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Permalink Reply by Judy on March 28, 2009 at 8:05pm

By george, you win. Its not leaks! You've assurred us you are using the right Mask Selection for the mask you are using. The next step would be to get a copy of not just the doctor's dictated results (1-2 pages each) but also the full scored data summary report w/condensed graphs (5+ pages each) from both your sleep evaluation study AND your titration study. They are part of your medical records and you have a legal right to copies under HIPAA if you are in the USA. Look carefully for any mention of Central or Mixed Apneas.

Your software says you have the Resmed AutoSet II and are using it in straight CPAP mode. If there were no centrals or mixed apneas or just a couple of them then the next step would be to put the AutoSet II in auto mode. Set the pressure range 1-2 cms below your current 14 cms and 1-2 cms above your current 14 cms. Check your average data for a week w/no other changes made. Then you have something on which to base your next pressure range, either lower or higher as indicated.

At least that is what "I" would do. Keep in mind I am only a fellow patient! One thing I would NOT do is set the pressure range at 4 cms to 20 cms in auto mode!!!

If 14 cms is anywhere near your needed pressure starting at 4 cms doesn't give your APAP enough time to reach the optimal pressure whatever it is. I can't put my finger on the abstract I read, but there was a research study done comparing Resmed, Respironics and another brand, I believe Fisher & Paykel but wouldn't swear on the latter and the Resmeds did require or report 1 cm more or less pressure than the other two models. I just don't remember which. (I know, fat lotta good that tidbit is worth). I'll betchya RestedGal could put her finger on the article in a minute!!

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Permalink Reply by Judy on March 28, 2009 at 9:00pm

So much for my memory!!!

Titration efficacy of two auto-adjustable continuous positive airway pressure devices using different flow limitation-based algorithms.
Hertegonne KB, Rombaut B, Houtmeyers P, Van Maele G, Pevernagie DA.
Department of Respiratory Diseases, Ghent University Hospital, Ghent, Belgium. Katrien.Hertegonne@UGent.be

BACKGROUND: Auto-adjustable continuous positive airway pressure devices are widely used in titration procedures to determine therapeutic pressure levels in obstructive sleep apnea patients. However, differences in operational characteristics may influence the effect on the apnea-hypopnea index (AHI). OBJECTIVES: We compared the titration performance of two devices based on detection of inspiratory flow limitation, i.e. the Respironics REMstar Auto (RR) and the ResMed Spirit (RS). METHODS: Fifty obstructive sleep apnea patients were recruited for a double-blind randomized crossover trial. Both devices were employed overnight by means of split-night polysomnography. The primary outcome was the AHI. Secondary outcome measures were the snoring index, pressure profiles and subjective appraisal of sleep quality assessed the morning after the sleep study. The Wilcoxon signed rank test for matched pairs was applied to assess differences between treatment conditions. RESULTS: No significant differences were found in sleep parameters, subjective sleep quality and snoring index. The use of the RR was associated with a significantly lower AHI in comparison with the RS [mean (SD) 6.9 (11.6)/h vs. 9.4 (9.2)/h, p = 0.004]. This result was obtained at significantly lower pressure levels [P95 9.2 (2.3) cm H(2)O vs. 10.2 (1.5) cm H(2)O, p = 0.001]. CONCLUSION: While the RR provided a lower AHI than the RS at lower pressure levels, it could not be assessed whether this difference was relevant for clinical outcomes. However, this face-to-face comparison of Auto-adjustable continuous positive airway pressure devices seems useful for the assessment of titration efficacy. Copyright (c) 2007 S. Karger AG, Basel.

Publication Types:
Randomized Controlled Trial

PMID: 17541262 [PubMed - indexed for MEDLINE]

Full text of the article at:

http://content.karger.com/produktedb/produkte.asp?typ=fulltext&...http://content.karger.com/produktedb/produkte.asp?typ=fulltext&...">

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Permalink Reply by Dave D. on March 28, 2009 at 9:46pm

This is only one day and indeed the day you chose you did not have any significant air leak. There are plenty of days that you do.
Dave said:

I figured out how to look at detail by day. Here is an example day. Is everyone still so sure that it is all related to leak? To me it just looks like the therapy is not working.

