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What does this tell me Sleepyhead
#11
If you get CA events increasing the pressure won't help and will more likely result in more CA's. The machine should increase pressure upon flow limitations, and after hypopneas, and obstructive apneas. The machine does not try to treat obstructive apneas when they are underway but increases pressure after so as to hopefully prevent more.

If you want a machine that treats apneas while they occur, then you want a VPAP machine which basically increases pressure during apneas to force air into your lungs. They need higher maximum pressure than your average APAP can deliver and may be harder to adapt to.
Ed Seedhouse
VA7SDH

Your brain is not the boss.

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#12
First of all: what the others said.

for what it's worth: all I see in your charts is a very HIGH Leak-Rate! With going to APAP you effectively lowered your pressure by 1cmH2O.
I'm not so sure if you maybe set the mask or the tube wrong in the machine .. you maybe want to double-check that.

leaks - or at least the leaks you have are not a concern with CPAP ... all the machine has to do is keeping the pressure steady (event recording is just a gimmick not a necessity there!)

with APAP the machine has to evaluate the flow. the devices can not measure the leaks directly - they have to "guess" that from the measured pressure and the total flow. Therefore every leak has a direct impact on the respiratory flow - if the machine guesses the leak wrong the flow is wrong too. Very rapid or short leaks are completely missed by all machines - if the intensity of the leaks changes very much in short times the "respiratory flow" that the machine calculates with is a total mess.

I would have to look on each event zoomed in - but I seriuosely doubt that your "central" apneas are real ... too much leak around that. just from the looks of it I would say that the hypopnea / RERA cluster before the drop in pressure around 1:05 wasn't real either.

going back to CPAP (any maybe twaek the pressure there a bit to lower the AHI more) seems like a wise idea - or fix the leak-problem (and see what APAP really can do if it gets the chance to actually measure something and not just guessing^^)
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#13
The leak issue is what it is so to say. Hose is correctly set and mask is the proper type. Not quite sure how the centrals became an issue, my only comment on them was to question if the few that occur are preventing the pressure from increasing.

As far as the leaks, even when there is no discernable mask leak the reported leaks are in the 6- LPM range. Suppose there is an issue with the machine itself and its ability to detect leaks? I may report that to the DME but am 90% sure they will say that any leak under 24 LPM is not significant.
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#14
(05-12-2017, 10:54 AM)OpalRose Wrote:
(05-12-2017, 09:14 AM)Timur Wrote: I must admit I am intrigued by this too, why didn't the pressure increase ...? Also, if flow limitations are precursors to hypopneas and obstructive apneas, why did the flow limitations decrease, and yet the hypopneas increase? Weird.


It's possible that your machine isn't set at an optimal pressure to tackle the apnea events.
Upload a screenshot here, and we can take a look.

Just to clarify, since I was not clear in my post, I was commenting on the SH report TASmart linked to, which I found quite interesting, not my own situation, which is fine, no problems.
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#15
TASmart,
I don't see from your graph that the leak rate was excessive. Yes, you had two large leaks recorded, but that could just be from tossing and turning and/or bumping the mask. It could also be mouth breathing.

Now if you would see leaks for most of the night, then that would need attention.

As far as clear airway events, the apap will not raise the pressure when they are detected. Higher pressure could make the CA events worse. I don't pretend to know if they are real or not. Some here seem to be able to analyze that.

If you don't normally see alot of CA events, then I wouldn't worry about it, but is probably the reason the apap pressure stayed low during those times.
OpalRose
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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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#16
I posted mostly because it was an interesting looking set of plots, and raised some interesting questions in my mind. More an intellectual exercise and a learning opportunity. And lots of good thought being expressed here.
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#17
(05-12-2017, 02:53 PM)TASmart Wrote: The leak issue is what it is so to say. Hose is correctly set and mask is the proper type. [..]
As far as the leaks, even when there is no discernable mask leak the reported leaks are in the 6- LPM range.

that is actually very, very interesting.

If it is no problem I would really love to see a detailed chart around 1:00. A 2 to 3 Minute window aorund the time it raises the pressure there would be ideal - please zoom in to the point where single breaths can clearly be seen in the flow-chart.
I would be interested in the following graphs (preferrably in that order): the flow-rate, the high-resolution mask pressure, the leakrate and the flow-limitations.

please show in the flow-rate the dotted-lines for the zero-line. (right click on the y-axis) and please overlay all events on all the 4 charts.
(you can unpin the event-chart from the top or move it out of the way.)

...

having such a high-leak-rate of over 6 l/min all the time is really interesting. (and yes! I call it high - as explained already leaks do really mess with event-detection! on CPAP leaks are not so much a concern - with APAP there is only 1 acceptable leakrate and that is 0.0!)
If it would be really 'constant' and only pressure dependent the machine should write it off as CO2-Vent-Flow - as your machine clearly does not, that "leak" has to be fluctuating.
I have to admit that I am a "data-believer" .. I do not really trust the pre-interpreted events the machines try to tell us - but I really want to trust the raw-data the machine collects. (this may sound paradox - but it's actually not!)

