the minimum set to 6cm and the maximum permissible set to the default 20cm. >The data at home over a one month period shows that I never exceed 12cm.  

Is this from the software or the menu on the display? The absolute max reading is not very important, which is why a 95th percentile is used – basically to take out the very short term peaks for statistical purposes.     >This coincides with the sleep study results of the pressure being 12cm and the best efficiency, although for a short period of time due to >compliance issues is with an AHI index  of 8.9 and  HI at 7.

The sleep study pressure of 12cm is as a result of a one night study – an interesting correlation but not much more. What are the leak values?   Can you look at a few days of this? Generally with this mask, I would expect it to be below about 0.3 l/sec but < 0.4  is OK.    More than 0.5 should be checked out. What is the AHI and HI now looked at for a week and a month? Is it still at 11.6? FWIW, I have a virtually zero AI but HI is average around 4 as described before. Some doctors do consider an AHI reduction to <10 to be a success as I mentioned before. If you are concerned, ask to borrow an oximeter for a couple of nights to check oxygen levels.    That is a pretty good test of effectiveness of treatment. >I am considering a dental appliance but the doctor measures success as reducing the AHI below 10.  The cost is also quite high.

I wouldn’t bother with that at this point.   – Hide quoted text — Show quoted text ->Sam >"eric pearson" <nonono.ericp1.non…@nonono.fuse.net> wrote in message news:olgqa0986t8tngm2ngtvc7dv7ll6ce59lo@4ax.com… >: Andy >: >: Why do you think the doc should ever fail to try to get the results to >: ‘nontreatable’. I would not forgive my doc for doing so.  My ‘very >: severe’ AHI of 96+ has been treated to (always < 5, sometimes < 1). >: >: BTW, as a data point: >: 1) What machine? >: 2) What facial interface? >: 3) What target pressure range is set on your machine? >: >: I have a reason for asking. Different machines sense things >: differently. I’ve used a couple of models with several interfaces and >: might be able to reassure you and/or suggest things at which you could >: look (no dangling participles here!) >: >: regards, >: eric pearson >: nonono.ericp1.non…@nonono.fuse.net >: >: >: P.S. Sir Winston Churchill on dangling participles: >: ‘That is the silliest rule up with which I have ever had to put’. >: >: n Thu, 20 May 2004 10:48:03 +0100, Andy Hall <an…@hall.nospam> >: wrote: >: >: >On Thu, 20 May 2004 01:46:44 GMT, "Sam" <rcm…@hotmail.com> wrote: >: > >: >>Just curious…why on my sleep titration study, my AHI is was relatively >: >>high (for me) with CPAP use 100% of the time @ 11.6 , while without CPAP it >: >>was 16? >: >>That’s not much of an improvement, now is it?  My starting pressure was 10 >: >>and shortly thereafter, it was set and maintained at 12 but the AHI index >: >>was still 11.6. >: >> >: >>Something sounds weird to me here? >: >>

.andy To email, substitute .nospam with .gl

Response:

On Thu, 20 May 2004 19:51:18 -0400, eric pearson – Hide quoted text — Show quoted text -<nonono.ericp1.non…@nonono.fuse.net> wrote: >Andy >Why do you think the doc should ever fail to try to get the results to >’nontreatable’. I would not forgive my doc for doing so.  My ‘very >severe’ AHI of 96+ has been treated to (always < 5, sometimes < 1). >BTW, as a data point: >1) What machine? >2) What facial interface? >3) What target pressure range is set on your machine? >I have a reason for asking. Different machines sense things >differently. I’ve used a couple of models with several interfaces and >might be able to reassure you and/or suggest things at which you could >look (no dangling participles here!) >regards, >eric pearson >nonono.ericp1.non…@nonono.fuse.net >P.S. Sir Winston Churchill on dangling participles: >’That is the silliest rule up with which I have ever had to put’.

