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New CPAP User - Need Help
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robysue Online
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Posts: 1,231
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: #11
RE: New CPAP User - Need Help
(08-02-2014 09:58 AM)Rosanne Wrote:  My first question has to do with leaks, reading the charts etc. My ResMed Auto elite ...
Can you please confirm what machine you are actually using? There is NO machine called a ResMed Auto Elite.

The Resmed S9 Elite is a full efficacy data machine that runs only in CPAP mode; it has no Auto mode.

The Resmed S9 AutoSet is a full efficacy data machine that can be run in either CPAP mode or Auto mode.

The Resmed S9 Escape Auto is an auto CPAP that does not record full efficacy data.

We need to know which of these three machines you actually have in order to help you.

Quote:My ResMed Auto elite typically shows 1L/m (something like that--1 leak a minute?) when I check it
I assume you are getting this off the machine's LCD in the morning. Is that correct?

If so, it represents your 95% Leak rate. In other words, the unintentional leaks were AT or BELOW the number for 95% of the night and they were AT or ABOVE this number for the remaining 5% of the night. That's a phenomenally good leak rate.

In general I would expect more variability in the 1-day numbers. But the S9's LCD also shows 7-day, 30-day, 6-month, and 1-year summary data as well. And if the display is set to one of those longer time frames, then it is quite likely that the 95% leak rate would be the same day after day ....

Quote:Does it automatically change should the leaks increase or is that a permanent setting? On the readout I got the other day there were periods of higher leak rates shown on the graph. I don't check for the leaks each day as the smiley face is always green.
What graph from what software? And how high were the biggest leaks?

Mr. Red Frowny Face shows up only when the unintentional leak rate is AT or ABOVE 24 L/min for at least 30% of the night, by the way.

Quote:Does opening my mouth to check to see if air is blowing count as a leak?
Yes, but this will only show up IF the machine samples the leak rate during the time you have your mouth open.

Quote:Do I also skew the readings if I hold my breath to see if the air is blowing or to listen for some other operational process?
If you hold your breath for more than 10 seconds, an event of some sort is likely to be scored by the machine. Whether it will be scored as a CA, an OA, or an H really depends on how you hold your breath.

Quote:I believe that the air blowing through my mouth (I use nasal pillows) does wake me up and has helped me learn to no longer breathe through my mouth--which is a good thing. I can't imagine having to wear a chin strap too.

[quote]I thought I was sleeping really well last night, and even used bag balm on my nose. Felt like the nasal pillows were set just right. Only aware of waking up once, but chose not to get up for the bathroom, but did note that I switched positions from side to side 4-6 times. Was very tired when I went to bed and had had a nap earlier in the evening. Lots of dreaming.
Sounds like you may be experiencing a bit of REM rebound (i.e. more dreaming than usual). That should settle down once your body figures everything out.

Quote:When I read my results this morning it showed 10.2 hours of usage but my API was 8.5 ! This is the highest it's been since I started cpap at the end of June. The other times it was at 7 or above were also nights I was really tired but felt like I slept well and had lots of dreaming. So what's the deal?
Without seeing the graphical data it's hard to say anything intelligent about why your treated AHI is sometimes still too high or why it was so high last night.

It could be that you are still having clusters of events during REM and more REM means more events. But without seeing the data, that's just idle speculation on my part.


Quote:Finally, my machine is set at continuous pressure of 6. Should I try and tweak it to an automatic readjustment, or wait for the doctor to recommend and let the DME do it?
Without seeing any data it is impossible to answer this question. And if you have a Resmed S9 Elite, this is a moot point since the Elite only does straight CPAP.

In general, however, I'd say talk to the doc about this issue.

Quote: I see my medical doctor who ordered the sleep study later this month, but don't know if he will send me to the "specialist" or not--who would know more interpreting the results.
That may depend on how comfortable the doc is when it comes to treating OSA. And whether you really need to see a specialist depends strongly on what the data actually shows.

Questions about SleepyHead?
See my Guide to SleepyHead
08-02-2014 11:10 AM
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robysue Online
Wiki Editor
Advisory Members

Posts: 1,231
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: #12
RE: New CPAP User - Need Help
(08-02-2014 10:56 AM)NickDanger Wrote:  1 L/m on the machine display means a leak of 1 liter/minute is your 70th percentile leak amount.
No. This is not correct. The S9's LCD displays the 95% leak rate, not the 70% leak rate.

