Sleepyhead data - Help needed please

[Hannibal 2]

I thought my nasal congestion was about the same but because of others noticing it I assume it's worse.

6.5 hours is normal for me on work days and have been feeling good on it so thought that was fine.

I'm going up now, was thinking of reducing pressure to about 5.6 and using the eucalyptus oil but open to other suggestions

[Hannibal 2]

Max to 10? That sounds a bit low to catch the events?

[Pugsy]

Max to 10? That sounds a bit low to catch the events?

Wellll.....all it might miss will be some FLs that we don't know for sure or not if they are worth killing.
I am thinking that the big guys...the OAs and Hyponeas are killed off well by the pressure of 10. I could be wrong but I don't expect to see many OAs and hyponeas pop up with a lowering of the max to 10.
Your choice...like I said I have several ideas to try to see what can be done to optimize therapy and sleep quality. First thing I wanted to do was eliminate those higher pressures that are the primary suspect in the leaks which could be impacting sleep quality.

Whatever you do..other than the oil...only make one change at a time...don't lower the minimum and maximum at the same time.
If you lower the minimum I am pretty sure the OAs and the hyponeas will have a better chance to materialize...and if you lower the max at the same time we wouldn't know who to blame.

Tell me..when you take a hot shower does it seem to help the nasal congestion or make it worse?
What settings are you using now on the humidifier.

So one change in the settings at a time....okay?
And when you have time the answers to my other questions please.

From what I have seen from other people with significant FL graphs and nasal congestion is for sure the culprit...more pressure won't fix it.
I don't know at this point that your FLs are nasal or from the airway down below the nasal cavity.

[Pugsy]

I actually think that you are probably real close in terms of settings where you need to maybe think about using the settings for a week to see how things trend and how you feel.
So whatever you decide to do...be prepared to stick with it unless the results end up being just a total disaster for some reason.
Your AHI is nice and low.
You are feeling decent for the most part.
Sleeping decently for the most part.
Leaks are a bit ugly but not horribly horrible and to be honest...leaks are a war we never totally win. We do the best we can each night and go on.

You are going to have some variations in everything from night to night. We simply don't sleep the same each night.

Last night my AHI was 0.39 and I didn't hit large leak territory once (which is a miracle in itself)....but I had a bad night and have had a bad day today but it had nothing to do with cpap or sleep apnea.
We had thunderstorms last night..wind, hail, lightening, thunder, etc so I only got 5 hours of highly fragmented sleep. I finally just got up at 4:30 AM because there just wasn't going to be anymore chance of sleep.
Numbers don't tell the whole story...and you have to know the whole story to make accurate evaluations and decisions on how to proceed.

[palerider]

can't tell if the leak rates are pushing the pressure up, or the pressure up is causing the leaks.

leaks *NEVER* EVER cause pressure to go up, in fact, bad leaks cause the opposite.

example:

[Hannibal 2]

I missed your responses last night as I’d already gone to bed, but had also coincidentally decided that whatever I changed I would now try for a week or so. I feel that each time I make a change my body will need time to adjust, and as you point out we cannot rely on machine stats alone, there are too many variables outside of OSA and PAP that can disrupt or enhance our sleep. Also, I had promised myself not to get too obsessed with chasing numbers, yet here I am doing exactly that!

So last night I just decreased the lower pressure to 5.6, and put some eucalyptus oil next to the air intake, I haven’t touched anything else. I am now very conscious that my nasal breathing is not great at low pressure and the oil didn’t seem to be helping much, the machine did kick in at a higher pressure eventually and I found breathing much easier. Perhaps I have Rhinitis or something else, I am going to the Pharmacy today to try and get something to help with this but if it continues will see if I can get a referral to an ENT specialist.

I checked the display when I woke up and was disappointed to see an AHI of 6.2! That’s the highest so far on this new machine, but it’s one night and I am going to stick with the settings, I had a good night’s sleep, maybe awoke briefly once or twice (as I did the night before – to answer your question), but I feel pretty good today. I’m not going to get anxious about it as my therapy has clearly improved overall since changing.

