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Medicine Summaries
Sleep Disorders

Sleep Apnea
Self Diagnosis and Treatment

by Vaughn Aubuchon

MAD Device - Tilt Bed -
Polysomnogram - Treatment
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My Apnea
My Self-Diagnosis
My Snoring and Apnea
My Apnea Breathing Graph
My MAD Device
My Tilted Bed

The Sleep Center
My Polysomnogram
Polysomnogram Electrodes
Polysomnogram Glossary

My Solution and Treatment
Disclaimer

CPAP-BiPAP Equipment Summary
CPAP-BiPAP Equipment History

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My Self Diagnosis
This was a revelation. I always wondered about my sleep apnea problem. How bad was it? I live alone, and I have no sleeping partner to tell me the details of my sleeping habits. Since sleep labs are very expensive, I came up with an idea to self-diagnose my sleep apnea.


I went to Radio Shack, and bought a really cool miniature Olympus WS-400 Digital Voice Recorder, which can record up to 20 hours. I only needed 8 hours, so I can store up to 2 nights worth of snoring, and breath-holding (apnea). I suspended the recorder just above my head, with a wire from the bedstead.

Olympus Digital Voice Recorder WS-400

The DVR has a retractable USB plug, which goes right into your PC or Mac. Downloading the files is very simple, and you can listen to them on your computer sound system - at high volume, if you want to freak out.

Sitting through (listening to) 8 hours of your own sleep can be eye-opening. Many times during the night, I simply STOP BREATHING. Here are the summarized results of many night's recording playback.

This self-recording experiment was instrumental in me getting a professional sleep study - a polysomnogram. Too bad it didn't "take". I did not sleep a wink.


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My Snoring and Breath-Holding

I turned off the TV, and closed my eyes, to go to sleep.
The snoring began within 5 minutes.

FIDGETING - Turning over - Adjusting sleep position.

GIBBERISH - It is unbelievable, the number and weirdness of the sounds that I make. Laughing, jibberish, and huh? sounds.


BREATH RATE - My breath rate tends to be 16 breaths per minute while snoring. It takes twice as long to inhale, as it does to exhale.

I have 2 modes of sleep -

L - LABORED BREATHING - SNORING
- It's very hard to get the air in, so the exhale is fast and forced, to prepare for the next restricted inhale.

A - APNEA - STOP BREATHING - Holding of the breath, for no apparent reason, for as long as 30 SECONDS.
And then, breathing in and out vigorously several times to compensate for the out-of-breath condition.
And then repeat. Repeat again. And again. And again.

N - NORMAL SLEEP BREATHING occurs only sporadically, for short periods of time - inhale, exhale, pause.

The realization of the severity and extent of MY sleep apnea problem is sobering. I actually feel sick, just listening to myself from the night before. It is now SO EASY to understand how I wake up in the morning feeling "not-refreshed."

My mean time of breath-holding was 25 seconds.
My doctor's mean time of breath-holding was 45 seconds - which is REALLY bad.

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Sleep Apnea Breathing Graph
An Apnea Breathing Graph
Comparing normal sleep breathing, with sleep apnea breathing.

NORMAL BREATHING
Normal sleep breathing consists of rhythmic breathing, at about 12 breaths per minute for adults. All breaths are of the same approximate "depth". There is a pause between the exhalation, and the next inhalation. This pattern is maintained for MANY minutes, before the sleeper takes a deep breath, and/or rolls over in bed.

SLEEP APNEA BREATHING
There is nothing rhythmic about sleep apnea breathing. Breathing is labored and more rapid WHEN it occurs. Great variation in the "depth" of breath occurs. In my case, I average about 2 "no breathing" incidents per minute. There is almost always movement during the gasping, such as head movement, or shifting position in bed, often accompanied by moans and other sounds.

Notice how the depth of breath becomes more shallow, just before breathing ceases.
Notice also that there is no pause between exhalation, and the next inhalation.
Many others with sleep apnea do not have the "pre-gasp" breath like I do, but instead go directly from no breathing to a HUGE gasp, which can frequently awaken them completely.

