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[CPAP] Where do I start (my first night on cpap + sleepyhead)
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verbatim1 Offline

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Machine: Remstar Auto
Mask Type: Nasal mask
Mask Make & Model: F&P Eson Nasak Mask SL-Large for CPAP or bi-level venti
Humidifier: none
CPAP Pressure: 10 to 20
CPAP Software: SleepyHead EncoreBasic

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Sex: Undisclosed
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Post: #11
RE: Where do I start (my first night on cpap + sleepyhead)
(05-22-2016 12:26 PM)green wings Wrote:  If you go into the Setup menu on your machine and look at the settings, you will find the A-Flex or C-Flex setting. It may be on or off. It it's on, it will have a value of 1-3. (You can do a search to read more about this setting.) 1, 2, or 3 all give you in the neighborhood of a 2 cm drop in exhalation pressure.
Thank you for telling me what to look for in the machine settings.
I just checked and it is set to A-Flex 1.
There is no C-Flex anywhere.
(05-22-2016 12:26 PM)green wings Wrote:  A BiPAP machine basically lets you set the exhalation pressure independently of the inhalation pressure.
Thank you for summarizing so succinctly!

(05-22-2016 12:26 PM)green wings Wrote:  Some people have problems exhaling against pressure and need a wider gap between their set inhale and exhale pressure than typical. If they don't have it, they will swallow air, have the feeling that they can't exhale, etc.
I scuba dive. Nothing can be like that so exhaling isn't going to be my problem, I don't think.

(05-22-2016 12:26 PM)green wings Wrote:  BiPAP machines come in fixed pressure or auto-adjusting. With fixed pressure BiPAP, you might set your inhale pressure at 13.0 cm and your exhale pressure at 9.0 cm.
I kind of like the auto-adjusting idea better!

(05-22-2016 12:26 PM)green wings Wrote:  Auto-adjusting BiPAP would be like the APAP that you're using now, but with the ability to set a fixed difference between inhale and exhale pressure.
Thanks again for making it easy for me to understand the differences.

(05-22-2016 12:26 PM)green wings Wrote:  If you want to know how you breathe while you're asleep, I think looking at the breathing flow rate graph is the most helpful. If you click repeatedly on it, you can zoom in so that you can see individual breaths.
Thank you for that hint of clicking to see individual breaths!
Here is a zoomed in screenshot of those individual breaths, around a blue H bar.

i.share.pho.to/c2ab135c_l.gif
05-22-2016 01:36 PM
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verbatim1 Offline

Preferred Members

Posts: 70
Joined: May 2016

Machine: Remstar Auto
Mask Type: Nasal mask
Mask Make & Model: F&P Eson Nasak Mask SL-Large for CPAP or bi-level venti
Humidifier: none
CPAP Pressure: 10 to 20
CPAP Software: SleepyHead EncoreBasic

Other Comments:

Sex: Undisclosed
Location:

Post: #12
RE: Where do I start (my first night on cpap + sleepyhead)
(05-22-2016 12:26 PM)green wings Wrote:  When the sleep tech said that most people are nose breathers, maybe she meant that they primarily inhale through their nose. When you are wearing a mask that doesn't cover the mouth, you keep air from escaping from your mouth by blocking your airway with your tongue. When we get into really deep sleep, sometimes our muscles relax and this tongue "block" may let air escape.
That is very interesting!
I would have thought that we keep our mouth CLOSED which would prevent air from coming out. You're saying it's the tongue. Interesting. Thanks for that tidbit!

(05-22-2016 12:26 PM)green wings Wrote:  That can vary from just a tiny bit escaping from time to time (which I believe will look like the "expiratory mouth breathing" graph) to letting so much air rush out of our mouth that it shows up as a large leak. You may want to do a search about what large leaks of air from your mouth do to the effectiveness of your therapy.
Looking for evidence of these "leaks", I see around midnight last night that everything went through the roof. Pressure. Leaks. etc.

Is this midnight graph below indicative of what you're talking about?
i.share.pho.to/549a3775_l.gif

Here is a zoomed in graph of the same thing:
i.share.pho.to/84b46784_l.gif
(05-22-2016 12:26 PM)green wings Wrote:  If you wake up with a very dry mouth, that's a sign that you're probably doing quite a bit of mouth breathing.
Interesting. I don't recall my mouth being dry, but I will look for that.
There is no humidifier.