Did you mean me, Eric,or Sam? – Hide quoted text — Show quoted text ->n Thu, 20 May 2004 10:48:03 +0100, Andy Hall <an…@hall.nospam> >wrote: >>On Thu, 20 May 2004 01:46:44 GMT, "Sam" <rcm…@hotmail.com> wrote: >>>Just curious…why on my sleep titration study, my AHI is was relatively >>>high (for me) with CPAP use 100% of the time @ 11.6 , while without CPAP it >>>was 16? >>>That’s not much of an improvement, now is it?  My starting pressure was 10 >>>and shortly thereafter, it was set and maintained at 12 but the AHI index >>>was still 11.6. >>>Something sounds weird to me here? >>Yes and no. >>The target values for AHI tend to be a matter of opinion depending on >>where you are.  In some countries the recommended practice is to try >>to go for 5 or less with treatment, while in others it’s 10 and there >>are some specialists who won’t treat apnoea with CPAP at AHI <10. >>People with very severe OSA may have AHI figures of 60 or more and >>getting the figure down to 11.6 as you have would be considered a >>major success.     With a starting point of 16, there is not as much >>room for improvement. >>I think that you also have to realise that a titration study results >>in a single pressure that is set in artificial lab conditions on one >>night.   It could easily be that at home, in your own environment that >>the results are better.   Empirically you can test that by how you are >>feeling.  More scientifically you could ask to borrow a finger >>oximeter to actually check that treatment is being effective. >>It’s also import to realise that AHI figures vary considerably from >>night to night for most people, so a more thorough test would actually >>check AHI over at least 3 or 4 nights.    This is why in some >>countries, lab titrations are being abandoned in favour of equipment >>that you take home and run the tests automatically in your own >>environment. >>I looked at my own results over the last couple of weeks as reported >>on my autotitrating machine. >>The average value for AHI was 4.7 (with 4.4 of that being hypopnoea) >>and median pressure 8cm and 95th percentile pressure 11cm, max 12cm. >>However, on the worst day (which interestingly corresponded to when I >>was travelling) was AHI of 10.5 and on the best day was 2.8.   On most >>days it is in the 4 – 4.5 area.    On the 10.5 day, a high mask leak >>was reported as well and I am pretty sure was due to mouth breathing. >>One none of these days did I feel unusually tired, however. >>I would suggest going back to the sleep centre and asking them to run >>the test again, or alternatively ask for a study running over several >>days or oximeter test. >>.andy >>To email, substitute .nospam with .gl

.andy To email, substitute .nospam with .gl

Response:

I am not sure if this is directed at me, but in any case, I will respond. The machine at home is the Resmed Autospirit, while at the lab it was a Respironics brand.   The mask is a Mirage Activa. The target range is 6-15cm. The data at home over a one month period shows that I never exceed 12cm.  This coincides with the sleep study results of the pressure being 12cm and the best efficiency, although for a short period of time due to compliance issues is with an AHI index  of 8.9 and  HI at 7. I am considering a dental appliance but the doctor measures success as reducing the AHI below 10.  The cost is also quite high. Sam "eric pearson" <nonono.ericp1.non…@nonono.fuse.net> wrote in message news:olgqa0986t8tngm2ngtvc7dv7ll6ce59lo@4ax.com…

: Andy : : Why do you think the doc should ever fail to try to get the results to : ‘nontreatable’. I would not forgive my doc for doing so.  My ‘very : severe’ AHI of 96+ has been treated to (always < 5, sometimes < 1). : : BTW, as a data point: : 1) What machine? : 2) What facial interface? : 3) What target pressure range is set on your machine? : : I have a reason for asking. Different machines sense things : differently. I’ve used a couple of models with several interfaces and : might be able to reassure you and/or suggest things at which you could : look (no dangling participles here!) : : regards, : eric pearson : nonono.ericp1.non…@nonono.fuse.net : : : P.S. Sir Winston Churchill on dangling participles: : ‘That is the silliest rule up with which I have ever had to put’. : : n Thu, 20 May 2004 10:48:03 +0100, Andy Hall <an…@hall.nospam> : wrote:

