newbie- sleep onset apnea

Thanks .. Other than AirSense Resmed 10 are their any other CPAP/BiPap machines which help with sleep onset apneas? I have heard there are some machines which automatically detect absence of breathing for a set period of time and start it if absent. I also probably have mild OSA as per my sleep report( Though not official , i had a chance to peep into it as the tech was preparing it). The machine needs to be portable as well as O travel sometimes

In general sedative type drugs have been blamed for causing or aggravating central apnea, with opiods probably being the worst. Sleep medications are more controversial as to their effect on CA. Something to discuss with your doctor for sure.

I would think so but I dont normally snore so it makes me think these are mostly sleep onset CSAs. During my sleep study the technician did tell me that I had mild OSA but I am not sure if these are playing up at sleep onset or are they Sleep onset CSAs.

I dont seem to have any 10 second breathing pauses normally associated with csa.

1) Is there any way to know if these hypopneas are central or obstructive, since the report does not tell about it? The doctor was fairly confident that these are obstructive in nature , since I don't have underlying conditions for a central.

One would have to look at the breath by breath flow charts to see what is happening. In my experience looking at results on SleepyHead a hypopnea can be either central or obstructive. If you are getting a waxing and waning of breathing depth in a smooth cycle that does end in a full apnea, then that would suggest a central event. And I would think during the sleep test they would monitor not only the flow but your effort to breathe. Central apnea is basically a reduction in effort to breathe. Perhaps the doctor has looked at that when making the opinion.

They should be able to tell during the titration test though. If increasing pressure does not resolve the hypopnea then that suggests they are central in nature.

2) What to expect during a CPAP titration test , since I am quite apprehensive about it?

If you had an in lab sleep test it should be very similar to that. They will just increase the pressure over the night and find out what is required to resolve your hypopnea. They will also be checking for any indication that increasing pressure causes central apnea events.

3) What kind of CPAP device will be best suited for my condition ?

If pressure resolves your hypopnea, then the two obvious choices would be a fixed pressure CPAP, or an APAP. I push as much as you can for an APAP that saves detailed data to the SD card. You don't want to get stuck with a fixed pressure "brick" that gives you no data to monitory your results. I would push for the ResMed AirSense 10 AutoSet.

Now if the pressure does not resolve your hypopnea because it is central in nature, then an APAP may not work that well. The other choices would be a BiLevel machine or ASV. Probably a bit premature to be considering them at this point though.

Simply put, there is no such thing as a central hypopnoea. Hypopnoeas are not actually classified as obstructive or central, they are just hypopnoeas, so I wouldn't worry about it. A better question is "does CPAP get rid of them?", which a titration study will tell you.

I think you may also have misunderstood what I wrote. I certainly didn't suggest that hypopnoeas and central apnoeas are the same thing. See my post above for an expanded explanation.

1. I believe the VPAP Tx machine is a special machine that ResMed makes for titration testing. It is not one that would be prescribed to a user for ongoing use.
2. Did you get any feedback on the results of the titration testing? On the initial in lab test was there any indication of RERA events, or a RDI index value? They are helpful in determining what type of apnea you have.

In the absence of any further detail, my suggestion would still be to push for a ResMed AirSense 10 AutoSet For Her version. It has an optional For Her mode in the machine that is better for treating hypopneas and RERA events. It also has the advanced features that can be set for getting to sleep.

Here is a link that provides a deep dive into how a titration test is done and the various options for treatment. But, at this point it would be really helpful to get more detail on what the outcome of the titration test was. At this point I don't see anything that would suggest you need a AirCurve BiLevel or ASV type of machine.

Sleep Lab Titration Guide

Getting back to your issue of apnea right at sleep onset, that could be either central or obstructive. Your muscles relax when you go to sleep and it is quite possible that your upper airway constricts to reduce flow or even collapses stopping flow as you go to sleep. Since your sleep report had no central apneas reported, it seems more likely that it is obstructive. It would be helpful to know if any centrals were detected during the titration test, as the pressure from the test can produce central apneas.

But, assuming the more likely case of it being obstructive in nature, and that the hypopneas are a flow reduction due to upper airway restriction, a PAP device is likely to address the issue. If you get the pressure in the airway up BEFORE you go to sleep it is much less likely to have the airway collapse when you do fall asleep.

The next step should be to get a trial machine and see what the machine can do for you in actual use at home. It would be most efficient to get a flexible machine like the ResMed For Her AutoSet, as it can be set up to get you to sleep in a few different ways, which you could try to see which works the best. They would be:

• Use it in CPAP fixed pressure mode and start at that fixed pressure with no ramp up or hold in pressure. The machine will be active right from the start in detecting any apnea events, so you will quickly see if you continue to have sleep onset apneas, and what pressure is required to stop them. That said they should know that from the titration test...
• You could add in the ramp/hold and use EPR and not use EPR during the ramp or hold.
• You could use the For Her AutoSet algorithm to see if that works best for hypopnea reduction while sleeping, or if the standard mode works best.

In other words lots of options to try. I suspect one of them will work for you.

I would try turning off FLEX to see if that helps.