(05-22-2016 12:26 PM)green wings Wrote:  I'm not clear about whether some people also inhale through their mouths all the time (unless there's lots of nasal congestion).
Unless I'm sick, generally my nose is not stuffy.
(05-22-2016 12:26 PM)green wings Wrote:  A "full face" mask covers your mouth as well as your nose, so if you exhale through your mouth, the air doesn't leave the pressurized system of the xPAP machine, tubing, mask, and you. (Full face mask doesn't mean it covers your eyes.)
I gathered this but thanks for the clarification.

(05-22-2016 12:26 PM)green wings Wrote:  Another interesting graph is the pressure graph. You can look at events and see how the machine's algorithm varies the pressure in response. (You'll want to look at the flow limitation graph in addition to the events graph if you're doing this.)
Thanks for that advice to look at the pressure and flow limitation graph.
There is a LOT of data in those graphs.

Here is the pressure & flow overnight last night:
i.share.pho.to/05ff85e9_l.gif

And here it is zoomed in at midnight:
i.share.pho.to/4bf20b0b_l.gif

Both vary a tremendous amount it seems!
05-22-2016 01:50 PM
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Sleepster Offline
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Posts: 4,995
Joined: Feb 2012

Machine: ResMed AirCurve10 VAuto
Mask Type: Full face mask
Mask Make & Model: F&P Simplus
Humidifier: HumidAir and SlimLine Hose
CPAP Pressure: MaxI 13.6 | MinE 5.2 | PS 4.4
CPAP Software: ResScan SleepyHead

Other Comments: Diagnosed Nov 2011. Conquered aerophagia.

Sex: Male
Location: Houston, Texas

Post: #13
RE: Where do I start (my first night on cpap + sleepyhead)
(05-22-2016 12:09 PM)verbatim1 Wrote:  It doesn't look like I have a chin strap or full face mask, so, I won't be able to tell if it's leaking.

All you have to do is call your equipment provider and ask. Often the cost is covered by your insurance.

Sleepster
Apnea Board Moderator
www.ApneaBoard.com


INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED AS MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEB SITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
05-22-2016 02:24 PM
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green wings Offline

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Posts: 548
Joined: Feb 2016

Machine: Respironics System One RemStar Pro (460)
Mask Type: Nasal pillows
Mask Make & Model: AirFit P10
Humidifier: integrated humidifier
CPAP Pressure: 13.0 cm
CPAP Software: SleepyHead

Other Comments: using CPAP since Jan. 2016

Sex: Undisclosed
Location: US

Post: #14
RE: Where do I start (my first night on cpap + sleepyhead)
Hi verbatim. It looks like you're doing very well. It's normal to have a period in the night where your pressure requirements are lots higher. I'm not entirely sure why - I think it's because of the phase of sleep you're in or sometimes it can be your body position, or a combination of the two.

Most of us have more apneas if we're sleeping on our backs. So if you are lying on your back and also go into very deep sleep, that can cause your airway muscles to relax even more than other times of the night, and the pressure increases when you start having apnea events.

You've probably heard of the "attach a tennis ball to your back" method of keeping you from sleeping on your back. If you have more lots more apneas while sleeping on your back, figuring out a way not to sleep in that position would decrease your pressure needs.

I think that's probably really only necessary if you're having leaks and are trying to stop them without using a chin strap or full face mask.

Be sure to keep an eye on your leaks graph. I saw one float by somewhere when I was looking at your screenshots just now, and it looked very good. It's the lower trace on the graph that you want to worry about. The upper trace includes the vent from the front of your mask.

Regarding your tongue preventing leaks, keeping your mouth closed will do the job, too, when you're awake, but when the air is pressurized slightly, as with APAP, if you relax the tongue "block", air will usually start to leak from your lips if you relax them. Your lips will flutter like a fish breathing.

I used to scuba dive many years ago, and I agree that xPAP use is pretty mild compared to that. It's much quieter, and you don't have to put the mask in your mouth.

From looking at your graphs, I find it hard to imagine that you wouldn't end up with an APAP machine, since your pressure needs are so different at different parts of the night.

