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Please review my Sleepyhead results and settings
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robysue Online
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Posts: 1,233
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: Please review my Sleepyhead results and settings
Chris,

As others have said, you really shouldn't be changing the settings on the ASV just yet. It sounds like your doc needs the data it's currently gathering and you have a follow up scheduled in 10 days.

You write:
(07-11-2014 07:22 PM)Chris12 Wrote:  I've been compliant, but I'm going to need sleep some time.
Let's focus on the "need some sleep" problem directly rather than talking about the settings.

Are you having trouble falling asleep or are you having problems staying asleep?

Are you fighting leaks? The leak data you posted indicates that Large Leaks are not an issue, but are you finding yourself constantly battling with the mask fighting small leaks?

Are you dealing with severe discomfort? Super dry mouth? Or severe bloating? Headache from headgear that's too tight?

Are you trying to stay very still while in bed for fear of triggering leaks?

Questions about SleepyHead?
See my Guide to SleepyHead
07-11-2014 10:14 PM
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Chris12 Offline

Members

Posts: 8
Joined: Jul 2014

Machine: Resmed s9 adapt
Mask Type: Nasal mask
Mask Make & Model: None
Humidifier: Resmed
CPAP Pressure: None
CPAP Software: SleepyHead

Other Comments:

Sex: Male
Location:

Post: #12
RE: Please review my Sleepyhead results and settings
(07-11-2014 10:14 PM)robysue Wrote:  Chris,

As others have said, you really shouldn't be changing the settings on the ASV just yet. It sounds like your doc needs the data it's currently gathering and you have a follow up scheduled in 10 days.

You write:
(07-11-2014 07:22 PM)Chris12 Wrote:  I've been compliant, but I'm going to need sleep some time.
Let's focus on the "need some sleep" problem directly rather than talking about the settings.

Are you having trouble falling asleep or are you having problems staying asleep?

Are you fighting leaks? The leak data you posted indicates that Large Leaks are not an issue, but are you finding yourself constantly battling with the mask fighting small leaks?

Are you dealing with severe discomfort? Super dry mouth? Or severe bloating? Headache from headgear that's too tight?

Are you trying to stay very still while in bed for fear of triggering leaks?

Thank you for the reply.

The leaks I'm having are a symptom of my not breathing, and the pump ramping up to make me. My wife is telling me that it will be blowing all over me and I will be continually exhaling, making a sound. So, when I finally wake up it's ramped up blowing all over my face.

I realize that this is what the machine is for, but without these wake ups throughout the night (when the machine isn't worn) I feel rested.

If anyone is wondering, I'm 32 years old, 195lbs, between 5'11" and 6'0" and active. I don't use any tobacco products, or drink. They said this could have started at birth.
07-11-2014 11:23 PM
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justMongo Offline

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Posts: 3,853
Joined: Sep 2013

Machine: ResMed VPAP Auto (S9)
Mask Type: Full face mask
Mask Make & Model: ResMed Mirage Quattro
Humidifier: ResMed H5i
CPAP Pressure: 18 IPAPmax - 11 EPAPmin, PS=5
CPAP Software: Other Software

Other Comments: μολὼν λαβέ

Sex: Male
Location: Калифорния

Post: #13
RE: Please review my Sleepyhead results and settings
(07-11-2014 11:23 PM)Chris12 Wrote:  If anyone is wondering, I'm 32 years old, 195lbs, between 5'11" and 6'0" and active. I don't use any tobacco products, or drink. They said this could have started at birth.

You sound physically fit. Yes, it could be congenital.

Stick with it for the 10 days so the doc can get the data.
You can discuss what's going on; the difficulty you're having; and what to do next.

The machine seems to be running up to 25 cm-H2O to try to get your lungs full of air. It can be difficult to keep a masked sealed at 25. Especially if strapped on and adjusted at a lower pressure.

Your doc may totally change your therapy at your next visit. Or, a different mask may be the key to getting comfortable with therapy.

Best wishes...

