Intro and beginner's questions...

[stienman]

So I bit the bullet and bought the S9, the P10 nasal pillows, and the climate tube while they were on sale. Should arrive Tuesday, and then the adventure begins...

Wish me luck!

[Cardsfan]

You will need a gallon of distilled water (for the humidifier)- a gallon lasts me a month.
a pack of baby wipes (for the mask)( non alcohol)- daily wipe
Mild soap for the mask, Blue Dawn dish soap, or Baby shampoo.- weekly hot water wash.

[stienman]

Thanks. Is reverse osmosis purified water sufficient? We have a GE RO filter and I'd rather not have to buy distilled water separately if I can avoid it.

Still have two in diapers at home, so I have lots of baby wipes, but I'm not fond of the scent, so I'll think about what to do.

I imagine I can just drag the hoses into the shower with me once a week and keep a bottle of dish soap in there, then let them drip dry until the evening. Bad idea, or ok?

[palerider]

Thanks. Is reverse osmosis purified water sufficient? We have a GE RO filter and I'd rather not have to buy distilled water separately if I can avoid it.

Still have two in diapers at home, so I have lots of baby wipes, but I'm not fond of the scent, so I'll think about what to do.

I imagine I can just drag the hoses into the shower with me once a week and keep a bottle of dish soap in there, then let them drip dry until the evening. Bad idea, or ok?

sure.
myself, I use a tissue and a dab of purell to clean the mask of facial oils every morning, then it's ready to go at night.

hose washing is, in many peoples minds, optional.

[OkyDoky]

You can get generic unscented alcohol free baby wipes at Walmart that will last a long time.

[Cardsfan]

Distilled water is recommended because it does not leave a white scale residue in the water tank from the minerals left behind. It's 88 Cents a gal. at our wal-mart


About the hose- my Sleep specialist's advice was clean the hose with a white vinegar (1/3) and water (2/3) solution once a week.. Since reading on here, I don't think that long hose can even get dirty on the inside. I've been cleaning the long hose about once every 6 weeks.
I wash the water tank and mask weekly.

The filter will need to be replaced on a schedule- I find my lasts 2-3 months. But, I'm in a pretty dust free zone here, no smokers, no pets, and have a big air purifier in my bedroom. The Resmed literature said replace it at least every 6 months.

[palerider]

Distilled water is recommended because it does not leave a white scale residue in the water tank from the minerals left behind. It's 88 Cents a gal. at our wal-mart

RO water, that the OP already had, has very low mineral content.

[Julie]

Very many of us have not cleaned our hoses in years... no reason to. Nothing goes back into them from the mask end, and the air from the machine is filtered before it even hits the hose.

[stienman]

Ok, so I came home yesterday to some boxes, and was able to try out the S9. I was already sleepy when I came home (3:30pm), and wanted a test of the data transfer before spending a whole night on it (in case I do something wrong), so I took a nap (I know, bad sleep hygiene, probably messed up my night, etc) and spent an hour waiting to fall asleep during which time I tried many positions, got used to the venting, figured out reasonable placement of the tube, moved my pillow around and generally figured out how the system might feel while in various poses. I ended up falling asleep and had about 90 minutes of sleep on the machine.

I went to bed late in the evening (11:30pm), took an hour or so to fall asleep (which is 3-4x longer than normal, but reasonable given this new situation and my earlier nap), but probably never reached REM. I woke at least twice overnight, and it took 30-60 minutes each time before I fell asleep again. Both times are about when I would expect to enter REM. Both times with noticeable leaking - once at the mask, once from my mouth - and both times with an uncomfortable level of pressure. I was able to wear the nasal pillows all night.

Results

In the chart you'll see both periods in the event flags, but I've zoomed in on the overnight portion:



In order to better understand my situation I purchased a logging pulse oximeter (CMS50F) and wore it for several days prior to getting the apap. Of those pre-pap days, the best one is on top, and last night's is on bottom. Given that I probably didn't reach REM, and looking at my previous reports my apnea seems to be centered on REM, these two reports aren't strictly comparable. That said, as much as I didn't sleep last night, I am glad I didn't have any wild desaturations, and this might be interesting to a few here who like graphs:



Experience

Now that you have the setup, here are my notes from this morning:

Felt like the mask leaked several times overnight. By the middle of the night my nose was sore on the inside where it felt like the mask was touching the interior. Strap marks on face and mask marks under nose were very noticeable by morning.

Woke with dry mouth and leaking through mouth during the second waking. Ears feeling pressure and needing relief at beginning and a few more times. Felt like swallowing a lot more than usual, worried about aerophagia.