: : >On Thu, 20 May 2004 01:46:44 GMT, "Sam" <rcm…@hotmail.com> wrote: : > : >>Just curious…why on my sleep titration study, my AHI is was relatively : >>high (for me) with CPAP use 100% of the time @ 11.6 , while without CPAP it : >>was 16? : >>That’s not much of an improvement, now is it?  My starting pressure was 10 : >>and shortly thereafter, it was set and maintained at 12 but the AHI index : >>was still 11.6. : >> : >>Something sounds weird to me here? : >> : >Yes and no. : > : >The target values for AHI tend to be a matter of opinion depending on : >where you are.  In some countries the recommended practice is to try : >to go for 5 or less with treatment, while in others it’s 10 and there : >are some specialists who won’t treat apnoea with CPAP at AHI <10. : > : >People with very severe OSA may have AHI figures of 60 or more and : >getting the figure down to 11.6 as you have would be considered a : >major success.     With a starting point of 16, there is not as much : >room for improvement. : > : >I think that you also have to realise that a titration study results : >in a single pressure that is set in artificial lab conditions on one : >night.   It could easily be that at home, in your own environment that : >the results are better.   Empirically you can test that by how you are : >feeling.  More scientifically you could ask to borrow a finger : >oximeter to actually check that treatment is being effective. : > : >It’s also import to realise that AHI figures vary considerably from : >night to night for most people, so a more thorough test would actually : >check AHI over at least 3 or 4 nights.    This is why in some : >countries, lab titrations are being abandoned in favour of equipment : >that you take home and run the tests automatically in your own : >environment. : > : >I looked at my own results over the last couple of weeks as reported : >on my autotitrating machine. : > : >The average value for AHI was 4.7 (with 4.4 of that being hypopnoea) : >and median pressure 8cm and 95th percentile pressure 11cm, max 12cm. : > : >However, on the worst day (which interestingly corresponded to when I : >was travelling) was AHI of 10.5 and on the best day was 2.8.   On most : >days it is in the 4 – 4.5 area.    On the 10.5 day, a high mask leak : >was reported as well and I am pretty sure was due to mouth breathing. : > : >One none of these days did I feel unusually tired, however. : > : >I would suggest going back to the sleep centre and asking them to run : >the test again, or alternatively ask for a study running over several : >days or oximeter test. : >.andy : > : >To email, substitute .nospam with .gl : :

Response:

Just curious…why on my sleep titration study, my AHI is was relatively high (for me) with CPAP use 100% of the time @ 11.6 , while without CPAP it was 16? That’s not much of an improvement, now is it?  My starting pressure was 10 and shortly thereafter, it was set and maintained at 12 but the AHI index was still 11.6. Something sounds weird to me here?

Response:

Couple of possibilities: 1) Pressure still too low. I was titrated at 10, then moved to 14, then another study said 18. No weight change or lifestyle changes. 2) Mouth breathing. regards, eric pearson nonono.ericp1.non…@nonono.fuse.net – Hide quoted text — Show quoted text -On Thu, 20 May 2004 01:46:44 GMT, "Sam" <rcm…@hotmail.com> wrote: >Just curious…why on my sleep titration study, my AHI is was relatively >high (for me) with CPAP use 100% of the time @ 11.6 , while without CPAP it >was 16? >That’s not much of an improvement, now is it?  My starting pressure was 10 >and shortly thereafter, it was set and maintained at 12 but the AHI index >was still 11.6. >Something sounds weird to me here?

Response:

On Thu, 20 May 2004 01:46:44 GMT, "Sam" <rcm…@hotmail.com> wrote: >Just curious…why on my sleep titration study, my AHI is was relatively >high (for me) with CPAP use 100% of the time @ 11.6 , while without CPAP it >was 16? >That’s not much of an improvement, now is it?  My starting pressure was 10 >and shortly thereafter, it was set and maintained at 12 but the AHI index >was still 11.6. >Something sounds weird to me here?

