First Night Results

[Pudgyjr]

Thanks Pugsy,

Not really new to this. I've been using the cpap for 6 years. Just new to the S9. My old machine was a brick. Last night I tried the Tape trick (very strange feeling). Didn't get a chance this morning to view my data. I'll check it tonight and see if it helped with the leaks. But, I agree what you say about wether its worth sweating the small things. Anyway, I'll post another graph tonight. I have an Appt. with a Sleep Dr next week. Will he read the data from my card?

[Pugsy]

Sorry, I never know just how long someone has been on cpap therapy when they are so newly joined to the forum and mention a new machine...I assume a real newbie.
Will your doctor care to read the SD card? I don't know. Some do and some don't and some that do only look at hours of use.

Taping the mouth is a pretty good experiment to see if those leaks are related to mouth breathing. If you still see some..then you know it is related to mask movement. Not ever leak is related to mouth breathing...though it is usually the first thing we consider since it is common.

A while back I did an experiment to see if what I was seeing was real mouth breathing...so I taped.
I still got a couple of blocks with increased leak that looked like yours but they didn't last but 5 or 10 minutes. If I had not have taped I would have assumed mouth breathing by looking at them because they had sort of a plateau.
Tape was still secure in the AM...so mouth breathing was eliminated as a culprit. So the only other culprit would be my nasal pillows and movement. I mention this only because we assume mouth breathing a lot of the time (and the chances are good that it is) but sometimes it is simply mask movement and then taping is really not needed.
I am a big fan of "doing the least amount of stuff to my face as possible".

I sleep right through this stuff. Sleeping soundly is my primary goal. My leak line isn't perfect but it isn't horribly trashed for the bulk of the night and since I have taped and used a chin strap I know that doing those things keep me from sleeping soundly...
So since my leak line isn't horrible all night and I sleep well...I choose to just shrug my shoulders and move on.
Perfect is not my goal... I do achieve "perfect" numbers fairly often but that's just something that happens. I don't feel any better or worse with a perfect flat line of 0.0 or with a 30 minute block above 24 L/min.

[Pudgyjr]

Thanks for all the info Pugsy! Very Helpful!

[Pudgyjr]

Here's another graph from the other night. I'd really like to get my leaks down a little lower. What exactly is the difference between Centrals and Obstructive?

[Pugsy]

wiki/index.php/Category:CPAP_Definitions

or http://sourceforge.net/apps/mediawiki/s ... r_Glossary

Obstructive apnea: A respiratory episode where there is a complete cessation of airflow, caused by an obstruction in the upper airway and accompanied by a struggle to breathe. To be defined as an obstructive apnea the episode should last 10 seconds or more.

Hypopnea: A respiratory episode where there is partial obstruction of the airway lasting greater than 10 seconds. Also called partial apnea or hypo-apnea.

Central apnea: A respiratory episode where there is no airflow and no effort to breathe lasting greater than 10 seconds.

With centrals/clear airway there is no air flow but the airway is open...no collapse or partial collapse of the airway tissues to create the blockage or reduction in air flow.
With obstructives or hyponeas...the airway tissues have actually collapsed fully or partially and physically blocking the airway.

[Pudgyjr]

Thanks again Pugsy for the definitions. Here's my stats from the last five days with my new machine. What do you think? Anything jump out at you?

[Pugsy]

Average hours of use...5 plus...but you are new to this and it will get better. This was only 5 nights after all.
The 3 nights not used....now that stands out..
Overall compliance..not quite 70 % but you will improve on that I am sure.

Otherwise...all those averages look quite acceptable.

[Pudgyjr]

Oops! Had the wrong date range. I've only been using S9 Autoset for 5 days. Here's the correct summary.

[Pugsy]

That's much better.
Everything looks great.
We like to see the AHI less than 5...you have that well covered.
We like to see the leak number less than 24 L/min...you have that covered.

Very good. Anything you don't understand. All I can say is keep on doing what you are doing.

Did you get it figured out how to get the detailed graphs for these days?

[Pudgyjr]

Yes Pugsy! I think I got the detalied graphs down pretty good. I've been using ResScan and I followed the video tuturial. So...... From what I read, Central apnea's are more from your brain just not telling your body to breath (correct?) verses Obstructive apnea is an obstruction in the airway. Now the question is....... I guess on a OA the machine senses the obstruction and increases pressure? What happens on the Central apnea's? Can we do anything about the Central Apnea's?

[Pugsy]

From what I read, Central apnea's are more from your brain just not telling your body to breath (correct?)

Correct. Bear in mind that the brain may just be doing what is natural...like often we hold our breath when we turn over in bed..it's a subconscious thing we do..we don't really make a conscious effort and don't even realize it...the machine doesn't know why there is no air flow...only that there is no air flow. This type of "central" would be disregarded in a sleep lab setting because the tech can see what is happening.

Also, sleep onset centrals are normal...the machine doesn't no that you are asleep or not. In a sleep lab setting the tech can correlate that central with EEG sleep data and see that the central is happening when it is normal to see them and not a big deal.
Sleep onset centrals can be a problem if they cause sleep disruptions (wake you up repeatedly) or significant repeated drops in oxygen levels. A random sleep onset central...not a big deal.

