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General Discussion on any topic relating to CPAP and/or Sleep Apnea.
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crestifer
 
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Re: Started on Craigslist - Now need a real machine

Postby crestifer on Sun Mar 12, 2017 12:00 pm

trslp1 wrote:Like this? Neither of these appear clickable... going back to try and fix... Better??

Yes, I know that I should wait until I get more data... but this is fun. I'll cease posting once I get this figured out until I have several days worth.
Thanks for being patient.

Image



ok. great. looks like you got it down.

i think we were posting at the same time.

now the good folks here can check out your data and give you feedback.
Resmed Airsense 10 Autoset_____ Amara View mask and Resmed Airfit F20 mask________11CWP prescribed CPAP.

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Pugsy
 
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Re: Started on Craigslist - Now need a real machine

Postby Pugsy on Sun Mar 12, 2017 12:24 pm

Do you remember waking often during the night for some reason or other?
Did the leaks disturb your sleep or did you sleep right through them? I have slept through worse myself.

I don't see any need to increase the minimum at this point. The stuff we could fix with more minimum really isn't enough to worry about.
Now if the variations in pressure disturb your sleep...maybe tightening the range to lessen the variations could be beneficial.

You are having some big leaks even at lower pressures so the higher pressures aren't like the sole cause of the leaks.
Could be mask movement or mouth breathing going on there. I don't remember if you said which mask you were using.
When you have time please update your equipment profile so we know at a glance what you are using.

The centrals seem to mainly cluster a bit...if you know you were awake a lot then we might explain away the bulk of the centrals as awake/semi awakening breathing irregularities and not worry about them.
If you are sleeping soundly then maybe we look at them a little closer.

If you are sleeping soundly...I think I would turn EPR off and see if the centrals are still numerous.
There is a very small subset of cpap users who will have centrals pop up because of the way EPR works.
Yours doesn't look like that normally looks but if you aren't waking often...wouldn't hurt to turn EPR off just to see if it helps the number of centrals reduce or not.

If you are having trouble falling asleep or getting back to sleep in the middle of the night then awake/semi awake breathing irregularities could be to blame for the centrals.

I would try to work on the leaks...whatever they are caused from.
While I will let less than perfect slide....yours is pushing it a bit. :lol: Especially when you spend much time above 30 L/min. We don't know if not much happened to result in the low obstructive stuff or the machine missed it.

_________________
Machine: AirCurve™ 10 S BiLevel Machine with HumidAir™ Heated Humidifier
Mask: AirFit™ P10 For Her Nasal Pillow CPAP Mask with Headgear
Additional Comments: Actually using the AirCurve 10 ST but using it in S mode...have the S9 Adapt for backup right now.

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Re: Started on Craigslist - Now need a real machine

Postby trslp1 on Sun Mar 12, 2017 12:57 pm

Pugsy wrote:Do you remember waking often during the night for some reason or other?
Did the leaks disturb your sleep or did you sleep right through them? I have slept through worse myself.

I don't see any need to increase the minimum at this point. The stuff we could fix with more minimum really isn't enough to worry about.
Now if the variations in pressure disturb your sleep...maybe tightening the range to lessen the variations could be beneficial.

You are having some big leaks even at lower pressures so the higher pressures aren't like the sole cause of the leaks.
Could be mask movement or mouth breathing going on there. I don't remember if you said which mask you were using.
When you have time please update your equipment profile so we know at a glance what you are using.

The centrals seem to mainly cluster a bit...if you know you were awake a lot then we might explain away the bulk of the centrals as awake/semi awakening breathing irregularities and not worry about them.
If you are sleeping soundly then maybe we look at them a little closer.

If you are sleeping soundly...I think I would turn EPR off and see if the centrals are still numerous.
There is a very small subset of cpap users who will have centrals pop up because of the way EPR works.
Yours doesn't look like that normally looks but if you aren't waking often...wouldn't hurt to turn EPR off just to see if it helps the number of centrals reduce or not.

If you are having trouble falling asleep or getting back to sleep in the middle of the night then awake/semi awake breathing irregularities could be to blame for the centrals.

I would try to work on the leaks...whatever they are caused from.
While I will let less than perfect slide....yours is pushing it a bit. :lol: Especially when you spend much time above 30 L/min. We don't know if not much happened to result in the low obstructive stuff or the machine missed it.


