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General Discussion on any topic relating to CPAP and/or Sleep Apnea.
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Pugsy
 
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Re: Maybe need a pressure increase?

Postby Pugsy on Sun Jan 07, 2018 9:54 am

TedVPAP wrote:Your latest charts still doesn't show leak rate and you have zoomed in so all we see is pressure and flow rate over a short time period.


We can see the leak statistics and the 95% statistic is 0.00...max is 142 which is probably a mask reseating thing.
His leaks aren't an issue unless tiny leaks are disturbing sleep.
I don't really need to see a leak graph when the events graph is showing no large leak flags and the 90/95% leak number is 0.00. There's not going to be much movement beyond normal vent rate with those numbers....add in the fact that there are no large leak flags at all then I don't expect to see much from the leak graph which is why I haven't asked for it.

Ruinednose wrote:What changes do I make now


You only showed a segment of the graphs (you took the screen shot when zoomed in on a section) and from the statistics it looks like you hit max IPAP of 13.5...don't know for how long because we can't see the whole pressure graph.

How was your sleep quality and how do you feel? This is always just as important as the AHI.

I would just open up that IPAP max if it were me. You don't seem to want to do that and that is of course your choice. It's probably not a critical issue...all depends on how long the machine might have been stuck at 13.5 and did it really want to go higher or not.
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TedVPAP
 
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Re: Maybe need a pressure increase?

Postby TedVPAP on Sun Jan 07, 2018 9:55 am

Ruinednose wrote:
TedVPAP wrote:Your latest charts still doesn't show leak rate and you have zoomed in so all we see is pressure and flow rate over a short time period.



It's the default.. It's how it looks on my computer, what can I do to correct it?


The second link below shows you how to adjust size.
Regarding zooming in, the charts show the region that was highlighted in the events chart. When you first view the a daily, the entire event chart is highlighted. You zoom by click and dragging over a region. Click and drag over the entire night to highlight all.

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Machine: DreamStation Auto CPAP Machine
Mask: AirFit™ P10 Nasal Pillow CPAP Mask with Headgear
Humidifier: DreamStation Heated Humidifier
Additional Comments: AutoPAP 16-20, Ultimate Chin Strap http://sleepapneasolutionsinc.com/
Use data to optimize your xPAP treatment:
how to see your data https://sleep.tnet.com/resources/sleepyhead
how to present your data https://sleep.tnet.com/resources/sleepyhead/shorganize
how to post your data https://sleep.tnet.com/reference/tips/imgur

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Pugsy
 
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Re: Maybe need a pressure increase?

Postby Pugsy on Sun Jan 07, 2018 10:00 am

You can organize and resize the graphs so that leak graph is included.
https://sleep.tnet.com/resources/sleepyhead/shorganize


DON'T do the full screen toggle thing using SleepyHead...if you want to make the image larger use your computer browser page to enlarge things.

You can get the basics on one image just by a little moving and resizing of the graphs.

I don't need the leak graph myself...I can tell by the numbers and lack of LL flags that the leak graph isn't going to be very exciting.
Now if you were having a lot of LL flagging going on...different story.

Total leak...95% number...30 L/min....that's pretty much the mask's expected vent rate at your pressure. Minimal to none excess leak.

The max leak number we toss out as a mask fitting thing when the 95% number is so low.
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Re: Maybe need a pressure increase?

Postby TedVPAP on Sun Jan 07, 2018 10:01 am

Pugsy wrote:TedVPAP wrote:Your latest charts still doesn't show leak rate and you have zoomed in so all we see is pressure and flow rate over a short time period.

We can see the leak statistics and the 95% statistic is 0.00...max is 142 which is probably a mask reseating thing.His leaks aren't an issue unless tiny leaks are disturbing sleep.I don't really need to see a leak graph when the events graph is showing no large leak flags and the 90/95% leak number is 0.00. There's not going to be much movement beyond normal vent rate with those numbers....add in the fact that there are no large leak flags at all then I don't expect to see much from the leak graph which is why I haven't asked for it.


The reason I like to see them is to try to determine if changes in leaking are causing disturbance.
In this case it is low priority as the machine is still not adjusted properly.