To answer a couple of other questions, No I am not on any meds, and the hot shower? – I can’t honestly say I’ve noticed more or less congested but I will look out for that tonight and let you know. I guess you’re trying to work out if the heated humidifier is good or bad for me? One thing I’m unsure about is the heated hose, the machine says it’s connected although it doesn’t feel warm to the touch and the vented air doesn’t seem to be any warmer than before. There is no rainout or condensation so can I assume from this that it’s working?

The aerophagia is not bad enough to bother me, even when it was a little more uncomfortable with my fixed 12cm CPAP I would occasionally take 3 or 4 charcoal tablets which seemed to disperse the gas by the time I got to work.

Overall, my issues are minimal compared to others on the forum, so I’m fortunate. I have noticed a marked difference in the past week or so and even my boss has noticed the change in me. I felt I was in danger of losing my job for a while as I was disinterested, couldn’t focus well, making mistakes etc, so I’m very happy with my progress. I’m really pleased that you and others are helping me to take control of my own therapy, I cannot rely on the hospital to do this and it’s of course very important to me.

Did I answer everything? Let me know, I will have a go at embedding images to make it easier for you

[Hannibal 2]

can't tell if the leak rates are pushing the pressure up, or the pressure up is causing the leaks.

leaks *NEVER* EVER cause pressure to go up, in fact, bad leaks cause the opposite.

example:

Thanks again for clarifying. Does that Flow Limit look bad or is it me?

[rick blaine]

If I can help with the humidity-possible-relief-of-nasal-congestion issue ...

Hannibal 2 lives in London, England, where the humidity is already quite high. There isn't any part of the UK that is more than 100 miles from the sea, and the wind is always coming from somewhere - bringing if not rain then quite wet air.

The official numbers (for annual humidity) in the London area are: high = 92; low = 70.

Now, if Hannibal 2 lived in Phoenix, Arizona where the average humidity is 37 - with 47 in the morning and 23 in the afternoon - then standing next to a hot shower in the bathroom would make a difference.

I use a humidifier in the UK - but mainly to offset the cooling effect of moving air, not particularly to add moisture to the air - because the air in my home is already quite humid. On a scale of 0 to 5, my setting is 2, sometimes 3.

I'd even go so far as to say that, in a UK home where the windows are sometimes open, and with central heating and the bedroom temperature at 68°F, a heated hose might be unnecessary. And over-heating can cause irritation.

And to Hannibal 2 - you said : "I feel that each time I make a change, my body will need time to adjust," and I want to reinforce that.

It's my belief, backed up by what I've read in psychology and neurology, that getting used to and benefitting from APAP is not a passive process.

You are not an inert substance or purely mechanical system, having things done to you. You are in a learning process, in a dynamically-changing environment - and you are (or, hopefully, should be) changing and shaping your physiological responses to make best use of that environment. And this process takes time.

It took me three months to get used to my therapy - altho' I knew after the first two hours it was better sleep than I'd had in a long time.

What I'm endorsing is: make one change at a time - and give it a few days, a week even, to see what the effects are.

[Jay Aitchsee]

And to Hannibal 2 - you said : "I feel that each time I make a change, my body will need time to adjust," and I want to reinforce that.It's my belief, backed up by what I've read in psychology and neurology, that getting used to and benefitting from APAP is not a passive process.You are not an inert substance or purely mechanical system, having things done to you. You are in a learning process, in a dynamically-changing environment - and you are (or, hopefully, should be) changing and shaping your physiological responses to make best use of that environment. And this process takes time. It took me three months to get used to my therapy - altho' I knew after the first two hours it was better sleep than I'd had in a long time. What I'm endorsing is: make one change at a time - and give it a few days, a week even, to see what the effects are.

+1

Thanks again for clarifying. Does that Flow Limit look bad or is it me?

Flow Limitations are considered to be precursors of apneas and I have concluded, from examining my own data, that ResMed machines in the auto mode will raise the pressure (or keep it from falling) when a Flow Limitation above 0.05 on the SleepyHead scale is encountered. Looking at your example, it can be seen that your FL exceed 0.05 quite often and the pressure is being driven to the max IP setting where it stays until the limitations are reduced. If your max was set higher, the machine would raise the pressure higher in response to the limitations.
Flow Limitations might be reduced by increasing the pressure. I have found that a soft cervical collar will also reduce (my) flow limitations.
Are your Flow Limitations bad? Maybe, maybe not. It seems to be an individual thing. Some people are disturbed by them. Some people are disturbed by the machine response to them. The only thing for sure is that the machine is programmed to respond to them.

