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Disappointed
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bwexler Offline

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Posts: 563
Joined: Mar 2012

Machine: PRS 1 BiPAP autoSV Advanced, with Heated Tube humidifier
Mask Type: Nasal mask
Mask Make & Model: Sleepweaver √Član
Humidifier: Resperonics Heated Tube humidifier
CPAP Pressure: Max pressure 25.0 cm H20, Max
CPAP Software: SleepyHead EncorePro

Other Comments: CMS 50i with Software for SpO2

Sex: Male
Location: San Marcos, CA, USA

Post: #21
RE: Disappointed
It may, or may not help with dry mouth and keeping the nasal passages open.
07-30-2014 02:25 PM
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becker44a Offline

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Posts: 181
Joined: Jan 2014

Machine: ResMed S9 Autoset
Mask Type: Full face mask
Mask Make & Model: F&P Simplus Lg
Humidifier: ResMed H5i
CPAP Pressure: Rx 10 - 20cm, Usually 10-14cm
CPAP Software: ResScan SleepyHead

Other Comments:

Sex: Male
Location: NE Ohio, USA

Post: #22
RE: Disappointed
(07-30-2014 02:05 PM)Clementine Wrote:  3 is what was set at the DME. I haven't messed with it. I'm a "hot mama" and don't need any additional warm anything right now. Warm air just isn't good. Maybe this winter it will be better.

I guess my thought was that humidified air would reduce the number of OAs? maybe slightly...

Hi Clementine,
Early this year I went thru a time somewhat like yours, looking for what might influence the AHI. I tried dinking with pressures, EPR, ramp, etc. Nothing made any significant or consistent difference. Then, after reading more on this board, I decided to try avoiding sleeping on my back. That was really the key for me. It took a few different tries to see what might work, and continue to work, but that did the trick. Before, my AHI was routinely in the 10 - 15 range. Now, it is rarely above 1.

This is a simple thing to try, and it helps enough people to be worth the experiment. I got some large, heavy memory-foam pillows, and wedged them behind me. That was enough to start improving the AHI, but not sufficient. Then I tried the tennis ball-tee shirt, and that wasn't enough either. I found that wearing a school backpack loaded with light, lumpy uncomfortable objects was effective, for me.

Good Luck on your journey.

A.Becker
PAPing in NE Ohio, with a pack of Cairn terriers
07-30-2014 03:48 PM
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robysue Offline
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Advisory Members

Posts: 1,233
Joined: Oct 2013

Machine: PR Dreamstation BiPAP Auto
Mask Type: Nasal pillows
Mask Make & Model: Swift FX
Humidifier: PR Dreamstation humidfier
CPAP Pressure: min EPAP = 4; max IPAP = 9;
CPAP Software: SleepyHead EncoreBasic EncorePro

Other Comments: Papping since September 2010

Sex: Female
Location: Buffalo, NY

Post: #23
RE: Disappointed
(07-30-2014 09:38 AM)Clementine Wrote:  repeating my question from above; not sure it was seen:

Last night I slept better/longer, but my AHI was 11. How long do I give this current pressure before I ask the doc for something higher? It seems like --- if the pressure is not correct, one night will tell me that, or just a couple of nights, anyway. No point waiting around for a week or more?
Personally I would not change anything based on one night's data.

How long have you been using the current settings? 1-2 days? or 5-7 days?

Yes, the last data you posted had an OAI that was way too high. If your AHI stays that high for 4-5 out of 7 days, then it's clear that the pressure should be adjusted.

You have a choice: You can be a squeaky wheel and call or email the doc's office every day to report the too high AHI and beg for a call back and/or a pressure increase and/or a switch to VPAP Auto. OR you can join the dark side and learn to get into the clinical menu and make an adjustment yourself.

If you choose to join the dark side, I second idea of switching to VPAP Auto. But before making any kind of recommendations on how to set the min EPAP, max IPAP, and PS settings, I'd want to see the following:

1) Confirmation of the current mode on the machine:
    Mode = VPAP S or VPAP Auto??
Since there's no PS listed in the SH data, I believe you are indeed running in VPAP S mode and not VPAP Auto mode, but I'd feel more comfortable if you would get into the clinical settings on the S9 VPAP Auto itself and make sure of the mode.

2) Confirmation of the current therapeutic settings on the machine.
    If Mode = VPAP S, then
    • EPAP = 5 (Please confirm this)
    • IPAP = 11 (Please confirm this)
Please understand: We don't often see new bi-level PAPers with an EPAP to IPAP spread of 6cm when using VPAP S mode. I'm not saying that something is wrong with the settings; I'm simply saying that it's a bit unusual to have IPAP - EPAP = 6.

3) A screen shot of the Daily Data graphs from SH from one or two of the recent "bad nights". The graphs I'd want to see are:
  • The Event table
  • The Flow Rate graph
  • The pressure graph
  • The leak graph
For step by step instructions of how to create and post a screen shot showing these graphs, please read through 14. Posting SleepyHead Graphs to the Forum

And once I had that information, I'd still urge caution and I would suggest making no more than ONE change at a time, and I'd make SMALL changes instead of large ones.

