Different Results with new APAP

Different Results with new APAP - Printable Version

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Different Results with new APAP - Gadgit - 06-04-2015

This forum is a blessing, thank you. I have learnt so much and thought it's about time I said hello and asked some questions.

I had my sleep study on the 28/4/15 and got the results on the 14/5/15.
Here are the figures:
AHI 46
Ave Oxy Desat 4%, nadir sat 82%
Ave Sat 92%
Desat index 31/Hr
Loud Snoring
ECG normal, 70bpm
8:28 record time, sleep 504 min
REM 14 min, Non-REM 468 min
Arousals: Respiratory 25, Spontaneous 36, Total 61. Arousal index 7
Heart Rate Ave 60, Min 48, Max 95
Index: OA 23 (184), CA 0 (2), Mixed 1 (4), Total A 24 (190), HA 22 (173). Tot 46 (363)

I took home an F&P Icon Auto that night on trial, set at 4-20, with a FFM.
I have been going back each week and they look at the results and possibly adjust the pressure.
On the 22/5 it was changed to 6 to 18 and then on the 27/5 it was changed to 5 to 15.

I change to a AirFit P10 pillow on the 27/5. One hour on the first night, all night except the last hour on the 2nd night and then full time going forward.

I have been working hard on loosing weight and have lost 18.5 Kg in 7 weeks. Still in the obese category at the moment.

At the visit on the 3/6, I mentioned the weight loss and between that and the results the pressure was changed to 4-15 (the last week had been 90% at 5, so maybe it could be lower).

It's getting close the the end of the trial and so I have to make a decision on what I'm going to do. The person I have been seeing is a technician. I did see a sleep doctor when I got the results and he recommended a CPAP machine. I am in Australia and it seems like it works a bit different to what others members have been saying.
So, I asked about the weight loss and if I do need to get a machine. Next week, instead of seeing the technician, I will be seeing the doctor again. He will look over the results and I will ask him about the the weight effect. I will see what happens.

I make another change at the last visit. I change the trial machine to an RESMED Airsense A10 Auto. I noticed on this board that the SH data has a lot more info and it seems like others could be getting better results?

Some questions.
The ICON didn't show the Clear Airway but the A10 does. Should I take this off the AHI to get a proper idea of how the AHI is going?
The A10 does not have the Flow Limitations. To be honest, I'm not sure what this means. Is it translated in the A10 data?
Early days, but any thoughts on the different machines? In Australia the prices are at lot different. E.g. ICON $1595, A10 $1990. I know there are other non Australian options from the supplies list, but I'm not sure what to do. Maybe a PM is in order from an Australian member.
The clinic would like me to pay $250. I get 2 years where I go in every 6 months and they look at the data, I get free filters every 6 months and I get free rental if I need to get my machine repaired, normally $50 a week. Between SH and the forum, I don't see a need to do this. The only reason is if the insurance wants compliance data from the clinic. Any thoughts?

I haven't got the required number of posts yet to attach links or files showing my results.

RE: Different Results with new APAP - under pressure - 06-04-2015

I use both the Icon Auto and the Airsense. The F&P does not have the technical capability to differentiate between an obstructive or a Central Apnea so it is going to score either one simply as an apnea. The ResMed machines usea a pulse technique called FOT to determine if your apnea is the obstructive type or the central type, the small pulses can sense whether your airway is open or not. The total AHI calculation should be close to the same, it's just that the ResMed can tell which kind of apnea you're experiencing.

Both the F&P and the ResMed will display your Flow Limitations, that is a pretty basic feature of modern cpap machines and one of the main driving determinations for pressure increases on an Auto cpap.

Keep in mind that you will see slight variations between both machines because each manufacturer has their own proprietary algorithms that the machine function with, but your results from both should basically be in the same ball park.

I like both machines although there are some differences, but for the average person treating mostly obstructive Apneas either machine is a good choice. If someone tended to have more of a problem with Central Apneas (aka clear airway) then that patient might benefit more with the ResMed machine because it has the ability to score a central whereas the F&P cannot tell the difference between an obstructive or a central........for the majority of patients this does not really make much difference because the average apnea patient's problem is treating obstructive Apneas. If someone was trying to treat mostly central they would not be using either of these machines, but most likely an ASV machine that is more appropriate for treating central Apneas.

Hope that helps a little bit

RE: Different Results with new APAP - Gadgit - 06-04-2015

Thanks for the reply under pressure.
From my sleep study, there were only 2 Central Apneas which ended up being scored 0 for the average/hour. So I guess this isn't really my issue.
It's good to know that the ICON still picks up on the CA even if it's in the total, which wasn't apparent to me.

RE: Different Results with new APAP - Dafod - 06-04-2015

Hey Gadgit,
interesting that you say about compliance for insurance purposes. I haven't heard anything like that in Australia. If you have private cover they will give you $500-$900 (depending on cover) to help pay for the flow generator (xPAP machine). Are you saying yours requires compliance data? All the insurance typically requires to get the sum I mentioned is a receipt and a Dr letter with your apnea diagnosis (which is just a copy of the letter from the sleep study). After that I don't think insurance wants to know about you. At least thats the case with Bupa, Medibank Private, HCF, etc.

Also, don't dismiss CAs too quickly. I only had one on my sleep study but now get a lot more (still low levels) and this is probably due to the air pressure of the flow generator. You can find other threads addressing this as I believe it affects 5-10% of people.