But the 70% leak rate does determine whether Mr. Red Frowny Face or Mr. Green Smiley Face shows up on the LCD's sleep quality report:
    If the 70% leak rate is AT or ABOVE 24 L/min, Mr. Red Frowny face shows up.
    If the 70% leak rate is BELOW 24 L/min, Mr. Green Smiley Face shows up.

Quote:With a ResMed (assuming you have set the mask type properly), leaks are considered under control if they are no higher than 24 L/m (you get Mr. Smiley Face as long as the 70th percentile doesn't exceed 24 L/m).
This is correct.

Quote:Opening your mouth to check to see if air is blowing counts as a leak. Holding your breath for at least 10 secs should be identified as a central apnea or an unidentified apnea (assuming the machine is not in ramp mode and still ramping up).
Holding your breath can result in the machine scoring an OA. I've seen it in my own data. It all depends on how you wind up "holding" your breath.

Questions about SleepyHead?
See my Guide to SleepyHead
08-02-2014 11:15 AM
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retired_guy Offline

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Posts: 2,744
Joined: Jan 2014

Machine: ResMed S9 Autoset
Mask Type: Nasal pillows
Mask Make & Model: Resmed Airfit P10
Humidifier: ResMed
CPAP Pressure: 10.6/14, EPR 3
CPAP Software: ResScan SleepyHead

Other Comments: Is it bedtime yet?

Sex: Male
Location: Beautiful, albeit very wet Oregon Coast

Post: #13
RE: New CPAP User - Need Help
When they gave me my machine the very first thing they told me was "This is your machine now. We do not want it back." I thought that was kind of peculiar, but fine with me.

So if the machine is mine that's not so different than the car sitting in my driveway. If I feel a need to open the hood and tinker around, that's my right. I'm going to try and avoid dumb, and get educated about what I'm tinkering with, but I'm not going to feel I'm not allowed to open the hood just because some guy at the car place told me not to.

Also it's my body, and my funky little things that go right, or go wrong with it. So I need to take responsibility for finding out what's wrong and what I can do to make them right. Or at least a little less wrong. I'm not going to do dumb, and I'll ask for help from the doc's as needed, but I will be in charge of me.

I have an appointment with my sleep clinic coming up this month. I figure they might get a little excited to see I have changed my settings here and there the last 6 months, but I would challenge them to argue with the results. But I sound a little militant about this, and I'm really not that way. I am committed to doing everything possible to work with the medical folks that have provided me with this wonderful machine. So I will be very willing to teach them everything I know.

Of course, my car isn't working all that well right now, so we may have to do a "phone" appointment.
08-02-2014 11:16 AM
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robysue Online
Wiki Editor
Advisory Members

Posts: 1,231
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: #14
RE: New CPAP User - Need Help
(08-02-2014 11:16 AM)retired_guy Wrote:  So if the machine is mine that's not so different than the car sitting in my driveway. If I feel a need to open the hood and tinker around, that's my right. I'm going to try and avoid dumb, and get educated about what I'm tinkering with, but I'm not going to feel I'm not allowed to open the hood just because some guy at the car place told me not to.

Also it's my body, and my funky little things that go right, or go wrong with it. So I need to take responsibility for finding out what's wrong and what I can do to make them right. Or at least a little less wrong. I'm not going to do dumb, and I'll ask for help from the doc's as needed, but I will be in charge of me.
I agree with all of this.

But I routinely caution newbies from starting to experiment with the therapeutic settings without input from their docs because newbies typically don't yet know enough to know what they're doing or what they're trying to accomplish. Once they've learned the ropes, understand how to interpret their data, and have a good idea of what they want to accomplish with tinkering with the therapeutic settings, then I'm happy to endorse their tinkering and I'm even willing to make suggestions if asked.

And it's the same with the car in my driveway: I personally would not go tinkering around with things under the hood that I know I don't understand without some guidance from the quality mechanics that hubby and I have been using for 17 years.

Questions about SleepyHead?
See my Guide to SleepyHead
08-02-2014 12:05 PM
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retired_guy Offline

Preferred Members-2

Posts: 2,744
Joined: Jan 2014

Machine: ResMed S9 Autoset
Mask Type: Nasal pillows
Mask Make & Model: Resmed Airfit P10
Humidifier: ResMed
CPAP Pressure: 10.6/14, EPR 3
CPAP Software: ResScan SleepyHead

Other Comments: Is it bedtime yet?