Questions about SleepyHead?
See my Guide to SleepyHead
07-30-2014 04:11 PM
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Clementine Offline

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Posts: 208
Joined: Sep 2013

Machine: ResMed VPap Auto
Mask Type: Nasal pillows
Mask Make & Model: ResMed AirFit P10
Humidifier: ResMed H5i--not using currently
CPAP Pressure: Auto -- 8/13.2 PS 3.2
CPAP Software: SleepyHead

Other Comments: Began with machine on 7/7/14.

Sex: Female
Location: eastern Iowa

Post: #24
RE: Disappointed
Not very good sleep last night: AHI of 16. ugh.

I believe it was because I cleaned all day yesterday, and I do have a dust allergy. I was clogged up last night; slept in the recliner in hopes of getting some sleep. It's not surprising that the AHI was 16 last night -- my throat was froggy and full.

On the top of my machine it says ResMed Vpap Auto. On the back white label it says S9 and #36006A.

I have been on the 11/5 setting since July 24. The 11/5 shows on the machine when it's turned on .... not sure how to confirm? (Yeah, I'm kinda thick)
You say the epap/ipap spread of 6 is unusual. What is a more usual number?

It's gonna take me a while to figure out how to do a screen shot of the graphs. Will get to that soon.
(This post was last modified: 07-31-2014 09:39 AM by Clementine.)
07-31-2014 09:26 AM
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Clementine Offline

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Posts: 208
Joined: Sep 2013

Machine: ResMed VPap Auto
Mask Type: Nasal pillows
Mask Make & Model: ResMed AirFit P10
Humidifier: ResMed H5i--not using currently
CPAP Pressure: Auto -- 8/13.2 PS 3.2
CPAP Software: SleepyHead

Other Comments: Began with machine on 7/7/14.

Sex: Female
Location: eastern Iowa

Post: #25
RE: Disappointed
i think I have it figured out:

[Image: screenshot-20140731-094324_zpsf595db28.png]
[Image: screenshot-20140731-095547_zps99007c96.png]
(This post was last modified: 07-31-2014 10:00 AM by Clementine.)
07-31-2014 09:59 AM
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me50 Offline

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Posts: 2,559
Joined: Aug 2013

Machine: resmed S9 VPAP Auto
Mask Type: Nasal mask
Mask Make & Model: Wisp and Silicone Head gear
Humidifier: resmed H5i
CPAP Pressure: 18/8
CPAP Software: SleepyHead

Other Comments:

Sex: Undisclosed
Location: USA

Post: #26
RE: Disappointed

Hi Clementine,

This is a simple thing to try, and it helps enough people to be worth the experiment. I got some large, heavy memory-foam pillows, and wedged them behind me. That was enough to start improving the AHI, but not sufficient. Then I tried the tennis ball-tee shirt, and that wasn't enough either. I found that wearing a school backpack loaded with light, lumpy uncomfortable objects was effective, for me.

Good Luck on your journey.
[/quote]

My favorite sleeping position is on my right side. I sleep on my back because when I try to sleep on my side, I cannot fall asleep. I have no clue why but I always end up on my back because I don't want to be on my side and be awake all night.
07-31-2014 10:06 AM
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robysue Offline
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Advisory Members

Posts: 1,233
Joined: Oct 2013

Machine: PR Dreamstation BiPAP Auto
Mask Type: Nasal pillows
Mask Make & Model: Swift FX
Humidifier: PR Dreamstation humidfier
CPAP Pressure: min EPAP = 4; max IPAP = 9;
CPAP Software: SleepyHead EncoreBasic EncorePro

Other Comments: Papping since September 2010

Sex: Female
Location: Buffalo, NY

Post: #27
RE: Disappointed
Clementine,

The pressure data indicates that you are indeed running in VPAP S (fixed bilevel) mode with a very short ramp period. Your fixed EPAP = 5 and your fixed IPAP = 11. The PS = 6 = IPAP - EPAP is a bit larger than what we usually see with new PAPers using bilevel machines; more typically we see PS numbers in the 4-5 range. There's nothing necessarily wrong with having a larger PS, but it is a bit unusual. Did you have a titration study using a bilevel machine? If so, you should request a copy of the full sleep study report including the summary graphs. The whole thing will run 3-7 pages or so. And having it would explain why your original settings of IPAP 10 and EPAP = 4 were settled upon.

It looks like you took an hour long nap in the early evening on this day. The nap data looks better than the night time data.

The CAs scored at the very end of the night (after 7:00AM) are probably just "sleep/wake/junk" breathing when you were beginning to wake up, and the control of your breathing was in transistion between the autonomous nervous system (in charge of sleep breathing) and the voluntary nervous system (in charge of wake breathing). When you are drifting in and out of sleep before waking up for good, it's not uncommon some "transition centrals."