On the $250 deal I think thats up to you. You are correct in saying that with utilising this forum, having rescan/Sleepyhead software and getting feedback from the experienced users here is probably sufficient. I wouldn't pay the sum as I think the individual concerned managing the detail on a daily/weekly basis is probably far more effective and timely than a tech every 6 months. In addition, if you have an APAP, it should adjust if needs require. Just my 10c

RE: Different Results with new APAP - Gadgit - 06-04-2015

(06-04-2015, 11:18 PM)Dafod Wrote: Hey Gadgit,
interesting that you say about compliance for insurance purposes. I haven't heard anything like that in Australia. If you have private cover they will give you $500-$900 (depending on cover) to help pay for the flow generator (xPAP machine). Are you saying yours requires compliance data? All the insurance typically requires to get the sum I mentioned is a receipt and a Dr letter with your apnea diagnosis (which is just a copy of the letter from the sleep study). After that I don't think insurance wants to know about you. At least thats the case with Bupa, Medibank Private, HCF, etc.

I haven't spoken to my private health insurance about this. I have only checked my insurance for the amount of cover. For everything else they have just required a receipt of the purchase, but I have the sleep study letter anyway if they want that as well.

(06-04-2015, 11:18 PM)Dafod Wrote: Also, don't dismiss CAs too quickly. I only had one on my sleep study but now get a lot more (still low levels) and this is probably due to the air pressure of the flow generator. You can find other threads addressing this as I believe it affects 5-10% of people.

Ok, good to know. I'll keep an eye on it, especially now that I can see them split out in the data with the Resmed.

(06-04-2015, 11:18 PM)Dafod Wrote: On the $250 deal I think thats up to you. You are correct in saying that with utilising this forum, having rescan/Sleepyhead software and getting feedback from the experienced users here is probably sufficient. I wouldn't pay the sum as I think the individual concerned managing the detail on a daily/weekly basis is probably far more effective and timely than a tech every 6 months. In addition, if you have an APAP, it should adjust if needs require. Just my 10c

I agree. I don't like to say bad things, but during one of the weekly visits, the tech said that they had just done some training and there is support to be a leak rate for the masks. Before that, they were saying that the leak rate was high, even though it was around the 25 mark. I had even said that the masks have a certain leak rate. They also said that different masks have different leak rates and they were going to try and get that info.

I guess the above is another reason to be happy about seeing the doctor next week. Maybe I can get better information.

RE: Different Results with new APAP - under pressure - 06-05-2015

(06-04-2015, 10:40 PM)Gadgit Wrote: Thanks for the reply under pressure.
From my sleep study, there were only 2 Central Apneas which ended up being scored 0 for the average/hour. So I guess this isn't really my issue.
It's good to know that the ICON still picks up on the CA even if it's in the total, which wasn't apparent to me.

It's very common for people to score a few random centrals. Many times we will have a central or two as we transition from wake to sleep, or sometimes when we roll over in bed to a new position the brain will naturally cause us to hold our breath and if you hold for ten seconds or more when rolling over you'll have a central get scored. If you were in a sleep study they would ignore those centrals because they would have EEG data that tells them you were not asleep at the time of the event.

So don't worry too much with a few scattered centrals every now and then, they do happen. Patients with a real central problem have many more and it's somewhat obvious from your sleep data if you are one of the few that has primarily central Apneas which would require a different treatment approach.

RE: Different Results with new APAP - trish6hundred - 06-05-2015

Hi Gadgit,
WELCOME! to the forum.!
Much success to you with your CPAP therapy.

RE: Different Results with new APAP - PaytonA - 06-05-2015

There is a potential problem with machines that can not discriminate between obstructive and central (clear airway) apneas. What Resmed used to do before they installed the algorithm that makes the determination between an obstructive and a clear airway apnea was to not react to any apneas that occurred at pressures higher than 12 cm H2O. I feel confident that other auto machines that only score "apneas" probably do the same type of thing to prevent runaways due to centrals. For me, that caused a problem with using the auto mode on my old S8 VPAP Auto.

Best Regards,

PaytonA

RE: Different Results with new APAP - Gadgit - 06-05-2015

(06-05-2015, 03:40 PM)PaytonA Wrote: There is a potential problem with machines that can not discriminate between obstructive and central (clear airway) apneas. What Resmed used to do before they installed the algorithm that makes the determination between an obstructive and a clear airway apnea was to not react to any apneas that occurred at pressures higher than 12 cm H2O. I feel confident that other auto machines that only score "apneas" probably do the same type of thing to prevent runaways due to centrals. For me, that caused a problem with using the auto mode on my old S8 VPAP Auto.

Best Regards,

PaytonA

Thanks Payton,
I guess the question is, did the F&P Icon Auto score CA and put them under OA or did it just not puck them up at all?
My Max pressure for each machine has been under 12 cm H2O.

(06-05-2015, 03:17 PM)trish6hundred Wrote: Hi Gadgit,
WELCOME! to the forum.!
Much success to you with your CPAP therapy.

Thanks for the welcome.

RE: Different Results with new APAP - PaytonA - 06-05-2015

(06-05-2015, 05:32 PM)Gadgit Wrote: Thanks Payton,
I guess the question is, did the F&P Icon Auto score CA and put them under OA or did it just not puck them up at all?
My Max pressure for each machine has been under 12 cm H2O.

No question. It would pick up centrals but just as an apnea. With your max pressure it should not be a problem.

Best Regards,

PaytonA