First to clarify the data. It is actually using 2 different masks. First part of the night was my first time trying a full face Mirage Quattro, and then we have a 2 hour break before I went back to bed wearing a ResMet Swift LT For Her nasal pillow that I had been using before on the other machine S8 Escape II. The machine was made aware that I had switched from one to the other.

Yes, the leaks disturbed me on the full face mask especially once the pressure built up. About 1/2 way through the first part of the night I readjusted and tightened the Mirage Quattro, but I still had leaks after that. The second part of the night was with the nasal pillow mask. I am surprised that there are as many leaks there, as I didn't feel them. I will keep playing around with both masks until we get the leakage down. The nasal pillow is too small for me (space between the nostrils)

I never noticed the variations in pressure at all....

I'll work on one thing at a time until we get some improvement. Comfort and leakage are both important. I am a mouth breather and the nasal pillow was tough to wear on the S8 Escape, but it feels much better on this Resmet Airsense Autoset 10. The full face mask might be a bit better for the mouth breathing part, but it is huge and annoying. With leakage being a third variable to control, I will try and find an optimum balance

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Re: Started on Craigslist - Now need a real machine

Postby trslp1 on Mon Mar 13, 2017 9:39 am

Now we have another data point. AHI is coming down, and large leaks are way down from 51 to 9. But I still had to change from the full face mask at 1:45 am to the nasal pillows. The pressure was so high with the full face mask that I couldn't make it stay sealed at all and woke me up. For some reason, the nasal pillows work better at 12+ pressure. I may have to go with nasal pillows long term? When sleeping on my side the full face mask gets pushed sideways but the pillow, and starts leaking.

The Airsense was set for full face mask the entire time (even though the graph above shows pillows, it was changed later)

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Pugsy
 
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Re: Started on Craigslist - Now need a real machine

Postby Pugsy on Mon Mar 13, 2017 9:58 am

Some people just need more pressure when using a full face mask. I think it has to do with what that lower strap on the full face mask does to the positioning of the jaw.
Also pressure needs can vary with sleeping position (need more when on our backs) or in REM sleep (need more in REM).

Here's a little hint though...sometimes when the minimum pressure is set more optimally people find that the pressure line doesn't go up as high as it does when the minimum is a bit too low.
I can't promise you that it will work for you but if that minimum is more optimal then you may not see the pressure go as high as it is going now no matter what mask is ultimately used.

You might want to investigate another bed pillow so you can lay on your side without the mask getting compressed with the bed pillow.
They make special cpap pillows with cut outs for the mask or you might look at a buckwheat hull pillow because it allows for movement of the hulls to make a "nest" for the mask (I use a buckwheat hull pillow).
Or if you want to try one of the bed pillows with the cut outs...before spending a lot of money go to WalMart and get one of those cheap memory foam pillows and cut out your own spaces for the mask to rest.
An electric kitchen knife cuts the memory foam super easy.
Google cpap pillows and look at all the options and get an idea on a pattern and start cutting.

_________________
Machine: AirCurve™ 10 S BiLevel Machine with HumidAir™ Heated Humidifier
Mask: AirFit™ P10 For Her Nasal Pillow CPAP Mask with Headgear
Additional Comments: Actually using the AirCurve 10 ST but using it in S mode...have the S9 Adapt for backup right now.

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Re: Started on Craigslist - Now need a real machine

Postby trslp1 on Mon Mar 13, 2017 10:50 am

Pugsy wrote:Some people just need more pressure when using a full face mask. I think it has to do with what that lower strap on the full face mask does to the positioning of the jaw.
Also pressure needs can vary with sleeping position (need more when on our backs) or in REM sleep (need more in REM).

Yes, the full face mask may be relegated to the backup bin. The nasal pillow is working best for me, but the one I have is too small. Has anyone done a favorite headgear poll? It would be a good place for newbies to start, at least newbies who aren't being babysat by a sleep technician. I would like to weed through the best nasal pillow options.

Here's a little hint though...sometimes when the minimum pressure is set more optimally people find that the pressure line doesn't go up as high as it does when the minimum is a bit too low. I can't promise you that it will work for you but if that minimum is more optimal then you may not see the pressure go as high as it is going now no matter what mask is ultimately used.

I think you may be heading towards a recommendation of a higher minimum pressure setting? Should I bump to 8 tonight, or get some more data first?

They make special cpap pillows with cut outs for the mask or you might look at a buckwheat hull pillow because it allows for movement of the hulls to make a "nest" for the mask (I use a buckwheat hull pillow).

Special pillow? How far down this rabbit hole are you going to lead me?? <grin> I already has my special pillow and nobody is going to take it away from me <big grin>

Thanks for your help...