My apnea gets worse as morning approaches, after 3 AM. This is supposed to be the time of deep REM sleep. For me, it is the period of worst apnea - the most events, the longest-lasting events.

How are you going to get proper rest, when all this is occurring? You don't. Instead, you arise tired, with high blood pressure, since your body never gets a chance to rest.

The most frequent cause of sleep apnea is being overweight, floppy uvula notwithstanding.




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My MAD Device - Mandibular Advancement Device

All right, so the problem is really bad, What are you going to do about it?
When you realize just how much you are laboring while trying to sleep, it is time to do something about it!

The first thing I did was obtain an anti-snoring device from my dentist. I can test it myself.
I was hoping that this works well - I am just not ready for CPAP. A friend of mine used it, and hated it.

FOLLOW UP: My dentist fitted me for a new MAD device (Mandibular Advancement Device), called the TAP Device - the Thornton Adjustable Positioner.
The website is
www.amisleep.com/
The device is discussed on the
Apnea Support Forum.

I wore the device several times, and duly recorded the sessions. They all sounded pretty much like they did without using the device. I adjusted the device to position my lower jaw much farther forward, and repeated the tests. There was not much difference. I am sure these devices work for some individuals, but not me. I am done with it. It was a $1,500 exercise in futility.

I would like to put my apnea audio recordings online, but they are 100's of megabytes long - just ONE file is larger than this ENTIRE WEBSITE!

UPDATE: I went back and tried to use the device again. I believe that slight variations of teeth positions now cause the device to be really hard to put in place, and almost impossible to remove. This is one of those "too much precision" situations. One would think that loosening would be the problem, when in fact, it is tightening that is the problem, with this device.




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My Inclined (Tilted) Bed

I have tilted my bed, so that the end where my head is, is much higher than the end where my feet are. I feel that there are multiple benefits -

1. Gravity has less of an effect on the physics of the throat - reduced pressure on the uvula, reduced propensity of the lower jaw to recede towards the throat,
2. Breathing is easier, since there is less pressure on the chest,
3. Snoring is reduced,
4. There is less pooling of blood in the upper half of the body, lowering blood pressure, and easing congestive heart failure.
5. IMHO


What is the optimal angle for your bed? The figure of a 30° angle is frequently mentioned on other websites, but I find that figure far too high. You would slide straight to the bottom. The higher the angle, the more the tendency to slide down toward the bottom. My bed is angled at about 6°.

BULL! I suffered from swollen feet every day, until I finally decided to make my bed level once again. Bye-bye swollen feet. I think I will stick with a level bed. (edit)

Sleep apnea tilted bed



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My Sleep Study - Polysomnogram (PSG) (Sept. 2010)
A Complete Description of My PSG Experience
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Subject /
How it is
supposed to work
How it worked (not) for me
My Experience

Initial Consultation

Go to Watsonville

I told them I do not like to go to Watsonville. The sleep center has 2 locations - one in Watsonville, and one in Santa Cruz. I was told that I had to go to Watsonville ONLY ONCE, for my initial consultation.
I filled out many pages of a survey.

From eHow

2. "Make yourself comfortable by changing into your loose-fitting pajamas."

I haven't owned any pajamas in over 50 years.

5. "Give your sleep diary to the technician."

What sleep diary? Not mentioned to me.

7A. They will also inform you that if needed, you may get up during the night to use the bathroom.

If I wanted to use the restroom, I had to call the technician, so that she could disconnect me from the electrical interface, and hang all the wires around my neck, so I could trot down the hall to the communal bathroom. The 4 wires going down from my neck, through my shirt and pants to my calves were particularly troublesome. I had to be careful not to pee on the 4 calf wires.

7B. "There will be a private bathroom in your room for you to use."

There was one restroom for the 6 sleep rooms.
At full tilt, it could be Grand Central Station.

The Electrodes

For each sensor, your skin is abraded, to remove the top layer of skin. Sticky electrode gel is applied, and then the sensor is taped to your body. This process takes about 45 minutes, if there are no interruptions (there will be).

A shower is required right after the test, to remove the very sticky gel you are covered with. You cannot simply "wipe it off". There is NO shower at the sleep center.

