I just got the following results after one month on CPAP
IPAP:  23.0  
EPAP:  18.0
Avg Obstructive Apnea Index:  13.8
Avg Hypopneas Index:  1.0
AVG AHI:  14.8
Avg Vibratory Snore Index:  1.0
Avg Max Leak:  91.0
Avg 90% Leak:  59.1
Avg Leak:  49.3
Avg Large Leak:  1.8 min
Avg usage:  5 hrs 25 min

It took me three weeks before I quit worrying about the leaks.  I talked to DME about the mask with no resolution.  I talked to the sleep clinic Doctor and was told to use saline, Nasonex and a sleeping pill.  I refused the sleeping pill but do use Benadryl (25 mg) some nights.  On those nights I sleep 6 or 7 hours.  I wake up, take the mask off and fall back to sleep for another 1 or 2 hours.  I can't say I feel rested.  I am also wondering if the smartcard can identify the central apneas.  There was no mention of them on the report.  Would like to know your comments on the results including all those leaks!  Thanks in advance, CJ


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AHI=101 Lowest oxygen 73% Started CPAP 7/22/08
Respironics BiPap M 23/18 with 3L oxygen
Resmed Ultra Mirage FF mask
Humidifier set at 3

My understanding is that the only xPAP that at least tries to identify central apneas is the Puritan Bennett GoodKnight 420E auto PAP. But that doesn't mean that is gospel. And even if so, xPAPs really aren't capable of detecting central per se since they don't have EEG capabilities to coordinate w/the airway data.

If you look at the literature that came w/your Respironics bi-PAP there is a table w/the allowed vent rate at your pressure range which you would then subtract from the reported leak rate to determine what your true leak rate is.

For most of us it takes time, Patience, Perseverance and a good Sense of Humor to get acclimated to sleeping w/a CPAP and mask. Goshes, my first 30 nights on CPAP were the worst 30 nights' sleep I'd ever had, barring the 2 nights of titration when I only slept 42 minutes outta 6 hours bed time so had to return for a 2nd titration when I only slept 98 minutes out of 6 hours bed time. How they managed to come up w/even a by guess and by gosh pressure setting for me is beyond my ken! But a small pressure change did help and I started noticing SOME improvement. I just kept pushing the sleep lab's doctor every 30 days and a loaner autoPAP, the addition of 2L of 02, a re-titration w/bi-level, the exchange to a bi-level and the cessation of the 2L of 02 has finally gotten me restful, restorative sleep for the most part. Each change brought some improvement.

So just hang w/us and keep using that Bi-PAP and keep your local DME supplier's RT and your sleep lab's doctor aware of your problems. They can't help w/problems they don't know you have. Don't be bashful. It is your health and your therapy! You're paying for this therapy and care, whether thru insurance or out of pocket.


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Some people are like Slinkies... Not really good for anything, but they still bring a smile to your face when you push them down a flight of stairs.
Resmed VPAP Auto. Humidaire 3i, Simplicity & Micro masks, ResScan 3.4, S8 ResLink, Embla oximeter.

Good to hear from you seajay515 it has been awhile, if I remember right they wanted you on VPAP ASV but then wouldn't do it? Is that right? and they said maybe later? It looks like they are doing to you what they did to me, you have to go thru the stepping up game, go from one to the other till they get you on VPAP ASV. Like Crohnie said just keep at them your sleep Doctor and RT and your DME, it might take some time but they will eventualy realize they need to get you on the other machine! Just don't give up! Keep using the BiPAP as you have been and keep on the XPAP folks. We are all here to help you, in anyway we can!  Good Luck to you seajay!


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White Beard with a White Beard
Resmed VPAP Adapt SV Enhanced, HumidAire 2i, ResLink with Model 8000 Flex sensor Pulse Oximeter, and ResScan 3.5 software. Respironic EverFlo OPI Oxygen Concentrator 3 lpm
EEP 9.0, min PS 6.0, max PS 16.0

Thanks for the encouragement, Crohnie Too.  You are right about giving it time.  The first two weeks tried my patience.  I'm able to sleep longer now, but want to get away from taking the Benadryl.  I guess I'll have to cut out the caffine!  

I looked for the table you talked about but did not see it.  Maybe their website will have something on the leaks.  I do go to see a Pulmonalogist on Monday.  I'll see what his take is on everything.  CJ


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AHI=101 Lowest oxygen 73% Started CPAP 7/22/08
Respironics BiPap M 23/18 with 3L oxygen
Resmed Ultra Mirage FF mask
Humidifier set at 3

Thanks White Beard.  I wondered if you would jump in here.  Yes, I am the one who was told I had to wait and see before the vpap was used.
I guess an AHI from 101 to 14 is worth something.  I'm handling the high air pressure better and so is my face!  Makes me wonder if it's working right...CJ


_________________
AHI=101 Lowest oxygen 73% Started CPAP 7/22/08
Respironics BiPap M 23/18 with 3L oxygen
Resmed Ultra Mirage FF mask
Humidifier set at 3

Well, I'd call it a "graph" rather han a "table", but for UMFFM:



Leaks are pressure-dependent, the greater the pressure, the greater the "expected" leak. At your pressures, you're not bad at all, not a great deal of overall "unplanned" leaks.  But 23/18 is a bear, so there will be some bursts.