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Re: Started on Craigslist - Now need a real machine

Postby Pugsy on Mon Mar 13, 2017 11:02 am

trslp1 wrote:I think you may be heading towards a recommendation of a higher minimum pressure setting? Should I bump to 8 tonight, or get some more data first?


I wouldn't waste anymore time at 6 if it were me. I don't like what I am seeing on the report and it all points to more pressure being needed. No sense in waiting...I don't think it will change for the better with more nights at what we are seeing here especially the last half of then night when nasal pillows were used.
Once the pressure increases it never really drops down below 8 anyway.
I would consider 8 or 9 minimum if it were me.

trslp1 wrote:Has anyone done a favorite headgear poll? It would be a good place for newbies to start, at least newbies who aren't being babysat by a sleep technician. I would like to weed through the best nasal pillow options.


Mask preferences are highly personal and a poll won't necessarily point you to what might be the best choice for you. All it does is point to what is the best choice for the people that posted and that doesn't really mean much.

So which mask do you want to concentrate on using first?

_________________
Machine: AirCurve™ 10 S BiLevel Machine with HumidAir™ Heated Humidifier
Mask: AirFit™ P10 For Her Nasal Pillow CPAP Mask with Headgear
Additional Comments: Actually using the AirCurve 10 ST but using it in S mode...have the S9 Adapt for backup right now.

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Re: Started on Craigslist - Now need a real machine

Postby Pugsy on Mon Mar 13, 2017 11:08 am

Is the only nasal pillow mask you have the Swift LT?
I have tried almost every nasal pillow mask out there...so I can offer input on many of those.
If you want to try to target nasal pillow masks...there are better masks out there now than the Swift LT ...at least in my opinion.

_________________
Machine: AirCurve™ 10 S BiLevel Machine with HumidAir™ Heated Humidifier
Mask: AirFit™ P10 For Her Nasal Pillow CPAP Mask with Headgear
Additional Comments: Actually using the AirCurve 10 ST but using it in S mode...have the S9 Adapt for backup right now.

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Re: Started on Craigslist - Now need a real machine

Postby trslp1 on Mon Mar 13, 2017 11:15 am

Pugsy wrote: Mask preferences are highly personal and a poll won't necessarily point you to what might be the best choice for you. All it does is point to what is the best choice for the people that posted and that doesn't really mean much.

So which mask do you want to concentrate on using first?


The Airfit P10 and competitors would be a good start. It looks like the P10 doesn't have adjustable straps?? The RESMET Swift LT I have is too small.

OK, I'll bump min pressure to 8 tonight.

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Re: Started on Craigslist - Now need a real machine

Postby Pugsy on Mon Mar 13, 2017 11:34 am

The P10 doesn't have adjustable straps in the sense of velcro type of adjustment but instead the tension adjustment is accomplished by the positioning of the straps...further apart or closer together.
For most people this type of adjustment is sufficient. For some people with really big or really small heads it may not work well.

If you like the looks of the P10 but really want velcro adjustment then look at the Swift FX nasal pillow mask.
The pillow is pretty much the same and it has the traditional velcro on it.

I have used the Swift LT...first mask I ever bought and used it until the Swift FX was released. I wasn't in love with those plastic side things on the LT that come across the cheeks. I liked the soft silicone of the Swift FX better.

The P10...that headgear will stretch quite a bit and more than you might think. In fact it's weak point is the headgear can stretch out too much too soon and it will be too loose. We usually wash it in really hot water to help it shrink back but after a while no amount of hot water will shrink it enough.
I do love the venting on the P10 though...pretty much silent and you can't feel the vented air unless you put your hand about an inch away from the holes.

If you want to try the P10...I have a headgear that is simply too stretched out for me and I can't get it to shrink back enough. I will send it to you for free..but you would need to get the frame and a nasal pillow from someplace..Ebay might work well.
If you decide to do that...the P10 nasal pillow tends to run a little bit smaller that the Swift LT pillows so step up a size if you can. A bit too large is more forgiving than too small in the nasal pillow sizing.

_________________
Machine: AirCurve™ 10 S BiLevel Machine with HumidAir™ Heated Humidifier
Mask: AirFit™ P10 For Her Nasal Pillow CPAP Mask with Headgear
Additional Comments: Actually using the AirCurve 10 ST but using it in S mode...have the S9 Adapt for backup right now.