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.
(This post was last modified: 07-12-2014 02:26 AM by justMongo.)
07-12-2014 02:25 AM
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Chris12 Offline

Members

Posts: 8
Joined: Jul 2014

Machine: Resmed s9 adapt
Mask Type: Nasal mask
Mask Make & Model: None
Humidifier: Resmed
CPAP Pressure: None
CPAP Software: SleepyHead

Other Comments:

Sex: Male
Location:

Post: #14
RE: Please review my Sleepyhead results and settings
Edit: I put the Sleepyhead graphs on the other SA board. Shall I post them here too?

Thank you very much to everyone here. It is very apparent how knowledgeable you all are. The information and comments you have given me really have helped and I feel much more settled today than I did yesterday. I think my lack of sleep was bothering me too, albeit the quality that I am accustomed to is horrible.

BTW: I logged 6.5 hours last night with my worst AHI yet of 28 Sad
(This post was last modified: 07-12-2014 08:39 AM by Chris12.)
07-12-2014 08:36 AM
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vsheline Offline

Advisory Members

Posts: 1,908
Joined: Jul 2012

Machine: S9 VPAP Adapt (USA Model# 36007, not better 36037 or 36067)
Mask Type: Full face mask
Mask Make & Model: F10 or SimPlus w/ 2Liners. MirageQuatro & Gecko gel pad
Humidifier: H5i
CPAP Pressure: 15 EPAP, PS 5-10
CPAP Software: ResScan

Other Comments: Marfan Syndrome, chronic bradycardia, occasional Cheyne-Stokes Respiration

Sex: Male
Location: California, USA

Post: #15
RE: Please review my Sleepyhead results and settings
(07-11-2014 07:22 PM)Chris12 Wrote:  My prescribed settings are:

Asvauto
Min Epap - 5
Max epap - 15
Min ps - 3
Max ps - 15
Start epap - 5.0

Sleepyhead:

Last 4 days average (all I've had it)

6:43 hours/night
9.70 ahi
0.00 obstructive apnea
6.98 hypopnea index
5.06 average leak
16.80 90% leak
7.09 average epap
4.08 min epap
20.42 max epap [Added by Vaughn: Maybe mistake? Was 20.42 the Max IPAP actually used?]
20.18 90% ipap
5.00 min ipap [Added by Vaughn: Maybe mistake? Was 5.00 the Min EPAP setting?]
25.00 max ipap [Added by Vaughn: I suspect the 25.00 here was the Max IPAP setting, not the max IPAP actually used.]

(07-12-2014 02:25 AM)justMongo Wrote:  The machine seems to be running up to 25 cm-H2O to try to get your lungs full of air.

Hi justMongo. I suspect that the "25.00 max ipap" is reflecting the setting for Max IPAP, not the highest IPAP actually used. I suspect the highest IPAP actually used was 20.42, which would be a little higher than the 90 percentile value for IPAP.

(07-12-2014 08:36 AM)Chris12 Wrote:  Edit: I put the Sleepyhead graphs on the other SA board. Shall I post them here too?

Hi Chris12,

I suggest using ResScan to look at the data for your machine. SleepyHead is terrific but is still beta software and is still in development and may not be reporting your data perfectly, especially since your machine is one of the less common models.

Whatever numbers are reported in ResScan are reliable.

In particular, on your machine the highest which EPAP can be set is 15, so it seems unlikely that the Max EPAP was 20.42 as reported by SH.

And the lowest that IPAP should be is:
Min EPAP (which is 5) + Min PS (which is 3) = 8. So it seems unlikely that the Min IPAP was 5.00 as reported by SH.

If you are used to using a higher EPAP than 5, then I think it would be normal for you to feel a little suffocated and uncomfortable at the new, lower EPAP pressure.

Regarding your prescribed settings, I think it may be unfortunate that the settings were left at their default values. I have a hunch that if your Min EPAP setting was higher on your previous machine then it would be best to use the larger Min EPAP which was used earlier, and I have a hunch that it would also help for your Min Pressure Support setting to be raised to 4.