So just to double-check: the hose, mask, humidifier .... are all correctly assembled - there is not even the smallest chance of (unintentional) leaks up to the mask?
You have not "modified" your mask and (very small) mouth-breathing is not an issue?
You use the correct filters and they are "clean" / changed according to the recommended intervals?
Your tube is not crinkled or pressed together or such? (do you use the small tube or the big one? and just to be sure: you use a "normal" length and not that extralong 3 meters tube?)
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#18
For anyone interested in learning more about Leaks from the Beginners Guide to SleepyHead, and how they are recorded relating to the brand machine you are using.

http://www.apneaboard.com/wiki/index.php...Head#Leaks
OpalRose
Apnea Board Moderator
www.ApneaBoard.com

How to Organize and Post ScreenShots

http://sleep.tnet.com/resources/sleepyhead/shorganize
https://sleep.tnet.com/reference/tips/imgur

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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#19
(05-13-2017, 02:01 AM)TBMx Wrote:
(05-12-2017, 02:53 PM)TASmart Wrote: The leak issue is what it is so to say. Hose is correctly set and mask is the proper type. [..]
As far as the leaks, even when there is no discernable mask leak the reported leaks are in the 6- LPM range.

that is actually very, very interesting.

If it is no problem I would really love to see a detailed chart around 1:00. A 2 to 3 Minute window aorund the time it raises the pressure there would be ideal - please zoom in to the point where single breaths can clearly be seen in the flow-chart.
I would be interested in the following graphs (preferrably in that order): the flow-rate, the high-resolution mask pressure, the leakrate and the flow-limitations.

please show in the flow-rate the dotted-lines for the zero-line. (right click on the y-axis) and please overlay all events on all the 4 charts.
(you can unpin the event-chart from the top or move it out of the way.)

...

having such a high-leak-rate of over 6 l/min all the time is really interesting. (and yes! I call it high - as explained already leaks do really mess with event-detection! on CPAP leaks are not so much a concern - with APAP there is only 1 acceptable leakrate and that is 0.0!)
If it would be really 'constant' and only pressure dependent the machine should write it off as CO2-Vent-Flow - as your machine clearly does not, that "leak" has to be fluctuating.
I have to admit that I am a "data-believer" .. I do not really trust the pre-interpreted events the machines try to tell us - but I really want to trust the raw-data the machine collects. (this may sound paradox - but it's actually not!)

So just to double-check: the hose, mask, humidifier .... are all correctly assembled - there is not even the smallest chance of (unintentional) leaks up to the mask?
You have not "modified" your mask and (very small) mouth-breathing is not an issue?
You use the correct filters and they are "clean" / changed according to the recommended intervals?
Your tube is not crinkled or pressed together or such? (do you use the small tube or the big one? and just to be sure: you use a "normal" length and not that extralong 3 meters tube?)

 Here you are:

Everything is correctly assembled. No modifications. Moth breathing is sometimes an issue, don't think it is here, usually if I see moth stuff it is a large blast. I am using a chin strap here. A ll filters, hoses, seals changed and maintained per manufacturers recommendation or better. APAP is less than 2 months old. No damage to hoses, mask, normal length heated hose. 

[Image: TXT39E7l.png]
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#20
damn, I forgot to request to rescale the flow ... but nevermind - looks clear enough to me as it is.

your machine really calculates your flowrate with the leakage shown - which - quite obvious - is wrong!
there seems to be a not completely shut mouth for a very short time after the RERA ... but I really can't see the next hypopnea there. (but I can imagine how your device got to that conclusion with that wrong leckage)

Your machine somehow really gets the resistance of your "flowsystem" (tube + mask) wrong. ...that's actually (to my believe) defined through the mask-setting.
I noticed that your profile says P10 and SH shows "nasal" for the mask type setting. (I'm really not sure if SH is reading that one correct.)

I looked it up from the manual of the mask:
Quote:Mask setting options
For S9: Select 'Pillows'
For other devices: Select 'SWIFT' (if available), otherwise select 'MIRAGE' as the mask option.

But if the manual from your device says otherwise that might be more accurate^^ (depending on whatever was published last)

As you always have that leakage and your AHI seems to mostly consist of hypopneas, I really would suggest changing the mask-setting and see what you get out of it. (don't overshoot and simply set it to fullface^^)
(Also the variation in the pressure as you switch from inhale to exhale looks a tiny, little bit too much (and too even))

If changing the setting helps with adjusting the leak-line more towards 0 (or mostly to 0), I really would love to get a response from you (and I definitely ask than for more screenshots - if it's not too much of a problem, as this is really interesting regarding how resmed measures hypopneas)
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