Also normal to have some centrals get flagged during a semi awake stage and even awake because we tend to breathe more irregular during semi awake/awake state and the machine doesn't know if you are asleep or not and it flags things that wouldn't be flagged during a sleep lab setting as a bad event causing a problem.

OA the machine senses the obstruction and increases pressure?

Correct

What happens on the Central apnea's? Can we do anything about the Central Apnea's?

The cpap/apap machines do nothing when the machine senses a central. Increasing pressure when the airway is already open isn't going to do a thing.
We can't do anything about Centrals (with cpap/apap) and unless they present themselves in large enough numbers to create a problem...we don't even worry about them. If they are present in enough numbers to be a problem then that's when the diagnosis is either complex sleep apnea or central sleep apnea and not plain obstructive sleep apnea and you get to use a different type of machine that is designed to help you initiate breathing when your brain is not telling you to breath enough times to be a problem.

So having a few centrals is normal...some are probably real and some are probably the machine flagging centrals that wouldn't be flagged in a sleep lab setting. Should they be in large numbers...then we try to figure out for sure if they are real or just awake/semi awake flags. If someone wakes often and spends a lot of time laying in bed awake with mask and machine on...there likely will be a truckload of centrals get flagged but they don't mean anything at all because we are awake.

So if in relatively low numbers...we shrug our shoulders and move on.
If present in large numbers consistently throughout the night and we can't explain them away as awake/semi awake junk...then further evaluation is needed and that's where the doctor gets to earn his big bucks.

I remember a man who had AHI of 20 plus with well over half of it being centrals...scary looking reports but he also had some time frames where absolutely nothing happened for a couple of hours. With a bit of detective work we found out he was having some really bad insomnia issues and was spending hours and hours awake with the mask and machine on. Once he learned to just turn off the machine and try to do other things to relieve the insomnia so that time spent awake using the mask was very minimal...his AHI dropped to 1 to 2 and matched what we saw on those few hours where we saw absolutely nothing go one for a couple of hours.

People tend to panic when they see even an occasional central.
It's not the end of the world. Even if the diagnosis does end up including centrals as being a problem..that's why we have those high dollar ASV type of machines.

If your AHI is consistently less than 5.0....even if half of it were centrals...that's not enough to be of a concern unless you think they are disturbing sleep.
Once the central index itself starts pushing 5.0 every night and every hour and we can't explain away the centrals with sleep wake junk...then get to the doctor and discuss it and see what else needs to be looked at.

Random weirdo stuff...like when I had 17 centrals in 17 minutes back to back...flukes or aliens and while it made me curious I knew it wasn't because I had suddenly developed central apnea. I just had to chuckle and I like to blame it on alien experiments.
Sometimes we simply aren't going to know all the answers and for really random stuff like that for me I won't worry about it.

[Guest]

Pugsy, Thank you so much again for explaining things so clearly! I do suffer from insomnia from time to time.

[Otter]

Here's my stats from the last five days with my new machine. What do you think? Anything jump out at you?

Minimum Pressure: 4.0 cmH20
Maximum Pressure: 20.0 cmH20

Pressure cmH20:
Median: 9.0
95th percentile: 11.4
Maximum: 12.4

Obviously you're doing pretty well, but narrowing this range might help with the insomnia. You might raise the minimum to 8 or 9 and lower the max to 14 or 15 and see how that feels while you gather more data.

[Guest]

Minimum Pressure: 4.0 cmH20
Maximum Pressure: 20.0 cmH20

Pressure cmH20:
Median: 9.0
95th percentile: 11.4
Maximum: 12.4

Obviously you're doing pretty well, but narrowing this range might help with the insomnia. You might raise the minimum to 8 or 9 and lower the max to 14 or 15 and see how that feels while you gather more data.

Thanks for the help Otter! I will try those changes. The 4-20 was just how the machine was setup.

[Pugsy]

Next time you post and image of a report could you include the pressure line? The ups and downs.
Otter's right...increasing the minimum might help with the insomnia if you think the pressure changes are maybe disrupting sleep.
I wouldn't worry so much about the max though...It's a moot point unless it wants to go wild for some weird reason. Just because it can go to 20 doesn't mean it will and if you never see it go above 14...any setting above 14 becomes a moot point.

I don't get too excited about the 95 % number until I see the actual graph lines. Sometimes the machine doesn't really spend all that much time up there. Remember the OR BELOW part of the definition. The median pressure is 9...so 50 % of the time above and 50 % of the time below. I have seen my own 95/90 with PR S1 % numbers be up in the 17 range but when I look at the graphs I maybe spent 30 minutes at that number and rest of the time it was a lot lower. So don't forget the OR BELOW part of the % definition...be it pressure or leaks.

I know you have been on cpap for several years and just now getting a full data machine and playing with the settings to get a feel for things. I would have done the same thing. Have some fun...try some new things...learn new stuff.

There are some people who find that the varying pressures of auto adjusting mode can cause some low level disturbances to sleep quality..minor arousals maybe. So while there is no pressing need to increase the minimum to deal with the events because those appear to be well controlled, if there is a chance the pressure variations themselves are maybe disturbing things...might want to try a setting with less chance of variations. It sure wouldn't hurt anything.