But I appeal to you to work with your doctor and (if at all possible) continue to use the settings prescribed by him, or to email a ResScan Report to the doctor and ask him if it would be okay to increase EPAP to what you had been using earlier.

In designing the S9 VPAP Adapt, ResMed seemed to be targeting a "one size fits most" type of machine, inasmuch as it has very few adjustable settings. Almost everything is automatic.

In contrast, the ASV machine called the Philips Respironics System One BiPAP autoSV Advanced is far more adjustable (and misadjust-able).

The way the S9 VPAP Adapt works is EPAP is adjusted similar to how the S9 AutoSet adjusts its pressure, except that the S9 VPAP Adapt does not take the time to distinguish central apneas from obstructive apneas.

Within seconds of an apnea starting (way before it lasts as long as 10 seconds or is recorded as an "event") the S9 VPAP Adapt simply quickly jumps in to increase Pressure Support in order to keep your Minute Volume at least 90% of its recent value. (Vm = average volume of air actually inhaled or exhaled, in one minute.)
Take care,
--- Vaughn

Membership in the Advisory Member group should not be understood as in any way implying medical expertise or qualification for advising Sleep Apnea patients concerning their treatment. The Advisory Member group provides advice and suggestions to Apnea Board administrators and staff on matters concerning Apnea Board operation and administrative policies - not on matters concerning treatment for Sleep Apnea. I think it is now too late to change the name of the group but I think Voting Member group would perhaps have been a more descriptive name for the group.
(This post was last modified: 07-13-2014 03:49 AM by vsheline.)
07-13-2014 03:18 AM
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robysue Online
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Advisory Members

Posts: 1,233
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: #16
RE: Please review my Sleepyhead results and settings
(07-12-2014 08:36 AM)Chris12 Wrote:  Edit: I put the Sleepyhead graphs on the other SA board. Shall I post them here too?
If you want a response from people over here, you need to post the graphs over here.

While many of us do read both boards, not all of us do.

And those who do read both boards often only respond on the board we see the questions rather than scouring both boards for posts by the same user.

Questions about SleepyHead?
See my Guide to SleepyHead
07-13-2014 10:36 AM
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robysue Online
Wiki Editor
Advisory Members

Posts: 1,233
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: #17
RE: Please review my Sleepyhead results and settings
(07-11-2014 11:23 PM)Chris12 Wrote:  The leaks I'm having are a symptom of my not breathing, and the pump ramping up to make me. My wife is telling me that it will be blowing all over me and I will be continually exhaling, making a sound. So, when I finally wake up it's ramped up blowing all over my face.
Sounds like the mask, which is leak free at low pressures, is having a difficult time maintaining the seal once the IPAP pressure is ramped way up in an effort to trigger inhalations.

This is a pretty common problem in ASV users. You might want to make sure that ASV is in the title of the thread, both here and on your thread at the other forum. Some of the most experienced ASV users tend to only read threads with ASV in their titles: They use that as a quick screening tool to find the folks who are in most need of their expertise.

I wonder if a mask liner might help?

Questions about SleepyHead?
See my Guide to SleepyHead
07-13-2014 10:42 AM
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Chris12 Offline

Members

Posts: 8
Joined: Jul 2014

Machine: Resmed s9 adapt
Mask Type: Nasal mask
Mask Make & Model: None
Humidifier: Resmed
CPAP Pressure: None
CPAP Software: SleepyHead

Other Comments:

Sex: Male
Location:

Post: #18
RE: Please review my Sleepyhead results and settings
(07-13-2014 03:18 AM)vsheline Wrote:  
(07-11-2014 07:22 PM)Chris12 Wrote:  My prescribed settings are:

Asvauto
Min Epap - 5
Max epap - 15
Min ps - 3
Max ps - 15
Start epap - 5.0

Sleepyhead:

Last 4 days average (all I've had it)

6:43 hours/night
9.70 ahi
0.00 obstructive apnea
6.98 hypopnea index
5.06 average leak
16.80 90% leak
7.09 average epap
4.08 min epap
20.42 max epap [Added by Vaughn: Maybe mistake? Was 20.42 the Max IPAP actually used?]
20.18 90% ipap
5.00 min ipap [Added by Vaughn: Maybe mistake? Was 5.00 the Min EPAP setting?]
25.00 max ipap [Added by Vaughn: I suspect the 25.00 here was the Max IPAP setting, not the max IPAP actually used.]

