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[Treatment] May be Too Late for Me Too
RE: May be Too Late for Me Too
(06-11-2019, 03:22 AM)Tubaman Wrote: Short addendum.  I went back and located 2 more instances of premature ramp start ups under the autoramp setting.  Both of them happened while I was still awake (slow respiration rates around 10 - 12 bpm) and both of them happened at approximately 24 minutes (as with my example above).  Too consistent for being coincidental.  Looks like my ResMed machine's autoramp default of ~30 minutes delay is more like ~24 minutes -- if that's what is happening.  Probably a defect in my machine, I suppose.

FYI,
Tubaman/Carl

Carl,

You should be able to just start your Resmed without any ramp at all.  It doesn't hurt to have your prescribed pressure start the moment you go to bed.

I routinely leave my cpap machine on at full pressure when I wake up in the morning. I might have it going for 30 - 45 minutes while I'm awake in the morning. To me, it doesn't feel uncomfortable at all... It's almost like I'm not even using a mask.

Alternatively,  since it seems to take you quite a while to fall asleep, you may just decide you want your ramp engaged for 30 or 45 minutes, and set it to that. It won't stop in 24 minutes... I suppose if it kicks in to full pressure and that bothers you, you could merely hit the stop and restart button for another full 30 - 45 minutes of ramp time.

Have you ever tried not using ramp?
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RE: May be Too Late for Me Too
Tubaman- if you look at that quote from the clinician’s manual that I posted earlier, it says if sleep is not detected, that it will reach the target pressure by 30 minutes. The implication is that the pressure increase would start earlier than that (your 24 minute observation) in order to have a smooth ramp up that ends with your target pressure at the 30 minute mark. If you want more time than that, you would need to switch off the auto ramp and set the ramp feature to the amount of time you want.

I assume from your post that you do not know how to enter the clinical settings menu or set the features. Is that correct?
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RE: May be Too Late for Me Too
Mr. WhyMe:
Why do you assume I don't know how to get into the clinician's menu?  I've been doing it for years.  Setting the ramp-up time manually is not what I want to do.  I want a reasonably rapid ramp-up to occur quickly after I go to sleep and not before.  Of course I could always reach over and punch the on/off button to stop the premature (for me) ramp-up that starts @ ~24 minutes but physically that is difficult since I have a dog gate between me and the machine.  I occasionally act out my dreams -- wave my right arm around while dreaming.  Once I knocked the CPAP machine to the floor and another time I knocked my hose loose.  I can live with hose removal but knocking the machine off the end table is not so good.  Therefore the dog gate which has worked well preventing my arm from striking the machine (my wife has seen me waving my arm around and nothing untoward has happened since the dog gate).  When it happens I'm usually dreaming about throwing things or grabbing at people so my arm starts waving.

Mr. Bear & Mr. WhyMe:
This morning I awoke around 1050 for a sandbox break.  I could not get back to sleep after returning to bed.  After going back to bed I listened to a boring audiobook and autoramp reached its ~24 minute maximum and started (prematurely for me) ramping up into therapy pressure range.  At ~1133 it registered a hypoapnea event.  Again at ~1138 it registered a 2nd hypoapnea event.  I was definitely awake and listening to my audiobook during these events (see my respiration rate at those times).  Previously it's registered multiple CA and OA events while being awake, sometimes in large quantities.  This is why I wish the autoramp feature would not start prematurely (for me) @ its default of ~24 minutes while I'm still awake (insomnia reigns supreme).  I previously was in error thinking it was happening around 30 minutes as you have previously informed me and I thought that's what it's supposed to do -- thank you!.  In fact, I wasn't aware that autoramp had a default 30 minute (24 minute for my machine) time-out -- thank you for enlightening me.  Please note that my respiration rate was steady at its usual 10 to 12 bpm, typical for when I'm awake in bed when this morning's 'H' events occurred.

This is also why I don't wish to use the "manual" or "off" ramp settings as it could give the CPAP machine even more time to erroneously register events while I am still awake.  Conversely, it could sometimes cut down significantly on my actual sleep time under therapy with long ramps still occurring while I was already asleep.  The time it takes me to go to sleep varies considerably from < 5 minutes to > 60 minutes so using the "manual" or "off" settings is not practical for me.

Incidentally, I recently learned about the autoramp feature from an ad I received (email) from ResMed (I don't have a users manual as I mentioned previously).  The ad said nothing about the default 30 minute (or less based on the manual's weasel wording) time-out as the manual apparently states.  Nor did I find anything describing the 30 minute "target" online on the ResMed site.  The manual should be more specific about the time-out, giving a +/- range (example: "20 minutes to 30 minutes" instead of "target pressure of 30 minutes") which implies 30 minutes to those of us innocents less observant of fine details-- and means any time 30 minutes or less (in my machine, 20% less @ 24 minutes).  A time-out of 10 minutes would qualify from the way it's worded in the manual.  How about "target pressure of 30 minutes +/- 1 minute"?  That would be great!

