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Suggestions on a postcard....
#1
Hi All

Firstly, thanks for a great forum and to anyone that can help...

I'm about three weeks into my therapy. I've been given a Philips machine which they set to auto with a max pressure of 8.

I'm having mixed results - some nights are good and some are bad. But what I need help on is suggestions about how to deal with leakage... You see I'm a side sleeper and a mouth breather. I had a week long trial with a nose mask, but that didn't go so well so they switched me to a full face mask, which is much better. The problem I have is that I can usually fall asleep on my back ok, but end up on my side where the mask starts leaking due to it being pushed into the pillow. I seem to spend more time awake dealing with annoying small leaks than actually sleeping! I've also awoken too many times with dry mouth, usually related to mask leakage I think?

I've just started playing with Sleepyhead but one thing that jumps out at me is my AHI is up and down with a low of about 4 and high of around 15 over the course of the 3 weeks.

My machine also seems to spend all its time at maximum pressure. I guess I should go back and see the Doc but who know how long I'll have to wait for an appointment!

If anyone has a workable solution to stop leakage when on my side I'll buy a virtual beer! (Sleepyhead shows 0 large leak but lots of small leaks)

Cheers

Nick
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#2
Nick, welcome to the forum. If your machine is set to a minimum of 4 and maximum of 8, then there is little doubt in my mind your minimum pressure is too low to help your obstructive apnea. Especially with a full face mask, it will feel claustrophobic and like you don't get enough air. If you had a study at a sleep clinic where they adjusted your pressure, the maximjm pressure of 8 may be okay, but I would suggest raising it anyway. The machine will only go as high as needed to resolve obstructive events (OA, hypopnea, flow limitations). The first two links in my signature show how to organize SleepyHead data and post it on the forum. We can certainly help more if we can see what's going on. You can obtain a clinical manual for your machine by following instructions here. http://www.apneaboard.com/adjust-cpap-pr...tup-manual Most of us take charge of our own therapy, and knowing how to make adjustments is an important step.

Getting the mask fit right is a bit art and a bit science. The fit needs to be physically correct, and everyone seems to have a bit different face; so it may take trying several different models of mask to get it right. Is the leak mainly near the bridge of the nose, the side or chin? It would help to know the make/model of the current mask. I'd like to help and claim that virtual beer.

Welcome to the forum. Post back, and hopefully we can sus this out for you.
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#3
Thanks for your time and reply Sleeprider.

Oh darn it... I just typed a long reply with image links to be told I don't have enough posts. So I'll do it bit by bit...

First off, I've updated my profile with the mask details etc. I can't say I feel claustrophobic with the mask. When I first start at night, it is comfortable and breathing is fine. The issue is waking up often because of leaks and dry mouth (usually accompanied with dribble, ironically!).
Generally, if I'm semi-awake turning on my side make the mask leak from the top of the nose or at the bottom sides of the chin. When I wake up with dry mouth, the leak seems to be around the bottom sides of the mask.


Thanks again. Virtual beer is all yours. Pizza to follow ;-)

Nick

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#4
Now my statistics page is confusing me... It is saying it's changing itself from fixed to variable on an almost daily basis. I didn't know it can do that. I'll post a screen grab shortly - perhaps someone can tell me what is happening?

Cheers

Nick
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#5
Lets try again....

Here's the statistics page showing 'changes in prescription'. It's confusing me... Can someone explain?

[img][Image: TNFvep4l.png][/img]

Here's a screengrab from two nights ago. I've done two so you can see all of the left column...

[img][Image: c5QQNVOl.png][/img]
[img][Image: aoCOPhHl.png][/img]

Other days vary - AHI can be in double figures. I can post more if it will help or more detailed images as needed.

Thanks again.