(07-12-2014 02:25 AM)justMongo Wrote:  The machine seems to be running up to 25 cm-H2O to try to get your lungs full of air.

Hi justMongo. I suspect that the "25.00 max ipap" is reflecting the setting for Max IPAP, not the highest IPAP actually used. I suspect the highest IPAP actually used was 20.42, which would be a little higher than the 90 percentile value for IPAP.

(07-12-2014 08:36 AM)Chris12 Wrote:  Edit: I put the Sleepyhead graphs on the other SA board. Shall I post them here too?

Hi Chris12,

I suggest using ResScan to look at the data for your machine. SleepyHead is terrific but is still beta software and is still in development and may not be reporting your data perfectly, especially since your machine is one of the less common models.

Whatever numbers are reported in ResScan are reliable.

In particular, on your machine the highest which EPAP can be set is 15, so it seems unlikely that the Max EPAP was 20.42 as reported by SH.

And the lowest that IPAP should be is:
Min EPAP (which is 5) + Min PS (which is 3) = 8. So it seems unlikely that the Min IPAP was 5.00 as reported by SH.

If you are used to using a higher EPAP than 5, then I think it would be normal for you to feel a little suffocated and uncomfortable at the new, lower EPAP pressure.

Regarding your prescribed settings, I think it may be unfortunate that the settings were left at their default values. I have a hunch that if your Min EPAP setting was higher on your previous machine then it would be best to use the larger Min EPAP which was used earlier, and I have a hunch that it would also help for your Min Pressure Support setting to be raised to 4.

But I appeal to you to work with your doctor and (if at all possible) continue to use the settings prescribed by him, or to email a ResScan Report to the doctor and ask him if it would be okay to increase EPAP to what you had been using earlier.

In designing the S9 VPAP Adapt, ResMed seemed to be targeting a "one size fits most" type of machine, inasmuch as it has very few adjustable settings. Almost everything is automatic.

In contrast, the ASV machine called the Philips Respironics System One BiPAP autoSV Advanced is far more adjustable (and misadjust-able).

The way the S9 VPAP Adapt works is EPAP is adjusted similar to how the S9 AutoSet adjusts its pressure, except that the S9 VPAP Adapt does not take the time to distinguish central apneas from obstructive apneas.

Within seconds of an apnea starting (way before it lasts as long as 10 seconds or is recorded as an "event") the S9 VPAP Adapt simply quickly jumps in to increase Pressure Support in order to keep your Minute Volume at least 90% of its recent value. (Vm = average volume of air actually inhaled or exhaled, in one minute.)
Take care,
--- Vaughn

Thank you very much for your response.

I am a kaiser permanente member here in Ca (Bay Area), I'm hoping they use resmed to view my results when I bring my machine in. The dr setting my machine up is kind of an air head, and hasn't explained what they are setting everything at. This is what led me to this board. I am a bit tech savy, so I know my way around the machine, and I'm also able to parrot back what the data for each night says.

What should I ask the dr when I go back? Resmed reports? Prescription settings?

I'd like to report back to this group, so I will know if I need to push for a second opinion.

Thank you very much to everyone hear. I'm slowly understanding more about this machine and my condition. I'm also hatching info from this thread, so I know what to research more.

Thanks again!
07-13-2014 10:56 AM
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robysue Online
Wiki Editor
Advisory Members

Posts: 1,233
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: #19
RE: Please review my Sleepyhead results and settings
(07-13-2014 10:56 AM)Chris12 Wrote:  What should I ask the dr when I go back? Resmed reports? Prescription settings?
I would bring in a full report generated in ResScan, including the detailed data graphs for several days. The doc needs to see where the events are occurring and how they're being scored by the machine. He also needs to see when and how the machine is responding to your breathing by ramping up the IPAP.

