Welcome to Apnea Board !
As a guest, you are limited to certain areas of the board and there are some features you can't use.
To post a message, you must create a free account using a valid email address.
Login or Create an Account
@Expat31, thank you for the taking the time and effort to provide details. While I am aware of some of the steps I might need to take, your insight is going to help me get my ducks in a row. It is becoming obvious that this is going to take a while. I need to drill down into the data and learn how to analyze the information. I didn't post the first night with the new mask due it being off a lot for a few times.
I feel tired and cloudy tonight. I'll have to reread your post again tomorrow. I did want to add that I learned what you mean by incremental changes last night. I tried Crimson's settings of 11-13 last night. I had terrible leaking. I think my mouth was opened a lot. I had a terrible dry mouth in the morning (not as bad as I have read others describe). But I also experimented without any heat or humidity. Not only that, I added a head wrap to keep the mask in place. Somehow, the head wrap made the mask tighten up on my nose. Now it's swollen and cut. This leaves me with wondering which of these contributed to last night's issues. It's the first time I got a unhappy face for mask seal.
The minimum pressure was upped by 57% (7 to 11)!
This was a very aggressive move.
A move like this must be justified by clear data and logical reasoning.
-The result is that you had had:-
- Considerable leakage
- Obstructives too high
- A bunch of centrals
And a terrible night
As I indicated in my last post, slow incremental and careful changes must be made, always one at a time, also no other experimentation in parallel, otherwise you will never know what therapy change caused the problem.
No shortcuts, ever, without a clear logical base.
Anyway, concerning settings, I suggest you bring the minimum back to 8, leave maximum cap at 12 for the moment. I would suggest you leave everything else the same, including EPR at 3.
Once the pressure is dialled back downfrom 13 down to 8, leaks should reduce considerably, and sleep quality hopefully will be better. Mask issues are always complicated, and not easy to get right.
Review in a week or so giving time to stabilise things.
Did you switch from the p30i mask to a different one?
The last charts you posted, with the p30i?, showed very little leak... something you changed made those leaks skyrocket! Mouth opening is likely.
You have to get those leaks under control. The machine can't accurately respond to your breathing with so much leak.
Many people use mouth tape. Some learn the tongue trick to block air coming out of the mouth even when it's open.
I have to use a hybrid mask.
Control the leaks.
And then stick to the settings recommended by Expat for a few days and post your data for further recommended changes.
How bad is the cut on your nose?
Use whichever mask you own that limits irritating that cut, if possible, while still trying to combat leaks.
A small bit of a neosporin type ointment should help it heal.
@Brazen: Thank you for the tips. I tried to push through (yes, with the p30i) and realized that it's not going to work. Need to use the N20 for a few nights to let it heal. I applied some ointment as well.
@Expat, I went back to the original settings with the increase on the min to 8, thanks. Not before trying to push through one more night with the same settings. I am posting it. You will notice that something changed at around 4am. I woke up and put some mouth tape on out of curiosity. I wouldn't use that tape every night. Just some gauze tape. I woke a few times with the feeling of tufts of air escaping through the tape. Not pleasant. I don't know how to identify those in OSCAR, but I certainly felt them.
I can see that I was still having more events than usual--even with the tape. I am not sure what is happening. I had bad nights with the previous settings as well. I stay at the 8-12 settings until I can get back to the p30i for a few nights. The only change I may make is trying different pillows.
One thing I have noted is that the Resmed seems to be missing some events that should have been flagged. I saw a couple of clips from cpap reviews about resmed not flagging events because they aren't using the correct definition of a hypopnea in the algorithm. Not sure if its that, or just missed. It sure seems that this should these should have been flagged as they are longer than 10sec. I attached an example.
I am def. not feeling well the last few days, even though I am back to the usual settings. I don't know if it's a lagging effect, missed events, a bit of allergies, sleeping position, longer events, pillows etc. It certainly is tiring trying to figure all this out. I don't have kids, so I like to think I have more time than most others. Yet I can't seem to find the time to figure all this out. It's quite time consuming. Step by step, I guess...
Hi, a really quick reply, and will look at in detail tomorrow, hopefully when I have more time.
The big thing I see is that you have not quite understood the settings. In the screen shots included, settings are still at 11min, 13 maximum.
Look at top left corner, under the line PAP Mode APAP. You will see Min 11 Max 13(cmH20)
These are the pressures before EPAP.
At the moment don't worry about EPAP, we can talk about this if necessary after things have stabilised.
To change pressure, go into the clinicians menu and after changing the pressures, make sure you validate changes by pressing the centre of the dial, can't remember the right term.
Sorry, in a rush at the moment, but it is just to help for you tonight.
Yes, you had not validated your pressure changes. Make sure when to select minimum pressure, and turn the knob for the pressure pressure of 8, you validate by pressing the centre button the knob. Same as for max. pressure, but at 12.
Doing this is a start to stabilise the situation.
Looking at your second screen shot, I have attached a zoom I have done which makes it a little easier to see.
It looks like the indicated purple zone of no breathing is 9 seconds, although there seem to be perhaps several more seconds on either end outside the zone.
I don't know how precise the algorithm is in flagging the event. It does look like you inhaled quite strongly then held your breath like you were turning and changing position. (We can all do this from time to time.)
Equally to could be when you were fixing the gauze tape on your mouth. ( A note: gauze is porous, and could have been the the cause of the air problem. I use either Micropore tape ( which is in fact not really porous) or Cover-Roll tape. (See Lanky Lefty's YouTube channel on this - it's pretty good).
Just to clarify on the pressures, the top red graph line is the maximum pressure (inspiration) line,
the bottom green minimum line is the (expirational) line after EPR of 3. So between the two lines there is always a gap of 3, to make it easier to breathe out. A comfort measure of Resmed's CPAP.
There could be some further adjustments once things stabilise, and we have a clearer picture. Say in about a week.
I apologize. I think I may have not explained in a clear manner, leading to some misunderstanding. I have been using the settings of 8-12 for the last 3 nights, the last night with the N20. The screens I posted are of the second night I tried with the previous higher settings. I didn't see your response and make the subsequent changes until after the second night. Regarding the tape, I meant that the tape is used for fixing gauze. It is very sticky. Yet, somehow, the air still managed to escape under the tape. If I were to use tape again, I would look for wider tape. Maybe try the 5cm that you use. I'd like to hold off using tape as a last resort. I will def check out those videos though.
I seem to have many "events" that should be flagged. Since I am still learning, I will wait until I complete the wiki and understand all of this more. The video I mentioned earlier is titled the hard truth about CPAP reports. It mentions that resmed uses a reduction of 50% or more to label a hypopnea, but the AASM classifies it as 30% or more. The video is quite informative.
As an additional source of information, look at any sleep apnea you can find on youtube. You will find just about all you need, but it takes time.
When you can send screen shots of nights of just the 8/12 pressures we can look at these and hopefully get a clearer picture. Screen shots of the previous 11/13 pressures are not needed.
Pressures, leaks and events are all inter-related. Let's just focus on these, one by one in an orderly manner.
1. Essentials are set to ON, maybe a little bit easier to set to PLUS. It does not effect your therapy, but you get more information on the Airsense screen.
2. Response set to SOFT. This is perfectly allright, but there is another setting STANDARD.
I understand the latter setting makes the algorithm react quicker to events.
Frankly I have tried both, but could not detect any difference. Just for information, but in the early months best probably to leave on SOFT.