The folks who designed and built the ResMed CPAP machines have done an excellent job with such a complex piece of technology.  However, you just cannot please / accommodate everybody.  I think the machine could do without a default autoramp time-out -- at the least.  Even better, make that optional for the user / clinician to select (on/off setting for default time-out).

No, I have never tried turning off the ramp (for the above reasons).  My awake AHI events would increase dramatically, I think.  I shouldn't worry so much because my %SpO2 readings have remained good in the 93% to 95% range regardless of my AHI counts.  As I've mentioned before, my %SpO2 levels have never correlated with my AHI counts since I've started CPAP in June 2016.  I've even tried sleeping with just the oxygen running and no CPAP (for a few hours) and my %SpO2 levels remained the same.  The CPAP machine just makes breathing more comfortable for me while sleeping and I've grown accustomed to the cumbersome mask + hose on my face.

Different subject -- FlashPap:
For the 1st time in weeks I could not download last night's CPAP data (kept hanging after several attempts) using FlashPap.  I then realized my wife was using her computer (also on our Wi-Fi network) at the time.  I asked her to temporarily turn off her computer (close the lid on her laptop to disconnect from our network).  I then tried downloading again and this time it zipped right through the daily CPAP data download.  Her computer was connected to our Wi-Fi network and messed up the FlashPap download even though her computer has a different IP address from the FlashPap chip.  For what it's worth...

Thank you for your help and explanations over the years!  I have learned much from this exchange and previous exchanges of information.  I think I shall not return to this forum (this is my last posting).  Too much frustration and anxiety (keeps me awake).  I don't need any additional stress @ 81 years and counting.

Carl / Tubaman
"We run as fast as we can.  To get as far as we can.  So that when we finally get there we have that much further to run to get back to where we should have been."
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RE: May be Too Late for Me Too
Hey Tubaman, I have not read the full update to the thread since I last looked at it, but I did read your above post and I have some questions/comments. This of course is my opinion but sounds somewhat like my dealings with ResMed.

Unless they have updated the firmware in the machine I was under the impression or perhaps how I would phrase things is different. IMHO the ramp does not "time out", you can however set how long it will take to get to your target pressure. We may be saying the same thing here. The machine as far as I know cannot determine if we are asleep or not. If it detects an obstructive apnea it will change the pressure to try and stop the next breath from being obstructed. No real need to detect if we are asleep or not. oh and if you are in ramp mode and have a hypopnea of OA the machine will increase the rate of pressure change, attempting to stop you from having another apnea. IE you will get to your target faster

You BPM is somewhat lower than mine and mine is lower than average, This is the main reason I was changed to AirCurve. I needed the pressure settings of the AirCurve but the AirCurve also has some settings that the AirSense just does not allow anyone to change and for me that default setting just did not work because of my slow breaths.

Both machines do their best to try and detect when you start a breath and when you stop inhaling, for a fact the AirCurve has a maximum inhale time that was shorter than I needed, I do not however know if the AirSense will cut off your inhale.

The other two setting I know that both machines do this, because they have to do it, and I know also that the AirSense does not have adjustments for these and the AirCurve does. the first is a trigger setting, how sensitive is the machine detecting the start of your inhale and the second, cycle, is how sensitive is the machine at detecting the end of the inhale. For me I had to make the trigger more sensitive and the cycle less sensitive.

This for me was an irritating comfort thing. I could and did sleep, but not soundly at all. I never woke up rested and changing to the AirCurve allowed me to fix all that. My Doctor had given up by then and given me permission to change any of the settings that I wanted to. He did respond with an "interesting" at the changes I found to work.

Since an obstructive apnea is just the airway partially or fully collapsing, this can happen anytime we are horizontal, awake or asleep. They can also be caused by changing position, yawning, swallowing while suppressing an inhale to do it. My Doctor said to now worry about apneas while going to sleep or waking up as our bodies do all kinds of strange things during that time. The effect of having apneas is a slow thing over time, we do not desat quickly, this is why with CPR it's 10 compressions to one breath, the blood has lots of O2 in it, but it must be circulated.

Anyway a long post here, I hope not all of it was already understood. Basically a long way of saying that you may have some luck switching to the AieCurve and that I have never heard of any CPAP or even ventilator being able to detect when we are actually asleep.
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RE: May be Too Late for Me Too
Mr. PoolQ:
I was kind of discouraged when I last visited this site so this is the 1st time I have returned since my last posting in June.  In fact, I did not think I would return.  Thank you for all the information, however, my BPM is quite rapid compared to what most folks get (I'm usually around 25 BPM when I should be around 10 to 15 BPM (I think).  Also, my tidal volume is usually lower than it should be (max of 1000, sometimes slightly lower, sometimes slightly higher).

