Which machine type should I go with? Depressing!

[red1]

Hello everyone,
I am trying to figure out what would be the best type of machine to use at this point in my life. My sleep doctor has set me up for a titration for the BIPAP machine, even though she is not sure yet as to what I should be using. I am trying to figure out if I need the Bipap or VPAP, or, if a Autoset will work for me. Right now I have a regular cpap S8 elite ii.

Back in 2008, I had a sleep study done. Based on the results, my sleep doc put me on a regular cpap machine. I have never been able to get my AHI down lower then 13.4. My AHI's were always the higher number.

MY results from my July 2008 sleep study was:
TST
Centrals index of 1.7
Obstructive index of 1.0
Mixed/Other index of 1.1
Hypopneas Index of 19.9
AHI Index of 23.7
RERA's index of 0

Oxygen Sats 100-90% - 98.1% of time 80-89% - 1.5% of time Lowest Saturation 86.8% Highest Saturation 98.5%

Spontaneous Arousals Index of 8.2
A & H Arousals Index of 17.6
Total Arousals Index of 25.8
Heart Rate - Range - 60-72 BPM

I got into Sleep Stage 1,2,3 & REM. No Stage 4

THe highest AHI index came from back sleeping.


MY results from my Nov. 2011 sleep study was:

TST
Centrals index of 12.2
Obstructive index of 27.7
Mixed/Other index of 1.8
Hypopneas Index of 61.7
AHI Index of 103.4
RERA's index of 16

Oxygen Sats 100-90% - 89.5% of time 80-89% - 10.4% of time Lowest Saturation 85.0% Highest Saturation 99.0%

Spontaneous Arousals Index of 18.8
A & H Arousals Index of 71.6
RERA's I Index of 5.9
Total Arousals Index of 96.4
Heart Rate - Range - 64-80 BPM

I got into sleep stages 1 & 2. No 3, 4 or REM.


THe highest AHI index came from back sleeping.

Her comment on the paperwork was Very Severe Obstructive Sleep Apnea at 103.4 (I do not understand why she put it all under Obstructive. There were certainly Centrals there.

My doctor did not actually view the study. IT was reviewed by another doctor. THe comment at the signiture area said Reviewed but not signed. name MD, FRCPC

Your feedback would be greatly appreciated. What sort of PAP machine do you think I'll need? I am kind of afraid of doing the titration with the BIPAP, as I have never been above a pressure of 7.6

Thanks

Rick

[jamiswolf]

Hi Red1,
It's surprising that your apnea worsened so much in three years, Did you gain a lot of weight or any other big change in your life?

On the obstructive diagnosis, I'm sure it was because your Doc lumped your hypopnias together with your OAs which then together dominate the picture.

I wouldn't worry about using a BiPap. They are actually quite nice to breath with. Higher pressures won't necessarily be more difficult to deal with...assuming they aren't way up. So just relax, your titration shouldn't be traumatic at all.

I wouldn't think you would need an auto BiPap since you are being followed by a Doc and will have a titration. Robysue just posted a lengthy discussion comparing the two major brands. Here's the link...

viewtopic/t71017/Best-BiPap-machine-for-new-user.html

Good luck,
Jamis

[red1]

Thank you jamis,

Actually I have not changed in weight at all. I am a little concerned that the bipap could cause more centrals then I have now. My pressure right now on the cpap is 6.8, with an EPR of 2.

When I increased te cpap pressure to seven, the HI's slightly decreased & the AI's slightly increased giving me a AHI of 13.4. I can't seem to get it lower then that with the cpap machine. At home, I only side sleep, which is not as bad as sleeping on my back.

Thank you again for the info.

Rick

[moresleep]

I would say the BiPap is the right choice for the titration, to be followed by an ASV if the BiPap doesn't do the trick.

As for buying the BiPap and later deciding you need straight Cpap, you can generally use a BiPap like a straight Cpap by setting the inhale/exhale pressures the same. Just be sure that whatever machine you get records waveform flow data.

Be alert to any problems like mouth recirculation or nasal congestion that might explain why Cpap isn't working well for you.

[red1]

I would say the BiPap is the right choice for the titration, to be followed by an ASV if the BiPap doesn't do the trick.

As for buying the BiPap and later deciding you need straight Cpap, you can generally use a BiPap like a straight Cpap by setting the inhale/exhale pressures the same. Just be sure that whatever machine you get records waveform flow data.

Be alert to any problems like mouth recirculation or nasal congestion that might explain why Cpap isn't working well for you.

Thankyou moresleep.

I know I do not mouth breath, because my leaks are very minimal, at least according to my Resmed Elite ii.

My doctor was not sure wheather to try the autopap or the bilevel. I suggested the bipap, "only" because of the centrals.

I am afraid of them increasing the pressure, well beyond the max I have had on, which was 7.6. I remember my first titration with cpap, between 5 & 7 gave me a very bad headache later the next day.