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Re: Started on Craigslist - Now need a real machine

Postby trslp1 on Mon Mar 13, 2017 1:06 pm

>> I have a headgear that is simply too stretched out for me and I can't get it to shrink back enough. I will send it to you for free.

Pugsby that is sweet of you. Thanks so much. PM sent....

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Re: Started on Craigslist - Now need a real machine

Postby trslp1 on Tue Mar 14, 2017 10:21 am

I wish I had another night of vast improvement again, but it was mostly a repeat of the previous. Using the full face mask to start the night, I awoke at 3:48 with irritation because of little annoying leaks that I couldn't seem to resolve. At that time I also had very dry mouth. The full face mask was ripped of and replaced with the nasal pillows, however at 6:12 again, I had very dry mouth again and took a drink after pulling the mask off for a few seconds. Both of those times, my AHI was getting bad so I'm guessing further adjustments are in order.

Min pressure was bumped from 6-8 last night. Should I bump from 8-10 tonight?

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Last edited by trslp1 on Tue Mar 14, 2017 10:52 am, edited 1 time in total.

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Pugsy
 
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Re: Started on Craigslist - Now need a real machine

Postby Pugsy on Tue Mar 14, 2017 10:44 am

You don't need to include the snore or AHI graphs.
Omit those and make the flow limitation a little bigger.
I assume you were awake a good bit of the night due to leaks and dry mouth????
If so that could explain the high ClearAirway/Central index which is the bulk of the AHI and won't respond to more pressure.

_________________
Machine: AirCurve™ 10 S BiLevel Machine with HumidAir™ Heated Humidifier
Mask: AirFit™ P10 For Her Nasal Pillow CPAP Mask with Headgear
Additional Comments: Actually using the AirCurve 10 ST but using it in S mode...have the S9 Adapt for backup right now.

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Re: Started on Craigslist - Now need a real machine

Postby trslp1 on Tue Mar 14, 2017 10:58 am

Pugsy wrote:You don't need to include the snore or AHI graphs.
Omit those and make the flow limitation a little bigger.
I assume you were awake a good bit of the night due to leaks and dry mouth????
If so that could explain the high ClearAirway/Central index which is the bulk of the AHI and won't respond to more pressure.


Graph replaced above. Yes I was awake at the 3:48 time but other than that I don't remember. After 8am I was awake enough to answer emails on my phone. Perhaps the mask should have been removed earlier?

Does the Clear Airway / Central index point to other things?

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Re: Started on Craigslist - Now need a real machine

Postby Pugsy on Tue Mar 14, 2017 11:12 am

trslp1 wrote:Does the Clear Airway / Central index point to other things?


Not if the bulk of those CAs are awake/semi awake breathing irregularities getting flagged by mistake.
Often referred to as SWJ...Sleep/Wake/Junk
If that's the case all it points to is crappy sleep from likely leaks causing little arousals or awakenings.
Fixing the crappy sleep will usually fix the CA.
Fixing the crappy sleep isn't so easy though. :lol:

It's fairly obvious that the flow limitations are probably what is driving the pressure upwards. The changing in pressure also makes it harder to anticipate keeping the mask sealed well. Fitting at the lower minimum pressure doesn't work so great when the pressure gets up over say 10 and minor leaks (even though they may not hit large leak territory) can be highly annoying.

The mouth breathing with the nasal mask also impacts therapy and impacts the dry mouth.
Dry mouth impacts sleep quality no matter if it is with a full face mask or a nasal mask.
Using a full face mask doesn't guarantee that the dry mouth won't happen even with a humidifier set to maximum humidity.
Some people simply get dry mouth easier than others for any number of reasons. Sometimes meds dry us out...sometimes we just draw the short straw for luck and we dry out easier than others. The humidifier wasn't really design to rehydrate the oral cavity...it was designed mainly for the nasal cavity which is much smaller.

Have you considered a mask liner to make the small but annoying full face mask leaks less likely to annoy you and wake you up?

I wouldn't worry about the CAs as long as we can likely blame them on SWJ. Now if you sleep the night straight through with not much in known awakenings and you still have the CAs so numerous...then we start looking more closely at the CAs.
I think if you can fix the awakenings that the CAs will reduce to minor numbers that don't mean anything.

_________________
Machine: AirCurve™ 10 S BiLevel Machine with HumidAir™ Heated Humidifier
Mask: AirFit™ P10 For Her Nasal Pillow CPAP Mask with Headgear
Additional Comments: Actually using the AirCurve 10 ST but using it in S mode...have the S9 Adapt for backup right now.

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