Yes and no. The target values for AHI tend to be a matter of opinion depending on where you are.  In some countries the recommended practice is to try to go for 5 or less with treatment, while in others it’s 10 and there are some specialists who won’t treat apnoea with CPAP at AHI <10. People with very severe OSA may have AHI figures of 60 or more and getting the figure down to 11.6 as you have would be considered a major success.     With a starting point of 16, there is not as much room for improvement. I think that you also have to realise that a titration study results in a single pressure that is set in artificial lab conditions on one night.   It could easily be that at home, in your own environment that the results are better.   Empirically you can test that by how you are feeling.  More scientifically you could ask to borrow a finger oximeter to actually check that treatment is being effective. It’s also import to realise that AHI figures vary considerably from night to night for most people, so a more thorough test would actually check AHI over at least 3 or 4 nights.    This is why in some countries, lab titrations are being abandoned in favour of equipment that you take home and run the tests automatically in your own environment. I looked at my own results over the last couple of weeks as reported on my autotitrating machine. The average value for AHI was 4.7 (with 4.4 of that being hypopnoea) and median pressure 8cm and 95th percentile pressure 11cm, max 12cm. However, on the worst day (which interestingly corresponded to when I was travelling) was AHI of 10.5 and on the best day was 2.8.   On most days it is in the 4 – 4.5 area.    On the 10.5 day, a high mask leak was reported as well and I am pretty sure was due to mouth breathing. One none of these days did I feel unusually tired, however. I would suggest going back to the sleep centre and asking them to run the test again, or alternatively ask for a study running over several days or oximeter test. .andy To email, substitute .nospam with .gl

Response:

Andy Why do you think the doc should ever fail to try to get the results to ‘nontreatable’. I would not forgive my doc for doing so.  My ‘very severe’ AHI of 96+ has been treated to (always < 5, sometimes < 1). BTW, as a data point: 1) What machine? 2) What facial interface? 3) What target pressure range is set on your machine? I have a reason for asking. Different machines sense things differently. I’ve used a couple of models with several interfaces and might be able to reassure you and/or suggest things at which you could look (no dangling participles here!) regards, eric pearson nonono.ericp1.non…@nonono.fuse.net P.S. Sir Winston Churchill on dangling participles: ‘That is the silliest rule up with which I have ever had to put’. n Thu, 20 May 2004 10:48:03 +0100, Andy Hall <an…@hall.nospam> wrote: – Hide quoted text — Show quoted text ->On Thu, 20 May 2004 01:46:44 GMT, "Sam" <rcm…@hotmail.com> wrote: >>Just curious…why on my sleep titration study, my AHI is was relatively >>high (for me) with CPAP use 100% of the time @ 11.6 , while without CPAP it >>was 16? >>That’s not much of an improvement, now is it?  My starting pressure was 10 >>and shortly thereafter, it was set and maintained at 12 but the AHI index >>was still 11.6. >>Something sounds weird to me here? >Yes and no. >The target values for AHI tend to be a matter of opinion depending on >where you are.  In some countries the recommended practice is to try >to go for 5 or less with treatment, while in others it’s 10 and there >are some specialists who won’t treat apnoea with CPAP at AHI <10. >People with very severe OSA may have AHI figures of 60 or more and >getting the figure down to 11.6 as you have would be considered a >major success.     With a starting point of 16, there is not as much >room for improvement. >I think that you also have to realise that a titration study results >in a single pressure that is set in artificial lab conditions on one >night.   It could easily be that at home, in your own environment that >the results are better.   Empirically you can test that by how you are >feeling.  More scientifically you could ask to borrow a finger >oximeter to actually check that treatment is being effective. >It’s also import to realise that AHI figures vary considerably from >night to night for most people, so a more thorough test would actually >check AHI over at least 3 or 4 nights.    This is why in some >countries, lab titrations are being abandoned in favour of equipment >that you take home and run the tests automatically in your own >environment. >I looked at my own results over the last couple of weeks as reported >on my autotitrating machine. >The average value for AHI was 4.7 (with 4.4 of that being hypopnoea) >and median pressure 8cm and 95th percentile pressure 11cm, max 12cm. >However, on the worst day (which interestingly corresponded to when I >was travelling) was AHI of 10.5 and on the best day was 2.8.   On most >days it is in the 4 – 4.5 area.    On the 10.5 day, a high mask leak >was reported as well and I am pretty sure was due to mouth breathing. >One none of these days did I feel unusually tired, however. >I would suggest going back to the sleep centre and asking them to run >the test again, or alternatively ask for a study running over several >days or oximeter test. >.andy >To email, substitute .nospam with .gl