Obviously increased pressure was uncomfortable. Turned out to be 10cmh20, perhaps due to leaks?

Leaking really bothered me, leaking around the nose pillows caused a lot of air. Certain spots of the nose where the mask contacted were painful, wonder if they were due to leaks or pillow pressure.

Swallowing air seems to be an issue. The pressure inflated my mouth a little, and seems to have activated my salivary glands, and I needed to swallow while I was awake. I assume this may also be happening while asleep.

I was surprised to see the machine cranking up the pressure without reporting any events. I expected to see no pressure increases until the machine saw an event, so clearly I don't understand the triggers it's using, though I'm pleased to see the variation of the AIMDalgorithm I know from networking.

I simply used the medium nasal pillow that was already attached to the P10. The mask fit test went fine, and the nap I took suggested it would be ok. I understand the leaks I was experiencing are not very significant, and easily handled by the S9, still for my own comfort I'd like to reduce them.

I had EPR essentially turned off - it's on, but as 0cmh20.

I left the machine at 5-15 for this first night.

Actions

On the one hand, I want to go slow so I can see the effects of each change, on the other hand I'm already in a period of significant change in getting used to the mask and process itself that anything I change for the first week won't be definitive anyway. So I'm considering several changes for this evening:

- Try out the large and small pillows and see how they feel and fit.
- Change EPR to 1 or 2 and play with it a little before I go to sleep so see how it changes
- Change my lower limit to 6, and my upper limit to 8 or 9, hopefully to decrease leaking and swallowing, but also to avoid getting to the more uncomfortably high 10.

At this point I want to try to make the whole thing as comfortable as possible and get used to it as quickly as possible, then once I'm used to it adjust the values as needed to eliminate any events as they come up. Given my normal sleep architecture was broken last night, I'm not sure how much we can infer from the above data anyway, so focusing on comfort first seems to be the best path.

Questions

Any thoughts or recommendations?

Does anyone understand the resmed S9 autoset algorithm well enough to tell me why and when it ramps up in the absence of events?

[Okie bipap]

The pressure is going up in order to control your events. After a few nights treatment, you will begin to see a trend in the pressure your machine goes to in order to control your events and you will then be able to fine tune your settings.

[stienman]

The pressure is going up in order to control your events. After a few nights treatment, you will begin to see a trend in the pressure your machine goes to in order to control your events and you will then be able to fine tune your settings.

Given than I had 0 events, how does the machine determine when to increase the pressure?

[HoseCrusher]

Interesting loose correlation between your pulse rate and leak rate. It looks like around 1:00 you started moving (based upon pulse rate) and finally knocked your mask loose. You "played" around with the mask and leaks until around 2:15 then settled back down. Only to do a repeat at around 3:00 and 4:30.

Your O2 levels "survived" all this fussing around so you may find that if you can figure out how to keep the mask in place you will achieve "restful sleep."

[OkyDoky]

Given than I had 0 events, how does the machine determine when to increase the pressure?

The AutoSet algorithm automatically adjusts pressure in response to inspiratory flow limitation, snore and apnea.
Your flow limitation and snores don't seem like much but must be what the machine is responding to and increasing pressure.
If you don't have your clinical manual you can get one here. Scroll down to section three and follow instructions to get one by email. http://www.apneaboard.com/adjust-cpap-p ... tup-manual

[palerider]

Given than I had 0 events, how does the machine determine when to increase the pressure?

flow limitations and snores cause pressure increases, they are both conditions that happen when your airway is narrowed. (Affirming what OkyDoky said)

[stienman]

Thanks all, I think I understand. I'll take a closer look at the pressure graph and how it correlates with snoring and flow limitations.

I did go ahead and make the following adjustments last night:

Pressure: 5-8 (was 5-15)
EPR: 1 (was 0/off)
Nasal pillow: small (was medium)

I recall waking once, maybe twice, but being able to go back to sleep immediately. One of the wakings I adjusted the nasal pillows - the headband slipped down the back of my head and the pillows were pressing against my upper lip rather than nose. Breathing was much more comfortable and effortless compared to the previous night, though I'm sure part of that was simply getting used to the pressure. I can see where ramp would be useful, my desats only occur in REM, and starting off on the high pressures could delay my sleep. Fortunately starting off at 5 is fine for me for now.

My AHI went up to 0.15, I had one OA event. Looking at my pulse and respiration it appears I may have had at least one REM state, and possibly three following my normal pattern. My lowest desaturation was 89%.

I didn't wake with a headache, and I feel a little better today than I usually do.

I'm not going to post a graph today, but I am going to start increasing my top pressure by 0.2 daily until I'm happy with my desaturation and event levels.