Here is a list of all the sensors attached to your body -
4 on the top of your head
4 on your calves - 2 on each one
3 on your chin
2 behind your ears - one on each side
2 eye electrodes - one next to each eye
1 stomach band - 2 wires
1 chest band - 2 wires
1 oximeter sensor on your index finger
1 nasal sensor taped into your nostrils (the worst, because it obstructs your breathing)
I think I may have missed a couple.

The Problems

The bed is flat. The sheets are tightly tucked in, military style. On your back, your toes are squashed. They WANT you to sleep on your back, because it is typically the worst case for OSA (Obstructive Sleep Apnea).

1. I sleep on a radically tilted bed, which I devised myself.
2. Both of my feet must be bare, and sticking out into the air.
3. I require 2 pillows, the top one being high-tech memory foam.
4. I sleep on a memory foam mattress.
5. I CANNOT sleep on my back - I never do. My throat slams shut, as both nostrils become useless.
6. I usually have a glass of wine before getting into bed - they insisted upon no booze. Fine. No sleep for me.

The sleep room should be quiet.

My sleep room was noisy.
1. Conversations in the next room
2. Intercom instructions to other participants are clearly audible.
3. People walking outside are clearly heard - thump, thump
4. The air conditioning was very noisy.
5, There was no remote control for the TV. She had left the volume on much higher than I usually listen at, and I had to summon her to turn the d@mned thing off. I usually go to sleep with the TV on, and then awaken briefly and click it off.

I live in the country, where it is SILENT at night. I am not too big on a CITY sleep center, where there is always going to be some noise.

The infrared camera and IR light sources are physically and psychologically intrusive.

There were 2 large infrared LED light sources on the ceiling, pointing directly into your face. They can be seen in the darkness as a red glow. Although the room appears dark, every single move you make is recorded as if it were broad daylight. The knowledge of this will result in you not being able to act naturally. This made me feel like I was acting. The microphone duly records all your moans, verbal outbursts, gasps, and of course, your f@rts and burps.
READY? LIGHTS! CAMERA! ACTION!
GO TO SLEEP, NOW!
No wonder I couldn't sleep.

Outcome Summary

Your sleep is sensed, measured, recorded, evaluated and categorized.

It was horrible. I never lost consciousness (went to sleep), even once.
- the flat bed impaired my breathing
- the device in my nose reduced air flow a lot
- the tape was very itchy - I carefully scratched
- the air conditioning sounded like a 747 - every 30 minutes
- my mouth was super dry - I found myself eating the peeled skin off my lips

I pleaded to end the test at 2 AM (began at 10 PM), but she got me to stare at the ceiling for another 3 hours until 5 AM. It was horrible.

The one bright spot was the sleep technician. She was very personable, patient, informative and obviously highly experienced. Unfortunately, she was dealing with a tough cookie. I apologized several times for not being able to sleep. She said I slept "a little". I don't believe I did.

Before I left, the technician asked, "You have your follow-up appointment, right?" I replied, "No, I don't". She said, "Oh, you should have been given that at your initial consultation." They did not tell me that, probably because it was IN WATSONVILLE! In addition, the date and time were rammed down my throat, with no consultation with me whatsoever. The appointment was DURING THE MORNING RUSH HOUR. There is a reason I am self-employed - I DON'T do commuting, and I DON'T do RUSH HOUR. EVER. FOR ANYTHING.

YAVOL! AUCTUNG! YOU VILL COMPLY! Sleep Nazis.

I drove home at 5:30 AM, and hit the sack. Ahhh, Sweet Bliss. I slept like a baby until 11:30 AM. Head elevated, quiet, no electrodes, bare feet hanging out, constant temperature, no air conditioning, no infrared jammed into my face.

I recorded the sleep session. I fell asleep in 3 minutes. I had multiple apneas, per my usual sleep. Yet, I did not awaken ONCE in over 5 hours.

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MY QUESTION

Just what kind of a "sleep study" is it, that ENSURES you will NOT BE ABLE to sleep, AT ALL? Huh? HUH? Not a very good one, I submit.