The OAs scored throughout the night ARE a concern. They are clustered and some of the clusters are about 90 minutes from each other. So there's a chance that some of these clusters are REM related. If this were my data, I would ask the sleep doc for permission to change to VPAP Auto for a week or so with these settings:

min EPAP = 5
max IPAP = 13
PS = 6

This would still have you starting out at IPAP = 11 and EPAP = 5 once the ramp is over. But it would allow them machine to increase both IPAP and EPAP by up to 2 cm when the clusters of OAs start happening. And that might be just enough to allow the machine to prevent most of the OAs that are currently getting by the PAP defenses.

I'd re-evaluate the data after a week at the proposed settings: I'd be looking for whether or not the number of OAs had increased and what the pressure curves were doing. In other words, I'd be looking at whether the machine is very quickly increasing the pressures to IPAP = 13, EPAP = 7 and keeping them there for very long periods of time OR whether the machine was only occasionally increasing the pressure above IPAP = 11 and EPAP = 5 OR somewhere in between.

Questions about SleepyHead?
See my Guide to SleepyHead
07-31-2014 10:19 AM
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Clementine Offline

Preferred Members-2

Posts: 208
Joined: Sep 2013

Machine: ResMed VPap Auto
Mask Type: Nasal pillows
Mask Make & Model: ResMed AirFit P10
Humidifier: ResMed H5i--not using currently
CPAP Pressure: Auto -- 8/13.2 PS 3.2
CPAP Software: SleepyHead

Other Comments: Began with machine on 7/7/14.

Sex: Female
Location: eastern Iowa

Post: #28
RE: Disappointed
that's fantastic help, RobySue! Thank you.
Please, could you tell me what the PS stands for? I understand it is the Ipap minus the Epap --- but that doesn't compute with the Ipap at 13 and Epap at 5. So, obviously I'm not understanding.
07-31-2014 10:27 AM
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Clementine Offline

Preferred Members-2

Posts: 208
Joined: Sep 2013

Machine: ResMed VPap Auto
Mask Type: Nasal pillows
Mask Make & Model: ResMed AirFit P10
Humidifier: ResMed H5i--not using currently
CPAP Pressure: Auto -- 8/13.2 PS 3.2
CPAP Software: SleepyHead

Other Comments: Began with machine on 7/7/14.

Sex: Female
Location: eastern Iowa

Post: #29
RE: Disappointed
(07-31-2014 10:06 AM)me50 Wrote:  
(07-30-2014 03:48 PM)becker44a Wrote:  

Hi Clementine,

This is a simple thing to try, and it helps enough people to be worth the experiment. I got some large, heavy memory-foam pillows, and wedged them behind me. That was enough to start improving the AHI, but not sufficient. Then I tried the tennis ball-tee shirt, and that wasn't enough either. I found that wearing a school backpack loaded with light, lumpy uncomfortable objects was effective, for me.

Good Luck on your journey.

My favorite sleeping position is on my right side. I sleep on my back because when I try to sleep on my side, I cannot fall asleep. I have no clue why but I always end up on my back because I don't want to be on my side and be awake all night.
[/quote]

thanks for your ideas --- I had been doing just this kind of thing before diagnosis, as well as sleeping in the recliner.

I hope with this therapy that I can avoid doing all of that .... isn't that kind of the goal? That I can sleep however I want, and be able to breathe and not have OAs? That's my hope, anyway.

It certainly is a journey, isn't it.
07-31-2014 10:31 AM
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robysue Offline
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Advisory Members

Posts: 1,233
Joined: Oct 2013

Machine: PR Dreamstation BiPAP Auto
Mask Type: Nasal pillows
Mask Make & Model: Swift FX
Humidifier: PR Dreamstation humidfier
CPAP Pressure: min EPAP = 4; max IPAP = 9;
CPAP Software: SleepyHead EncoreBasic EncorePro

Other Comments: Papping since September 2010

Sex: Female
Location: Buffalo, NY

Post: #30
RE: Disappointed
(07-31-2014 10:27 AM)Clementine Wrote:  that's fantastic help, RobySue! Thank you.
Please, could you tell me what the PS stands for? I understand it is the Ipap minus the Epap --- but that doesn't compute with the Ipap at 13 and Epap at 5. So, obviously I'm not understanding.

PS = Pressure Support and Pressure Support is defined as the difference between IPAP and EPAP. In other words Pressure Support is the additional pressure delivered only when you are actually inhaling.
(07-31-2014 10:31 AM)Clementine Wrote:  I hope with this therapy that I can avoid doing all of that .... isn't that kind of the goal? That I can sleep however I want, and be able to breathe and not have OAs? That's my hope, anyway.
Yes, for many of us, once the pressure settings are fine-tuned and we've learned how to sleep with the mask, we do find that we can sleep in any position we want (including on our backs) without having a clinically significant number of OAs. And that allows us to wake up more refreshed and more rested.

Quote:It certainly is a journey, isn't it.
It is indeed a crazy journey for some of us.

Good luck!

Questions about SleepyHead?
See my Guide to SleepyHead
(This post was last modified: 07-31-2014 11:10 AM by robysue.)
07-31-2014 11:07 AM
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