+- Apnea Board Forum - CPAP | Sleep Apnea (https://www.apneaboard.com/forums)
+-- Forum: Public Area (https://www.apneaboard.com/forums/Forum-Public-Area)
+--- Forum: Main Apnea Board Forum (https://www.apneaboard.com/forums/Forum-Main-Apnea-Board-Forum)
+--- Thread: Auto Titrating Machine Recommendation REM dominated OA (/Thread-Auto-Titrating-Machine-Recommendation-REM-dominated-OA)
Auto Titrating Machine Recommendation REM dominated OA - BoxcarPete - 11-13-2023
Hello all,
I hope it's appropriate for me to ask a question that I'm sure has been asked a thousand times already, but I want to make sure that I'm doing what's right for my personal situation here, and you might be able to see why I am asking in particular.
Back in September of 2020, I received a diagnosis of "mild" sleep apnea with an overall AHI of 5.8 during the overnight in-lab polysomnography. However, that number I think is a little misleading because I had a total of 29 recorded events (17 apnea, 10 hypopnea, 2 mixed), and 27 of them were during the REM sleep they recorded (REM AHI 24.9). I hope I can tap into some experience of other members here with near-exclusive REM based OSA for this next bit.
Anyway, the physician's assistant (never did see hide nor hair of the MD at any point...) let me know that since my oxygen saturation never dropped below 90% that there was no real medical need for treatment, but CPAP was always an option and since I was young and healthy (age 30 at the time of diagnosis) I could try other things like positional sleeping or oral appliances.
Two years of positional sleeping, and another year using an MAD, and my dentist has expressed concern over the semi-permanent changes to my bite. Also I don't feel any better than I did three years ago, though each of the attempts to manage it seemed to help for some time. Went back a week or two ago to the Philips Respironics REMstar Auto that I had gotten right at the beginning of it all but hardly ever used before deciding that CPAP wasn't for me. Round 2 provided instant relief for a few days, but then a frustrating return to baseline. I looked at the tracked AHI, and it has me at 3.3 over the week, and 4.4 last night! If it takes total events/total hours used, that may not even be any improvement over my original diagnosis at all, due to the longer nights of sleep at home vs in the lab!
I am looking for a replacement for this machine in particular due to the polyurethane foam recall, and I want to make sure I am getting something that will actually help me. Is there a unit that is especially good for people with REM-Dominant OSA? Is there something like my current machine that can track data and let me look at some stats without uploading everything to some cloud or portal? I want this for myself, and to manage it myself. I don't want a unit that shares my biometric data to the highest bidder, or tracks compliance for some faceless healthcare system to decide what's good for me. I hope there even is a unit on the market that allows for private tracking of the relevant information and setting adjustments by the owner without any third-party access.
My current unit states that it is in "C-Check >90%" mode, with a reported 7.0 cm H20 as the level. I don't fully understand that metric, and I believe that I need a higher pressure during REM sleep, but hardly any in light or deep sleep. I don't know if this is the appropriate setting for this unit, but I know it has an "Auto Trial" mode where it presumably adjusts the pressure throughout the night and allows more significant changes to what it sends my way?
I don't like whatever the feature is called where the machine backs off when it thinks you should breathe out. I want to breathe out against the constant pressure, because my airway seems to fill up and equalize quickly with the higher pressure air and after 4-5 breaths I hardly even notice the difference to normal breathing. It's a lot more comfortable to me than slowing down my breathing rate below 6/min trying to relax and go to sleep and hitting the 10-second mark and having air shot up my nose. That's just the worst.
Anyway, sorry for the novel, and I will appreciate any experience or advice any of you have to share. Thanks!
RE: Auto Titrating Machine Recommendation - SarcasticDave94 - 11-13-2023
Welcome to Apnea Board,
Your best solution will be a newer and much better machine, the ResMed 10 AutoSet. It can reduce exhale pressure, it's an option called EPR. If you don't turn it on, it's not on. You can view your own data in detail if you download a free program called OSCAR. It's safe to use. Members here can help you get it setup easy.
PS it will focus on all your obstructive apnea, including the REM segments, but there's no CPAP I'm aware of that focus only on treating REM segments.
RE: Auto Titrating Machine Recommendation - BoxcarPete - 11-13-2023
Thanks for the vote of confidence in OSCAR. I am certain we have made some advancements in the decade or more since my machine was first released, but some of those strides have come at the cost of ever-encroaching reach into the cookie jar of data privacy which I want to resist in my own small way.
I took another look at the report from the sleep center, and although the math checks out (according to the sleep minutes recorded, REM% and REM AHI) to 27 in REM and 29 overall, on the chart it almost looks like two of the OAs are placed in the "wake" portion of the bar directly adjacent to the REM, and so they may not have counted as REM if they didn't terminate till after I woke up. That's sorta why I want to explore peoples' experience here since I go straight from "no problems whatsoever" directly to "woah, that's pretty bad" at the flip of a switch in REM sleep.
I don't necessarily need it to detect REM sleep per se, but an aggressive change in pressure from a minimum like 3 or 4 during most of the night where there is no trouble right up to like 12-15 if I need it once the O2 outages roll in, it seems like we could save on wear and tear along with most of the other issues associated with higher titration pressures.
