FAQ

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GENERAL QUESTIONS
I don't know the jargon here. Is there a glossary of terms?
What's the difference between mild, moderate and severe Sleep Apnea?
For winters, is there a way to warm the air from the CPAP?

MACHINE QUESTIONS
What is CPAP?
What is an Auto-PAP?
What is a a Bi-level/BiPAP Machine?
What are the fully data-capable machines?
Data via LCD screen for Resmed S8 Elite or S8 AutoSet Vantage?
Get data via the LCD screen for Resmed S8 Elite or S8 AutoSet Vantage?

I don't know the jargon here. Is there a glossary of terms?
Apnea
A cessation of breathing/airflow lasting greater than 10 seconds.

Apnea Hypopnea Index (AHI)
A measure of one's severity of sleep apnea, as determined by the number of apneas plus hypopneas, on average, in an hour of sleep; <5 events /hour = ("normal"); 5-15 events/hour = (mild sleep apnea); 15-30 events/hour = (moderate sleep apnea); >30 events/hour = (severe sleep apnea).

Arousal
An interruption of sleep of a duration greater than 3 seconds.

ASV
Adaptive Servo Ventilation machines: essentially operates as would a bilevel machine, but with the added ability to adjust IPAP (inhalation pressure) upward very rapidly (within one breath) if the sleeper looks like they won't reach the target volume or flow that the machine has been tracking.

Bilevel
This device regulates airway pressure at prescribed levels, alternating between inhalation (IPAP) and exhalation (EPAP) pressures. Usually, the inspiratory pressure is higher than the expiratory pressure. Bilevel therapy is helpful to those with sleep apnea combined with other respiratory conditions.

BiPAP
Philips Respironics trademark for its bilevel machine.

Bruxism
Grinding of the teeth. Often associated with sleep apnea.

Central Sleep Apnea
Sleep Apnea characterized by episodes where there is no airflow and no effort to breathe lasting greater than 10 seconds. Different from an obstructive sleep apnea because the cause of the cessation of breathing is not a physical obstruction.

Cheyne-Stokes Respiration
A form of Central Sleep Apnea where one's breath becomes progressively shorter and shallower, pauses completely, and then after a period starts the cycle over. Could be a sign of a problem with the heart.

Chinstraps
A chinstrap is worn to keep the mouth closed to prevent leak from the mouth.

Complex Sleep Apnea
When central sleep apneas are triggered by the application of positive airway pressure. Contrast with Mixed Sleep Apnea, Obstructive Sleep Apnea and Central Sleep Apnea.

CPAP
Continuous Positive Airway Pressure. Filtered room air is delivered to a mask that fits over the nose to prevent upper airway tissues from collapsing. The prescribed pressure acts as a splint to maintain the airway. This pressure is continuous during both inhalation and exhalation. CPAP is used to treat Obstructive Sleep Apnea (OSA) as well as Upper Airway Resistance Syndrome (UARS). CPAP is a corrective therapy that should be used on a nightly basis to be beneficial.

Desaturation
Drop in O2 oximetry distribution saturation by 3% below average saturation.

DME
Durable Medical Equipment provider, home health care provider or any other person or entity that sells CPAP supplies and equipment. Equipment is prescribed by a physician, and supplied by the DME. CPAP supplies can be rented on a month-to-month basis or purchased, depending on insurance requirements.

ENT
Ear Nose Throat physician

Epworth Sleepiness Scale
<10=(does not indicate EDS (Excessive Daytime Somnolence));10-15=(indicates daytime somnolence-not excessive);>16 (indicates EDS).

Filters
Filters attach to pressure devices to improve the quality of air inhaled. There are two types of filters available: reusable and disposable.

GERD
Gastroesophageal reflux disease

Humidifier
Humification is provided by passing air across a tray of water to prevent nasal dryness. There are two types of humidifiers: heated or non-heated. A humidifier can increase the comfort and tolerance while using a positive pressure device. Some insurance companies do not cover humidification.

Hypopnea
>50% decrease in airflow for 10 seconds or greater with a decrease in oxygen saturation of >3%.

Mask
There are several interfaces for positive pressure devices, most involving a mask with headgear, worn over the nose. A properly fitted mask creates a good seal around the nose, while maintaining comfort. Air leaking into the eyes should be avoided. The user's mouth must be closed during therapy while using a nasal mask or pillows or a leak will occur.

Mixed Sleep Apnea
Sleep Apnea characterized by episodes of both central and obstructive apnea events (the centrals not being triggered by the cpap therapy). Contrast with Central Sleep Apnea, Complex Sleep Apnea and Obstructive Sleep Apnea.