[Pugsy]

Does that Flow Limit look bad or is it me?

Are you talking about the flow limitation graph on the image PR posted? If yes...yeah, it's pretty bad but believe it or not I have seen worse than that.

One thing I’m unsure about is the heated hose, the machine says it’s connected although it doesn’t feel warm to the touch and the vented air doesn’t seem to be any warmer than before. There is no rainout or condensation so can I assume from this that it’s working?

It won't necessarily feel warm to the touch even at max of 86 degrees F or whatever C max it is. The reason is because even at the max it is cooler than your own body temp of 98.6 F...
So don't worry about that part.

I guess you’re trying to work out if the heated humidifier is good or bad for me?

Yep...that's what I was trying to do or trying to figure out if another setting on the humidifier needs to be tried.
What setting are you using and what temp? Or are you on auto?'

Here's how the humidifier works when the heated hose is attached.
First of all it maintains whatever temp it gets set at.
For humidity setting it takes into account whatever your ambient humidity is and then works from there to keep the humidity at whatever humidity level you choose. It doesn't necessarily drop 60% more humidity on top of your already rather humid bedroom humidity (assuming it is humid in London which I hear it is).
It takes the starting ambient humidity and works from there to try to maintain the chosen humidity on the machine.
When it rains outside and the humidity is high everywhere...the machine probably won't use much water at all because there's no need.

Example...if your ambient humidity is 70% and the setting you have chosen on your machine for humidity ends up being 80% the machine will only be cranking out enough extra humidity (10 %) to get you up to 80%. It doesn't/can't try to unload an additional 80% on top of the already moist 70% if it did you would have a rainstorm in your face.

With the heated hose attached your machine will deliver only what is needed to reach the target you set.
If your ambient humidity is already really high the machine may not crank out any extra moisture and thus may not use any water to speak of.

Without the heated hose there isn't quite as much control but there is still some and the ambient humidity sensor in the machine plays a part in things but it isn't as precise as with the heated hose sensors being used too.

Some people need a lot of humidity to keep the nasal mucosa happy (I am one of those) but others don't need much if any added humidity.
I live in a fairly humid area...my normal ambient humidity in my bedroom with be in the 50% range. My nose like 80% when I am on cpap. When it rains and the humidity in the bedroom climbs to close to 80% my machine doesn't have to put out much humidity and uses very little water. When the humidity in the bedroom is lower like the upper 40s and lower 50s I might use up all the water or almost all the water in an effort to maintain the 80% my nose likes.

The symptoms when the nasal mucosa are unhappy....congestion, drainage, pressure, itchy, etc...might have one or all of the symptoms.
Now I don't know if your congestion is because your nasal mucosa is unhappy or not. Could just be bad luck too.
I was wanting to know what your settings were so I would know which way to suggest you go in terms of playing with the humidity setting to see if it helps or hurts the congestion.

Also, I had promised myself not to get too obsessed with chasing numbers, yet here I am doing exactly that!

Here's what I did early in my therapy...I waited until evening to look at the numbers that way I could evaluate how I felt without creating a self fulfilling prophecy. I know you want to look first thing but it might be better to wait.

So last night I just decreased the lower pressure to 5.6, and put some eucalyptus oil next to the air intake, I haven’t touched anything else. I am now very conscious that my nasal breathing is not great at low pressure and the oil didn’t seem to be helping much, the machine did kick in at a higher pressure eventually and I found breathing much easier. Perhaps I have Rhinitis or something else, I am going to the Pharmacy today to try and get something to help with this but if it continues will see if I can get a referral to an ENT specialist.

I checked the display when I woke up and was disappointed to see an AHI of 6.2!