$9.50 per minute - $571 per hour - $4,000 per night for NOT SLEEPING A WINK

You MUST conform to THEIR sleeping conditions, even though they are TOTALLY UNNATURAL AND UNSUITABLE.

They have NO INTEREST in YOUR DAILY, ESTABLISHED sleeping conditions, which you require for good sleep (or ANY sleep).
-- "Forced to go to bed at 10 PM" - I go to bed at midnight.
-- "NO alcohol" - I always have a glass of wine before bed.
-- "The flat bed" - Extremely uncomfortable - I sleep on a tilted bed, angled at 6°.
-- "Sleep on your back" - I NEVER sleep on my back - I can't breathe.
-- "Military bedding" - feet are crushed by the tightly tucked in sheets - My bare feet must hang out.
-- "Noise" - talking and air conditioning - At home in the mountains, there are only the crickets.
OK. Go sleepy-bye now. Right.
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The Follow-up

Here are the results of my follow-up -
1. "You have a very bad case of sleep apnea." I already knew that.

2. I did not sleep at all, yet they say I slept "for 17 minutes", based upon my brain waves.

3. "Medicare will NOT PAY, unless you sleep for a minimum of 2 hours."
Where the heck was the disclaimer for THAT?

THE ONLY REASON I TOOK THE TEST WAS BECAUSE MEDICARE WAS GOING TO PAY 80%. And they want me to take the test again? NO WAY. How do I know the second try will work? "We will give you a sleeping pill." Why the heck didn't you give me the sleeping pill the FIRST TIME?

4. I was told that I must repeat the PSG test, AGAIN, to which I replied, "I only HAVE to do two things, pay taxes and die - all the rest is up for grabs."
Is the quest for sleep during a test merely a crap-shoot? At $4,000 a roll, on my dime? I'm done playing. I lost, and it is time for me to limit my losses. "Couldn't sleep on the first $4,000? No problem. We will MAKE you sleep on your second $4,000." Easy for you to say, on my dime. After all, it's only patient money.

How many times do you think I am going to throw good money after bad. Fool me once, shame on you; fool me twice, shame on me. I have no desire to turn a worthless $4,000 into a worthless $8,000. One definition of crazy is to repeat identical behavior, while expecting a different outcome.

5. Where is my copy? Where is my data? What are my parameters? Where is my evaluation? Where is my prescription? They gave me NOTHING! NOTHING! Big, big money, and I don't even get a printout! What a scam.

6. NO CPAP PRESCRIPTION FOR ME! The whole thing was in vain. Utterly useless. "Just do it again."
Maybe that first P in CPAP should be an R.

7. The whole experience just made me feel like a noncompliant errant child, too stupid to benefit from any printed results. This REALLY piffes me off. There is no way I am going to repeat the unbelievably intrusive test. I gave it my best shot - they gave me their best shot. It wasn't good enough.

8. I was quoted $3,500. The BILL presented was over $4,000.

I could probably benefit from a CPAP device. I would buy one right now if I didn't need a prescription. But I will be darned if I am going to endure that PSG torture again, only to experience the same sleepless, uninsured outcome.
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My Opinion

I think that "Sleep Labs" are far more about milking you for your money, than about fixing an incredibly obvious problem. Why?

1. The PSG is an uncomfortable intrusive procedure, and looks like overkill to me. I'm surprised there wasn't an @nal probe as well.

2. NO EFFORT WHATSOEVER is made to duplicate the patient's sleeping conditions. They just don't care.

3. They are totally unconcerned with the COSTS to the patient - What The Heck, just order another test. The PSG is just the "prelude" for ordering the next test. Next, you are going to need a "Split Night PSG". That will probably be inadequate, so then we will schedule you for a "Standard CPAP Titration". After that, you should have a MSLT - Multiple Sleep Latency Test, which may indicate the need for a MWT - Maintenance of Wakefullness Test. Are we at $15 Grand yet?

4. All the equipment the sleep lab sells is TWICE as much as it is any place else! Read price comparison.

5. IMHO, CPAP appears inferior to BiPAP in every respect. So why do they prescribe CPAP?
- - - A. You must come in frequently for "titrating", at significant cost. An "Auto" unit is best for ALL patients.
- - - B. You must be "upgraded" later, which means purchasing another device, and taking another test. Some sleep centers appear to be really big on "starter units", which must be replaced by a better unit later.