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Permalink Reply by Kristen on March 30, 2009 at 10:11pm

The ResMed Liberty FFM (hybrid nasal pillow and mouth mask) is a good alternative to the traditional, bulky, leak-prone FFM's out there. I have set it up with the majority of my FFM pt's and have had a lot of success with it.

Also - EPR in the ResMed line is not the same as the CFlex in the Respironics line. Typically, apneas occur at the end of the exhalation. Figure you have a pressure of 10 with CFlex of 3. With CFlex, the machine returns to the set (prescribed) pressure of 10 before the beginning of the next breath, allowing for the correction of the potential apnea, with the CFlex kicking in at the beginning of the next exhalation, bringing the exh pressure to 7 for a brief period. However, with the ResMed line the EPR stays at 7 after the exhalation and remains there until the next breath is initiated - potentially allowing apneas to occur. I have tested and verified this with both a digital and water manometer, and get the same results. Don't get me wrong - I love the ResMed line, but I'm not sold on the EPR yet for the above reason, and hope they resolve this issue - and wonder if possibly this is one of the problems the CPAP user above could be having??? Maybe after leak issues are resolved, try turning EPR off and see if AHI decreases to <10.

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Permalink Reply by Mike on March 31, 2009 at 1:09am

very interesting insight into the difference betwee c-flex (respironics) and EPR (resmed)...makes sense to try without the EPR. we'll let you know what the results are of that experiment.

Kristen said:

The ResMed Liberty FFM (hybrid nasal pillow and mouth mask) is a good alternative to the traditional, bulky, leak-prone FFM's out there. I have set it up with the majority of my FFM pt's and have had a lot of success with it.

Also - EPR in the ResMed line is not the same as the CFlex in the Respironics line. Typically, apneas occur at the end of the exhalation. Figure you have a pressure of 10 with CFlex of 3. With CFlex, the machine returns to the set (prescribed) pressure of 10 before the beginning of the next breath, allowing for the correction of the potential apnea, with the CFlex kicking in at the beginning of the next exhalation, bringing the exh pressure to 7 for a brief period. However, with the ResMed line the EPR stays at 7 after the exhalation and remains there until the next breath is initiated - potentially allowing apneas to occur. I have tested and verified this with both a digital and water manometer, and get the same results. Don't get me wrong - I love the ResMed line, but I'm not sold on the EPR yet for the above reason, and hope they resolve this issue - and wonder if possibly this is one of the problems the CPAP user above could be having??? Maybe after leak issues are resolved, try turning EPR off and see if AHI decreases to <10.

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Permalink Reply by Wooly on May 21, 2009 at 6:00pm

Hello Addy
I am reading this with interest two months after your post. I live in rural Victoria in Australia and we have no sleep apnea technicians in town anymore and so I have lost my ability to get someone to check my reports. You mentioned that you had the manual for the S8 AutoSpirit II - does it also have the directions on how to read the reports? If so I would dearly love a copy as I do want to be involved in understanding my health issues. My email is flyfisher@spin.net.au

cheers

Wooly

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Permalink Reply by Mike on May 21, 2009 at 9:05pm

you can download the user manual for the s8 autospirit ii at http://www.resmed.com/au/products/s8_autoset_spirit_ii_epr/s8-autos...

Wooly said:

Hello Addy
I am reading this with interest two months after your post. I live in rural Victoria in Australia and we have no sleep apnea technicians in town anymore and so I have lost my ability to get someone to check my reports. You mentioned that you had the manual for the S8 AutoSpirit II - does it also have the directions on how to read the reports? If so I would dearly love a copy as I do want to be involved in understanding my health issues. My email is flyfisher@spin.net.au

cheers

Wooly

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