Central Detection Driving Me Nuts!!

[Sleeprider]

Reznik, I'll look up the post you're talking about. My "fake news" comment was sarcasm. This is not the first time I have heard of complaints about FOT or the Philips pulse.  This forum is pretty strict about links to CPAP-talk and the host site, but it is not for any affiliation, but because it is important to avoid any possible commercial affiliation to allow distribution of the clinical manuals as an educational site.

[Reznik]

Reznik, I'll look up the post you're talking about. My "fake news" comment was sarcasm. This is not the first time I have heard of complaints about FOT or the Philips pulse.  This forum is pretty strict about links to CPAP-talk and the host site, but it is not for any affiliation, but because it is important to avoid any possible commercial affiliation to allow distribution of the clinical manuals as an educational site.

I completely understand the reason for the rule, and was not intending to criticize it.  My only purpose in mentioning it was to point out that this has been an issue since at least 2011, and to criticize both ResMed and Respironics for failing to take action.

It would be an easy matter for both of them to include an option to enable/disable central apnea detection.  Better yet, they could follow Fisher & Paykel's leak and use a passive mechanism to detect centrals instead of literally shoving extra air down our throats...

[Walla Walla]

Reznik, I'll look up the post you're talking about. My "fake news" comment was sarcasm. This is not the first time I have heard of complaints about FOT or the Philips pulse.  This forum is pretty strict about links to CPAP-talk and the host site, but it is not for any affiliation, but because it is important to avoid any possible commercial affiliation to allow distribution of the clinical manuals as an educational site.

I completely understand the reason for the rule, and was not intending to criticize it.  My only purpose in mentioning it was to point out that this has been an issue since at least 2011, and to criticize both ResMed and Respironics for failing to take action.

It would be an easy matter for both of them to include an option to enable/disable central apnea detection.  Better yet, they could follow Fisher & Paykel's leak and use a passive mechanism to detect centrals instead of literally shoving extra air down our throats...

I don't disagree with you. But all Resmed and Respironics care about are what the DME's want. They operate under the assumption that DME's are the only one's that make machine adjustments.

[isuckatsleeping]

Well the Craigslist guy fell through, so I'll be on the lookout for a Resmed Airsense CPAP going forward.

[Reznik]

Reznik, I'll look up the post you're talking about. My "fake news" comment was sarcasm. This is not the first time I have heard of complaints about FOT or the Philips pulse.  This forum is pretty strict about links to CPAP-talk and the host site, but it is not for any affiliation, but because it is important to avoid any possible commercial affiliation to allow distribution of the clinical manuals as an educational site.

I completely understand the reason for the rule, and was not intending to criticize it.  My only purpose in mentioning it was to point out that this has been an issue since at least 2011, and to criticize both ResMed and Respironics for failing to take action.

It would be an easy matter for both of them to include an option to enable/disable central apnea detection.  Better yet, they could follow Fisher & Paykel's leak and use a passive mechanism to detect centrals instead of literally shoving extra air down our throats...

I don't disagree with you. But all Resmed and Respironics care about are what the DME's want. They operate under the assumption that DME's are the only one's that make machine adjustments.

Three thoughts:

1.  The DMEs make adjustments per doctor's orders, and so, ultimately, it should be what the doctor's want.  They must know that this is an issue, and so far, seem to have addressed it by ensuring that the super-cheap models (Airsense 10 CPAP) and the most expensive models (ASV doesn't do central detection) don't have the feature.

2.  ResMed and PR both know that consumers make adjustments to things that they allow consumer adjustments to, i.e., humidity, ramp time, etc.

3.  ResMed in particular is building a huge database from all the data they're downloading from our machines.  It probably benefits them greatly to know what's central and what's obstructive in that database.  They know that if our AHI is high, our doctor is going to order a new sleep study, regardless of whether the machine says that they're central or obstructive.  So, in some ways, they may be creating this problem for the benefit of their database, and not for the benefit of our health.

[Reznik]

Well the Craigslist guy fell through, so I'll be on the lookout for a Resmed Airsense CPAP going forward.

Be sure to call around.  Most of the vendors that sell on the internet will give you 10% to 15% off their current asking price if you ask nicely.

[Reznik]

Well I just tested my VAUTO on S mode without Easy breath and it recorded CA events when I held my breath with my mouth open.

Which means it must of been using FOT.