6. IMHO, the words "Auto" and "BiLevel" should be in the name of your device.
CPAP = Horse and buggy (antique, with high exhalation pressure)
BiPAP = Automobile (modern, exhalation pressure reduced)

7. CPAP, VPAP and BiPAP are NOT for everyone. According to Wikipedia - "A recent study showed 60% of patients abandon CPAP use entirely." So don't get your hopes up too high.

8. Virtually ALL CPAP masks contain Bisphenol A. In spite of the fact that manufacturers pooh-pooh any criticism, we now know that ANY Bisphenol A is bad for ANY human being. It emulates female sex hormones. Terrible for babies, and bad for adults.
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How Bad Am I?

Sometimes, I get sleep apnea, while I AM AWAKE. When things are slow, I am staring at my computer, seated upright at my desk. I will spontaneously start gasping, because I haven't been breathing. So, in addition to obstructive sleep apnea (OSA), I also suffer from central sleep apnea (CSA).
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Polysomnogram (PSG) Electrodes
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The Polysomnogram Sensors

LEOG - Left electrooculogram - measures left eye movement
REOG - Right electrooculogram - measures right eye movement
Chin - Chin EMG - electromyogram - to determine teeth grinding
C3A2 - Central lobe left hemisphere - Right ear
C4A1 - Central lobe right hemisphere - Left ear
O1A2 - Occipital lobe left hemisphere - Right ear
O2A1 - Occipital lobe right hemisphere - Left ear
C3O2 - Central lobe left hemisphere - Right occipital lobe
C4O1 - Central lobe right hemisphere - Left occipital lobe
LEMG - Tibial EMG - Electromyogram - leg movement sensor
NAF - Nasal Air Flow
THO - Thoracic effort (motion) - chest band sensor
ABD - Abdominal effort (motion) - stomach band sensor
ECG - Pulse - from index finger oximeter sensor
SAO2 - Arterial Oxygen Saturation - oximetry sensor on index finger
BODY - Body position (L, R and Supine)

The list above is in the order found on the polysomnogram printout, top to bottom.
Sometimes, a penile sensor is also used, to measure the tumescence of the penis.
Sometimes, a GERD sensor is also used, to measure esophageal reflux.




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Polysomnogram (PSG) Glossary - Sleep Apnea Terms
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AASM
AF
AHI
APAP
Auto
AVAPS
AVS

Bi-Flex
BiPAP
BMI

CAD
CHF
CMS
CompSA
COPD
CPAP
CSA
CSR

DME

ECG
EDC
EEG
EF
EMG
EOG
EPAP
EPR
ESS

FOT

IH
IPAP

American Academy of Sleep Medicine
Atrial Fibrillation
Apnea/ Hypopnia Index
Automatic Positive Airway Pressure
No titration - pressure is set automatically
Aver. Volume Assured Pressure Support
Alveolar Hypoventilation Syndrome

"Air-flow softening" technology
BiLevel Positive Airway Pressure
Body Mass Index

Coronary Artery Disease
Congestive Heart Failure
Centers for Medicare Services
Complex Sleep Apnea
Chronic Obstructive Pulmonary Disease
Continuous Positive Airway Pressure
Central Sleep Apnea
Cheyne-Stokes Respiration

Durable Medical Equipment

ElectroCardioGram (also, EKG)
Event Detection Circuit
ElectroEncephaloGram
Ejection Fraction
ElectroMyoGram
ElectroOculoGram
Expiratory Positive Airway Pressure
Expiratory Pressure Relief
Epworth Sleepiness Scale

Forced Oscillation Technique

Idiopathic Hypersomnolence
Inspiratory Positive Airway Pressure

LVEF

MSLT
MWT

NOT
NPPV
NPV
NREM

OSA

PAP
PCO2
PIB
PLMD
PPV
PSG

RDI
REM
RERA
RLS
ROC
RVI

SaO2
SDB
SRBD
ST

UARS
VPAP

Left Ventricular Ejection Fraction

Multiple Sleep Latency Test
Maintenance of Wakefulness Test

Nocturnal Oxygen Therapy
Noninvasive Positive Pressure Ventilation
Negative Predictive Value
Not REM sleep

