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First night results - Auto titrating
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justMongo Offline

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Post: #11
RE: First night results - Auto titrating
(04-16-2016 09:24 PM)jhtrazor Wrote:  I ordered a chin strap on Amazon, which will be here in a few days. I guess that's what I need.

Sometimes you have to do a little DIY to fit it. It's more of a training aid to remind you to not open your mouth. It's actually possible to open your mouth under PAP pressure and not leak. It's a matter of tongue position. The alternative is a full face mask (FFM.) The P10 is very popular, so stick with the P10 for now. It almost has a cult following here; and if it wasn't good, there wouldn't be so many users.

Eventually, after accumulating enough data, you'll want to narrow that 4-20 pressure window. Story for another day.

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.
04-16-2016 10:13 PM
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vsheline Offline

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Machine: S9 VPAP Adapt (USA Model# 36007, not better 36037 or 36067)
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Mask Make & Model: F10 or SimPlus w/ 2Liners. MirageQuatro & Gecko gel pad
Humidifier: H5i
CPAP Pressure: 15 EPAP, PS 5-10
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Other Comments: Marfan Syndrome, chronic bradycardia, occasional Cheyne-Stokes Respiration

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Post: #12
RE: First night results - Auto titrating
(04-16-2016 12:12 PM)jhtrazor Wrote:  Ok, I used windows snipping tool. When I used Sleepyheads screen shot, it created one under 200kb, so let's try the upload again.

Hi jhtrazor,

Terrific first night.

The Min Pressure setting is mostly a comfort setting, as is EPR usually.

Your 95 percentile pressure was 11.88 cmH2O. This is the pressure you were at or below at least 95% of the night. It is also the pressure you were at or above for at least 5% of the night.

If you never ever allow yourself to roll over onto your back while sleeping you would probably need much less pressure.

In any case, I suggest eventually walking your Min Pressure higher, to somewhere between 2 and 4 below your average 95% pressure. (Or, a few PAPers have found they do best when their Min Pressure is nearly the same as their 95% pressure, resulting in nearly constant pressure all night.). But there is no hurry to start slowly increasing the Min Pressure unless your present Min Pressure of 4 feels uncomfortably low.

The lower the Min Pressure, the faster the pressure drops between obstructive events and becomes too low again, leading to more obstructive events. If there are no further signs of obstruction the pressure will have gradually dropped most of the way (63% of the way) toward the Min Pressure in 20 minutes. (After being raised the pressure decays with a 20 minute Time Constant.)

Also, raising the Min Pressure can make it easier to breathe in. If breathing in ever seems a little too hard, with an uncomfortable feeling of being slightly suffocated, all you need to do is raise the Min Pressure and/or (if you use the Ramp) the Start Pressure.

When changing settings, usually it is best to change only one thing at a time and only by a small amount and not more often then one adjustment per week or two. That way you have time to gather data at each setting and gain a clear picture of the effect of the last change.

But I would suggest making an exception to this procedure for the case of Start Pressure changes (if you use the Ramp) and Min Pressure changes, allowing immediate adjustment to a more comfortable setting.

For example, you might find an increase in Min Pressure to 6 is more comfortable than starting at 4.

EPR makes it easier to breathe out. The way EPR works is to lower the pressure while we are exhaling, but it will never lower the pressure below 4. If EPR is 2 and you raise the Min Pressure to 6, the pressure while exhaling would be 4 whenever the inhale pressure is 6. As the pressure is raised if symptoms of obstruction occur, the exhale pressure would be 4.8 whenever the inhale pressure is 6.8, and so on.

Take care,
--- Vaughn

Membership in the Advisory Member group should not be understood as in any way implying medical expertise or qualification for advising Sleep Apnea patients concerning their treatment. The Advisory Member group provides advice and suggestions to Apnea Board administrators and staff on matters concerning Apnea Board operation and administrative policies - not on matters concerning treatment for Sleep Apnea. I think it is now too late to change the name of the group but I think Voting Member group would perhaps have been a more descriptive name for the group.
(This post was last modified: 04-17-2016 12:00 AM by vsheline.)
04-16-2016 10:59 PM
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jhtrazor Offline

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Post: #13
RE: First night results - Auto titrating
Vaughn, thank you for the detailed information. It's very helpful. One of the things that caused me to toss aside the denial of knowing for years I had OSA, is the fact that I've got a bum shoulder, which is being made worse by sleeping on my stomach with my arm under the pillow.

So, being able to sleep on my back pushed me to stop ignoring what I knew I should have dealt with a long time ago.
04-16-2016 11:33 PM
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jhtrazor Offline

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Machine: Resmed Airsense 10 Auto
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Post: #14
RE: First night results - Auto titrating
Went to bed very late and didn't sleep as long, but still feel like it was a good night. Leaks appear to be worse. Again, woke up several times with air escaping through my mouth.