I'm not entirely sure why your pressure didn't increase even more than it did, since I can see flow limitations recorded. That's when a decrease in your breath is detected, but it doesn't progress far enough to become a hypopnea or apnea.

A flow limitation looks like a flatness or dip in a breath waveform. If the top of the breath waveform is squiggly, that indicates snoring on inhalation.

I would recommend keeping an eye on your graphs during your test period to be sure you're not having large leaks and to be sure that your pressure isn't needing to go higher than 20.

I think your minimum pressure looks good.

Oh, humidity. Most people who post on this board do use a humidifier. A few don't. If the air you're breathing at night doesn't feel too dry and if you're not waking up with dried-out nasal passages, then you're probably okay.

I'm guessing that when you get your own machine that it will have a heated humidifier that can be turned on or off.

Most people do use humidification at least during the winter. If you look up photos of the PR (Philips Respironics) machines, the ones with humidifier have a rectangular shape as opposed to a square shape.

It looks like things are going really well for you. It took me around three months to get to where you are. like


(05-22-2016 01:50 PM)verbatim1 Wrote:  
(05-22-2016 12:26 PM)green wings Wrote:  When the sleep tech said that most people are nose breathers, maybe she meant that they primarily inhale through their nose. When you are wearing a mask that doesn't cover the mouth, you keep air from escaping from your mouth by blocking your airway with your tongue. When we get into really deep sleep, sometimes our muscles relax and this tongue "block" may let air escape.
That is very interesting!
I would have thought that we keep our mouth CLOSED which would prevent air from coming out. You're saying it's the tongue. Interesting. Thanks for that tidbit!

(05-22-2016 12:26 PM)green wings Wrote:  That can vary from just a tiny bit escaping from time to time (which I believe will look like the "expiratory mouth breathing" graph) to letting so much air rush out of our mouth that it shows up as a large leak. You may want to do a search about what large leaks of air from your mouth do to the effectiveness of your therapy.
Looking for evidence of these "leaks", I see around midnight last night that everything went through the roof. Pressure. Leaks. etc.

Is this midnight graph below indicative of what you're talking about?
i.share.pho.to/549a3775_l.gif

Here is a zoomed in graph of the same thing:
i.share.pho.to/84b46784_l.gif
(05-22-2016 12:26 PM)green wings Wrote:  If you wake up with a very dry mouth, that's a sign that you're probably doing quite a bit of mouth breathing.
Interesting. I don't recall my mouth being dry, but I will look for that.
There is no humidifier.

(05-22-2016 12:26 PM)green wings Wrote:  I'm not clear about whether some people also inhale through their mouths all the time (unless there's lots of nasal congestion).
Unless I'm sick, generally my nose is not stuffy.
(05-22-2016 12:26 PM)green wings Wrote:  A "full face" mask covers your mouth as well as your nose, so if you exhale through your mouth, the air doesn't leave the pressurized system of the xPAP machine, tubing, mask, and you. (Full face mask doesn't mean it covers your eyes.)
I gathered this but thanks for the clarification.

(05-22-2016 12:26 PM)green wings Wrote:  Another interesting graph is the pressure graph. You can look at events and see how the machine's algorithm varies the pressure in response. (You'll want to look at the flow limitation graph in addition to the events graph if you're doing this.)
Thanks for that advice to look at the pressure and flow limitation graph.
There is a LOT of data in those graphs.

Here is the pressure & flow overnight last night:
i.share.pho.to/05ff85e9_l.gif

And here it is zoomed in at midnight:
i.share.pho.to/4bf20b0b_l.gif

Both vary a tremendous amount it seems!
05-25-2016 08:58 AM
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kwhenrykerr Offline
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Posts: 242
Joined: May 2016

Machine: DreamStation Auto, AirSense 10 Auto
Mask Type: Full face mask
Mask Make & Model: Amara View
Humidifier: Philips, AirSense 10
CPAP Pressure: 12-20
CPAP Software: SleepyHead

Other Comments: 2L added oxygen with CMS50F to check usage

Sex: Male
Location: Florida

Post: #15
RE: Where do I start (my first night on cpap + sleepyhead)
"The way we confirm mouth-leaking is by looking at the extended chunks of elevated leak rate on the graph and seeing how they change when we apply a chin strap or a full face mask"

