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New to CPAP - Need advice!
#11
RE: New to CPAP - Need advice!
(09-02-2018, 05:38 PM)allanri Wrote: Does leak rate figure into AHI? I thought it was just the sum total of all apneas hypopnea, etc. divided by the total hours of sleep?

It doesn't, but you might find that you have more events (higher ahi) when you have a high leak rate - for ResMed, I think it's something over 26 - because the machine is just blowing air out of your mask and *not* into your airway, which allows the airway to collapse again.

If the leak rate is too high, or the leak is too large, then you're not getting the therapy.
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#12
RE: New to CPAP - Need advice!
moderators can tell you about attachment limits. IDK about that. I thought they recently became unlimited but haven't really paid attention to it.

these phantom breaks are interesting. can't quite see a pattern yet other than they happen about the same time each night and they get a little later each night. here are the times from the posted charts. I've more or less counted the differences on my fingers and toes so hope I'm not too far off.

8/29 1:09:54
8/31 1:11:16 +82 seconds (2 days * 41seconds)
9/2 1:12:37 +81 seconds (2 days * ~41 seconds)
9/3 1:13:28 +51 seconds
9/4 1:14:09 +41 seconds

what does it mean? I have no idea. seems like a lot for clock drift and that wouldn't explain the breaks but check your time setting anyway.

re a variety of things in those charts. on a superficial level I mostly mean you're having too many events. looks like the same settings throughout: min 12, max 18, epr 2. ahi ranges from 2.49 to 13.91, median 8.93. too high. ca ranges from 1.05 to 6.16, median 3.63. too high, IMO.

looks like you haven't been at it long so it may take some time and the help of better informed members than me to see if your body adapts and ca's come down. failing that, you may be one of the growing numbers of members with mixed apnea requiring a different modality machine. time will tell.

if mixed apnea (as opposed to cpap induced ca), your ahi will be inconsistent (like it is) and generally average >5 over time (like it does). ca's will persist and you will continue to feel poorly even when ahi is close to <5. however, some % that I can't quote do adapt. in the 30-90 days it might take to make that determination, experts may be able to coach you to a better result. then reevaluate if indicated.
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#13
RE: New to CPAP - Need advice!
I figured out my leak problem. It was the mask. Wednesday I visited my DME once again to check for proper fitment of the Air Fit F10 I was using and the tech I worked with gave me the Air Touch F20 to try. WOW! I noticed a big difference immediately. With its memory foam cushion, I have a complete seal around my face and for the past 3 nights have had negligible leakage! Yeah!

I'm still having wildly fluctuating AHI readings and I'm also still seeing the one second drop of the CPAP unit while asleep. Wednesday night I slept fairly well and felt pretty good on Thursday. Thursday night was horrible. I woke up at 1 am on the dot after a bad dream. Looking closer at the Flow Rate graph just prior to 1 am, it looks similar to the images I've seen of Cheyne–Stokes respiration. What do you think? 

[attachment=8155]

Friday night was a great night and I felt really good today.

I guess its one day at a time until my 1 month check up...

Wednesday
[attachment=8156]

Thursday
[attachment=8157]

Friday
[attachment=8158]
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#14
RE: New to CPAP - Need advice!
What is your Flex setting?
Sleeprider
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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.
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#15
RE: New to CPAP - Need advice!
A-flex 1.
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#16
RE: New to CPAP - Need advice!
Sleeprider - Is there a specific reason why you asked that question? Note that I originally had the unit set at 'A-Flex 3' and I was having major issues breathing. It was almost as if I was hyperventilating. So I changed it to '1' and it has been much better since that change.

Moving the timeline further to the left it looks as if I actually woke up between 12:05 am and 12:10 am. So that other stuff is just Sleep Wake Junk events, correct?
[attachment=8172]

Last night was OK i guess. One question I do have regarding the first part of the night. From 10:30 pm until about 10:55 pm, I was awake but in the dark and trying to sleep. I got up at 11 pm to go the restroom, laid right back down and did not get up for the rest of the night. Is it better to DISABLE that first non-sleeping session to get a better graph of my real numbers?

Do you have any suggestions on getting my AHI lower than 4-6? That seems to be the best average I've landed so far.