M.

Thank you so much, Morbius.  I didn't see anything like that in my paperwork.  Yes, it does seem like I'm not doing bad!  Things are looking up as long as I can stay asleep.  

I've had a strange thing happen a few times.  In the middle of the night, I wake up and I don't hear or feel the rush of air.  I did re-adjust the tubing and the air came back.  I didn't want to wake up enough to check the machine.  Anytime I have checked it, the right pressures shows up.  I have the tubing going over the top of the bed so it doesn't put my arthritic shoulders in the wrong position.  I have to say, four weeks into this, the pressure doesn't bother me as much as it did at first.  My cheeks don't blow up and it appears I'm keeping my mouth closed more.  There is so much more to this than putting on a mask and pushing a switch!  I applaud all you experienced ones for keeping us newbies on track.  Thank you, thank you, thank you!  CJ


_________________
AHI=101 Lowest oxygen 73% Started CPAP 7/22/08
Respironics BiPap M 23/18 with 3L oxygen
Resmed Ultra Mirage FF mask
Humidifier set at 3

Don't forget to pick up the "long reports" on Monday.

See if you can get the complete "raw data" studies while you're at it.  If you don't get the "video files", then all 3 files will fit on a CD.  They should have a "Physician Reader" along with it, if not, there are other options.

BTW, if I may ask, re: the weight gain, how much was that, from what to what?  Also, what medications besides the Vicodin and Benedryl are/were you on?  That was one heckuva REM latency and the sleep efficiency stinks, which makes those results all the more questionable.

M.

I received 11 pages with the report from the smartcard.  It sounds like they have much more info than I was given.  I had to fight to get a machine with the smartcard and when they picked up the first card, I had to tell them I wanted it replaced.  What is the "normal" procedure when you have a smartcard?  My machine is not set to give me the daily AHI or air leaks.  Correct me if I'm wrong, the machine can only give me the time I'm on the machine whether I'm sleeping or not.  Does any of the raw data tell me when I'm awake?

Last night I elected to NOT take the benadryl and I had no caffeine (spelled right this time!).  I woke up one hour later and watched the fourth quarter of the USA/Spain basketball.  Fell asleep after the game and woke up slightly later with air leaks.  All in all I had the mask on for 7 hours.  The sleep efficiency not good in my terms.  I have always been a light sleeper and for years do not sleep more than 4 hours at a time.  Is CPAP suppose to keep me asleep???  

The weight gain was 25# over the span of three or four months.  However, I had a lot of swelling in the legs that I had not had before. I've been overweight all my life.  I was having my preop workup for a total knee when I was sent to a Cardiologist to look at my EKG.  He found my BP at 137/100 and was put on Toprol LA 25mg daily.  The cardiologist suggested the sleep study.  I'm also on Hydrochlothrazide 25mg, Detrol LA 4mg, Celexa 40 mg..all daily.  Twice a day I take Clinoril 200 mg, Axid 150 mg and Tylenol Arthritis along with several supplements.  Vicodin is only taken now when the arthritis pain is too bad.  Average one or two a week.

Thanks for all your help.  CJ


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AHI=101 Lowest oxygen 73% Started CPAP 7/22/08
Respironics BiPap M 23/18 with 3L oxygen
Resmed Ultra Mirage FF mask
Humidifier set at 3

seajay515 wrote:

I received 11 pages with the report from the smartcard.  It sounds like they have much more info than I was given.

The data I was referring to are the actual sleep studies:

Morbius wrote:

Don't forget to pick up the "long reports" on Monday.

See if you can get the complete "raw data" studies while you're at it.  If you don't get the "video files", then all 3 files will fit on a CD.  They should have a "Physician Reader" along with it, if not, there are other options.

Get all 3 of them.  As discussed in the other thread, a bunch of things don't make sense.

seajay515 wrote:

I'm also on...Celexa 40 mg...

OK, that explains the delayed REM onset at 328 minutes, SSRIs are REM suppressants.  They can also generate severe sleep fragmentation.  For that matter, they can also generate weight gain.

I think there are a number of areas of the sleep studies that need close scrutiny.  First is sleep continuity, which keeps coming up basically as, there isn't any.  And obviously, with a number of good reasons.

But severe sleep fragmentation may make interpretation of the respiratory waveforms cloudy.  Alternating periods of normal breathing and post-sleep disturbance hyperventilation may make it seem as though there are airway obstructions, when in fact, that may not be the case.  That be be a far more plausible explanation than simply having hypopneas that persist all the way to 23/18.

