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New to CPAP and not experiencing relief...
#11
(10-05-2012, 09:49 PM)Extrospect Wrote: my median L/min is 0.0; 95th percentile is 28.8; max is 38.4
Pressure median is 8.3; 95th percentile is 11.3; max is 12.6
without seeing Resscan graphs cannot tell whats going on and if the S9 increasing the pressure to compensate for leaks and as pressure increase would also cause more leaks. the 95% percentile leak 28.8 L/min (unintentional leak = mask leak plus mouth leak) been AT and Below for 95% of the time and higher for 5% of the time 38.4 L/min. if this a typical night you need to get leaks below 24 L/min.
the S9 cannot guarantee the accuracy of data if leak goes higher (red line on the leak graph) than 24 L/min.


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#12
Quote:I am not widely experienced but the procedure in my case was to prescribe the upper limit as wide open (20) and increase the lower limit until the the AHI was optimised.
Interesting. Can I ask what your median pressure was before the bottom range was adjusted? Mine usually hovers around 7 or 8.

Quote:without seeing Resscan graphs cannot tell whats going on and if the S9 increasing the pressure to compensate for leaks and as pressure increase would also cause more leaks.
It doesn't look like that's happening to me, so you might take a look to double check? Last night was my second best for events; the image is attached below.

Quote:if this a typical night you need to get leaks below 24 L/min.
I'm guessing mask fit has a lot to do with this, but my leak rate looks fine for the majority of the night... How can I improve it?


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#13
Extrospect- Well, I don't see any correlation between your pressure changes and larger leaking events on the graph you attached. (I don't see that correlation on my own graphs either). So, now you know that the first goal is to keep your leak rate below that 24 cm red line level, and the second goal (for me anyway) is to get it and keep it as low below that line as possible. Perhaps someone else can offer suggestions re: how to get leaks lower than what you're seeing using nasal pillows. I recall one of the nasal pillow users mentioning that pillows don't do a very good sealing job at high pressures, but I don't know at what pressure level it becomes a problem with nasal pillows.
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#14
almost all of apnea events are centrals and frequents
I don,t know if your sleep study shows any centrals
if it does than increasing pressure don,t fix and cpap don,t corrects centrals either

there is a small number of folk who didn't have any centrals during their sleep study but developed them with cpap

turn EPR off and see if makes any difference ... some folk said it does

the S9 cannot tell if you,re awake or asleep but bc of the frequency of events during the night would like sleep physician take a look and recommend the right treatment














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#15
I think I read here on the forum that nasal pillows don't work very well with pressures from 15 and higher.
trish6hundred
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#16
(10-06-2012, 06:57 AM)Moriarty Wrote: I also do not think it is a safe assumption to equate Clear Airway Apneas with Central Apneas - especially if you have EPR enabled. That link can only be accurately made with a neurological sleep study.

Technically correct, but the S9 algorithm is pretty good about figuring out centrals.

However, people should not panic over centrals, even if they're real. Especially if you check your AHI often. Centrals may be harder to treat, but they're not necessarily more harmful for you. 4 centrals per hour are probably no more harmful than 4 obstructive apneas per hour. It's just that increasing the pressure may make centrals worse.

You should also look at the airflow graph for central apneas. See how long they last and how completely you stop breathing. If you're only stopping breathing for 11 seconds, or are only partly stopping breathing, that's a lot better than a long, complete cessation of breathing.

Get the free SleepyHead software here.
Useful links.
Click here for information on the main alternative to CPAP.
If it's midnight and a DME tells you it's dark outside, go and check it yourself.
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#17
Quote:You should also look at the airflow graph for central apneas. See how long they last and how completely you stop breathing. If you're only stopping breathing for 11 seconds, or are only partly stopping breathing, that's a lot better than a long, complete cessation of breathing.

Prior to the beginning of each central event, I have some pretty erratic flow activity (as shown in the attached file). I'm not breathing for the duration of each event, with some events lasting between 30-40 seconds.

Even supposing we want to say these events aren't long enough to cause significant drops in oxygen, they're still probably disruptive to sleep.


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#18
(10-06-2012, 11:08 PM)Extrospect Wrote: I'm not breathing for the duration of each event, with some events lasting between 30-40 seconds.

Hmmmm.... I would be concerned about that plot of yours if it were mine..... even if only that there are so many of them relative to the OA's - and they last so long. There seem to be about 40 events over 9 hours making your AHI the 6 that is indicated in the lower graph. Were you asleep for the 9 hours? (I am lucky to sleep more than 6 hours a night -although once or twice a week I sleep for 7)

One or two CA's lasting 10 Seconds would not neither here nor there, but the 20 to 30 Seconds plus seems to me to make it worth getting professional advice - a second opinion perhaps...

(10-06-2012, 11:08 PM)Extrospect Wrote: Even supposing we want to say these events aren't long enough to cause significant drops in oxygen, they're still probably disruptive to sleep.

Indeed - as my sleep physician said to me - 'Would we still be friends if I were to shake your shoulder that often through the night?'... (for the record - my answer was that the jury was still out on the question of our friendship anyway...)

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#19
(10-06-2012, 11:08 PM)Extrospect Wrote: Even supposing we want to say these events aren't long enough to cause significant drops in oxygen, they're still probably disruptive to sleep.

But they're no where near the level of sleep disruption you experienced before CPAP therapy.

Since your doctor changed your pressure range from 4-10 to 4-15 have the number of centrals increased?

If I were you I'd wait a week or two and see what happens. If you're still concerned at that point you should call your doctor.
Sleepster
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#20
Quote:Hmmmm.... I would be concerned about that plot of yours if it were mine..... even if only that there are so many of them relative to the OA's - and they last so long.
I'm thoroughly bummed about the whole thing. Indications are that my hope of treatment for my OSA is ineffective for CA, which isn't helpful given my cognition complaints.

Quote:Were you asleep for the 9 hours? (I am lucky to sleep more than 6 hours a night -although once or twice a week I sleep for 7)
No... After looking at the waveforms during the apnea free periods, it's probable I didn't sleep for 2.5 hours or so.

Quote:Since your doctor changed your pressure range from 4-10 to 4-15 have the number of centrals increased?
I still have a limited sample since the change. The first night looked about the same. Second looked better. Third was possibly the worst I've ever had with CPAP.
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