Is Resmed S9 Autoset mode suitable for central sleep apnea?

[vsheline]

...
With a fixed pressure of 10, you have essentially no obstructive apnea or hypopnea, and the clear airway events are very low, and could be simply disturbances in sleep. They are not a health concern or indicative of central or complex apnea. There is no harm in experimenting with some alternative machine settings if you want to. Putting the machine into Auto mode and a minimum pressure of 8.0 and maximum pressure of 11.0 might be more comfortable, and should provide comparable effectiveness. Whether this cleans up some of the arousals, we can't say, but it might be worth a shot. You can always resume CPAP at 10 if you don't like the results.

Hi napnaptime,

I second Sleeprider's observations.

You may be having RERA events which AutoSet therapy mode could better treat, so I suggest trying that. If for several nights in a row the pressure maxes out, I would suggest gradually increasing the Max Pressure setting, unless you observe the number of CA events increase to higher than perhaps a couple per hour, or unless air-swallowing becomes an issue, or unless you notice any hearing or balance or vision or lung problems which higher pressure may be making worse. For example, if you have glaucoma then get your intraocular pressure checked regularly and be very cautious in raising the Max Pressure setting, as higher CPAP pressure can raise intraocular pressure, but do not stop CPAP therapy: http://www.apneaboard.com/forums/Thread-...2#pid39742

ResMed published a white paper showing a comparison between the CA detection algorithm of the S9 versus polysomnography and the S9 was about 85% accurate, if memory serves. So I think your doctor was about 85% wrong to disregard the CA events reported by your machine.

I think no doctor alive would see in the data you posted any indication of Central or Complex Sleep Apnea Syndrome, which is usually considered to require at least 5 CA events per hour. Some insurance companies will not cover an ASV machine unless there are 10 or 15 CA events per hour.

If you do not have a pulse oximeter then I suggest trying to get one. The type which is worn like a watch with separate finger sensor is more comfortable, especially if used for two or more nights in a row. Supplier 19 has a lot of good information and I think fair prices. (A link to the Supplier List is at the top of every forum page.)

If your average SpO2 (Oxygen Saturation percentage measured percutaneously, meaning through the skin) is lower than 94 then I think supplemental O2 may be helpful, but please always be very careful to avoid too much O2, which can be dangerous, long term. Too much supplemental O2 can cause harm. Too much O2 can also render some prescription meds ineffective.

If you ever buy an Oxygen Concentrator, be aware they all tend to be very noisy (try to get the least noisy one available) and they remove O2 from the room they are in, so probably they should be placed in an adjacent room with closed door and open window, and with 25 or 50 ft tube to reach your bed.

Take care,
--- Vaughn

[justMongo]

If you ever buy an Oxygen Concentrator, be aware they all tend to be very noisy (try to get the least noisy one available) and they remove O2 from the room they are in, so probably they should be placed in an adjacent room with closed door and open window, and with 25 or 50 ft tube to reach your bed.

Take care,
--- Vaughn

Summed up, they remove no more O₂ that you use in your breathing. So, unless you are in a room that you would suffocate in anyway, there is no issue other than noise.

[archangle]

If you ever buy an Oxygen Concentrator, be aware ... they remove O2 from the room they are in, so probably they should be placed in an adjacent room with closed door and open window, and with 25 or 50 ft tube to reach your bed.

You might think that, but it doesn't work that way.

Any O2 removed from the room by an oxygen concentrator gets blown into your mask or cannula, so that it ends up back in the same room it started in. You are the only thing in the room that's consuming oxygen. At worst, the machine moves O2 around within the room.

If you put it in an adjacent room, you would then be depleting O2 from that room and boosting in in your room.

Even if the O2 concentrator were removing O2 from the room, the effect is unlikely to be significant anyway. A 10x10 foot room has around 20,000 liters of air, or about 4,000 liters of O2. A concentrator probably puts out no more than 4 liters of O2 per minute. That's about 1000 minutes, or 10 days of O2. Air "turns over" in a room a lot faster than that, usually once every couple of hours, even without any sort of ventilation system.

[vsheline]

You might think that, but it doesn't work that way.

Thanks justMongo and archangel.

I thought that my O2 Concentrator must be using up some O2 because it puts into the room stuffy ozone-ish smelling air, which I assume may be unhealthful to breathe. However, in googling how O2 Concentrators work it seems no O2 should be lost, so I suppose the warm, slightly smelly oxygen-depleted air it releases back into the room may be otherwise harmless. Not that I would want to breath it, though.

The user manual says to run it in a well-ventilated area. I keep it in an adjacient room with its window open wide and its door closed.

[napnaptime]

...
With a fixed pressure of 10, you have essentially no obstructive apnea or hypopnea, and the clear airway events are very low, and could be simply disturbances in sleep. They are not a health concern or indicative of central or complex apnea. There is no harm in experimenting with some alternative machine settings if you want to. Putting the machine into Auto mode and a minimum pressure of 8.0 and maximum pressure of 11.0 might be more comfortable, and should provide comparable effectiveness. Whether this cleans up some of the arousals, we can't say, but it might be worth a shot. You can always resume CPAP at 10 if you don't like the results.

Hi napnaptime,

I second Sleeprider's observations.