Looking at the graphs, it happens when the pressure is up, so I don't know if I open my mouth and then it increases pressure to compensate, or it was increasing pressure for a different reason, which popped my mouth open (when the pressure got higher).

Edit, looks like the total attachments is 200 until I hit my post limit. So, for now I'll delete the attachment from my first night and post just the second night.
(This post was last modified: 04-17-2016 05:13 PM by jhtrazor.)
04-17-2016 05:11 PM
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jhtrazor Offline

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Posts: 18
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Machine: Resmed Airsense 10 Auto
Mask Type: Nasal pillows
Mask Make & Model: Resmed Airfit P10
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CPAP Pressure: 4-20
CPAP Software: SleepyHead

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Sex: Male
Location:

Post: #15
RE: First night results - Auto titrating
Well, strike that. That post is too old and doesn't let me edit it, so at least for now, I can't upload any more picture.

Here's the text breakdown from the details tab:

Large Leak 8.97%
Clear Airway 0.00
Obstructive 0.93
Unclassified Apnea 0.00
Hypopnea 0.27
RERA 0.53

Event Breakdown

Statistics
Channel Min Med 95% Max
PressureTherapy Pressure (cmH2O)
W-Avg: 8.86 4.08 8.60 12.10 13.04
EPAPExpiratory Pressure (cmH2O)
W-Avg: 6.92 4.08 6.62 10.10 11.04
Minute Vent.Amount of air displaced per minute (L/min)
W-Avg: 7.20 2.62 7.00 9.25 21.88
Resp. RateRate of breaths per minute (Breaths/min)
W-Avg: 21.07 4.40 21.20 26.20 40.60
Flow Limit.Graph showing severity of flow limitations (Severity (0-1))
W-Avg: 0.02 0.00 0.00 0.12 0.83
Leak RateRate of detected mask leakage (L/min)
W-Avg: 8.62 0.00 4.80 28.80 57.60
SnoreGraph displaying snore volume (?)
W-Avg: 0.00 0.00 0.00 0.00 1.12
Insp. TimeTime taken to breathe in (Seconds)
W-Avg: 1.43 0.18 1.38 2.00 9.40
Exp. TimeTime taken to breathe out (Seconds)
W-Avg: 1.54 0.22 1.42 2.30 7.04
Tidal VolumeAmount of air displaced per breath (ml)
W-Avg: 345.52 80.00 340.00 480.00 880.00

Total time in apnea 00:01:41
Time over leak redline 8.970%
04-17-2016 05:15 PM
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jhtrazor Offline

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Machine: Resmed Airsense 10 Auto
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CPAP Software: SleepyHead

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Post: #16
RE: First night results - Auto titrating
Ok, now it's letting me post another screen shot.

So, here's night to. from what I can see, all is good except for the leaking, which I believe is all/mostly opening my mouth.

Are the two options to combat it chin strap or full faced mask? I do have a beard (beard trimmed on setting 5 on a Norelco trim, mustache 3).

Also, from a practical standpoint, if I'm down to 1-2 AHI and only 2-5 minutes a night in Apnea, is having these large leak problems a practical problem (assuming they don't drive my wife crazy with noise -- these been out of town the last two days)?


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(This post was last modified: 04-17-2016 07:14 PM by jhtrazor.)
04-17-2016 07:11 PM
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becker44a Offline

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Post: #17
RE: First night results - Auto titrating
(04-17-2016 07:11 PM)jhtrazor Wrote:  . . .
Also, from a practical standpoint, if I'm down to 1-2 AHI and only 2-5 minutes a night in Apnea, is having these large leak problems a practical problem (assuming they don't drive my wife crazy with noise -- these been out of town the last two days)?

Hi jhtrazor,
Welcome to the forum, and to the Hosehead community in general.

IMHO, yes, you should address the leak issue. Even if you or your wife aren't made uncomfortable by the leaking, your therapy is compromised during that time. From the screenshot you posted, the time above the leak redline was just under 9%. Your total sleeptime was about 450 minutes. So the time when the machine was unable to properly treat or perhaps score your apneas was about 40 minutes - hardly insignificant.

A.Becker
PAPing in NE Ohio, with a pack of Cairn terriers
04-17-2016 08:41 PM
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jhtrazor Offline

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Machine: Resmed Airsense 10 Auto
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CPAP Software: SleepyHead

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Post: #18
RE: First night results - Auto titrating
Ok, interesting, third night and I was only .2% over leak baseline and I think those were when I was showing my wife the mouth leak sounds like and trying to talk with it on.

I'm not sure if I'm training myself to keep my mouth closed, tongue in position, or I just got "lucky" last night.

My AHI's are staying below 2 and I really have not had any issues adapting to the CPAP, like I feared I would. Other than nasal congestion (see below), I've felt good and am not hating it at all, as I feared I would.

I did raise my minimum pressure, as suggested, to 6 last night. I started at the 4 I started with, but after 20 minutes or so, I changed it to 6, and I will say that 6 felt more comfortable than 4.