Obstructive Sleep Apnea (Syndrome)

Positive Airway Pressure
Pressure Carbon Dioxide
Patient Interface Box
Periodic Limb Movement Disorder
Positive Predicted Value
Polysomnogram

Respiratory Disturbance Index
Rapid Eye Movement (dream sleep)
Respiratory Effort Related Arousals
Restless Leg Syndrome
Receiver Operating Characteristic
Right Ventricular Impairment

Arterial Oxygen Saturation
Sleep-Disordered Breathing
Sleep Related Breathing Disorders
Spontaneous/ Timed

Upper Airway Resistance Syndrome
Variable Positive Airway Pressure

The abbreviations above are provided because -
The medical profession (+ other tech professions) love to bandy about TLAs - Three Letter Acronyms.
1. This helps immensely to keep you from understanding what they are talking about.
2. This prevents you from asking cogent, vexing questions.
3. They feel your job is to COMPLY, and not question, because you are an uneducated lay person,
unable to comprehend the technical aspects of your very complicated malady.
SO, memorize the TLAs above, and you too can sound like a knowledgeable apnea student.

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My Apnea Solution - BIPAP (Oct. 2010)
A Description of My BiPAP Experience
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Subject/ Discussion

My Solution

Should CPAP Equipment Be Deregulated? Andrew Senske thinks so. I totally agree.

I used to design, build, repair, and calibrate precision electronic equipment FAR more complex than a freaking air pump. I can "titrate myself", thank you very much. Especially with an auto-titration unit. That means it sets your pressure(s) automatically.

I purchased a low-hours Respironics "BiPAP Auto with Bi-Flex" in excellent condition, from Craig's List. It came with the integrated humidifier.
I then purchased a mask and hose from Amazon. I selected the Resmed Optilife Mask, which uses the nasal pillows. I chose this mask because many of the apnea forum posts I read were about those who loved it, after switching from a full-face mask.
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Equipment Selection and Purchase

You can buy all the CPAP and BiPAP DEVICES and ACCESSORIES you want on Craig's List, WITHOUT A PRESCRIPTION. The same is true of Amazon.

You can buy all the CPAP ACCESSORIES you want on eBay, without a prescription. But eBay does not sell CPAP or BiPAP devices (the pressure pumps), or the complete masks. However, they offer a large selection of mask parts, hoses and filters. It is possible to assemble a complete mask, by buying all the parts separately on eBay, especially the Swift Mirage II.

Some eBay search results, performed on Sept. 29, 2010 -
BiPAP - 334
CPAP - 1,312
REMstar - 136 (Respironics)
Resmed - 275 (#2 supplier)
Respironics - 540 (#1 supplier)
Other brands - nothing much at all

Update - First Night - First Try

I read the manuals, installed the filters, and checked all my settings. I liked the numbers, so I didn't change a thing.
First night observations -

1. NOISE - the whole system is noisy. This is an even bigger issue for sound recording, because it is much more difficult to hear your actual breathing, with all that whirring and hissing. I have wrapped the entire unit with a pair of old sweat pants to reduce noise. Device cooling doesn't seem to be an issue.

2. I did not employ the humidifier, because I wanted simplicity for my first try. In the morning, I decided I didn't need the humidifier (yet). I did however, install a cozy over the hose, not for rain out, but for noise reduction.

3. The mask was easy to fit, and the Medium-size nasal pillows sealed pretty well. However, I felt like I couldn't breathe easily due to the restriction. The hole size on the Medium pillows is small, compared to the Large pillow. Next, I must try the Large nasal pillows, not because they fit better, but because they have much larger holes for air, which provide 40% more air flow.
Here are the Respironics Optilife nasal pillow oval-shaped hole sizes -
P = 4 x11 32nds (relative hole area= 44) - hole center-to-center=17 32nds
S = 5 x 9  32nds (relative hole area= 45) - hole center-to-center= 22 32nds
M = 6x11 32nds (realtive hole area= 66) - hole center-to-center= 24 32nds
L = 8x13 32nds (relative hole area= 104) - hole center-to-center= 26 32nds

4. STENCH - The smell of new plastic and new rubber makes me gag - I feel like I can't breathe. There are no instructions with the hose or the mask about GETTING RID OF THE STINK. There should be. It is terrible. I suggest running the whole system for 8 hours, disconnected from your face, to purge some of the chemicals.