MMA
Maxillo-mandibular advancement, a type of surgery

Nasal Pillows
An alternative to the standard mask, small silicone "pillows" fit into the nostrils and deliver air directly to the nasal passages.

Nocturia
Frequent nighttime urination, often associated with untreated sleep apnea.

Non-supine
Sleeping in any position other than on the back.

Normal Sleep Architecture
Stage 1: 5%
Stage 2: 50%
Stage 3: 10%
Stage 4: 10%
Stage REM: 25%

NPSG
Nocturnal Polysomnogram, or sleep study.

Obstructive apnea
A respiratory episode where there is no airflow lasting greater than 10 seconds, and the cause of the airflow limitation is a physical obstruction.

Obstructive Sleep Apnea (OSA)
Obstructive Sleep Apnea is the partial or complete collapse of the upper airway which is caused by the relaxation of excessive tissue during sleep. This may result in frequent arousals associated with decreases in blood oxygen levels. This constant interruption of sleep results in a loss of restful, healthy sleep. This lack of sleep generally causes daytime sleepiness and poses a serious threat to physical health and mental well-being.

Outgassing
Process by which plastic component parts of CPAP masks and other CPAP supplies give off a chemical odor after being manufactured until they have been exposed to the air for a sufficiently long period of time.

PLM arousal index
The number of periodic limb movements that cause arousals multiplied by the number of hours of sleep.

PLMs
Periodic limb movements.

Polysomnogram study (PSGS)
Sleep study consisting of a test of sleep cycles and stages through the use of continuous recordings of brain waves (EEG), electrical activity of muscles, eye movement (electrooculogram), breathing rate, blood pressure, blood oxygen saturation, and heart rhythm and direct observation of the person during sleep

Polysomnographic technologist
Technician, typically registered, who administers a sleep study.

PSGT
Polysomnographic technologist.

Rain out
Jargon for the condensation that can build up inside a CPAP hose when warm, humidified air flows through a CPAP tube exposed to cold air.

Ramp
A feature of most units, allows for a gradual increase of pressure as the user falls asleep. The ramp time is usually measured in 5-minute intervals, ranging between 5 and 45 minutes to reach prescribed pressure settings.

REM latency
Time it takes to achieve REM (dreaming) sleep from sleep onset.

REM Sleep
Short for Rapid Eye Movement sleep, which is the dreaming stage of sleep; Normally occurs every 60-90 minutes.

RERAs
Respiratory effort related arousals. Episodes that are not apneas or hypopneas, often related to loud snoring, that generally do not cause a decrease in oxygen saturation.

Respiratory Arousal Index (RAI)
(AHI + snoring related EEG arousals)/hour of sleep.

Respiratory Effort Related Arousals (RERAs)
Sleep Arousals due to respiratory events characterized by pressure flow limitations in the airflow indicator channel without significant O2 desaturations.

Respiratory related sleep fragmentation
Sleep arousals due to respiratory events or snoring.

RT
Respiratory therapist.

RRT
Registered respiratory therapist (i.e., a respiratory therapist who has passed a board exam for certification).

RPSGT
Registered polysomnographic technologist (i.e., a polysomnographic technologist who has passed a board exam for certification).

SaO2 scale
a measure of oxygen desaturation in the body brought about by sleep disordered breathing; >89%=("normal"); 85-89%=(mild desaturation);80-84%=(moderate desaturation); <80% (severe desaturation).

Sleep Efficiency
Normal is >80%

Stage 1 Sleep
The lightest stage of sleep. Transitional stage from wake.

Stage 2 Sleep
The first true stage of sleep.

Stages 3/4 Sleep
The deepest, most restorative sleep; aka "Deep Sleep" -- Deep Sleep, along with REM sleep, decrease as we age

Supine
Sleeping on back. Without positive airway pressure, often associated with more severe obstructed sleep apnea than sleeping on one's side.

TMJ
Temporo-mandibular joint disease

Tracheostomy
A tracheostomy is a surgical procedure to create an opening through the neck into the trachea (windpipe). A tube is usually placed through this opening to provide an airway into the upper trachea. This tube is called a tracheostomy tube or trach tube. This airway bypasses the entire upper airway and therefore is 100% successful in curing sleep apnea.

UARS
Upper Airway Resistance Syndrome. UARS is a narrowing of the upper airway during sleep associated with frequent arousals due to difficulty breathing.