I've noticed the last few days an hour or two after I wake up my nose and sinuses feel very stuffy/congested. I had the humidifier set to the default 4, maybe I need to turn it up to 6 or 8.

[Image: screenshot-20160418-121835.png]
04-18-2016 12:30 PM
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jhtrazor Offline

Members

Posts: 18
Joined: Apr 2016

Machine: Resmed Airsense 10 Auto
Mask Type: Nasal pillows
Mask Make & Model: Resmed Airfit P10
Humidifier: Built In
CPAP Pressure: 4-20
CPAP Software: SleepyHead

Other Comments:

Sex: Male
Location:

Post: #19
RE: First night results - Auto titrating
A bit of a bad experience interrupting what would otherwise have been a nice night. Went to bed around 10:30 and feel asleep relatively soon, guessing 20-30 minutes. Woke up about 12:30 and my nose was a little itchy. I scratched it and water dribbled out of my nose. Adjusted pillows and more water. Boom, I was getting rainout and quite a bit of it on my Airsense 10 and Climateline hose.

So, first I try shaking some of the water out, and lowered the humidity, and started messing around and realize there is no temperature setting. I check, and realized that when I had taken the hose off after my first night and reconnected it, I put it on backwards and didn't get the contacts in the right spot (not sure how I managed that). So, last night when I upped the humidity from 4 to 8, combined with the fact my wife is back and keeps the bedroom around 68-69 led to me being soaked.

Once I got that fixed, I went back to bed with a nice warm hose.

AHI for the night was .73, and major leaks are way down. Again, only .2 and based on the graph, seems to only be from when I was adjusting the mask, or opening my mouth to make sure it was flowing right.

Last night my leak rate varied from 5-13, except for one five minute period from 5:20-5:25 where it went up to 18 for the five minutes.

My chin strap comes in today, but since the last two nights I've stayed well below the 24 that Resmed says is normal or expected, I'm wondering if it's necessary.

My body seems to be learning, because now even if I open my mouth with the mask on to see if it's flowing (sometimes when at low pressure before it's ramped up, I wonder if it's working right, because it doesn't seem to have much air flowing), I get no air leaking out of my mouth and then have to specifically move my tongue to get air flowing.

I'll probably just keep watching and if I my leak rate and AHI stays low, then not mess with the chin strap.
04-19-2016 07:33 AM
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vsheline Offline

Advisory Members

Posts: 1,907
Joined: Jul 2012

Machine: S9 VPAP Adapt (USA Model# 36007, not better 36037 or 36067)
Mask Type: Full face mask
Mask Make & Model: F10 or SimPlus w/ 2Liners. MirageQuatro & Gecko gel pad
Humidifier: H5i
CPAP Pressure: 15 EPAP, PS 5-10
CPAP Software: ResScan

Other Comments: Marfan Syndrome, chronic bradycardia, occasional Cheyne-Stokes Respiration

Sex: Male
Location: California, USA

Post: #20
RE: First night results - Auto titrating
(04-16-2016 10:59 PM)vsheline Wrote:  In any case, I suggest eventually walking your Min Pressure higher, to somewhere between 2 and 4 below your average 95% pressure. (Or, a few PAPers have found they do best when their Min Pressure is nearly the same as their 95% pressure, resulting in nearly constant pressure all night.)

Hi jhtrazor,

How are things going?

Near the top right of forum pages is a small "My Profile" link we can use to update our profile with our present settings.

A really great paper recommended in another thread (http://www.apneaboard.com/forums/Thread-...pid159349) also cautions against leaving the Min Pressure much below the 95% Pressure.

(04-16-2016 10:59 PM)vsheline Wrote:  The lower the Min Pressure, the faster the pressure drops between obstructive events and becomes too low again, leading to more obstructive events. If there are no further signs of obstruction the pressure will have gradually dropped most of the way (63% of the way) toward the Min Pressure in 20 minutes. (After being raised the pressure decays with a 20 minute Time Constant.)

Actually, the paper (linked below) indicates in Table 2 that the 20 minute Time Constant was used in the older ResMed S8 AutoSet algorithm. The S9 and A10 AutoSet algorithms variously use Time Constants of 10, 20, 40 and 60 minutes, depending on type of obstructive event and depending on whether the new For Her mode is used.

Although not light reading, I suggest bookmarking the paper for future reference, since it contains a wealth of information:

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4629962/?report=classic

Take care,
--- Vaughn

Membership in the Advisory Member group should not be understood as in any way implying medical expertise or qualification for advising Sleep Apnea patients concerning their treatment. The Advisory Member group provides advice and suggestions to Apnea Board administrators and staff on matters concerning Apnea Board operation and administrative policies - not on matters concerning treatment for Sleep Apnea. I think it is now too late to change the name of the group but I think Voting Member group would perhaps have been a more descriptive name for the group.
(This post was last modified: 05-08-2016 03:04 PM by vsheline.)
05-08-2016 02:38 PM
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