You may be having RERA events which AutoSet therapy mode could better treat, so I suggest trying that. If for several nights in a row the pressure maxes out, I would suggest gradually increasing the Max Pressure setting, unless you observe the number of CA events increase to higher than perhaps a couple per hour, or unless air-swallowing becomes an issue, or unless you notice any hearing or balance or vision or lung problems which higher pressure may be making worse. For example, if you have glaucoma then get your intraocular pressure checked regularly and be very cautious in raising the Max Pressure setting, as higher CPAP pressure can raise intraocular pressure, but do not stop CPAP therapy: http://www.apneaboard.com/forums/Thread-...2#pid39742

ResMed published a white paper showing a comparison between the CA detection algorithm of the S9 versus polysomnography and the S9 was about 85% accurate, if memory serves. So I think your doctor was about 85% wrong to disregard the CA events reported by your machine.

I think no doctor alive would see in the data you posted any indication of Central or Complex Sleep Apnea Syndrome, which is usually considered to require at least 5 CA events per hour. Some insurance companies will not cover an ASV machine unless there are 10 or 15 CA events per hour.

If you do not have a pulse oximeter then I suggest trying to get one. The type which is worn like a watch with separate finger sensor is more comfortable, especially if used for two or more nights in a row. Supplier 19 has a lot of good information and I think fair prices. (A link to the Supplier List is at the top of every forum page.)

If your average SpO2 (Oxygen Saturation percentage measured percutaneously, meaning through the skin) is lower than 94 then I think supplemental O2 may be helpful, but please always be very careful to avoid too much O2, which can be dangerous, long term. Too much supplemental O2 can cause harm. Too much O2 can also render some prescription meds ineffective.

If you ever buy an Oxygen Concentrator, be aware they all tend to be very noisy (try to get the least noisy one available) and they remove O2 from the room they are in, so probably they should be placed in an adjacent room with closed door and open window, and with 25 or 50 ft tube to reach your bed.

Take care,
--- Vaughn

It is funny you should mention RERA I do have a deviated septum and severe damage to my nose as a result of many broken noses,my respiratory also mentioned that I could be awakening at night, I have about 17 or 18 of those UF2 events per night as you can see in the pie charts its a big chunk of my sleep, I wonder could I also have UARS or even a misdiagnosis?

[Sleeprider]

I wouldn't get too close to the misdiagnosis bandwagon just yet. It would make doctors nervous, and doesn't really serve any purpose for you. Give the autoset mode a try and see where that takes you . Upgrading eventually to the newer Airsense 10 Autoset or a Philips Respirononics Auto would get you a RERA channel in the data, but bilevel (separate EPAP/IPAP) is the most effective approach for treating that. Unfortunately most insurance won't cover that for people adequately treated for OSA.

[SuperSleeper]

napnaptime, I merged your two threads together (on the same subject matter), and deleted a couple duplicate posts.

[napnaptime]

napnaptime, I merged your two threads together (on the same subject matter), and deleted a couple duplicate posts.

Thanks for that much appreciated.

[sonicboom]

I third the suggestions of sleeprider and vsheline. I would try 8-11 and see if that reduces your UF 1 and 2 numbers. They very well could be arousals interrupting your sleep. Give it a go. Track your results. You can always return to previous settings. Keep us posted.

[vsheline]

It is funny you should mention RERA I do have a deviated septum and severe damage to my nose as a result of many broken noses,my respiratory also mentioned that I could be awakening at night, I have about 17 or 18 of those UF2 events per night as you can see in the pie charts its a big chunk of my sleep, I wonder could I also have UARS or even a misdiagnosis?

The gold standard treatment for Upper Airway Resistance Syndrome is to eliminate its resulting Respiration Effort Related Arousals by using bilevel CPAP.

There is an excellent chance that the S9 AutoSet with EPR of 3 and a FFM will be able to provide great treatment for you.

However, if in a month or two you are still feeling little benefit from APAP therapy and want to try bilevel, you could work with your doctor(s) to try to get insurance coverage for a bilevel Auto like the AirCurve 10 Auto or DreamStation BiPAP Auto (except that Encore and SleepyHead software do not yet support the DreamStation machines, so I suggest avoiding DreamStation machines for now).

The PRS1 DS760 BiPAP Auto with heated tube, which is an excellent machine for treating RERA and is supported by SleepyHead and Encore software and is less expensive than the AirCurve 10 Auto, would be a great option if there would be no insurance coverage. But, on the other hand, you would already have the S9 humidifier so the S9 VPAP Auto would also be a great choice.

If you try to use a fixed pressure bilevel (S therapy mode) machine, the lack of the Auto feature would make it an order of magnitude more iterative to determine the best settings to use, and I think S (meaning Spontaneous, meaning the machine synchronizes itself to your spontaneous breathing rate) therapy mode may not be able to provide optimal treatment. ResMed says the bilevel Auto is their optimal machine for plain obstructive sleep apnea in cases like yours (meaning, for patients without an excessive amount of central apneas).

I think trying a ResMed ASV machine is not indicated and would likely be a waste of time and money and effort and likely would not be able to provide optimal treatment like a bilevel Auto would. I think the Philips Respironics BiPAP Auto is the most full-featured CPAP machine for treating UARS / RERA, with ResMed a close second. Some can't stand the feeling of using one but have no problem using the other, depending on the patient's breathing style. But I assume most could adapt to how therapy feels from either one.

Take care,
--- Vaughn