The diagnostic portion looks to be quite abbreviated at 150 minutes, and may have not been long enough to fully evaluate sleep quality.

While the O2 saturation is significantly decreased, it is important to determine if it was because of respiratory events or if the whole baseline dropped.

Further, no titration protocol that I'm aware of uses EPAP to chase hypopneas all the way to 18 cmH2O.  As a matter of fact, one does not chase hypopneas with EPAP at all.

It would also be interesting to see how REM behaves (as delayed as it is).  In Complex Sleep Apnea, the airway usually becomes quite stable (which is usually the exact opposite of "routine" OSA).

All of these concerns should be explained by looking at the more detailed data.

Speaking of which, do you know what software (sleep system) they used?

M.

From the original study....The study was performed on Embla's Rembrandt computerized polysomnographic recording system using gold plated electrodes, ECG pads, plezo/respiratory inductance plethysmography belts, thermocouple/nasal pressure transducer, snoring senser and a pulse oximeter.  The International 10-20 Electrode Placement System was utilized for recording EEG channels C3, C4, O1 and O2.  Eye movementws (EOG), chin EMG, anterior tibialis EMG, respiratory effort at the chest aned abdomen, airflow at the nose & mouth, ECG and oxygen saturation were also recorded.  

I can call the sleep clinic and see if they will give me the complete data.  At this point, I'm more confused than ever.  Why these clinics don't ask you to get off certain medications for a more exact reading, I don't know.  I suppose they want you on all the meds you usually take.  It seems that there are too many drug interferences.  I've been on an SSRI for over 40 yrs.  It wouldn't bother me to stop it along with the vicodin to get more accurate readings.  I read in some of these listings where the sleep clinic gave patients a sleeping aid instead of taking their own meds.  It appears the last study I took was way off the track with the amount of vicodin I was taking.  CJ


_________________
AHI=101 Lowest oxygen 73% Started CPAP 7/22/08
Respironics BiPap M 23/18 with 3L oxygen
Resmed Ultra Mirage FF mask
Humidifier set at 3

M...I'm having a problem with the sleep center giving me the raw data.  The one person I talked to said he didn't think I could get it but gave me the phone number of a Manager.  I had to leave a message.  I got a lot of questions from the first guy and he wondered if someone was questioning the answers and if he was a doctor.  I might be able to get the pulmonologist to request one.  He is suppose to specialize in sleep studies.  Still trying.  CJ


_________________
AHI=101 Lowest oxygen 73% Started CPAP 7/22/08
Respironics BiPap M 23/18 with 3L oxygen
Resmed Ultra Mirage FF mask
Humidifier set at 3

seajay515 wrote:

The study was performed on Embla's Rembrandt computerized polysomnographic recording system

Good, that software has a "Physician Viewer" option and anyway uses EDF.

seajay515 wrote:

plezo/respiratory inductance plethysmography belts

Must be a template, that is an "either/or".

seajay515 wrote:

recording EEG channels C3, C4, O1 and O2

That's the old system, but NBD.

seajay515 wrote:

Why these clinics don't ask you to get off certain medications for a more exact reading, I don't know.  I suppose they want you on all the meds you usually take.

Right.  It doesn't make sense to change around all the variables for one night to try to get a measurement of sleep quality that has not nor will not occur at home.

seajay515 wrote:

It seems that there are too many drug interferences.

You can say that again.

seajay515 wrote:

It seems that there are too many drug interferences.

OK, that was rhetorical.

seajay515 wrote:

I got a lot of questions from the first guy and he wondered if someone was questioning the answers

Tell him "Of course, why else would I want all that stuff?  For Show and Tell at the Science Fair?"

M.

Seajay,

You have a legal right to your results.  And, you don't owe them any reasons.  Just tell them it is for your own personal records and then ask them if there is a reason that they seem to be so overly concerned.

When you say you can't feel the air, are you putting your hand up to the exhaust ports to check?  That will make a difference and then I bet you will feel it.

Vicki


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That which does not kill you makes you stronger-Friedrich Nietzsche
Friedrich must of had apnea.

Vicki,

So far I have not received a call back from the manager at the Sleep Clinic.  I will have to call again.  I did see the Pulmonalogist.  I am NOT impressed with him.  I think I'm wasting my time.  He glances at the reports and never says anything about them.  He, too, wants me to take Ambien so I sleep through the night.  I'm going to try that and see how it goes.  

I didn't think about checking the exhaust ports when I didn't feel the pressure.  I will if it ever happens again.  I'm concerned about the 02 now as I have started waking with the headaches again.  My DME is going to put a pulse ox on me for all night to check it out.  My oxygen was 89 at the Doctor's office when it had been 95 the time before.

Carol


_________________
AHI=101 Lowest oxygen 73% Started CPAP 7/22/08
Respironics BiPap M 23/18 with 3L oxygen
Resmed Ultra Mirage FF mask
Humidifier set at 3