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Hypopnea and mask removal
#11
C-Flex is one of those weird things where the number does not just relate to pressure relief but also to timing. For the fastest transition, select 1. In your case, your inhale/exhale transitions are very abrupt. I'd select 1 and see how it feels.

Your expanded data makes me more certain your mask removal is actually a central apnea, and may be (this is a stretch) a form of complex apnea caused by CPAP pressure. I base this on the seat of my ass and what I'm looking at. :lol: You are fast asleep as shown by the breathing pattern. You just stop breathing, and it's usually on the exhale. This may be due to how your body is responding to pressure, in which case bilevel might help; or it could be CA in which case you need to be induced to breath (ASV). I dunno. Dont-know

Good thing to bring this up with the doc, but this is more than simple noncompliance.
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#12
Adding a link to an interesting study on C-flex. http://www.ncbi.nlm.nih.gov/pubmed/19122451

Quote:Using higher C-Flex gains, expiratory time decreased in favor of the inspiratory duty cycle

Your expiration cycle is already so fast during sleep, I have a hunch, you'd find a setting of 1.0 more natural.
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#13
(08-03-2015, 10:44 AM)Sleeprider Wrote: C-Flex is one of those weird things where the number does not just relate to pressure relief but also to timing. For the fastest transition, select 1. In your case, your inhale/exhale transitions are very abrupt. I'd select 1 and see how it feels.

Your expanded data makes me more certain your mask removal is actually a central apnea, and may be (this is a stretch) a form of complex apnea caused by CPAP pressure. I base this on the seat of my ass and what I'm looking at. :lol: You are fast asleep as shown by the breathing pattern. You just stop breathing, and it's usually on the exhale. This may be due to how your body is responding to pressure, in which case bilevel might help; or it could be CA in which case you need to be induced to breath (ASV). I dunno. Dont-know

Good thing to bring this up with the doc, but this is more than simple noncompliance.

Ah, interesting. I'll change it to 1 tonight and see if it makes a difference.

From what I read I thought that the value was the amount of pressure relief it provided... 1 being the least, 3 being the most.

I'm assuming that my doctor will see the same thing that you've seen here and will (hopefully) provide an way to deal with it.
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#14
Worth a try, and it's easy to change back if 3 feels better. I don't see it as a solution to the mask removal problem.
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#15
There is a simpler explanation of this:
1) your mouth opens up a few minutes before your hypo and taking off the mask.
2) this leads to your leak rate going real high as I can see from your leak rate graph.
3) since the Respironics machine only flags and records leak rate in 2 minute increments, it probably is 2 to 4 minutes of this before LL is flagged.
4) you are mouth breathing during this time.
5) your machine loses its ability to record the waveform since it's going out of your mouth like a jet stream.
6) your machine sensor does pick some noise in the waveform and classifies it as a long hypopnea. Your first chart shows an H event which is more than 1 minute long. It's a bit too large unless you are Michael phelps Smile
7) since mouth breathing is inferior, you start having apneas that the machine is not recording.
8) your hands go up and rip the mask off thinking you are not getting enough air thru this thing on your face.
9) you wake up in a bit due to the multiple arousals caused by apnea.

I would recommend that you fix your mouth breathing issue first. You may want to try a chin strap or get an FFM.

My 2 cents. YMMV.

Also are you using cflex OR cflex+?
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#16
(08-03-2015, 01:32 PM)AshSF Wrote: There is a simpler explanation of this:
1) your mouth opens up a few minutes before your hypo and taking off the mask.
2) this leads to your leak rate going real high as I can see from your leak rate graph.
3) since the Respironics machine only flags and records leak rate in 2 minute increments, it probably is 2 to 4 minutes of this before LL is flagged.
4) you are mouth breathing during this time.
5) your machine loses its ability to record the waveform since it's going out of your mouth like a jet stream.
6) your machine sensor does pick some noise in the waveform and classifies it as a long hypopnea. Your first chart shows an H event which is more than 1 minute long. It's a bit too large unless you are Michael phelps Smile
7) since mouth breathing is inferior, you start having apneas that the machine is not recording.
8) your hands go up and rip the mask off thinking you are not getting enough air thru this thing on your face.
9) you wake up in a bit due to the multiple arousals caused by apnea.

I would recommend that you fix your mouth breathing issue first. You may want to try a chin strap or get an FFM.

Outstanding analysis!

I have a chin strap but have not used it. During the titration the tech told me that my mouth was open so he put the chin strap on me, I got one to use at home but never have.

I'm very claustrophobic and don't think I'd be able to use a FFM.

Quote:Also are you using cflex OR cflex+?

The machine says C-Flex+ on it so I assume that's what I'm using? SleepyHead also says "Flex Mode C-Flex+". I didn't see an option in the any of the menus on the machine to change it from C-Flex+ to anything else.
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#17
Thanks.

If you find FFMs claustrophobic then you may want to look into Resmed F10 or Respironics Amara view. They don't interrupt your field of vision and you may like them. I had great results with the F10 when I started. To get over the initial hesitation, you may want to wear it while awake while watching TV or something.

CFlex+ is better than old Cflex. Cflex+ is called Aflex on the auto machine. You should use any of the 3 settings of Cflex+ that you find comfortable.
Started APAP 4-20, Closed range to 7.5-14, then straight 8.0 w/ Aflex 3
RDI always below 1. But sleep much much better at straight pressure.
Started on F10, Tried Quattro Air successfully. Finally settled on P10.
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#18
I didn't think I would be able to tolerate a FFM, either. I had nasal surgery 6 days ago and a FFM is my only option right now. I am actually liking the F10. I have way fewer leaks and it is much more comfortable than I ever thought it would be. Granted, I am still sleeping in my recliner due to the surgery. I'm curious to see how this mask does when I am sleeping on my side in bed again. Anyway, my point, don't discount a FFM, at least give it a try. You may be surprised.
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#19
Last night I changed the C-Flex+ setting from 3 to 1. At first it seemed harder to exhale but I got used to it after 10 minutes or so. My mask was off only once for about half an hour, but I don't think I took it off - I think it fell off. I was laying on my right side (which I hardly ever do) and the mask was right next to my face on the pillow so I think I may have just been moving around and accidentally pushed it off with the pillow.

RERA went from 3 (the night before) to 12, VS2 went from 16 to 19, obstructive went from 10 to 12, and the hypopnea count stayed the same at 5. AHI was up too, from 2.31 the previous night to 2.51 last night. However... My A/C went on the fritz at some point and instead of it being a nice 68 degrees it was in the high 70s and I don't sleep well when it's not cool. So without changing anything I'll see how I do tonight. That's assuming I can get the A/C fixed, otherwise I'll be sleeping the basement. Sad
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#20
Ash, I like your analysis better than mine. Well done!
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