I assure you that you are mistaken.  You either had Easy Breath ON, or you were not in S mode.  

You can **feel** the pulses if you're laying down.

Also, another side effect that I've noticed is that the FOT pulses interfere with hypopnea detection.  The machine will score hypopneas as apneas when FOT is on because the pulses prevent the machine from seeing the shallower breaths.  As a result, things that would have been scored as hypopneas get scored as apneas when FOT is on.

[Reznik]

Since this thread has recently gotten some attention, I thought I'd take the time to update everyone on my progress.  I've been on CPAP for just over a year now and I've definitely noticed some changes.

A few months back, I noticed that my throat and nose were starting to get dry.  As a result, I've been tweaking the humidity higher than my usual 1.  I've now settled on either 2 or 3.  Also, the nasal congestion that I used to suffer from when I increased the humidity level seems to have stopped.  

I've also been able to reduce my pressure settings from 8 to 7.  My AHI is now usually between 2 and 3 every night, with <1 scored as an apnea and the rest scored as hypopnea.  I rarely look at the detailed data anymore, but almost all of my apneas last about 10 seconds each.  Since I can easily hold my breath for 10 seconds, 3 times an hour, without causing my pulse oxygen level to drop, I'm not worried at all about these residual apneas. 

Occasionally, I put the VAUTO machine into a mode that does FOTs just to see what will happen.  I usually wake up within the first 40 minutes of using the machine.

I bought an AirStart 10 ($349) to use as backup in case my VAUTO fails.  I generally don't use it because it doesn't give ANY reports on AHI, and I wasn't yet comfortable enough knowing how my therapy is doing.  I'm now almost to the point that I might take it on vacation and leave my more expensive VAUTO machine at home, and I suspect that in another few months I'll even be ready to use it as my regular machine and just keep the VAUTO around in case things go awry and I want a more detailed look at what's happening while I'm asleep.

I'm also pleased to hear that F&P SleepStyle Auto does central detection without the use of any pulses whatsoever.  F&P tells me that they examine the waveforms and use that waveform data to determine whether an apnea is central or obstructive.  Hopefully, the rest of the industry will move in that direction in the future.  Fingers crossed!

[Sleeprider]

My personal experience with FOT is that I have never noticed it. I do know some people are extremely disrupted by it and even complain about it "shaking the mask". I have no idea how our experiences can be so different, but it is and I accept that there are sensitive individuals. It seems that central apnea detection could be a reasonable option in the clinical menu to enable or disable. Advanced machines in the ST series do not use FOT,and apnea is reported as UA. It seems like a reasonable request to have an on/off for FOT. Who have you contacted and did you get a reply?

[Reznik]

My personal experience with FOT is that I have never noticed it. I do know some people are extremely disrupted by it and even complain about it "shaking the mask".  I have no idea how our experiences can be so different, but it is and I accept that there are sensitive individuals. It seems that central apnea detection could be a reasonable option in the clinical menu to enable or disable. Advanced machines in the ST series do not use FOT,and apnea is reported as UA.  It seems like a reasonable request to have an on/off for FOT.  Who have you contacted and did you get a reply?

Some people are very deep sleepers and others, like myself are not.  It's great that there are people who aren't bothered by them.  But, what about the 50% of people who fail CPAP?  How many of them are failing because of the FOTs, but don't that's what's waking them up, or that there is an alternative?   

I agree that some form of Central Apnea Detection is needed when in Autoset mode, because you don't want the machine to increase the pressure when a person is having central apneas.   Because the Autoset machines are the same price at the CPAP machines, most DMEs just stock them, and set them in CPAP mode for patients that don't need Autoset.  So, everyone is getting FOTs, even if they are not needed for the therapy.  At least one of the doctors that I spoke with mistakenly believe that FOTs were only sent in Autoset mode, and had no idea that they were also sent when an Autoset machine is in CPAP mode.

I contacted a product manager at ResMed and a product specialist at ResMed.  They listened patiently to my concerns, and then reminded me that treatment induced central apneas were a serious concern with CPAP patients and that no changes were planned to address my concerns.  I reminded them that if AHI is high, a new sleep study would be ordered regardless of whether the machine concluded that the apneas were obstructive or central, and they thanked me for my thoughts.

I also contacted Resmed's Chief Medical Officer.  He said essentially the same thing that the product specialist and product managers said.