Second night on a CPAP

General Discussion on any topic relating to CPAP and/or Sleep Apnea.
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Nathan C. Morales
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Re: Second night on a CPAP

Post by Nathan C. Morales » Thu Jan 29, 2015 10:12 pm

I'm going to order a nasal pillow tonight.
I was thinking of getting a Swift FX Nasal Pillow. Any other suggestions?
If I use a nasal pillow, do I automatically need a chin strap?

I have a short beard, which probably doesn't help with the leaks in the mask.

When you guys are referring to my leak rate, is that just the chart on the right?
What is a normal leak rate if any?

Thank you all for your help!

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Pugsy
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Re: Second night on a CPAP

Post by Pugsy » Thu Jan 29, 2015 10:14 pm

Uncle_Bob wrote: any of the other stats are not deemed to be accurate if your leak is above 25 as the machine is unable to compensate.


Not true when talking about Respironics machines and total leak line (that's the top leak line) which probably has around a 90 L/min large leak territory beginning at these pressures.
The 25 L/min is a Resmed leak number and not Respironics.
His machine will flag Large Lleak (if it happens) and that shows up on the top events graph right under CSR on the LL line and I can't see any large leak flagging. If there is any...it's minimal and short lived.

The statistics actually show time in large leak over red line....0.49 %. Insignificant number and simply could be mask adjustment leak. I can't spot it on the LL events graph line probably because so tiny the color change is hard to see.

His machine can indeed compensate for the bulk of the leaks shown here...it isn't pretty but the data is very likely indeed accurate.
His primary problem right now..insufficient baseline (minimum) pressure and the machine can't get to where it needs to be to be able to prevent the airway collapsing.

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Nathan C. Morales
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Re: Second night on a CPAP

Post by Nathan C. Morales » Thu Jan 29, 2015 10:16 pm

Just so I am certain I understand, when you all are talking about minimum pressure, you mean that I should set my auto pressure at 10 on the bottom--something like 10-20?

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Uncle_Bob
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Re: Second night on a CPAP

Post by Uncle_Bob » Thu Jan 29, 2015 10:19 pm

Pugsy wrote: You need more baseline pressure (that's the minimum) to help hold the airway open and prevent the airway collapse in the first place.
Pressure is pointless at his leak rate, baseline or not, he is venting his bedroom and not helping his airway one bit.

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Pugsy
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Re: Second night on a CPAP

Post by Pugsy » Thu Jan 29, 2015 10:23 pm

Is that your picture in your avatar?

Give me a minute to find my leak explanation to save my fingers from typing it all over again.

Can you normally breathe through your nose without significant nasal congestion issues that force you to breathe through your mouth?
If you can...you may be able to not use anything to help keep the mouth closed. It all depends on how much the mouth wants to open out of habit. I would say try nasal pillow without any chin strap and see what happens...cross the mouth opening bridge only if you need to.

The Swift FX nasal pillow is a great mask...I used it for 2 years or so but I think the Resmed AirFit P10 nasal pillow is better (at least for my preferences)...see the link to my mask in my profile.
The Swift FX is probably a little more adjustable and stable though....can't go wrong with it and a good choice for newbies but I see a lot of newbies starting therapy with the P10 and doing awesome with it. The P10 has only been around a year...the Swift FX has been around coming up 5 years. New and improved. there's a reason the P10 is so popular.

Full face masks are difficult enough to keep sealed without adding in facial hair.
Unless you have significant nasal issues....try the nasal pillow mask.

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Pugsy
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Re: Second night on a CPAP

Post by Pugsy » Thu Jan 29, 2015 10:25 pm

Uncle_Bob wrote: Pressure is pointless at his leak rate, baseline or not, he is venting his bedroom and not helping his airway one bit.
You are totally incorrect about the leak rate.....he is NOT having massive leaks....look at the report....less than 1 % of the time over red line (for his machine at his pressures).
It's at the bottom of his statistics on the left side.

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Last edited by Pugsy on Thu Jan 29, 2015 10:34 pm, edited 1 time in total.
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Re: Second night on a CPAP

Post by Pugsy » Thu Jan 29, 2015 10:33 pm

Nathan C. Morales wrote:Just so I am certain I understand, when you all are talking about minimum pressure, you mean that I should set my auto pressure at 10 on the bottom--something like 10-20?

You need to increase the minimum pressure which is currently at 7 cm....Not sure how much but 10 cm would be a good number (9 might do it but your reports look an awful lot like mine did when I was using APAP with 8 minimum and I needed 10 cm.

The maximum....I don't have a good feel for it just yet because the minimum being so sub optimal it can make the machine want to go higher than it would if the minimum was more optimal. Meaning if the minimum was better suited for your needs then the machine might not even want to go to 15 where you see it maxed out.
Personally...I would just open the max to 20 and see what happens..if the machine doesn't need to go to 15 with the minimum of 10...doesn't hurt a thing to have it available to 20. If it does need to go over 15...then it can.

Should you end up going higher with that maximum and problems arise (comfort, centrals or air in the belly) then we address those problems if needed. I see no sense in fixing a problem until I know it exists. Cross that bridge if we need to.
Right now fix what is known to be a problem and that is the current too low minimum pressure of 7 cm.

