sleeptech

In adults, surgeries have a very low success rate for both snoring and, even more so, OSA. They are also painful with a high risk of post-operative infection and, in the rare cases they have any positive effect, they can revert over time. This is all based on the literature. Approach with great caution.

CPAP should still work just fine for snoring, even without any apnoea, of your decide to go that route.

I will attempt to answer your questions in under 500 words.

question 0: They are fine. Some of the adjustments are in an on screen menu, which is a problem if you are not a native English speaker or you are technophobic (most of my patients are one or the other), but from your history you should be fine. The humidifier is one of the better ones. The AirSense 10 is usually a bit more expensive that either a Respironics or a Fisher & Paykel and no better than either of these. If you can get a Respironics DreamStation for less I would probably go that way. The main issue with the Fisher & Paykel is that the humidifier is fiddly and hard to empty, but if you use a humidifier it is also cheaper because you don't have to pay extra for it (it is integrated).

question 1: That is a very technical question. The reps for each company will tell you that their machine adjusts itself faster than everyone else's, but they are all pretty similar. The simple truth is that there is no way of telling if a new machine will fix your sudden waking problem until you give it a try. The AirSense 10 is almost certainly no worse than your old Respironics machine, but whether or not it is better will only be revealed by giving it a try.

question 2: It is easy to put the AirSense into clinical mode. I don't feel comfortable disclosing how it is done here, but I don't think I'm giving away any secrets when I say that Mr Google will help you find and answer to your question in under 60 seconds. I totally understand why you wish t oadjust your own machine and, as you are using an auto, the lower pressure is really only for your comfort and there is little harm in you adjusting it. However, I feel I must add that, in general, I do not encourage people to adjust their own machines. Sorry, just had to get that in.\

question 3: The AirSense has it's own version of C-Flex called EPR. It's exactly the same thing. If you don't like it just turn it off. I personally hate C-Flex, EPR and all other similar forms of pressure relief. In 99.9% of cases they are unnecessary and in some cases can cause serious problems, but I don't want to break into a rant now (even if that's what internet fora are for). You can also turn the ramp off if you like.

Any further questions, I'm happy to help.

Short answer is that water which is safe for drinking is safe to use in your humidifier. If you use tap water or rain water you will need to clean your chamber occasionally because it will eave deposits as it evaporates. These are harmless enough but don't look great and, if they from a thick enough layer over the heater plate, may interfere with humidifier operation. Soaking with vinegar and a scrub with a tooth brush usually does the trick. Distilled water will keep you humidifier chamber much cleaner because there is nothing in it to get left behind when it evaporates, so you may never need to clean your chamber.

However, no matter what kind of water you use, you should ALWAYS empty your humidifier chamber daily and dry it out. It doesn't matter what kind of water you use, there are yeasts and moulds floating in the air everywhere and if you leave water in your humidifier long enough they will start to grow in it. If you empty and dry your chamber daily then this is adequate to prevent growth of pathogens.

I have seen the bottom of humidifier chambers corrode, but only very rarely. It is far more likely that there was a fault in the metal responsible for this than anything else. On the other hand I've seen thousands of humidifier chambers used with tap water for years with no corrosion. Regular cleaning was all that was required.

One of the things which varies most from one model of CPAP to another is how easy it is to use, empty and clean the humidifier chamber. The best at present would be the Respironics DreamStation which has the best humidifier design I've ever seen.

The only thing which passes through your machine is the same air you would be breathing without it. Of the many thousands of patient's I've dealt with, the only time I've heard of anyone catching anything from their machine was one person who never emptied the humidifier chamber and let it (and his tube) become completely filled with mould. Empty your chambers daily people. I have had a couple of people who let their machines get so dirty that they became infested with insects, and in one case this resulted in some vomiting when they were inhaled. This is not an infection per se, and is a very extreme case. Basically, unless you keep your machine in unbelievably poor condition, there is no danger of catching anything from it, and sterilising it is completely unnecessary. Just wipe it over occasionally and change the filter.

16 apnoeas and 32 hypopnoeas/night only works out to an AHI of 6 (assuming 8 hours of sleep). This is not high, in fact it's very nearly normal. Bear in mind that CPAP machines are designed to overestimate AHI. It is not a cause for immediate concern.

All I will say is that after more than 15 years of performing sleep studies and seeing the results of many surgical procedures, the best result I've seen is one patient who about a 50% reduction in the severity of their sleep apnoea (from staggeringly bad to just bad). In every other case it either did nothing or made it worse. Also there is the question of the long recovery and high rate of post-operative infection. Every doctor I know would never recommend it, and every patient I've met who had surgery told me it was hellish and they would never do it again. Make your own judgement, but I suggest you approach with care.

I am not a surgeon, just a technician who sees the results and deal with the patients afterward.

14 minutes is not long. Also, it is rare for genuine Cheyne-Stokes to occur for such a short period, so the machine may have misread it. It would normally occur for most of the night (approximately 80% of your sleep). I wouldn't be too concerned just yet.

An AHI of 3.6 is pretty good and suggests that you may not need BiPAP. 21 central apnoeas over a night is not a lot. Many people have some central events just as they are falling asleep (which we call sleep onset) but they disappear once sleep is properly established. These are called, rather unimaginatively, onset events. Onset events would more than account for 21 events and they are not a problem unless they regularly prevent you from getting into proper sleep. Also, the machine will always overestimate your AHI. It's designed that way, as most medical equipment it. The idea being that if there is something wrong it will pick it up but f it says there is nothing wrong it is pretty reliable.

When I say that ASV is not a magic bullet, it is because it was designed for one very specific purpose - the treatment of Cheyne-Stokes in the setting of low CO2 (I have met the people who invented it). It does this very well, but this is a very rare condition. ASV stands for Auto Servo Ventilation and, unfortunately, some doctors see "Auto" and assume that means that it is an automatic BiPAP that will automatically fix any problem. It doesn't. It is far more common that people who use BiPAP do so because they need to get more air in and out when they breathe and ASV does not do this. If anything, ASV is actually deigned to reduce the amount of air you are breathing (because Cheyne-Stokes respiration is a result of hyperventialtion - breathing too much). Sometimes ASV can be effective in treating central events when oxygen and carbon dioxide are otherwise normal, but definitely not always. Does that help you at all. I'm afraid it's all a bit technical.

After all that, as I said before, you may well not need BiPAP with those results.

If you have the tube going up from the mask and over your head, then the air coming out of the exhalation port will blow on the tube and make extra noise. Also, the Amara View seems to fit best when it its nice and snugly under your nose. If it is too low it doesn't seal properly around the nose. You could try moving it up a little, but from the descriptions the noise is nor from the mask. I find all of this quite surprising as I have used the Amara View on a lot of patients and watched/listened to it for many hours during studies without coming across this problem. When someone examines the data from your machine and says there is no leak, they are simply going by the fact that your leak level is within normal limits. That doesn't completely rule out the possibility of a small but noisy leak.

I have had a bit of a play with the DreamStation and it seems very good. It has the best humidifier design I've seen (simplest to use and clean). I have yet to issue a bunch to patients yet and get their feedback though.