How accurate is the S9 VPAP Auto clear airway data?

[arttest]

Is there anything in my settings I can adjust that may alter these clear airway events? A change in Pressure Support perhaps? I am concerned that most nights I have more clear airway events than obstructive. I have noticed that my respiratory rate is on the low side. I have not looked up my prior lab studies to see how this may have changed.

My doc is ok if I alter my settings. We discuss options when I see or call her. And she will see all the changes with my downloads during office visits. I've discussed my centrals in the past but more so I've wondered for years if I might benefit from an ASV device. She always says that I do not qualify. I've never even tested one. I've had many changes in my health in the last couple of years and associated hormone changes. It's probably time for another sleep study.

I have attached a couple pics that show my settings, typical night and an overview.

My current settings are:
S9 VPAP Auto
Mode: Bi-Level
EPAP: 6.0 IPAP: 9.0 cmH2O
PS: 2.0

Thanks for any comments you have.
   
   

[trish6hundred]

Hi arttest,
WELCOME! to the forum.!
It's great to hear that your doc is so open minded to your needs.
Hang in there and someone will be along to help you interpret your graphs, soon.
Best of luck to you as you continue your CPAP therapy.

[retired_guy]

Those numbers look pretty darn good... How long have you been using the current pressure settings? I ask because frequently the CA's will resolve themselves once your body gets used to the idea. But you need to give it some time before you change anything. In the meantime your numbers are fine and even the CA's are well within therapeutic limits.

[zoophaugus]

Is there anything in my settings I can adjust that may alter these clear airway events? A change in Pressure Support perhaps? I am concerned that most nights I have more clear airway events than obstructive. I have noticed that my respiratory rate is on the low side. I have not looked up my prior lab studies to see how this may have changed.

My doc is ok if I alter my settings. We discuss options when I see or call her. And she will see all the changes with my downloads during office visits. I've discussed my centrals in the past but more so I've wondered for years if I might benefit from an ASV device. She always says that I do not qualify. I've never even tested one. I've had many changes in my health in the last couple of years and associated hormone changes. It's probably time for another sleep study.

I have attached a couple pics that show my settings, typical night and an overview.

My current settings are:
S9 VPAP Auto
Mode: Bi-Level
EPAP: 6.0 IPAP: 9.0 cmH2O
PS: 2.0

Thanks for any comments you have.

arttest,
I am just a new guy here my self, I've been battling this stuff my whole life but diagnosed a mere 3 years ago. I've went from a resmed S9 elite set at 16 Cmh20 to a resmed S9 auto set 5 -16cmh20 to a Vpap auto 10-16 Cmh20,
to A Vpap Adapt set to Min/max EPAP 8-16 -Min/max PS 3-15
Every one of those machines recorded excellent results with no problems what so ever according to DME and even my own examination of data.
I how ever was feeling the total opposite, in fact going down hill and feeling worse each year that went by.
The big question here is how do you fell every day?
I would assume that your not feeling all to good other wise you wouldn't bother posting this thread.

My advice to you is to take what ever feed back those machines are giving you with a grain of salt and keep pushing your doctor to go to the next level - if doc doesnt wanna cooperate get another one or go the next step and "acquire the equipment " on your own.
I had 2 doctors tell me the machines dont lie and theres some thing else is wrong and ill just have to accept that reality and take madafonil for the rest of my life.
Ya i could have just rolled over and died ....... not this guy .... I dont give up easily and neither should you .

I have not yet solved my problem....... but I do see a light at the end of the tunnel.

My 2 cents.

[arttest]

I've been at similar setting for 2+ yrs or so. I can't really remember. I had to lower the pressure even more for a time until I had surgery and could tolerate xpap again. I've been on some sort of xpap since 2000. I've used several machines, types and masks and such. I can't tolerate higher pressures as I get too much aerophagia. My pressures are lower than I could benefit from but it's the aerophagia that is the limiting factor. That I have more clear airway events most nights than obstructive does not seem normal. I also have numerous micro arousals that are not breathing events. I think only a sleep lab study will show if these have changed.

I could just chalk up my increased sleepiness to surgery and chemo recovery, but I was sleepy before, Just not this sleepy. It's been suggested to me by one of my docs that my sleep issues were my biggest risk factor with my cancer. And my sleep issues are not resolved at all. I had some CBT for sleep and that helped me be more aware of and change some behaviors that hindered better sleep. Pre chemo I used Modafonil for around 1 year 10 yrs ago but I had an allergic response to it and it only helped some. Now I use Concerta and quick release methylphenidate, up to 60 mg daily combined. Some days even that amount cannot keep me alert.

thanks

[retired_guy]

Thanks,

Well it doesn't sound to me like your CA's are transient. Increasing your pressures would probably not help with them though. I don't know much about the drugs you're taking but I do know a lot of things can cause the CA's to be a bit high.

In your case your AHI is certainly within limits, but given your history I think I'd talk to the docs about a new sleep study.

[arttest]

Thanks retired_guy. I know my current AHI is good enough from my docs perspective. I've wondered if an ASV device would trigger me into breathing when I am not. Then again I've no idea if it would cause more aerophagia. Now nights I get a belly full of air I take the mask off for the night. Actually I should remember to pop in my oral device when that happens :-)

nite

[justMongo]

Your tidal volume is low; if not an artifact, then you breath shallow during sleep.
Normal Tidal Volume is around 500 ml.
Also, your I:E ratio (the ratio of the time in IPAP to the time in EPAP) is way off from the "norm" of 1:2.
And you resp rate is a bit slow -- although not so low as to be an issue by itself.

Keep in mind that I don't know Jack. I reason that a wider PS split would improve your tidal volume.
like PS=4. You would have to increase your IPAP pressure to 10 cm-H2O which might increase your centrals.
Talk it over with your doc.

I don't think you'll qualify for an ASV (or even need one.) However, another sleep study would seem a good idea.

Mit freundlichen Grüßen,

Mongo

[arttest]

Thanks Mongo. From my own perception apart from anything related to being an xpap user, I have thought I was a shallow breather. On my todo list are breathing exercises :-) I'll ask my physician about my breathing rate and volume when I see her next month.

I just located my last sleep study. The report I have does not include tidal volume. This now 5 yr old report suggests that I have a bi-level setting to start at 9/4 and increase to 11/6 as tolerated. But my events were fewer and oxygen higher at 8/4. I am going to do some gradual changes working down to 8/4 (if my device goes down to 4) from the current 9/6 and increase the PS.

BTW, my last study showed spontaneous arousals at 16.1/hr.

Thanks!