I just began to sleep well with the cpap. It had taken me over 2 years to adjust to it, only to have to go with a different pap machine now.

I am also shocked at my AHI of 103.4 from 23.7. I am also concerned about not reaching a sleep stage beyond stage 2. It's only been 3 years, I did not gain or loose any weight. Yet, again according to my s8 elite ii, I have had my AHI down to 13.4 at a pressure of 6.8. Maybe my machine is not calculating events properly?

There is also the expense of the Bipap machines. Much more then the Auto's. Out of pocket, & what if I cannot tollerate it?

Is the Resmed s9 vpap auto a go machine?

Thanks

Rick

[robysue]

My pressure right now on the cpap is 6.8, with an EPR of 2.

When I increased te cpap pressure to seven, the HI's slightly decreased & the AI's slightly increased giving me a AHI of 13.4. I can't seem to get it lower then that with the cpap machine.

If you are dealing with a combo of residual Hs and emergent centrals, there's at least a chance the bi-level might help. During the bi-level titration, the IPAP will be increased when you have hypops, but the EPAP will not. EPAP will be increased for the OAs. So the doc's reasoning may be that you might be able to tolerate a higher IPAP than your current pressure with an EPAP that is still low enough to not cause problems with centrals. And, unfortunately, if you do actually need an AVS or bi-level ST machine to take care of the centrals, your insurance may need proof that "you failed at bi-level", which actually means that the bi-level failed you---in the sense of not providing effective therapy.

[red1]

My pressure right now on the cpap is 6.8, with an EPR of 2.

When I increased te cpap pressure to seven, the HI's slightly decreased & the AI's slightly increased giving me a AHI of 13.4. I can't seem to get it lower then that with the cpap machine.

If you are dealing with a combo of residual Hs and emergent centrals, there's at least a chance the bi-level might help. During the bi-level titration, the IPAP will be increased when you have hypops, but the EPAP will not. EPAP will be increased for the OAs. So the doc's reasoning may be that you might be able to tolerate a higher IPAP than your current pressure with an EPAP that is still low enough to not cause problems with centrals. And, unfortunately, if you do actually need an AVS or bi-level ST machine to take care of the centrals, your insurance may need proof that "you failed at bi-level", which actually means that the bi-level failed you---in the sense of not providing effective therapy.

Thank you robysue.

If I do the titration using the bipap, and an autopap could do the job, are they able to tell this, if I am titrating on a bipap? It just seems extreme, (if my s8 elite ii is recording correctly) that I was able to get my AHI to 13.4 at a pressure of 6.8. Even though an increase above that caused the ai's & hi's to go in diffenent directions, still leaving me at 13.4.

I also noticed, when I set my EPR from 2 to 1, without changing the pressure, caused a slight increase in my AHI.

One other thing, I had some blood work done. The C02 range is from 22-30 mmol/L my count was 35. Can sleep apnea play a role here?

How much epr is there between the inhale & the exhale of the s9 Auto?

Thanks

Rick

[jamiswolf]

Red1 wrote: How much epr is there between the inhale & the exhale of the s9 Auto?

As I understand it, with ResMed machines, an EPR of setting 1 translates to a one cm drop in exhale pressure. Setting 2 is a two cm drop and same with 3.

So, as it was explained to me, using a setting of 3 is almost like a poor mans bulevel. Respironics machines are completely different.

I don't know where you live, but if it's an urban center, start watching Craigslist. It's where people go to get rid of un-used or un-needed cpap machines. I've seen BiPap's sell for hundreds rather then thousands so if you don't have insurance...there are options. There's secondwindcpap which sells gently used equipment, but he often just buys on Craigslist (I've seen his ads) and resells at a higher price.
Jamis

Edit: Regarding your CO2 being high. I can't imagine why it would be, but I would think cpap would help rather then hurt that situation. Do you have an underlying serious lung disease?

[red1]

Red1 wrote: How much epr is there between the inhale & the exhale of the s9 Auto?

As I understand it, with ResMed machines, an EPR of setting 1 translates to a one cm drop in exhale pressure. Setting 2 is a two cm drop and same with 3.

So, as it was explained to me, using a setting of 3 is almost like a poor mans bulevel. Respironics machines are completely different.

I don't know where you live, but if it's an urban center, start watching Craigslist. It's where people go to get rid of un-used or un-needed cpap machines. I've seen BiPap's sell for hundreds rather then thousands so if you don't have insurance...there are options. There's secondwindcpap which sells gently used equipment, but he often just buys on Craigslist (I've seen his ads) and resells at a higher price.
Jamis

Edit: Regarding your CO2 being high. I can't imagine why it would be, but I would think cpap would help rather then hurt that situation. Do you have an underlying serious lung disease?

Hi,
Nothing other then my brochitis.