Response:

Results from my sleep studies. Aaaaaagh! Help!

Question:

I finally got hard copies of my sleep study results from January and February. Here’s the basics (full results at end of post): ——————— Initial sleep study: AHI: 51 Arousal index: 63 Apneas: 104 (100% central) Hypopneas: 85 (100% obstructive) SatO2: 93% average, 85% minimum. Sleep efficiency: 50% Sleep time: 221 minutes Stage III/IV sleep: 3% REM: 13.3% ——————— Titration Study: AHI: 41 Arousals index: 77.3 (!!!) Apneas: 77 (100% central) Hypopneas: 48 (100% obstructive) Sleep efficiency: 40% Sleep time: 184 minutes Stage III/IV sleep: 0.5% (!!!) REM: 0% (!!!) ——————— I’d love to know what you think. I have a few particular concerns: 1) All hypopneas (~50%) are shown as obstructive in nature. All apneas (~50%) are shown as central in nature. Can this be right? I’m really concerned about the central apneas. 2) Lowest AHI achieved was 18 during the titration. It appears they tested me at 2, 3, and 4cm and finally prescribed 6cm. 3) Doctor prescribed Klonopin for RLS and "improved sleep density". When I expressed concern that might make the apnea worse he told me the CPAP would protect me from that. I tried the Klonopin and while at full dosage it improved my sleep density I would be wiped out and dizzy the next day and literally could barely function. Tried dropping dose down to 0.25mg and finally stopped taking it. 4) Apneas were reduced by 2/3 during REM sleep. Isn’t this backwards? Studies in PDF format at http://www.geocities.com/mikecccccc/sleepstudy.pdf (500kb) Initial Sleep Study ————————– Total sleep time: 221 minutes (damn lab setting!) Sleep Efficiency:  50% Sleep Onset:      137 minutes REM Latency:      251 minutes Stage I:            9 minutes  4% Stage II:         175 minutes  7% Stage III/IV:       7 minutes  3% REM:               30 minutes  13% Arousals:         231 Awakenings:         0 (???) Arousals Index:    63 Apneas, Total:    104   Index 28.2 Hypopneas, Total:  85   Index 23.1 Events (A+H):     189   Index 51.3 AI NREM:           33 AI REM:             0 (!) AI Total:          28 (How is this less than AI NREM?) HI NREM:           25 HI REM:             8 HI Total:          23 (Again… huh?) AHI NREM:          58 AHI REM:            8 AHI Total:         51 Movement Summary (PLMS/Total) —————————— Jerks:             16/38 Jerks w/ Arousal:   8/20 Jerks w/ Awake:     0 Jerks, no Arousal:  8/18 Jerks, Non REM:    16/36 Jerks, REM          0/2 EKG Summary (no idea what any of this means) —————————— 30-59    60-79     80-99    100-119  126      283       32         1 Various Graphs —————————— Sa02 graph which shows an average of 93% saturation with a few dips down to as low as 85%. Heart-rate which shows between 60-110 beats per minute with prolonged stretches above 90 (which seems a bit high to me) and closer to 60 during stage II sleep. Arousals chart which shows a vertical line for every arousal. Areas are nearly solid black most places during sleep. Obstructive apnea chart shows two OAs at the onset of sleep and two in the middle for 4 total. Obstructive hypopnea with ticks throughout the night accounting for about 50% of the total arousals. MA and MH charts which I assume are mixed apneas and hypopneas totally blank. Central Apnea chart which ticks through the night accounting for about half the total arousals. Central Hypopneas chart totally blank. Isolated leg movement chart showing about 26 events scattered but mostly in the second half of my sleep. PLMS chart showing intense PLMS activity from about 3:58 to 4:12am Titration Sleep Study —————————— Physician’s interpretation: 31 yo male with OSA and insomnia The PSG of 1/16/04 showed OSA RDI- 51 #189 with nadir desat to 85% with PLMS and fragmented sleep. This PSG with CPAP was little different with poor sleep and restless ness but O2 protection and reduced OSA Best cpap was not achieved but he tolerated CPAP 5cm PLM acted at a rate of 18/hour but REM was eliminated during titration RECOMMEND NasalCPAP at 6cm Klonopin 1mg at HS for PLMs regularly to improve sleep density and improve CPAP tolerance OSA 780.53-0 PLMs 780.52-4 Hypoxia 799.0 Chart —————————— Shows apneas and hypopneas for each pressure attempted  cmH20 | Time  | Apn | AI | Hyp | HI | AHI | Ar+Aw   Ar+AwI ——-+——-+—–+—-+—–+—-+—–+——-+—–     2     30.5    22  43.3    8  15.7  59.0    48     94.4       3     49.5    32  38.8   21  25.5  64.2    62     75.2     4    104.0    23  13.3   19  11.0  24.2   127     73.3   Sleep Summary —————————— Total sleep time:   184 minutes Recording time:     458 minutes Sleep Efficiency:   40% Sleep Onset:         45 minutes Stage I:             22 minutes   12% Stage II:           161 minutes   88% Stage III/IV:         0 minutes REM:                  0 minutes Arousals:           237 – 77.3 index     Awakenings:           0 Apneas, total:       77 – 25.1 index Hypopneas, total:    48 – 15.7 index Events (A+H):       125 – 40.8 index Apnea index NREM:    25 Apnea index REM:      0 (duh, no REM) Hypopnea index:      16 SaO2                 98% @ 89-100% O2                       2% @ 80-89%  O2