That doesn't surprise me...5.6 can create uncomfortable suffocation feelings and it obviously was too low of a pressure to hold the airway open optimally because the machine can't respond fast enough.
You would be better off to maybe use 6 something or 7 something. It moves more air so you will be more comfortable and does a better job holding the airway open.
So in this situation I wouldn't wait a week...the experiment had bad results if for no other reason than your comfort level in terms of ease of breathing.

The idea to limit the max to 10...something to try down the road. I didn't mean you had to try it right now if you want to try something else instead. Just put that idea on the back burner for now. I think when you get more experience under your belt with what you are seeing that you might come to understand the method to my madness when suggesting it.

[Hannibal 2]

Rick,

Thank you for clarifying my situation for the benefit of other posters, and for your observations and advice – always much appreciated.
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Pugsy,

Yes I was talking about the FL graph that palerider posted.

Thanks for the heated hose and humidifier explanations, I just can’t see how I can be sure that the hose is working just because the connection is recognised by the machine.

My humidifier and hose are both set to Auto – is that a bad idea?
I think I have suffered from some nasal congestion for a long time and just accepted it as normal, maybe the humidifier makes it slightly worse but I’m not sure.

Good idea to look at the AHI on the machine at the end of the day, and probably better not to look at Sleepyhead until I’ve done a week so long as I’m feeling good?

Yes I was struggling at 5.6 but had already done over a week on 4.0/20 so thought it would be fine, probably more noticeable because I went back from 7.4, I’ll either stick with it for now or just tweak it up to 6.0, I have bought a saline nasal spray to try so hopefully that will help.

Yes, I’ll keep the 10 max in mind and see where I am with it all next week – thanks again for your patience and advice.

[Pugsy]

I just can’t see how I can be sure that the hose is working just because the connection is recognised by the machine.

You have to learn to trust the machine and remember even at the maximum hose temp it isn't sauna like warm.

I don't know what the temps are when set to auto nor do I remember what the humidity might be in auto ...does it say what they are in the manual?

If you just need verification that it is working...change it out of auto mode and go set the hose air temp and humidity settings separately and manually.

Set it to 86 degrees and if you have some sort of thermometer you can stick in the hose..check it...but give it about 20 minutes to warm up.

Change it out of auto mode...so that you can set the humidity to something middle of the road like 4 and change the temp to 86 degrees and see if you can feel any warmth...it won't be much to the touch...you might stick it under the covers for about 15 minutes...you might feel a bigger change then.
It's hard because it will always "feel" cooler to the touch because of your own body temp. Anything below your own body temp can feel cooler even if it is real close to your body temp.

FWIW...I prefer humidity and hose air temps separate and not "auto".
I have ordered a heated hose for my new AirCurve machine...when I get it I can maybe better offer input on settings for humidity and temp ideas. Should be here in a couple of days.

[OkyDoky]

Here is a link that states the default with the heated hose is tub temp 81 degrees and humidity level at 4.
http://www.resmed.com/us/dam/documents/ ... sa_eng.pdf

[Pugsy]

Here is a link that states the default with the heated hose is tub temp 81 degrees and humidity level at 4.
http://www.resmed.com/us/dam/documents/ ... sa_eng.pdf

Thanks OkyDky..
Those are the default settings...did you spot where it said what you are getting with it set to "auto"?
I haven't had time to go reading stuff.
I spotted that "auto" is 85 % but doesn't mention temp except to say the patient can set it.

[OkyDoky]

Here is a link that states the default with the heated hose is tub temp 81 degrees and humidity level at 4.
http://www.resmed.com/us/dam/documents/ ... sa_eng.pdf

Thanks OkyDky..
Those are the default settings...did you spot where it said what you are getting with it set to "auto"?
I haven't had time to go reading stuff.
I spotted that "auto" is 85 % but doesn't mention temp except to say the patient can set it.

Tube temp 80 degrees and relative humidity 85%

Climate Control Auto
Climate Control Auto is the recommended and default setting.
Climate Control Auto is designed to make therapy as easy as
possible, so there is no need to change the temperature or
humidity settings.
The Tube Temperature is set to Auto (80°F [27°C]) and
Climate Control adjusts the humidifier output to maintain a
constant, comfortable humidity level of 85% relative humidity
while protecting against rainout (water droplets in the air
tubing and mask).