So thats how to understand, Thanks

Just my personal opinion. My posts are not medical advice or a statement of fact. Please consult a qualified physician or other qualified medical personnel. Please comply with all applicable laws, codes, regulations, and protocols.
05-26-2016 01:02 AM
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verbatim1 Offline

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Posts: 70
Joined: May 2016

Machine: Remstar Auto
Mask Type: Nasal mask
Mask Make & Model: F&P Eson Nasak Mask SL-Large for CPAP or bi-level venti
Humidifier: none
CPAP Pressure: 10 to 20
CPAP Software: SleepyHead EncoreBasic

Other Comments:

Sex: Undisclosed
Location:

Post: #16
RE: Where do I start (my first night on cpap + sleepyhead)
Everything people [/align]said was spot on!
Thank you for the wonderful advice!

Kaiser let me keep the sample mask and headgear and hose.
They gave me a "ResMed" "AirSense 10 Audoset" machine.
I'm confused if it's bipap or just cpap because they told me it's cpap but it has a different exhale pressure.
I picked up the encore software but it did not work with this new ResMed (but it worked with the loaner Respironics).
Sleepyhead works with both the ResMed and the Respironics.

Here are details gleaned by pressing both the round power button and the square home button for three seconds to get into "unlock" mode on the "AirSense 10 Autoset" machine.
THERAPY:
- Mode = Autoset
- Max Pressure = 20.0
- Min Pressure = 10.0
- Mask = Nasal

COMFORT:
- Ramp Time = Off
- EPR = On
- EPR Type = Full Time
- EPR Level = 2
- Humidity Level = Off

Accessories:
- Tube = SlimLine
- AB Filter = No

Options:
- Essentials = Plus
- SmartStart = On

Reminders:
- Mask = Off
- Water Tub = Off
- Tube = Off
- Filter = Off

Things I like:
- Very quiet
- Seems to work just fine without any water in the humidifier
- It figures out my pressure (average after 16 hours is 14.2 cm of water with an AHI of 1.1)

Things I don't like:
- 24VCD means it won't work from a car battery
- Airplane mode constantly nags me to turn it off
- Humidifier is required (or a $20 plate has to be ordered)

Things I don't understand:
- Why does it have both WiFi and CDMA?
- Does it spy on me via Verizon cellular somehow?
- They called it CPAP but it has a different exhale pressure (so isn't that bipap?)
05-28-2016 10:12 PM
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PoolQ Offline

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Joined: Jul 2015

Machine: AirCurve 10 VAUTO
Mask Type: Full face mask
Mask Make & Model: Amara View
Humidifier: Integrated
CPAP Pressure: 6.2, 15, PS4.0
CPAP Software: SleepyHead

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Sex: Male
Location: Sillicon Valley

Post: #17
RE: Where do I start (my first night on cpap + sleepyhead)
The Resmed BiLevel is called AirCurve. Yours is Autoset and has EPR Exhale Pressure Relief, you can set 1,2,or 3 cm decrease in exhale pressure
05-28-2016 10:38 PM
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verbatim1 Offline

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Posts: 70
Joined: May 2016

Machine: Remstar Auto
Mask Type: Nasal mask
Mask Make & Model: F&P Eson Nasak Mask SL-Large for CPAP or bi-level venti
Humidifier: none
CPAP Pressure: 10 to 20
CPAP Software: SleepyHead EncoreBasic

Other Comments:

Sex: Undisclosed
Location:

Post: #18
RE: Where do I start (my first night on cpap + sleepyhead)
(05-28-2016 10:38 PM)PoolQ Wrote:  The Resmed BiLevel is called AirCurve. Yours is Autoset and has EPR Exhale Pressure Relief, you can set 1,2,or 3 cm decrease in exhale pressure

I will just say that's confusing since bi means two so bi-level means two levels and the ResMed Airsense 10 autoset has two levels. I think the marketing guys are having a fun time confusing me though because I don't understand how two levels isn't two levels but thanks for trying to help (it's not your fault).