And if anyone knows about what that C-Check mode is, I'd like to know, if it's just holding me at 7 it seems to hardly make a difference.
RE: Auto Titrating Machine Recommendation - Sleeprider - 11-13-2023
i also recommend the Resmed Airsense 10 Autoset CPAP. You can get the card to cloud version less expensively than the one with a cellular modem and it will work great with Oscar. It's quieter and has a much better feel and more versatility than the Dreamstation. Instead of Flex, the Resmed uses EPR (exhale pressure relief) which is a bilevel implementation. Completely different from Flex and it's your choice whether to use it or not. I know Supplier #1 sells this machine for $442 for a Black Friday deal. If you need a discount code use Holideals23 at checkout. Sign up for deals at the online suppliers. With Black Friday coming there are usually some great deals.
RE: Auto Titrating Machine Recommendation - BoxcarPete - 11-14-2023
Well, with the REMstar machine set to "Auto Trial" it reports a 90% pressure of 11.1 and an AHI of 1.9 after the first night. We are moving in the right direction, but that's something like a REM AHI of 8+ still. I was awakened several times last night in the seven and a half hours the machine was on, plus another time to help the baby go back to sleep so I had to ditch the mask and get settled in again after that, which didn't help either.
I'm thinking I should just order the Airsense 10 so I can use OSCAR and really start digging into this. The amount of data available through the menus of my machine is frustratingly limited. I was hoping someone would swing by who also has REM dominated OSA, but maybe I should have mentioned that in the title. Any chance we could edit the title to that effect?
RE: Auto Titrating Machine Recommendation - Sleeprider - 11-14-2023
I can edit the title for you. You will find the breath by breath graphing of flow rate, mask pressure and many other respiratory statistics useful to understanding your therapy and the mechanics of arousal. The Resmed machine also records data at a rate of 25 Hz vs Philips which is 5 Hz. In addition the Resmed algorithm is highly affected by flow limitation which is a reliable precursor of OA and Hypopnea. I think you will find it is more proactive in preventing events rather than responding to them.
RE: Auto Titrating Machine Recommendation REM dominated OA - BoxcarPete - 11-14-2023
5 Hz of data collection would be an amazing step up from what I have, which is what I listed in my post this morning. 90% pressure of 11.1 and AHI of 1.9 over 7:24 of machine time is literally all I have to go on.
For the record, forget all those bogus definitions like "double the AHI in REM than what you have in deep sleep" this is what REM-dominated OSA looks like (excerpt from my sleep study report):
[attachment=56113]
RE: Auto Titrating Machine Recommendation REM dominated OA - Sleeprider - 11-14-2023
When apnea is clustered, it is often related to a sleeping position where the individual is chin tucking. This can also be sleep stage related. You may want to look into the use of a soft collar to stabilize your airway to see if this provides any relief. https://www.apneaboard.com/wiki/index.php?title=Optimizing_therapy#Positional_Apnea
RE: Auto Titrating Machine Recommendation REM dominated OA - Gideon - 11-14-2023
Some comments.
First is I agree with the ResMed AutoSet.
The Card to Cloud versions provide you with the most privacy
On using the same pressure for both inhale and exhale, it depends.
Exhale pressure, pressure on a CPAP, is what manages OA events.
A difference in pressure, PS/Pressure Support/EPR, between exhale and inhale is what manages hypopneas, flow limitations, RERAS and UARS so this could be very important depending on what events you are experiencing.
That said comfort is king simply because if you don't use it you will get no benefit from it. The team here will take all this into consideration when considering anyone's issues.
RE: Auto Titrating Machine Recommendation REM dominated OA - BoxcarPete - 11-14-2023
So are you positing that as I enter REM sleep, the natural muscular paralysis that helps prevent the body from acting out its dreams is causing me to chin tuck and this is the source of all my problems? Might be pertinent to note that the first full REM block was side sleeping (and somewhat less severe*), the other two were supine. From the link you posted, I tried the "chin tuck" test and sure enough, once I got my head all the way to my chest it was difficult to inspire air even with my full waking effort. Took about six or seven seconds to fill my lungs, trying my hardest to pull through the snore, versus only one with my head in a neutral position. I've played the Tuba for over 20 years, so my lung capacity is solid.
This reminds me that when I first started experimenting, I found that sleeping without a pillow seemed to help. I can't remember why I stopped sleeping that way, maybe due to neck discomfort without the pillow. I also happened to get an amazing night's sleep at a hotel one time, the firmness of the mattress and pillow size may have been just the ticket for this type of thing.
So now the question is, do I order the ResMed machine to do my own poor man's at-home sleep studies with maybe a variety of pillow combinations or cervical collars, etc? Or is there a better way to go for just data gathering? If this works without pressure, I will be a very happy man!
* If you look at the chart closely, you'll note that the first REM chunk is clean, but only a few minutes long. The next one is a full twenty minutes and contains a scattering of mostly 10-second long hypopnea. The third chunk has some short events with more complete blockages along with a monster spike of long duration partial blockages.