If you set the ramp type to auto it will stay at the ramp start pressure until you go to sleep, 30 min max. The for her mode is more responsive to hypopnea, and less to apnea. And if it does not work well in the for her mode, you can just switch it to standard mode.

I answered most of this a bit further back in the thread. Here is a copy.

A setting of 10 is moderate. The machine is capable of going from 4 cm to 20 cm. I am now using a pressure of 11 cm. If you are going to run the machine in the For Her Auto Mode, and your recommended fixed pressure is 10 cm, I would set the minimum pressure to 8 cm, and the maximum to 11 cm as a starting point. Then after some experience with that setting and using SleepyHead to monitor the results, you can either refine those pressures, or go to a fixed pressure based on actual experience with the machine. Here is a cut and paste copy of what I gave another user of the ResMed for initial setup for comfort.

• Ramp Time: Auto (This will hold the machine at the start pressure until you go to sleep)
• Start Pressure: 7 cm or more (I would not set it at less than 7 cm unless your minimum pressure has to be less than 7 cm. You can't set Start Pressure higher than your minimum pressure. I adjust this pressure even higher to give me a feeling that there is no mask on my face at all. This pressure should be high enough that breathing is very free and easy)
• EPR: On
• EPR Type: Ramp Only (The purpose of Ramp Only is to give more comfort while going to sleep and a more effective therapy pressure after you go to sleep)
• EPR Level: 3
• Climate Control: Auto (providing you have the heated hose)
• Tube Temperature: 27 C

A little further down on the setup menu under Options you will find this item:

• Essentials: Plus (Setting it to Plus will give you more options on your User Menu, and a more detailed Sleep Report.)

If the issue of apnea events right as you go to sleep is not solved by this, there are other options. But I would start with this.

Here is a link to a video on how to set the AirSense 10. I would also download SleepyHead so you can monitor the results you are getting from day 1. The settings may have to be adjusted a little based on your actual experience with the machine. Another poster put some examples of SleepyHead reports a little further back in this thread.

You for sure want to get a hard copy or pdf copy of your sleep report. You will want it for future reference as to where you started this CPAP journey, and if you ever want to buy even a mask, you need it in the US.

In your first post you reported that you were having sleep onset apnea. I would hope that with the settings I gave you the initial ramp start pressure would be high enough to prevent the apnea. It it doesn't post back and there are some other options you could try.

• Use it in CPAP fixed pressure mode and start at that fixed pressure with no ramp up or hold in pressure. The machine will be active right from the start in detecting any apnea events, so you will quickly see if you continue to have sleep onset apneas, and what pressure is required to stop them.
• You could use EPR and not use EPR during the ramp or hold.
• You could use the Standard AutoSet algorithm to see if that works best for hypopnea reduction while sleeping, or if the For Her mode works best. I would expect if you get the For Her model it will default to the For Her mode.

I get some RERA events flagged in my sleep. I have seen no indication they are linked to sleep onset apneas or hypopneas. When ResMed flags a RERA event it seems to be associated with flow restriction and flattening off of the top of the inhale breath flow rate, and an irregular breathing event signalling an arousal. If you end up getting an AirSense 10 AutoSet For Her, it is especially set up to respond to RERA flow limitations, and snoring.

I would still set up the AutoRamp as I described in the post 14 days ago first. If it does not stop sleep onset apneas, then there are the options I also described. In other words set it up for maximum comfort first, and if that does not work, then try the other options.

Relax and sleep well p3000g

Get Sleepyhead so YOU can look at the details of what is going on. You will need an SD card if one is not already in the machine. \I do suggest trying auto mode too while you have the machine.

If your prescribed pressure is 10 cm, I would ask them to switch the machine to an AutoRamp with a start pressure of 7 cm. 45 minutes is way too long for most people. I'm generally asleep in 15 minutes. In AutoRamp mode it will keep the pressure at 7 cm until you go to sleep and then ramp up to 10 cm. Also ask them to set the EPR to 3 and for Ramp Only. What that will do is give you 7 cm on inhale and 4 cm on exhale while you are awake. Most find that very comfortable. Easy to breath in, and easy to breath out. Only 5 cm can feel suffocating.

Could you expand the scale out some so I could see what the graphs look like leading up to the point where breathing stopped? What I am seeing is that you have the machine set at a fixed 12 cm, but the section you included has the pressure going up to about 12 cm but ramping back to 9 cm or so on exhale? I'm thinking you must have the EPR on and set a 3? If so, the first thing I would try is turning the EPR off. The flat top on the inhale cycle prior to the event may indicate flow is being restricted due to a partial obstruction of the airway. Once the flat tops on the inhale cycle and the short obstructive events stop, then you may be able to reduce the pressure some.

It is hard to tell how your machine is set because the whole calendar for the month is showing. If you click on that little black triangle beside the date it will hide the calendar and make more room. Also, if you go to File, Preferences, Appearance and uncheck the box that says show the pie chart, it will get that out of the way too.

Oh come on bonjour!

You could double that list with a bit of effort and we could triple it if we all got creative. :)