Sex: Male
Location: Beautiful, albeit very wet Oregon Coast

Post: #15
RE: New CPAP User - Need Help
(08-02-2014 12:05 PM)robysue Wrote:  I agree with all of this.

But I routinely caution newbies from starting to experiment with the therapeutic settings without input from their docs because newbies typically don't yet know enough to know what they're doing or what they're trying to accomplish. Once they've learned the ropes, understand how to interpret their data, and have a good idea of what they want to accomplish with tinkering with the therapeutic settings, then I'm happy to endorse their tinkering and I'm even willing to make suggestions if asked.

Yes, that's wise counsel.....

(08-02-2014 12:05 PM)robysue Wrote:  And it's the same with the car in my driveway: I personally would not go tinkering around with things under the hood that I know I don't understand without some guidance from the quality mechanics that hubby and I have been using for 17 years.

I agree, and I'll be happy to ask my friendly neighborhood mechanic about my car as soon as I remember where I put the carburetor.
08-02-2014 01:19 PM
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Rosanne Offline

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Posts: 16
Joined: Jun 2014

Machine: ResMed S9 Autoset
Mask Type: Nasal pillows
Mask Make & Model: ResMed AirFit P10
Humidifier: ResMedH5i
CPAP Pressure: 6
CPAP Software: Other Software

Other Comments:

Sex: Female
Location: Missouri

Post: #16
RE: New CPAP User - Need Help
Thanks everyone! My machine is actually the ResMed AutoSet. I got a printout of all the leaks/data etc but so far on my own only seem to be able to check for the preceeding night. I do plan to get the software as soon as I can get a reader for my ipad. Not planning on tweaking anything myself yet, just wondering if the variable versus the fixed setting would be better. Right now it is ramp 4 and fixed at 6. Highest APH I have had was the 8.5 last night and the lowest ever was 0.5. My 35 day average has been 3.2. (Is that per hour or per night?) Is it possible that you could have a whole bunch of them at once but few the rest of the night, which would then average out like that?

I've been keeping my own notes each night and when correlating with the readout, there is a definite increase in apneas that go with nights I've been super tired and have had lots of dreaming. I would love to see the graphs for the time of night these occur, just to see what environmental things are going on then--like that 3am train whistle or the neighborhood dogs barking, or son coming in from work.

I will try and remember to check my nightly leaks even though smiley face has always shown up. As I learn to interpret all this, it will get even more interesting. Maybe then I'll be able to return the favor to help other new users. You all are so awesome!!!
08-02-2014 08:00 PM
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PaytonA Online
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Joined: Dec 2013

Machine: ResMed S9 VPAP Auto
Mask Type: Full face mask
Mask Make & Model: Resmed Mirage Quattro
Humidifier: H5i(distilled-top up)
CPAP Pressure: VAuto MinE14.0 MaxI 20.6 PS4.0
CPAP Software: ResScan SleepyHead

Other Comments:

Sex: Male
Location: Orange County,California

Post: #17
RE: New CPAP User - Need Help
Your AHI scores are all averages per hour. Yes it is possible to have a large cluster of events and be quite clear the rest of the night and maybe even get a reasonable AHI score. Looking at the data in the graphical representation that you can get with the software will allow you to find out what your events really look like.

Keep up the good work.

Best Regards,

PaytonA
08-02-2014 08:13 PM
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zonk Offline

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Posts: 7,908
Joined: Feb 2012

Machine: A10 AutoSet
Mask Type: Nasal mask
Mask Make & Model: Activa LT
Humidifier: Integrated /ClimateLineAir
CPAP Pressure: 9/13
CPAP Software: ResScan

Other Comments: CPAP since Nov 2010

Sex: Male
Location: Australia

Post: #18
RE: New CPAP User - Need Help
(08-02-2014 08:00 PM)Rosanne Wrote:  Not planning on tweaking anything myself yet, just wondering if the variable versus the fixed setting would be better.
Everyone is different. Some people do better on fixed pressure but I favor the variables because as I fall asleep, my pressure needs to open the airways vary during the night. A bit more pressure to deal with those stubborn apneas, rolling on my back, rem sleep, and at times going to bed tipsy. Your mileage may vary

As for tweaking, at first when got the machine, I was so scared to touch it, let alone change anything. Used to download the data each morning but 4 years later, just quick glance at the data on the screen is all I need, 6 hours is good, 7 hours is fantastic, 8 hours over the moon - blue moon
08-02-2014 09:06 PM
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