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Remember2Breathe's First night new machine
#1
Remember2Breathe's First night new machine
Wow!  I was not as successful as azpapa.  Last night was my first night - quite an experience.  Sometimes felt like I could breathe deeper than since I was a teen.  Sometimes I felt like my mouth was being filled up with air like a baloon.  Often I had leak issues even though when I ran Mask Fit it was fine.  

Slept 8 hours in my P30i with medium pillows. Think I'll try small pillows tonight.  Downloaded Oscar; but haven't had time to figure out and upload SD card data yet.  Sleep report said I had 6:16 hours of usage, with 7.9 events per hour (down slightly from 10.3 in sleep studies), pressure  set by DME (6-14).  Sleep report said pressure at 10.2.  I had a frowny face for Mask seal and Leak at 53L/min, AHI 7.9, Total AI 5.2, Central AI 4.9.  I got up 3-4 times to use bathroom; but I know mask leak was bad at times, so hoping that the small pillows will help.  

When I got the AirSense 10 AutoSet ForHer, Ramp time was not set.  I put it at 5, just experimenting. I usually sleep soon after head hits pillow. Kept SmartStart On, which helped for those bathroom breaks.  Climate Ctrl and Tube temp were set at Auto.  I know I may want to finesse this eventually. But no rainout and all seemed fine there.

Two of these readings I don't know how to interpret:

Leak at 53L/min  - can someone translate
Central AI 4.9 - I never had any centrals on either of my sleep studies.  Mild OSA but desaturation as low as 75 and 78!

There was no EPR in the About menu.  Guess I'll just leave it at default for now.  But if I want to change, do I need to go into Clinician's menu?

I know Oscar will be better; but may be a day or 2 before I'm on top of that.

Thanks for any general input in the meantime.

Remember2Breathe
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#2
RE: First night new machine
Your setting is basically wide open, there will very probably needed changes but without Oscar there is no way of knowing. To download to Oscar go to welcome at the top of Oscar. It will ask where to look - all you have to do is choose the drive your SD card is in and click on it. Your nights will be loaded. Use F12 to take a screenshot and post with whatever you want to ask.
Apnea (80-100%) 10 seconds, Hypopnea (50-80%) 10 seconds, Flow Limits (0-50%) not timed  Cervical Collar - Dealing w DME - Chart Organizing
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#3
RE: First night new machine
(02-06-2021, 07:47 PM)Remember2Breathe Wrote: Wow!  I was not as successful as azpapa...
Please let's discuss your therapy in your own therapy thread. There is a lot to be done.
Sleeprider
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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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#4
RE: First night new machine
OK Stacey.  Downloaded already.  So will probably check readings tomorrow and upload.  Pleased with the way the small pillows fit.  Think the medium were just barely fitting and too easy to dislodge.  I'll see if that clears up the leaking at least for now.
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#5
RE: [split] Remember2Breathe First night new machine
[attachment=29700]     [attachment=29702]OK. I uploaded into Oscar and took screenshots of all the windows.

I just noticed on Sleeprider's post a link to which files to take screenshots of.  Mea Culpa.  Hopefully for now you can look at my first night this way and from now on I will rearrange and only upload the most important charts.

I think there were several issues that might have affected data:  
1. Medium Pillows may have come dislodged sometimes.  Going to try with Small Pillows tonight.  Think seal will be better (but might annoy nose after 8 hours).
2. First recorded data was while I was Fitting the Mask and setting up machine.  I confess by the time I was done setting up and started sleep session, it was 4 a.m. and I slept 'til Noon but think I stopped the machine earlier.
3. Each time I got up to use the bathroom, I unclipped the quick release atop the P30i but did not turn off the machine; just let SmartStart take care of it - which means there is about 30 seconds of major "air leak" from hose before automatically shuts off.

Hopefully my attachments 3 will only post one time.  Made some small as I thought max attachments is 3.

Remember2Breathe
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#6
RE: [split] Remember2Breathe First night new machine
When you click on the attachments, you might need to scroll left and right, up and down, to see all the data.

Thanks!

Remember2Breathe
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#7
RE: [split] Remember2Breathe First night new machine
Another OSCAR/SD card/ResMed machine question:

Never knew about the locked/unlocked switch on SD cards before. Of course, I put my card in the card reader and attached to my MBPro 10.13.6 before reading the tutorial on locking and unlocking. But did read the tutorial before importing into OSCAR, so I trashed, locked, remounted and then uploaded Data to OSCAR. Hopefully that took care of this idiosyncrasy??

Just put my SD card back in the AirSense10 (after unlocking it). There was a red light that came on that I don't remember. Machine was off. So I turned the machine back on to see if any error message re SD card. Something flashed on screen so fast I couldn't read it but I think it just said "Preparing SD Card" and hopefully red light just shows that a SD card is inserted. I thought I could reformat in my camera which is what I did before using it last night (in case my Mac inserted some hidden files to card before I locked it); but then it would erase last night's session and I wasn't sure that I wanted to do that.