So yes...change the minimum pressure to 10 (9 if you can't handle 10) and set the max to 20 and let's see what the machine wants to do and how you handle it and go from there.

Oh..BTW...I can't promise you that this will happen to you but often I see people be able to use a little less pressure with a nasal pillow mask vs a full face mask....

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OkyDoky
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Re: Second night on a CPAP

Post by OkyDoky » Thu Jan 29, 2015 10:34 pm

Every mask has a venting graph that shows you how much is the normal vent at each pressure. This is included in Respironics total venting but not in ResMeds. So with Respironics you have to take that amount off to determine the essential leak. I don't know what mask you used but you can look up the manual online and find that number.
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Pugsy
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Re: Second night on a CPAP

Post by Pugsy » Thu Jan 29, 2015 10:42 pm

Leak explanation... probably more information than you can absorb right now but skim over the material about the other machines and concentrate on what is said about Respironics and total leak and how it is reported.
This link...my 3rd post from the top
viewtopic/t88983/Pugsys-PointersSleepyH ... Hints.html

When using SleepyHead...there are 2 leak lines on the graph...the top line is the total leak line and the bottom line is a close approximation to excess leak.
For your machine...I don't even bother with the numbers if I don't see much time in large leak and you didn't have but less than 1 % of the night in large leak territory last night. I haven't looked at your other reports because I only care about last night.

Large leak territory is going to be up around 90 L/min with your current full face mask and your pressures showing maxed out at 15.
You push that limit a bit when you are up around 70 L/min but for the bulk of the night your machine is indeed capable of compensating for whatever leak you have from whatever cause.

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palerider
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Re: Second night on a CPAP

Post by palerider » Thu Jan 29, 2015 10:43 pm

Uncle_Bob wrote:
Pugsy wrote: You need more baseline pressure (that's the minimum) to help hold the airway open and prevent the airway collapse in the first place.
Pressure is pointless at his leak rate, baseline or not, he is venting his bedroom and not helping his airway one bit.
you're quite wrong about that...

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Re: Second night on a CPAP

Post by palerider » Thu Jan 29, 2015 10:48 pm

Uncle_Bob wrote:as palerider rightly said you have a leak problem as a priority. Did you try a nasal pillow mask as you mentioned?

any of the other stats are not deemed to be accurate if your leak is above 25 as the machine is unable to compensate.
his *first* night had terrible leaks, his second and third nights were fine.

the 24 (not 25) l/minute leak is for *resmed* machines, and not prs1 machines, like the OP has.

even then, the machine can compensate WAY more than 24lpm, it just starts to get fuzzy about determining what kind of an apnea you're having when it's over 30lpm, it knows you had an apnea, but can't tell whether it was central or obstructive.

as to maintaining pressure, the manual for the s9 autoset, for instance, says it can maintain say 12cm pressure at up to 142lpm total flow with a humidifier and slimline tube..

so... basially, your statement isn't factual.

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Re: Second night on a CPAP

Post by palerider » Thu Jan 29, 2015 10:52 pm

Nathan C. Morales wrote:Just so I am certain I understand, when you all are talking about minimum pressure, you mean that I should set my auto pressure at 10 on the bottom--something like 10-20?
yessir. listen to pugsy, she's VERY knowledgeable.

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Re: Second night on a CPAP

Post by palerider » Thu Jan 29, 2015 10:55 pm

OkyDoky wrote:Every mask has a venting graph that shows you how much is the normal vent at each pressure. This is included in Respironics total venting but not in ResMeds. So with Respironics you have to take that amount off to determine the essential leak. I don't know what mask you used but you can look up the manual online and find that number.
if you look at enough vent charts on masks, you'll see that they all are around 20l@4cm to 50l@20cm.. give or take a couple at the bottom end and a few at the top end... they're not exact, and different masks in the same class (ie, nasal pillows) can have a few lpm difference in leak up towards the end... but they're pretty much all in the same ballpark.

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Re: Second night on a CPAP

Post by palerider » Thu Jan 29, 2015 11:01 pm

Uncle_Bob wrote:as palerider rightly said you have a leak problem as a priority.
just as a fyi, my comments on his leak problem were referencing this, from his first thread, note this is at 5cm.

Image

note how the leaks were so bad that the machine only tried to raise pressure briefly before reducing it again to try and curb the leaks, and how much of the time was flagged as a large leak... vs 0% or the time on his next two graphs.

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Re: Second night on a CPAP

Post by OkyDoky » Thu Jan 29, 2015 11:06 pm

palerider wrote:
OkyDoky wrote:Every mask has a venting graph that shows you how much is the normal vent at each pressure. This is included in Respironics total venting but not in ResMeds. So with Respironics you have to take that amount off to determine the essential leak. I don't know what mask you used but you can look up the manual online and find that number.
if you look at enough vent charts on masks, you'll see that they all are around 20l@4cm to 50l@20cm.. give or take a couple at the bottom end and a few at the top end... they're not exact, and different masks in the same class (ie, nasal pillows) can have a few lpm difference in leak up towards the end... but they're pretty much all in the same ballpark.
That's close enough for me. I like the ballpark.
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