Response:

On 22 Apr 2004 20:24:01 -0700, EtherGnat pontificated at length: >I finally got hard copies of my sleep study results from January and >February. Here’s the basics (full results at end of post): >4) Apneas were reduced by 2/3 during REM sleep. Isn’t this backwards?

Typically but there’s always exceptions to the rules. >EKG Summary (no idea what any of this means) >—————————— >30-59    60-79     80-99    100-119 > 126      283       32         1

They recorded your heart rate as you slept and divided it into N samples… then did a summarization of the rates. You had very little tachycardia (rate >100). OTOH, I was swinging from 40 bpm to 150 bpm. — "So many sneakers, not enough feet." http://sneakers.pair.com/

Response:

Have been treated for PLMS for 7 years.  Just had another study.  Mild apnea. I jerked violently for quite some time midmorning but in my semisleep state they called it being awake so did not consider the movements PLMS or note them on report.  Was not being taped so can’t prove what I know to be fact. But from my experience, your formal results may not be a true reflection of PLMs. Before being diagnosed for this, I was being tested for rheumatoid arthritis and various neuro muscular problems due to chronic pain, and finally given label of "fibromyalgia". Treatment for PLMS cured my muscle & joint pain – so much for fibromyalgia! Unfortunately, medications still have a ways to go for long-term effective treatment.

Response: