Hypopnea's

[diamaunt]

Bad day with snore

fyi, in the last 30 days I had 5 days with an AHI over 5.

5.99, 12.18 (forgot tennis balls that night), 6.49, 9.72, and most recent 8.10. Various
low pressures and was experimenting with epr.

glad they pay you guys the big bucks

robysue, any idea what would make her pressure shoot up like that? it doesn't look like it was snoring, or apneas... flow limitations?

[readyforsleep]

Re/the pressure shooting up, I always assumed that the S9 was basing it on
what happenned the night before. SH shows a spike the prior night at that time
in response to a CA, OA, and a Hypopnea.



BTW, I will not be home until October. I do have an arrangement to trial a
Bilevel locally if needed. I don't want to wait until October to get the bilevel
Ball rolling if it could help me.l

[PaytonA]

about my mask fit, should I have the bottom straps nestle against the bottom
of my ear or try it further down?

i have not used the Simplus mask but I can tell you one thing about mask headgear. The way I see it is, when you have a lower strap that goes below the ears, you want to keep them as close under the ears as is comfortable. The reason for this is that the further off your head and down on your neck the straps are, the more the tension on the straps will change as you tilt your head forward and backward.

If your pressure is up around 20 cm/H2O most of the time, it requires a lot of detail to keep the leaks down. I will offer a couple of suggestions. Make sure your lower mask straps are the same length. Make sure your upper mask straps are the same length but not necessarily the same length as the lower straps. Uneven straps tend to cause uneven tension which has one side of the mask retained better than the other leading to leaks on one side. What I do is once I have adjusted the straps, I shut the machine down and take the mask off and take the headgear off the mask. I lay the headgear out so that I can look at the strap pair side by side. I use the comparative position of the end of the hook and loop fasteners to judge the relative length of the straps. If they are not even, I move one halfway towards the position of the other one and then move the second one to match the first. Voila, even straps.

The other thing that I do to keep the tension even on the mask occurs after I have put the mask on for the night. Once it is on and strapped up, I reach back with both hands and pull the strap slightly off my head. Then I move it back and forth slightly to make sure every thing is centered because fastening the last 2 straps one at a time means that the mask has been left with more tension on one side than the other. I have not seen any headgear that looks self centering. Repeat the process with the other set of straps and you should be good to go.

I use a bilevel CPAP that is set at 20 cm/H2O for my inhalation and I have to keep the straps quite tight on my FFM in order to keep my leaks under control.

Hope you continue to

Best Regards,

PaytonA

[readyforsleep]

Payton, very helpful info Thanks!

[PsychoMike]

RFS, it's good to hear that you've had some positive results already. I'm not as plugged in as Robysue, but I have a couple other things that could help...

When I gave the Simplus a whirl, it didn't like my chin that much. It has a wonderfully deep, soft seal/cushion...but that can also be a pain when it comes to blow-outs and leaks. I can't see all your graphs at work (silly IT limitations)...but if the leak jumps are semi-corresponding to the pressure jumps, there could be some blow-outs happening at "weak spots" in the seal between your face and the mask.

Sometimes a little time spent in the "mask fit" mode of an S9 can help pin down the fit a bit better, especially when you run a higher pressure or are having issues with leaks. The "mask fit" mode of an S9 is ~20cm H20 so it's not always the most comfy when awake, but it makes it possible to search for leaks... If you're able to, mask up and turn on the "mask fit" mode then adjust tensions, strap positions etc (initially sitting, then laying down like you were sleeping) and see if you can find any problem areas or reduce the leaks.

Another thing to try, if you're not wearing a liner, is a mask wipe shortly before masking up for the night. A wipe of the seal and where it contacts your face can help things be a bit more tacky and help improve the leak rate.

[robysue]

Bad day with snore

fyi, in the last 30 days I had 5 days with an AHI over 5.

5.99, 12.18 (forgot tennis balls that night), 6.49, 9.72, and most recent 8.10. Various
low pressures and was experimenting with epr.

glad they pay you guys the big bucks

robysue, any idea what would make her pressure shoot up like that? it doesn't look like it was snoring, or apneas... flow limitations?

We need to see a close up of:

• Flow Rate (wave flow)
  
• Pressure curve
  
• Snore
  
• Flow limitation

graphs all in the same time period that focuses on the pressure increase and not the obvious events.

The S9 can be pretty aggressive in increasing the pressure in response to flow limitations and snoring even when there are no OAs or Hs anywhere in sight.

[robysue]

Re/the pressure shooting up, I always assumed that the S9 was basing it on
what happenned the night before. SH shows a spike the prior night at that time
in response to a CA, OA, and a Hypopnea.

Not sure what you mean. Tuesday night's pressure spikes have nothing to do with what the machine chooses to do on Wednesday night.

The pressure is adjusted in real time based on what the S9 is seeing in TONIGHT'S flow rate. All decisions about pressure increases are based on what's been going on in the last five minutes of breathing as I recall.

The S9 will increase the pressure (sometimes drastically) when it sees:

• clusters of two or more OAs or Hs occurring within about 2 minutes of each other. It may chose to NOT increase the pressure for an "isolated" OA or H.
  
• Snoring
  
• Flow limitations

[diamaunt]

Re/the pressure shooting up, I always assumed that the S9 was basing it on
what happenned the night before. SH shows a spike the prior night at that time
in response to a CA, OA, and a Hypopnea.

to my knowledge, there's nothing in any xpap machine that reacts to what happened in previous days, that really wouldn't make *any* sense at all, if you think about it.

you're unlikely to be in the same sleep position, or needing the same amount of pressure the next night.

look at all the charts and see if you can see anything unusual happening at the same time you had that big ramp up.

[diamaunt]

robysue, any idea what would make her pressure shoot up like that? it doesn't look like it was snoring, or apneas... flow limitations?

We need to see a close up of:

• Flow Rate (wave flow)
  
• Pressure curve
  
• Snore
  
• Flow limitation

graphs all in the same time period that focuses on the pressure increase and not the obvious events.

The S9 can be pretty aggressive in increasing the pressure in response to flow limitations and snoring even when there are no OAs or Hs anywhere in sight.
[/quote]

I'm guessing it's got to be flow limitation, since there's a good graph with snore on it, and there weren't any showing.

perhaps we can get her to give us a zoom in around that big pressure increase with the flow limit chart showing too?

[readyforsleep]

I have looked at all the charts and did not see anything unusual happening at the time I had that big ramp up. I do remember having to clear my throat one
night, just after I had fitted the mask Possibility?

Last night ahi 4.4, leaks 95% 33.6. My saga continues...