If you're finding your CPAP uncomfortable ...

[Dr.Bob]

       
If you're having trouble with your CPAP machine, please be aware of one flaw in Respironics machines that can make CPAP very uncomfortable. If your Respironics machine is set to auto-titrate (auto-PAP), in which it adjusts the pressure depending on need, and if you find yourself waking up with uncomfortably high pressures, take a look at the OSCAR upload and see if it looks like the attached. If it's showing a lot of VS2 events (vibratory snores), that can be caused by a machine defect.

While I'm not qualified to give advice about sleep apnea, I would appreciate your letting me know if you experience this problem. I'm trying to understand how frequently it occurs. In exchange, I can share some information that may help your sleep medicine provider adjust the machine so that it works better for you.

Thanks!

[Sleeprider]

Dr Bob, just wait until you discover the "variable breathing" flaw which shuts down the auto algorithm. https://www.apneaboard.com/wiki/index.ph..._Breathing

My best recommendation, and one I have consistently given is, don't accept a Philips Respironics device. Hold out for the best. The Philips auto algorithm is obsessed with snores and endlessly raises pressure when VS1 or VS2 is detected. As you note the machine uses flow and pressure feedback to detect this, and "snores" can be detected from external factors, like a tube rubbing on a hard surface or vibrations in the mask and leaks. By the time snores are detected, it is probably already too late to prevent apnea which is why Resmed uses flow limitation, which results in a much more responsive algorithm to prevent apnea. All auto algorithms have some issues, and need to be contained by optimizing the upper and lower bounds. It is unfortunate how many professionals do not realize these limitations and prescribe 4-20 pressure ranges as if that reflects some kind of expertise. FWIW, most of the examples you posted actually suggest a positional apnea problem that is not even recognized by the profession. https://www.apneaboard.com/wiki/index.ph...onal_Apnea

[Dr.Bob]

Fascinating!

How do you distinguish the clusters of events due to positional apnea from clusters associated with REM sleep?

And, yes, I've switched to ResMed! The Respironics recall did it for me.  My Sleep Med doc and I have been wondering whether the false vibratory snore reads may actually be due to loose soundproofing foam, at least sometimes, though I recognize the other causes you mention. What do you think?

Thanks!

[Sleeprider]

DrBob, I don't accept that REM generates apnea clusters randomly throughout the night. When I see charts like these the patterns of apnea-arousal-apnea-arousal will only arise from an obstruction in the upper airway that is not resolved by what should be an effective CPAP pressure of 15 cm. We can trial higher pressure to resolve this pattern or just put a soft cervical collar on and usually see this pattern dramatically reduced. It's not accidental, and it's extraordinarily common. The pattern often resolves with simple interventions like getting the individual out of an inclined position or using lower pillows. Keeping the airway open like we would with artificial respiration (mouth-to-mouth) by tilting the chin up is not a dissimilar approach. Many people relax deeply when they sleep to the extent they self-strangulate. We can easily address that through positional training or devices like the soft cervical collar. Sometimes we don't see the desired response due to a very plastic airway or tongue obstruction, but by far the majority respond positively.

[DaveL]

Fascinating thread.
Thanks for posting.

@Sleeprider thanks for your knowledge and sharing. Salute for you.

DaveL