Therapy numbers, lack of them, weight loss, etc

[Galactus]

Ok so this looks ok to me for today. It looks like it is moving along.



But what about these leak rates, I read up on them, been doing a lot of reading for the sleepy head stuff. Are they cause for concern or not?



And is there any benefit to using the encore software over sleepyhead or vice versa?

[retired_guy]

You're over the red-line 6.5% of the time. That's not a big thing. Yeah, watch it, but don't worry much about it either. The AHI looks great. You are now an expert. Good job!

[vsheline]

And periodic breathing, what is that?

Hi Galactus,

Regarding Periodic Breathing, usually PB is nothing to be overly-concerned about, especially when it is reported for such a small percentage of the night.

From the SleepyHead glossary:

"Periodic Breathing is a Respironics data feature defined as a persistent waning and waxing breathing pattern which repeats itself between 30 and 100 seconds. The nadir of the breathing pattern is characterized by at least a 40% reduction in airflow from an established baseline flow. The pattern must be present for several minutes before it can be identified as periodic breathing. No therapy adjustments are made in response to periodic breathing."

In the SleepyHead time plots, I think there will be a PB event flag for each PB event. If the time flagged was while you were likely still falling asleep, then the event should probably be ignored, because our breathing is commonly abnormal when falling asleep.

The Flow plot shows the estimated rate (not amount) of airflow into and out from our airway.

The estimated average amount or volume of air breathed in or out during one breath is shown in the plot of the tidal Volume (Vt).

Zoom in on the Tidal Volume plot and the Flow plot, before and around the time of the PB, to see how much variation in Tidal Volume or Flow we are talking about here.

The "period" in periodic breathing refers to the period of one complete cycle in the pattern of breathing more and then less. This is the time between the peaks on the Tidal Volume plot. This is usually about a minute.

If the shallowness of breathing during the trough is so extreme that all breathing stops for a while, this would be called CSR (Cheyne-Stokes respiration). So CSR (which I occasionally used to get before I received my ASV machine) is a severe form of PB.

Take care,
--- Vaughn

[vsheline]

And honestly I swear this unit pumps differently. I mean 18 should be 18 on any unit no? This feels gentler than the other unit.

Hi Galactus,

That is interesting.

Regarding how the new machine seems gentler than your old machine, your present setting for Flex is 3. Was the setting for the amount of Flex the same on the other machine?

Are you using the same hose type/diameter as before? And in each machine, was/is the setting for hose type/diameter set properly, matching the hose being used?

[vsheline]

But what about these leak rates, I read up on them, been doing a lot of reading for the sleepy head stuff. Are they cause for concern or not?

When in CPAP mode, unless the Leak is so huge that it bothers you or prevents the machine from maintaining your pressure of 18, then the leaks are not a concern.

When in AutoB mode, however, leaks which are large (I don't consider the leaks you posted to be large) or quickly varying (I think your leaks do vary quickly) will at least slightly affect the accuracy of the auto-adjusting algorithms.

So you will want to keep an eye on it and try to reduce your quickly varying leaks, but the amount of quickly varying leaks shown in your posted plot would not be of great concern.

Even if operating in AutoB mode, I think the amount of quickly varying leak shown in your posted plot would not be very significant and would only very slightly affect the pressure adjustment algorithm in minor ways. Occasionally it may cause the machine to miss an obstructive apnea, or report a false central apnea (one which did not actually occur).

[Galactus]

And periodic breathing, what is that?

Hi Galactus,

Regarding Periodic Breathing, usually PB is nothing to be overly-concerned about, especially when it is reported for such a small percentage of the night.

Zoom in on the Tidal Volume plot and the Flow plot, before and around the time of the PB, to see how much variation in Tidal Volume or Flow we are talking about here.

If the shallowness of breathing during the trough is so extreme that all breathing stops for a while, this would be called CSR (Cheyne-Stokes respiration). So CSR (which I occasionally used to get before I received my ASV machine) is a severe form of PB.

Take care,
--- Vaughn

I'm trying hard to grasp what you mean, but honestly I'm lost, I learned so much of this new thing today my head is going to explode. I read a lot of the sleepy head info, and some if it is pretty straight forward others not so much. So i zoomed in and here is what it looks like. How that relates to what you explained I do not truly understand yet, but I'm working on it!

And honestly I swear this unit pumps differently. I mean 18 should be 18 on any unit no? This feels gentler than the other unit.

Hi Galactus,

That is interesting.

Regarding how the new machine seems gentler than your old machine, your present setting for Flex is 3. Was the setting for the amount of Flex the same on the other machine?

Are you using the same hose type/diameter as before? And in each machine, was/is the setting for hose type/diameter set properly, matching the hose being used?

I took your advice and RG's and set the machine up identical to my current PAP unit. I took the old hose and mask from my unit and put it on this one as they are basically the same unit. I even used my humidifier as well. So CFlex is set to the same, Humidification the same, Hoses identical, nothing I can tell changed. Except I believe this unit had a mask setting that I read to leave at 0 unless using their mask. Tubing size I do not believe was in my old unit but this one is set at 22. The old machine felt much harder when blowing and the mask always trying to push off my nostrils, this machine feels somehow gentler, hard to explain. But that is how I feel, like not assaulted so much by the air.

BTW- At the end of my 7 days this way I plan to change to BiPap using the information previously provided.