Test procedure:
This evening I did an experiment using my CPAP system and oximeter.  I intentionally left the oxygen assist (concentrator) off (no extra oxygen).  I sat in an uncomfortable chair, CPAP and Oximeter attached and running, for about 1 hour.  I did not sleep (too uncomfortable) and that was my intention.  I took deep breaths.  I did not try to slow down my BPM -- I breathed only when I felt the need to breathe in hopes I would not intentionally accelerate or decelerate my breathing rate.  Hard to do but I think I was somewhat successful.

Purpose of experiment:
I wanted to see if my %SpO2 level would remain OK with CPAP and without Oxygen assist if there was some way to cause me to breathe deeper (10 to 15 BPM) instead of my current shallow breathing rate (24 to 27 BPM).

Results of my experiment:
My oximeter gave me a nice, steady %SpO2 level (basal) of 97.4% with no oxygen assist.  Significantly better than I get while sleeping with oxygen assist running @ 3.5 lpm.  My respiration rate dropped from where it usually is (I got ~17 instead of its usual ~27 @ 95%) and my tidal volume rose (1360 instead of its usual 400 to 600 @ 95%).

Conclusion:
Is there is some way to deepen my breathing cycles while sleeping (bipap or ?)?  It looks like this could actually work in my case.  Maybe I could get off oxygen assist and save Medicare some $$$ in concentrator monthly rental charges.  If anybody knows what might work I would appreciate your input(s).

Thank you!
Carl


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"We run as fast as we can.  To get as far as we can.  So that when we finally get there we have that much further to run to get back to where we should have been."
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RE: May be Too Late for Me Too
tubaman, I'm not aware of a means to change a high respiration rate to a more normal rate, but you're not alone. I just responded similarly here http://www.apneaboard.com/forums/Thread-...#pid306375 I'd rather you not feel stressed over this, and if you are really concerned ask your doctor. As long as you are properly ventilated, as you appear to be, there is very little anyone can do about the respiratory rate during sleep. What is normal for you may be just fine, particularly if your PaCO3 tests are in the normal range.
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RE: May be Too Late for Me Too
Thank you SleepRider!  This question has been nagging at me for a long time and now you've answered it and explained why it is not possible to change breathing characteristics while sleeping.  They are what they are and we (I) must live with them.  It is a load off my mind because I kept thinking there might be a way to improve my sleep respiration quality.

At least my little 1 hour test showed what could be done if I could use my lungs more efficiently while sleeping.  Apparently I can't and that is not going to happen.  I wonder if all those years of playing tuba in German bands had anything to do with my respiration characteristics.  Water over the dam, I'll never know, I think.

Thank you!
Tubaman / Carl
"We run as fast as we can.  To get as far as we can.  So that when we finally get there we have that much further to run to get back to where we should have been."
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RE: May be Too Late for Me Too
I was going to suggest (mostly in fun) that you try to dream about playing the tuba. I think my time with a bassoon and also a saxaphone, led to me having deeper lung capacity than others. I'm surprised your tuba didn't also! But no, I can't imagine how one would change breathing, during sleep.
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RE: May be Too Late for Me Too
BadGoodDeb:
Last night I dreamed about driving around in a souped up, rumbling V8,  deuce coup, kind of like what was in the original movie American Graffiti.  I did have an old 1941 2-door Ford V8 that I rebuilt to have 2 carburetors, Melling 3/4 race cam, Offenhauser 8.5 to 1 aluminum heads and bored out (3" to 3 3/16" diam. pistons).  I remember drag-racing and beating a friend of mine once on a county road outside of town back in the day (mid 1950s).  My friend had a 1940 Mercury 2-door with a stock V-8 engine.  Kind of like that old song "Hot Rod Race" by Tiny Hill for any of you old timers who might remember back then.

I don't remember ever dreaming about playing tuba.  Maybe it's because I did so much tuba playing up through the mid 1970s that any novelty wore off.  Beer festivals, many outdoors, and at least one was an 11 hour 'marathon' (my lips and chest were very sore after those performances).  My horn is a 1936 vintage York concert bass (I still have it), large bore, very heavy brass, plenty of leaks, and takes a lot of wind to make it sound good (and loud) for outdoor German band performances.  I no longer have the wind (lungs) for it.  Apparently those many weekend beer festival marathons, almost every summer weekend from 1972 into 1977 did not improve my lung capacity.  I wonder if that excess playing caused my lungs to deteriorate in some way because of my current dependence on APAP plus oxygen assist.  My hard playing (hard blowing) tuba background is probably an example of too much of a good thing gone wrong.

Anyway, sorry I went a little off subject.  And then again, maybe I didn't go too far since my tuba playing may have been part causation (is that a word?)  of my current APAP + O2 sleep problem.
"We run as fast as we can.  To get as far as we can.  So that when we finally get there we have that much further to run to get back to where we should have been."
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