5. The BiPAP starts out at about Inhale pressure=10, and Exhale pressure=4. After auto ramp-up, Inhale pressure = 12, and Exhale pressure = 6.5.

6. The nasal pillow system is meant to be used with a CLOSED mouth, at all times. Don't believe me? Try opening your mouth. HA-HA! You won't do that again, will you? The flapper valve in your throat goes nuts.

7. Woke up about 4 AM, so it must have been working. Tossed it off, and went back to sleep, thinking, enough of this.

Second Night - Second Try (2010)

I replaced the Medium nasal pillows with the Large size pillows. The seal wasn't quite as good, but the air flow was noticably better, due to less airflow restriction.

I still feel that it is difficult to breathe out.
Just having the apparatus there, induces a psychological breathing restriction. When this is combined with actual restriction, the overall effect is EXTREMELY uncomfortable restriction.
Correction - After auto ramp-up, Inhale pressure = 13, and Exhale pressure = 8.5. I didn't let it fully ramp up before.

MY CPAP CONCLUSION (2010)

I managed four hours the first night, four hours the second night, and that was it. Done.

I haven't gone back since. Trying to breathe out against the pressure is intolerable. I don't like it. I don't want it. It is no wonder that compliance quickly drops for MOST of those who try CPAP or BiPAP.

CPAP REVISITED (2012)

Perhaps I abandoned CPAP prematurely, mostly due to my wretched experience with the sleep center.

I recently had a discussion with a baseball umpire, who swore up and down how absolutely necessary CPAP was to his very existence. He was extremely convincing. Add to that my continuing health problems, and I fired up my BiPAP once machine again. On my first try, I slept all night, after adjusting my mask several times. The second night, I slept 7 hours straight, not even getting up to pee once, which is unheard of for this 68-year-old male. I still don't get that "new-man" feeling that some have described, but I will continue to use the machine for awhile, to see what happens.

CPAP REVISITED AGAIN (2013)

I am now totally committed to CPAP. I am very happy with my old BiPAP machine.
--- I sleep through the night
--- I have stopped my big-time napping during the day
I am stilll fiddling with my nose pillows, but I learned how to adjust them easily if I should wake up.




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CPAP vs BIPAP Pressures
CPAP vs. BiPAP Air Pressures

CPAP-BiPAP Airflow Diagram

1. CPAP - Very difficult to breathe out - prevents natural breathing

2. BiPAP - Reduced exhalation pressure - an improvement
IPAP - Inspiratory Positive Airway Pressure
EPAP - Expiratory Positive Airway Pressure
EPR - Expiration Pressure Reduction

3. IDEAL PAP - On exhalation, shouldn't there be the least resistance (zero pressure)?
Why does this system not exist?

4. NO PAP - Normal breathing using no device - easiest exhalation


Disclaimer
I have omitted names, and changed the name of the particular sleep center.
It is not about identifying who performed my sleep study - it is about providing a general warning to others, that "one-size-does-not-fit-all." My Local Sleep Center seems to think it does. They employ uncomfortable, intrusive, regimented procedures which may not work for everyone, such as myself.

The author is NOT a doctor.
The opinions stated on this page are solely the opinions of the author.
And yes, I AM highly opinionated, due to the mealy-mouths of others.
Although the author exercises due diligence, errors can and do occur.

I hope this page helps you with your Sleep Apnea medical problem, and your search for an appropriate CPAP/ VPAP equipment solution.

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Vaughn's Summaries
©2009-2013 Vaughn Aubuchon
www.vaughns-1-pagers.com
All Rights Reserved
This Vaughns Sleep Apnea web page
was last updated on 2014-08-08.