UPPP
Uvulopalatopharyngoplasty, a type of surgery

VPAP
ResMed trade name for its bilevel machine.

XPAP
Generic term to refer to any positive airway pressure machine: CPAP, bilevel, etc.

What's the difference between mild, moderate and severe Sleep Apnea?
Mild Sleep Apnea = AHI between 5 and 15
Moderate Sleep Apnea = AHI between 15 and 30
Severe Sleep Apnea = AHI > 30

For winters, is there a way to warm the air from the CPAP?
There is a warming tube that wraps around the tubing although it is a bit expensive. You can also box up the CPAP and place a warming pad over it set on low. Then if you route the tubing under your pillow and covers, the air will be delivered warm and comfortable.

What is CPAP?
CPAP is short for Continuous Positive Airway Pressure, the most widely recommended treatment for moderate to severe obstructive sleep apnea.

CPAP entails wearing a mask-like device while you sleep, which provides pressurized air to prevent the airway from collapsing. Most CPAP units are the size of a tissue box and many now come with a built in humidifier for comfort. Cpaps come in several models and makes. The two best known brands are probably the Resmeds and Respironics. The lower end models do not provide data recording (although I think all record compliance in case the insurance or Medicare needs to know if the patient is using their machine). A ramp feature makes it easier for a patient to get used to the pressure by starting the pressure lower and gradually raising it to the prescribed pressure. Often times once the patient has become accustomed to treatment they no longer need the ramp feature. Epr, cflex, and aflex (other machines may have different names for this technology) offers exhalation relief. This means when you breathe out the pressure drops slightly to make it "more natural". Many use this feature and I, for one, still use the cflex mode on my machine. If at all possible, make sure that you get a data capable machine. This data allows the machine, with the help of a data card and additional software, to monitor your events while using the machine. Insurance will not cover the external software needed for your computer to monitor it yourself -- but many DME's will download the data for a small fee.

What is an AutoPAP?
An AutoPAP uses an internal regulator that adjusts pressure rather than remaining at one fixed setting. These machines are able to offer lower pressures and increase the pressure when they "sense" an event.

What is a Bi-level/BiPAP Machine?
A Bi-level, also known as a BiPAP, switches from higher to lower air pressure during the exhalation, making breathing easier for some. Often insurance companies require you to "fail" using CPAP before paying for this machine as it is more expensive. People that need higher pressure often benefit from bilevels since the pressure can be adjusted at a wider range than what epr, cflex, or aflex can offer.

What are the fully data-capable machines?
The fully data capable Resmed xPAPs are the:
Resmed S8 Elite w/EPR
Resmed S8 II Elite w/EPR
Resmed S8 AutoSet Vantage
Resmed S8 II AutoSet w/EPR
Resmed VPAP Auto
Resmed S8 II VPAP Auto 25

The fully data capable Respironics xPAPs are the:
Respironics M Series Pro w/C-Flex
Respironics M Series Auto w/C-Flex
Respironics M Series Auto w/A-Flex
Respironics Bi-PAP Auto w/Bi-Flex
Respironics M Series Bi-PAP Auto w/Bi-Flex

The fully data capable DeVilBiss xPAPs are the:
IntelliPAP Info
IntelliPAP AutoAdjust

The fully data capable Puritan Bennett xPAPs are the:
Puritan Bennett GoodKnight 420E autoPAP
Covidien (Puritan Bennett) Sandman AutoAdjust

Data via LCD screen for Resmed S8 Elite or S8 AutoSet Vantage?
The Efficacy Data menu reports the 9th percentile of Pressure, the 95th percentile of Leak, the AHI, AI and HI for that night, and the averages for the same for the previous week, previous month, previous six months and previous year. The Usage menu reports the hours used and number of nights used as well as number of nights since you first used it as well as the hours used that night.
Get data via the LCD screen on Resmed S8 Elite or S8 AutoSet Vantage?
Press the Left and Right buttons and hold for 3-4 seconds. Efficacy Data should appear on the LCD screen. From then on in it is a matter of Left button to Enter, Right button to Exit, Up button to return to the previous screen, Down button to proceed to the next screen. You cannot accidentally or intentionally change your therapy settings from these menus.

This button combination will work to access the Efficacy Data on all S8 and S8 II (and I think the S7) Resmed devices that are fully data capable if that access has been turned on from the Clinicians Menu by your DME supplier's staff. If Efficacy Data doesn't appear on the LCD screen w/the above button combination then access to that data has not been turned on in the Clinicians Menu by your DME supplier or your Resmed device is not fully data capable.

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