Also, usually when I wake up there is a small bit of water in the bottom of the humidifier bin. Is that something that I should be concerned about?
[attachment=8174]

Saturday
   
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#17
RE: New to CPAP - Need advice!
Avaholic, I sometimes sound like a broken record on this matter, and what follows is my opinion based on observing many many different users on various machines. I think AFlex sucks for some people. It works well for others, but for those that it doesn't work for, results like yours are common. The markers are a ridiculous inverse inspiration/expiration time like yours at 2.3/0.9. This is inevitably accompanied by many RERA, Hypopnea and a mixture of obstructive and CA events. My theory on why this happens is that the Respironics Flex algorithms are designed to momentarily drop pressure during the start of expiration, but to return pressure to the CPAP setting before exhale is completed. Similarly it drops pressure ahead of exhale during inhale. These changes are based on predictions of the user's respiration timing, and in your case (and many others), it is simply wrong. Your machine is increasing pressure far ahead of when you are done exhaling. If you look closely (zoom-in) at your flow rate, you will see that you have a fairly normal or possibly flow limited inspiratory flow, and normal expiratory times.

Read this section of the Beginners Guide to Sleepyhead wiki http://www.apneaboard.com/wiki/index.php...ailed_look and let's take a closeup look at your flow rate graph. The example I put into the Wiki was from another user like you where the machine totally missed the timing of I:E.
[Image: Normal_respiration_markup.png]

With all of that as background, I will contrast the Resmed Airsense 10 approach to EPR (exhale pressure relief). EPR is a true bilevel implementation, and the pressure follows the user's spontaneous respiratory effort. As the user begins exhaling, the mask pressure rapidly drops to EPAP and stays at EPAP until the user begins inhaling. For some people this results in a much improved result compared to what you are experiencing...there are plenty of exceptions as well. In general, this approach to inhale/exhale pressure changes seems to produce fewer problems in the individuals adversely affected by Flex. I know of several forum members that used this information to request a change of machines to Resmed and had these problems essentially disappear.

Let's take a closer look at your flow rate. Instructions for setting up a zoomed-in flow rate graph are in my Organizing Sleepyhead charts link in my signature.
Sleeprider
Apnea Board Moderator
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____________________________________________
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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.
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#18
RE: New to CPAP - Need advice!
As an example of how we want to look at flow rate, and to compare how Resmed pressure changes in response to inhale/exhale this chart shows an Airsense 10 with flow rate and mask pressure. As you can see, pressure rapidly increases during inhale and continues to slowly increase until the user finishes inhaling. The Respironics with flex lets off pressure near this mask pressure peak to supposedly help ease transition to exhale. As the user begins exhaling the mask pressure drops off to EPAP rapidly and the rate of pressure decrease slows as exhale slows approaching the next inhale. In some users, there is a considerable period of zero flow (I suspect this includes you) similar to the I:E graph I posted above. The mask pressure of the Resmed stays at EPAP until this zero flow condition is over and the next inhale begins. The Respironics returns pressure to IPAP just as the exhale flow slows. This seems to suppress the slow long exhale resulting in extended zero flow, or even the appearance of a positive flow during what should exhale. This is where the Flex algorithm fails for some users. Your chart will tell us what we need to see.

[Image: attachment.php?aid=4258]
Sleeprider
Apnea Board Moderator
www.ApneaBoard.com

____________________________________________
Download OSCAR Software
Soft Cervical Collar
Optimizing Therapy
Organize your OSCAR Charts
Attaching Files

How To Deal With Equipment Supplier


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.
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#19
RE: New to CPAP - Need advice!
Thanks for the explanation! That's alot to digest!

Here's an 8 min snip from last night show a few OA events. This was definitely while i was asleep. 
[attachment=8175]

Do you have some other specific times that you are interested in digging deeper?
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#20
RE: New to CPAP - Need advice!
Can you shorten that segment to 2-minutes so we can clearly see the wave form? I already see a lot of flow limits and can also see you expiration rebounding positive which is the flex kicking in at the wrong time.
Sleeprider
Apnea Board Moderator
www.ApneaBoard.com

____________________________________________
Download OSCAR Software
Soft Cervical Collar
Optimizing Therapy
Organize your OSCAR Charts
Attaching Files

How To Deal With Equipment Supplier


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.
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