I'd also suggest the following: Back up your data on your own computer and bring the SD card itself in. Ask the doc if he wants to download the data for himself. Many, but not all, sleep docs and their staff have Rescan available on their office's computer system. If the doc has the full data pulled from the card, he can zoom in on your breathing at whatever time periods he wishes to examine more carefully if he wants to.

I also would NOT wait until the day of the visit to bring the data. Rather I would suggest the following: Call the doc's office and report that you are having some real difficulties and that the machine's LCD shows that the AHI is still way too high. Ask if it is ok to bring the data in a day or two before your appointment so that doc has it to look at if he wishes to so that he's prepared for your questions. If you've got a short list of questions that you know you want answered, drop that list by the office as well.

By giving the doc the troublesome data before the meeting and letting him have a heads up what your questions are going to be, you give him the chance to be prepared to answer your questions more thoroughly in the small amount of time you'll get to actually talk with him.

Questions about SleepyHead?
See my Guide to SleepyHead
07-13-2014 11:07 AM
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vsheline Offline

Advisory Members

Posts: 1,908
Joined: Jul 2012

Machine: S9 VPAP Adapt (USA Model# 36007, not better 36037 or 36067)
Mask Type: Full face mask
Mask Make & Model: F10 or SimPlus w/ 2Liners. MirageQuatro & Gecko gel pad
Humidifier: H5i
CPAP Pressure: 15 EPAP, PS 5-10
CPAP Software: ResScan

Other Comments: Marfan Syndrome, chronic bradycardia, occasional Cheyne-Stokes Respiration

Sex: Male
Location: California, USA

Post: #20
RE: Please review my Sleepyhead results and settings
(07-13-2014 10:56 AM)Chris12 Wrote:  I'm hoping they use resmed to view my results when I bring my machine in. ...

What should I ask the dr when I go back? Resmed reports? Prescription settings?

Hi Chris12,

Ask the Dr for complete copies of your overnight sleep study reports and titration reports, including full data. You have a right to copies of these, for your own records.

And ask doctor for copy of your current prescription to take with you when traveling. And ask for a prescription for "CPAP mask of patient's choice" so you can quickly buy an emergency replacement of your choice if necessary when traveling.

I suggest you install ResScan to look at the data. ResScan produces reports in PDF format which can printed or emailed.

As robysue recommends, it would be best to drop off or email to the doctor selected ResScan reports and your questions ahead of time, before your meeting with the doc.

See if an earlier day is available so your appointment with the doctor can be advanced, explaining that you are having severe difficulties.

Here is the thread which gives download instructions for ResScan:
http://www.apneaboard.com/forums/Thread-...ersion-4-3

What settings were used on your previous machine? (By the way, if you don't have a record of what settings were used on your old machine and still have your old machine, then I would suggest requesting by email the Clinician Set-up Guide/Manual for both machines, and to go into the Clinician Menu of your old machine to find out what settings were being used. There is a link in the Important Threads section for requesting set-up manuals.)

As diamaunt mentioned, your S9 VPAP Adapt is the new model (36037) which was manufactured starting in November of 2012. I use the previous model of S9 VPAP Adapt (36007) which offers ASV therapy mode but not ASVauto therapy mode. The difference is that in ASV mode the EPAP setting is a fixed (manually adjusted) setting and cannot be given a range within which the machine will auto adjust itself. In ASV mode, only Pressure Support (PS) auto adjusts itself. (PS is the difference in pressure between IPAP and EPAP.) In ASVauto mode, both EPAP and PS will auto adjust as needed.

Take care,
--- Vaughn

Membership in the Advisory Member group should not be understood as in any way implying medical expertise or qualification for advising Sleep Apnea patients concerning their treatment. The Advisory Member group provides advice and suggestions to Apnea Board administrators and staff on matters concerning Apnea Board operation and administrative policies - not on matters concerning treatment for Sleep Apnea. I think it is now too late to change the name of the group but I think Voting Member group would perhaps have been a more descriptive name for the group.
07-13-2014 02:15 PM
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