Nick
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#6
Man, you just earned a graduate degree in how to post a chart! Good job. Regardlesss of your settings, the CPAP is detecting obstructive flow limitations, hypopnea and obstructive apnea. There are a few CA in there, but we're going to ignore that for now. You need a higher maximum pressure. The machine is acting like a fixed CPAP because it is prevented from going higher than 8.0 cm by the settings, and it stays at 8.0 all night.

This guide will show you how to enter the clinical settngs menu http://www.apneaboard.com/dreamstation-c...structions You need to change the maximum pressure to at least 12, and it's okay to go higher since the machine is automatic and only goes as high in pressure as necessary. There is no pressure that can be output by your machine that can hurt you, but if things are too intense, it's okay to set the maximum lower to give you time to adjust, and evaluate the effects. Anyway, set it at 12, and put the minimum pressure at 8.0. You are already there, because your machine is never less than 8.0 except during ramp.

So pressure range of 8.0 minimum, 12.0 maximum, and lets see if it feels and looks better. I bet the AHI tomorrow morning is less than half of the current 8 AHI.
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#7
Thank you Sir. Much appreciated. I will go ahead and do as you suggest, but my only concern is my leak issues. If I go ahead and up the pressure, won't that just make the leaks worse?

I'm also confused by the prescription section of the statistics page:

[img][Image: YeC8146l.png?1][/img]

The machine seems to be switching itself from fixed to variable, with my worst AHI when it is fixed? When it's on variable it has a maximum of 0?!? How does that work?

Last night I had quite a good noght - a solid 8 hours sleep and woke up feeling quite refreshed. However I was disappointed when I checked Sleepyhead to find my AHI was over 11!

[img][Image: wOiFPAll.png][/img]
[img][Image: d3MzCIrl.png][/img]

I've zoomed in on a 30 minute window where there were no events and all looks calm, but the pressure remained at 8. is that normal? As it was in variable mode, shouldn't it have lowered the pressure or have I got my understanding wrong?

Thanks again. I'll report back tomorrow with revised pressures.

Nick
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#8
Your machine appears to be in CPAP mode. You need to open the menu in clinical mode and look at the settings. If you turn off the pie chart in Sleepyhead, we can see the machine settings in the left-hand summary. The pie chart can be turned off in the menu at File/Preferences/Appearance, and uncheck the pie chart box on the right side.

We need to know exactly what machine this is. On the back of the blower do you see a number like 561P or 461P? I assume this is not the new Dreamstation, but is the 60 series.
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#9
On the statistics page above it seems to switch between CPAP and APAP. It says it is a Remstar Pro with C-Flex+ (461p)
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#10
You don't have a true auto cpap. The machine appears to have the Auto IQ feature. This feature offers up to 30 nights of auto adjusting capability, during which time the system works as an Auto CPAP delivering an adaptive pressure on a breath by breath basis. An Auto-Trial phase must be a minimum of 3 nights in length. After an initial Auto-Trial period as set the system switches to Auto-Check Phase and functions as a CPAP delivering the pressure that the patient was at or below 90% of the time. The Auto-Check Phase continuously verifies pressure requirements and makes adjustments after every 30 hours of use providing the user with more effective pressure levels over time.

So, you have a fixed pressure CPAP, and it has the ability to be put into and Auto-Trial, but that period is limited. You certainly don't want to waste it with a maximum pressure limit of 8.0, but should open it up if you want to let the machine perform a titration. Even without Auto IQ I can tell you your CPAP pressure needs to be higher than 8.0 to eliminate the obstructive events in the charts you posted earlier. With the data, it's easy to titrate pressure even manually...just increase pressure by 1 cm every few night and observe when obstructive events are minimized, or central events begin to be a problem. If you go too far, just back off 1/2 cm per adjustment. Auto IQ just makes it easier.

Get a copy of your clinical manual, and it will explain how this feature works. Send an email to: apneaboard@gmail.com and put "Setup Manual" (without the quotes) in the subject line. Then, in the body of your email paste the model of your machine: Respironics PR System One 60 Series REMstar Pro with C-flex+
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