So fingers crossed it will work tonight.

Remember2Breathe
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#8
RE: [split] Remember2Breathe First night new machine
With the Airsense 10 you don't need to worry about locking the card. Just leave it unlocked all the time, it is the S9 that has a problem with system files.

With a pressure of 6 to 14 your AHI was a hot mess. Upon starting, your pressure launches for the top of the settings, and we see a bunch of CA events, and the therapy stops, takes a break then restarts. The pressure algorithm is responding to very high flow limitation, and if you zoom in on the flow rate, we will probably see very irregular and flattened respiratory waves. It's hard to know if this is a real problem or not because there are lots of spiky leaks that go right along with the flow limits. We have to first ask if your sleep test identified any central apnea, then if not, assume we need to treat this as obstructive. The encouraging news is that your therapy seems to become more stable as you gained experience and the last sessions look far better than the early ones.

Priorities are to stabilize leaks, stabilize pressure and reduce flow limitations. For the leaks, increase the size of your nasal pillows, that should help the seal. You need to learn how to exclude air from your mouth, and that is done by firmly keeping your tongue sucked to the roof of your mouth behind the top teeth. Practice creating a suction seal and you will feel the seal. You can even practice by relaxing, even in a chair and letting the machine apply pressure while you figure out how to keep the air out of your mouth. Eventually you can get good enough at this to talk and sip water from a straw. As incredible as that sounds at this point, that is the level of air control most of us achieve.

To stabilize pressure you need a minimum pressure of 8.0 and at this point, I'm going to suggest fixed pressure by also setting the maximum pressure at 8.0. This will provide even pressure through the night. This will reduce CA and should be sufficient to prevent obstructive events. At least we can tame the chaos and see how you respond.

Flow limitations are a bit more tricky, especially with all the CA events. Anytime we see flow limitations like yours, we want to turn on EPR full-time and use a setting of 2 or 3, which will reduce the exhale pressure from the machine. This makes it easier to breathe because there is less resistance during exhale, and inspiration is supported by the increasing pressure of the machine. EPR is bilevel pressure and it can increase ventilation in a way that reduces respiratory CO2 resulting in increased CA events. I'm going to make an assumption that your CA arises from sleep disturbance and all the leaks and changing pressure, so I still want to use EPR. It would be good to try this when you're awake to make sure you find it comfortable. You can experiment with different settings to see what feels best to you. Finally, double check the date and time on your machine. Did you really start at 04:15 and end at about 11:00?

[Image: attachment.php?aid=29701]
Sleeprider
Apnea Board Moderator
www.ApneaBoard.com

____________________________________________
Download OSCAR Software
Soft Cervical Collar
Optimizing Therapy
Organize your OSCAR Charts
Attaching Files
Mask Primer
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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#9
RE: [split] Remember2Breathe First night new machine
Hi Sleeprider,
Just saw this when I came here to find "Organize your Oscar Charts" (which I'm about to do). For some reason, didn't get an email alerting me of a post. My results from last night with small pillows were slightly better with an AHI of 3.53; but the leak situation was awful again. I'll upload last night's data shortly.
Thanks so much for your input.
BTW, the clock is correct. I'm a night owl; but not usually that late. Was late again last night, as I initially fell asleep in front of computer and then got up later and went to bed.
I don't have larger pillows - at this point only have Small and Medium. I think my mask might have been too loose the first night when I used medium pillows. Seemed to fit better last night, though I loosened after an hour, as first hour was way uncomfortable. And didn't seem to change the leak rate. Could it be too much mouth breathing? Trying the tongue trick. Have not tried chinstrap DME gave me yet as wanted to master tongue instead. And then might want to order cervical collar. Especially the first hour; but throughout the night, I felt like I was mouth-farting. Like there was air that I couldn't stop from escaping. But didn't feel like mouth opened beyond allowing air to escape. Do you think changing ramp from 5 to 0 might help too?
Anyway, I'll get to organizing my charts and then upload.
Remember2Breathe
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#10
RE: [split] Remember2Breathe First night new machine
You can certainly try with no Ramp. Eventually we try to steer PAP users off Ramp as it restricts therapy for the time duration. Try it Off and see if it's tolerable, it probably will be OK.

Sleeprider calls that a mess and I'll say trainwreck. This may take some trial and error, which my typical response is lots of errors will be a bit of a trial. Just don't quit, you've got the guru there helping out.

Maybe it was mentioned, did you get a copy of the sleep study? If no you'd want to request it. It'll be helpful to see the redacted detailed report. For me, I like knowing the event breakdown of counts and type, useful on the CA.
Dave

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INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEBSITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
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