Anyway, I'll try to read the user guide and clinical guide to get a better sense of how it works.
- 22-page User Guide: http://www.resmed.com/us/dam/documents/p...er_eng.pdf
- 44-page Clinical Guide: http://www.shermanoaksmedical.com/v/broc...-CPAP2.pdf

The nice thing is that pressing the power button and the home button simultaneously for a few seconds puts me in the clinical setup mode, but it drives me nuts that I can't figure out yet how to turn off the airplane-mode nag screen.
- Airplane Mode is currently On, do you wish to turn if Off?

What I want to turn off permanently is that silly question!!!!!!!!

In addition, I think I saw mention of two software packages that work, one of which is the venerable SleepyHead, but the other is a ResMed package (the Philips Encore Basic didn't work with the ResMed).

Any more information on the ResMed software?
Is it worth the effort?
(This post was last modified: 05-29-2016 12:08 AM by verbatim1.)
05-29-2016 12:07 AM
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green wings Offline

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Posts: 548
Joined: Feb 2016

Machine: Respironics System One RemStar Pro (460)
Mask Type: Nasal pillows
Mask Make & Model: AirFit P10
Humidifier: integrated humidifier
CPAP Pressure: 13.0 cm
CPAP Software: SleepyHead

Other Comments: using CPAP since Jan. 2016

Sex: Undisclosed
Location: US

Post: #19
RE: Where do I start (my first night on cpap + sleepyhead)
Hello, verbatim. I'm glad to hear that things are going so well for you. You have yourself an APAP machine (auto-adjusting CPAP).

My understanding is that all of these machine are "CPAP", in the sense that they provide continuous positive airway pressure.

Although it's continuous and positive, the pressure may be fixed (usually called "straight CPAP", "fixed CPAP", or just "CPAP") or it may vary (auto-PAP).

You're right that the EPR feature is essentially a "BiPAP" function. EPR, C-Flex or A-Flex give you a limited ability to lower the exhale pressure by up to 2-3 cm.

The term "BiPAP" is usually reserved for machines that let you set a wider range than 3 cm between inhale and exhale pressure. I imagine that this terminology came about when regular CPAP machines didn't have any EPR feature.

I have a Respironics machine, so I can't help you with the airplane mode message. Sounds annoying.

(05-29-2016 12:07 AM)verbatim1 Wrote:  I will just say that's confusing since bi means two so bi-level means two levels and the ResMed Airsense 10 autoset has two levels. I think the marketing guys are having a fun time confusing me though because I don't understand how two levels isn't two levels

Heh, welcome to CPAP/xPAP terminology!
05-29-2016 09:31 AM
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Sleepster Offline
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Posts: 4,995
Joined: Feb 2012

Machine: ResMed AirCurve10 VAuto
Mask Type: Full face mask
Mask Make & Model: F&P Simplus
Humidifier: HumidAir and SlimLine Hose
CPAP Pressure: MaxI 13.6 | MinE 5.2 | PS 4.4
CPAP Software: ResScan SleepyHead

Other Comments: Diagnosed Nov 2011. Conquered aerophagia.

Sex: Male
Location: Houston, Texas

Post: #20
RE: Where do I start (my first night on cpap + sleepyhead)
(05-29-2016 12:07 AM)verbatim1 Wrote:  - Airplane Mode is currently On, do you wish to turn if Off?

What I want to turn off permanently is that silly question!!!!!!!!

I don't know how to help you with that. I leave airplane mode on so that my data is uploaded to myAir. This feature gives you a quick and easy way to evaluate some of your data without having to do anything other than open a browser on a device and point it to the myAir web site.

Quote:In addition, I think I saw mention of two software packages that work, one of which is the venerable SleepyHead, but the other is a ResMed package (the Philips Encore Basic didn't work with the ResMed).

Any more information on the ResMed software?
Is it worth the effort?

The ResMed software is called ResScan. It's free. It's not as easy to use as SleepyHead, but it does have some advantages. First, it's the official software so if there's something in your data that you want to show to a doctor, he may be more likely to accept it as valid if it's a ResScan print out. Second, SleepyHead is beta software and therefore has bugs. If you see something questionable in SleepyHead you can use ResScan to verify that it's indeed something real and not due to a SleepyHead bug.

Sleepster
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INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED AS MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEB SITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
05-29-2016 09:47 AM
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