[vsheline]

Galactus wrote:

I'm trying hard to grasp what you mean, but honestly I'm lost.... So i zoomed in and here is what it looks like. How that relates to what you explained I do not truly understand yet, but I'm working on it!

You can see that between 4:58 and 5:00, the envelope of the Flow pinches down and becomes small three times, and at these same three times the Tidal Volume (the amount of air we breathe in and out in each breath) dips toward zero.

These dips are spaced slightly more than 30 seconds apart, and the dips are deep, dipping to less than 60% of your recent average Tidal Volume. So these three dips managed to get scored as a PB event.

But this was a short and probably completely insignificant PB event.

[vsheline]

I took your advice and RG's and set the machine up identical to my current PAP unit. I took the old hose and mask from my unit and put it on this one as they are basically the same unit. I even used my humidifier as well. So CFlex is set to the same, Humidification the same, Hoses identical, nothing I can tell changed. Except I believe this unit had a mask setting that I read to leave at 0 unless using their mask. Tubing size I do not believe was in my old unit but this one is set at 22. The old machine felt much harder when blowing and the mask always trying to push off my nostrils, this machine feels somehow gentler, hard to explain. But that is how I feel, like not assaulted so much by the air.

Does your new machine have both C-Flex (for CPAP mode) and Bi-Flex (for BiPAP and AutoB modes)? Or does it have only Bi-Flex?

BTW- At the end of my 7 days this way I plan to change to BiPap using the information previously provided.

Yes, after the week is finished I suggest changing to AutoB mode.

[Galactus]

But what about these leak rates, I read up on them, been doing a lot of reading for the sleepy head stuff. Are they cause for concern or not?

When in CPAP mode, unless the Leak is so huge that it bothers you or prevents the machine from maintaining your pressure of 18, then the leaks are not a concern.

When in AutoB mode, however, leaks which are large (I don't consider the leaks you posted to be large) or quickly varying (I think your leaks do vary quickly) will at least slightly affect the accuracy of the auto-adjusting algorithms.

So you will want to keep an eye on it and try to reduce your quickly varying leaks, but the amount of quickly varying leaks shown in your posted plot would not be of great concern.

Even if operating in AutoB mode, I think the amount of quickly varying leak shown in your posted plot would not be very significant and would only very slightly affect the pressure adjustment algorithm in minor ways. Occasionally it may cause the machine to miss an obstructive apnea, or report a false central apnea (one which did not actually occur).

Got it, thanks!

Galactus wrote:

I'm trying hard to grasp what you mean, but honestly I'm lost.... So i zoomed in and here is what it looks like. How that relates to what you explained I do not truly understand yet, but I'm working on it!

You can see that between 4:58 and 5:00, the envelope of the Flow pinches down and becomes small three times, and at these same three times the Tidal Volume dips toward zero.

These dips are spaced slightly more than 30 seconds apart, and the dips are deep, dipping to less than 60% of your recent average Tidal Volume. So these three dips managed to get scored as a PB event.

But this was a very minor and probably completely insignificant PB event.

Yes, now I get it, thank you.

I took your advice and RG's and set the machine up identical to my current PAP unit. I took the old hose and mask from my unit and put it on this one as they are basically the same unit. I even used my humidifier as well. So CFlex is set to the same, Humidification the same, Hoses identical, nothing I can tell changed. Except I believe this unit had a mask setting that I read to leave at 0 unless using their mask. Tubing size I do not believe was in my old unit but this one is set at 22. The old machine felt much harder when blowing and the mask always trying to push off my nostrils, this machine feels somehow gentler, hard to explain. But that is how I feel, like not assaulted so much by the air.

Does your new machine have both C-Flex (for CPAP mode) and Bi-Flex (for BiPAP and AutoB modes)? Or does it have only Bi-Flex?

BTW- At the end of my 7 days this way I plan to change to BiPap using the information previously provided.

Yes, after the week is finished I suggest changing to AutoB mode.

CPAP shows as CFlex, If you look at the bottom of the stats it shows even there as CFlex and when in BiPap mode on the dial it said BiFlex. So I believe this is the same on both units as long as they are set at CPAP.

I can't wait to get a week in so I can switch and see if this change was worth the $$$ I spent, lol. I hate to put it in terms of money but it's how I feel some days. If it works it will be well worth the investment.

[vsheline]

CPAP shows as CFlex, If you look at the bottom of the stats it shows even there as CFlex and when in BiPap mode on the dial it said BiFlex. So I believe this is the same on both units as long as they are set at CPAP.

Seems to be no explanation then.

You can measure the pressure created by each machine by removing the mask from the hose and (with machine running) dipping just the end of the hose vertically into a deep bucket of water (having at least 8 inches of water depth) to find out the hose depth needed to stop the hose from blowing bubbles into the water.

If the depth at which bubbling stops is 18 cm (which is about 7"), this means the air pressure is correctly 18 cm H2O.

But at first the bubbles will be violent and splashy until the tip of the hose is deep into the pail, so put the water pail (but not the machine) in the bathtub so splashes will not get your bedroom wet.

I can't wait to get a week in so I can switch and see if this change was worth the $$$ I spent, lol. I hate to put it in terms of money but it's how I feel some days. If it works it will be well worth the investment.

You will probably find the new machine even more comfortable in AutoB mode.

Also, the cost and inconvenience of a new overnight sleep lab titration will be unnecessary (to find the pressure you need now that you have lost a lot of weight).

You may even find that BiPAP therapy is more effective for you and you have more energy during the day.