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Sierra

Sierra
Joined Jul 2018
Bio

CPAP: AirSense 10 AutoSet

Set to CPAP Fixed Mode

Pressure 11 cm

Ramp: Auto

Ramp Start: 9 cm

EPR: 2, Full Time

Mask: ResMed AirFit P10 Nasal Pillow

Canada

Sierra
Joined Jul 2018
Bio

CPAP: AirSense 10 AutoSet

Set to CPAP Fixed Mode

Pressure 11 cm

Ramp: Auto

Ramp Start: 9 cm

EPR: 2, Full Time

Mask: ResMed AirFit P10 Nasal Pillow

Canada

A few posts back you asked this question:

"If it is RERA's that can't fit into the Apnea or Hypopnea categories, is this going to end up with neurology and taking a pill for life instead of APAP?"

Not a medical professional but I do get RERA indications on my ResMed AirSense 10 machine. This is how ResMed defines them:

"Respiratory Effort Related Arousals (RERAs) are periods of increased respiratory effort leading to an arousal. Increasing respiratory effort will be seen as airflow limitation. These flow-based RERA events are logged and stored as summary and detailed data..."

I am not totally sure how the machine can tell that an arousal occurs. When I look at the detailed data in SleepyHead when a RERA is flagged sometimes I see something that looks like an arousal (disruption in flow rate), and sometimes I do not. What I do see fairly consistently are indications of Flow Limitation.

In any case here is an example I found in my SleepyHead file of an event which includes both a RERA and an obstructive apnea. The RERA event (flagged as a RE) is associated with a quite significant (for me) Flow Limitation indication. This is followed by a fairly significant drop in Minute Ventilation which is amount of air being breathed in and out. Blood O2 levels tend to follow Minute Ventilation. The RERA event is fairly quickly followed by a non flagged obstructive event at 06:17:30. I can tell that by the blob of blue on the Mask Pressure. That is showing the machine is cycling the pressure up and down to sense whether the event is obstructive or central. It does not reach the 10 second of duration so is not flagged, but it occurred. When it ended there was a big spike up in Minute Ventilation showing over breathing to compensate for the period of reduced air flow.

Things kind of settle out for a while after that, but at about 6:21:30 an obstructive apnea is detected and flagged this time. The blue blob is longer and the event met the minimum of 10 seconds criteria to flag it as an OA. You can see it had essentially the same impact on Minute Ventilation reduction as the RERA did, so probably the same impact on oxygen desaturation. If anything the Minute Ventilation was reduced for long as a result of the RERA than it did for the OA event.

Sorry for the long drawn out explanation, but the point is that RERA is not a lot different than a full obstructive apnea when you consider the impact it may have on Minute Ventilation, and as a result blood oxygen, and sleep quality. Also, from what I can see in my personal results a RERA is not really associated with a central (open airway) issue and is more obstructive in nature. For that reason a PAP device is likely to treat it sucessfully with pressure. My machine is set to a fixed pressure and did not respond. In Auto mode it would have responded to the Flow Limitation and bumped pressure up. And, the For Her algorithm would have bumped it up even more. That in turn could have prevented the OA event that followed. Hope that makes some sense. Any questions, just ask...

I watched a program on our Canadian public news network last night where they asked a panel of doctors various questions about sleep disorders. Marijuana (not CBD Oil) was raised. I recall they lumped it in with alcohol and when used before bedtime it could help you go to sleep, but when the effect wears off you wake up and then have even more difficulty going back to sleep.

My thoughts on central apnea is that there are a number of root causes, but they can generally be lumped into an umbrella category of a breathing system control instability. It is like a defective cruise control in a car, that cannot maintain a constant speed. Elevation makes it worse, air pressure from PAP devices can make it worse, and in general sedatives and in particular opiods which suppress the nervous system can make it worse. It is hard to guess how something like CBD Oil would or could improve the situation.

Now that marijuana is legalized in Canada for recreation use, I would assume people will now start being more open about how it affects apnea treatment. I have no personal experience, and don't plan to, so I can't help you there.

As far as PAP treatment for central apnea, I think there are three routes to go. First is to use a CPAP or APAP and do everything you can to minimize the pressure used for treatment. The second approach is to go to a BiPAP device and use lots of pressure support (difference between EPAP and IPAP) to help the breathing effect and hopefully prevent some of the full stoppage in breathing effort (central apnea). It is pretty blunt tool however, and statistics I have seen show that BiPAP is more likely to make total apnea worse instead of better. The third solution is to use an ASV device like the AirCurve 10 ASV from ResMed. It follows breathing on a breath by breath basis and cuts back or increases pressure support on a breath by breath basis. It can have quite a dramatic improvement in central apnea contribution to AHI. On the negative side it can only be used when heart function meets a minimum standard. And, there are no studies to date that it improves long term life expectancy. It other words, it may be just masking the issue.

Yes, you need the machine, and the basic package should include SlimLine tubing, the power supply, the humidifier which is built in, the SD Card, one filter, and a travel case. Some places will put together a few more things in a package, such as extra filters, the heated ClimateLine hose, and sometimes a choice of a mask from a limited selection. These can be a good deal when you add it up. Even if you have to buy it as an option I would recommend the ClimateLine hose. It does add to the comfort factor, and makes it easier to get the humidifier setting right. Some like to add in the SoClean machine and I think that is a bit of a scam and not worth it. Distilled water you can get from places like Walmart etc.

On the prescription I doubt that anyone would prescribe any specific mask, and you wouldn't want them to. I would think just a prescription to use a CPAP is all you need. Perhaps call a vendor you are considering using to ask what they want for a prescription. I suspect what that site means by saying they need a prescription to buy a mask, is that they are making the point that you need a prescription for a CPAP to get a replacement mask. It seems to be a goofy US rule. It is not a requirement in Canada. You should not have to get a prescription for each mask you buy. Perhaps if you can get as bonjour suggests just a prescription for the APAP and mask of choice you will be good to go.

On the mask, if you just have to pick one without trying it ahead of time, I would pick the ResMed Swift FX nasal pillow, or the ResMed AirFit P10 nasal pillow. They are two of the lower priced masks and typically get good reviews for comfort. The head straps on the P10 are somewhat flimsy and are not that durable, and can have issues with keeping the mask in place. The P10 has a very quiet exhaust port though. The headgear on the Swift FX is more substantial and I suspect will last longer without replacement. The Swift FX exhaust port is not as good as the P10 but it can be worked around. I've used the P10 for about 9 months now, and have just replaced it with the Swift FX. For either one if you are just buying them on line make sure you get the fit pack version. It includes three sizes of nasal pillow inserts.

They both come in standard and For Her versions. I would buy the standard if you are male, and the For Her if you are female. In both versions the nasal pillow inserts for the standard version are small, medium, and Large. In the For Her version they are extra small, small, and medium. The headgear on the Swift FX For Her is a bit smaller than on the standard. On the P10 I believe the headgear size is the same on them both. It is very elastic, and part of the reason why it is kind of flimsy.

Hope that helps some,