I live in Canada. Is there any issues a bibpap could cause, that a cpap/autopap would not? I am just a little uncomfortable titrating on one of these. I would really like to know if they can tell if an auto pap would do the job, even though you are titrating on a bipap?

Thanks

Rick

[jamiswolf]

Rick,
Short answer is no, there are no complicating issues with BiPap. I'm actually a little confused by your trepidation.

There are some seriously complicated machines out there that are based on BiPap architecture. I'm talking BiPap auto sv advanced or avaps machines or BiPap ST. Those are all $5,000 and above machines for specific breathing issues.

But your basic BiPap...piece of cake. Your pressures will probably be lower.

And don't get me started on auto cpaps...they can be difficult but I was just getting started when I used one. I don't even see why there is a choice between apap and BiPap...they are two different animals...

So sorry Dude, that's all I can offer. If you're the worrying type, nothing I say will change that. But you have nothing to worry about on this issue...
Jamis

[Pugsy]

Is there any issues a bibpap could cause, that a cpap/autopap would not?

No. In fact BiPap is often used to treat problems that arise from cpap/apap therapy.
Pressure discomfort, aerophagia, pressure induced centrals, anxiety with pressures, ear pain from pressures... I can't think of one negative thing about using one.

[red1]

Rick,
Short answer is no, there are no complicating issues with BiPap. I'm actually a little confused by your trepidation.

There are some seriously complicated machines out there that are based on BiPap architecture. I'm talking BiPap auto sv advanced or avaps machines or BiPap ST. Those are all $5,000 and above machines for specific breathing issues.

But your basic BiPap...piece of cake. Your pressures will probably be lower.

And don't get me started on auto cpaps...they can be difficult but I was just getting started when I used one. I don't even see why there is a choice between apap and BiPap...they are two different animals...

So sorry Dude, that's all I can offer. If you're the worrying type, nothing I say will change that. But you have nothing to worry about on this issue...
Jamis

Thank you so much Jamis & Pugsy. I am glad to hear all this. My trepidation regarding this was increased pressure. I have found increasing pressure with the cpap increases my Centrals & it also gives me wicked headaches. The highest pressure I have had my michine on was 7.6 with a fulltime EPR of 2. I also worry about the added pressure of a bipap causing mask leaks. I could not get use to a full face mask. I know there is the very odd time, where a puff of air will come out of my mouth while I am awake. My cheeks become like a squirrels mouth with a nut in it. I think it happens when I move my tongue, even just a little. Not often, but it has happened. How would that increase with added pressure on inhale.

I have finally gotten use to cpap & can sleep a lot more then I use to. With bipap, I have to start over with a whole new experience.

IS the Resmed Vpap a good machine?

Thank you so much in advance.

Rick

[Pugsy]

IS the Resmed Vpap a good machine?

I am sure it is an excellent machine. Rested Gal uses one and has explained the difference that she has noticed, since also has tried Respironics, in the thread I started about my BiPap experiment. Have you seen it? I think it answer some questions you may have.

viewtopic/t71067/My-Hybernite-2300-amp- ... iment.html

[jamiswolf]

Rick,
Just to broaden your perspective...the pressure you are at is very low. I would say that the average pressure (if there could be such a thing) is around 10cm and many people get by very nicely with pressures of 15cm and more. It's something your body adapts to. And I doubt very seriously that you are getting headaches because of a less then 1cm increase in pressure. Something else is probably causing them...and quite possibly not enough pressure. So anyhoo...have a nice titration and please report back on the results.
Jamis

[red1]

From past experience, When the doctor ordered a increase by even 1 in pressure, my AI's went up just slightly, & my HI's went down just slightly. MY EPR is full time. When my EPR was adjusted from 2 down to 1, the AI's slightly increaed & the HI's slightly decreaed.

IF I am understanding things correctly, it could possably be due to Centrals on the EPAP due to the increase in pressure on the EPAP, when EPR is set to 1 from 2 and also increase on EPAP due to an overall increase in pressure by the doctor of 1.

In regards to trying to purchase the right BIPAP, this would need to be taken into account?

I would have liked to purchase the S9 VPAP Auto, as opposed to the PR system 1 auto Bipap. I like the way the the Resmed brand records data & the mask leak data. But, from what I am able to understand from the description on the Resmed Vpap Auto & the PR biap Auto 1, posted by robysue, the S9 Vpap Auto increases & decreases both the IPAP & EPAP at the same time. SO, if the machine increased my pressure by 1 on the IPAP, it would also increase the pressure by 1 on the EPAP. IS this correct?

That in turn may cause centrals on the additional pressure on the EPAP, yes?

Where the PR system 1 auto Bipap only adjusts one or the other, not both the IPAP & EPAP at the same time. Snce there is no adjustment in the EPAP if it happens to raise the IPAP, would there not be less chance of a central, On the IPAP side? Therefore I would have no choice but to go with the PR Auto 1 system?

Thanks

RIck