_________________
Machine: DreamStation Auto CPAP Machine
Mask: AirFit™ P10 Nasal Pillow CPAP Mask with Headgear
Humidifier: DreamStation Heated Humidifier
Additional Comments: AutoPAP 16-20, Ultimate Chin Strap http://sleepapneasolutionsinc.com/
Use data to optimize your xPAP treatment:
how to see your data https://sleep.tnet.com/resources/sleepyhead
how to present your data https://sleep.tnet.com/resources/sleepyhead/shorganize
how to post your data https://sleep.tnet.com/reference/tips/imgur

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Pugsy
 
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Re: Maybe need a pressure increase?

Postby Pugsy on Sun Jan 07, 2018 10:04 am

TedVPAP wrote:The reason I like to see them is to try to determine if changes in leaking are causing disturbance.
In this case it is low priority as the machine is still not adjusted properly.


Fair enough.

Me...I just ask how is the sleep quality and then go from there depending on the answer. :lol:
I may have to RISE but I refuse to SHINE.

Ruinednose
 
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Re: Maybe need a pressure increase?

Postby Ruinednose on Sun Jan 07, 2018 10:10 am

Pugsy wrote:You can organize and resize the graphs so that leak graph is included.
https://sleep.tnet.com/resources/sleepyhead/shorganize


DON'T do the full screen toggle thing using SleepyHead...if you want to make the image larger use your computer browser page to enlarge things.

You can get the basics on one image just by a little moving and resizing of the graphs.

I don't need the leak graph myself...I can tell by the numbers and lack of LL flags that the leak graph isn't going to be very exciting.
Now if you were having a lot of LL flagging going on...different story.

Total leak...95% number...30 L/min....that's pretty much the mask's expected vent rate at your pressure. Minimal to none excess leak.

The max leak number we toss out as a mask fitting thing when the 95% number is so low.



Yes leaks aren't ever a problem for me

Here is what I did, I can't grasp how to move them around

https://imgur.com/a/DwfYM

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Pugsy
 
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Re: Maybe need a pressure increase?

Postby Pugsy on Sun Jan 07, 2018 10:18 am

Reduce your PS to 3...you need more EPAP and if you reduce PS then IPAP will drag EPAP up to fight those OAs and FLs.
Either that or increase minimum EPAP again.
Right now IPAP is going up but EPAP isn't going up because of the PS variable. See the times with the bigger gap between IPAP and EPAP...that's PS being higher.

So 2 ways to get more EPAP...either set it higher or reduce the PS range so that when the machine wants to increase IPAP then IPAP will drag EPAP up.
I may have to RISE but I refuse to SHINE.

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Re: Maybe need a pressure increase?

Postby Pugsy on Sun Jan 07, 2018 10:22 am

You can temporarily turn off the unneeded graphs so the graphs you want can be moved into view.

Lower right corner of the daily detailed page...see where it says "Events" and a little arrow....click on the arrow and see the graphs with green color...click on the ones you want to hide so the green changes to red.
This will let the leak graph move up into viewing. You don't need the AHI graph...and whatever else is maybe in between.

To get more than 3 graphs...upper right corner where you have the usual X to close out the page...click on the little page next to the X so that SH gets bigger.
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Ruinednose
 
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Re: Maybe need a pressure increase?

Postby Ruinednose on Sun Jan 07, 2018 10:27 am

Pugsy wrote:Reduce your PS to 3...you need more EPAP and if you reduce PS then IPAP will drag EPAP up to fight those OAs and FLs.
Either that or increase minimum EPAP again.
Right now IPAP is going up but EPAP isn't going up because of the PS variable. See the times with the bigger gap between IPAP and EPAP...that's PS being higher.

So 2 ways to get more EPAP...either set it higher or reduce the PS range so that when the machine wants to increase IPAP then IPAP will drag EPAP up.


Thank you so much, did all the graphs picture I took give you all the info you needed? Which should I do, decrease PS or increase EPAP?

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Re: Maybe need a pressure increase?

Postby Pugsy on Sun Jan 07, 2018 10:47 am

I got all I needed from the graphs.
Ted wanted the leak graph.

You are making changes nightly and that's faster than I prefer unless there is an urgent need (and there isn't in your case) and I don't really like to tell someone what to do without explaining why...so that you get educated and don't have to rely on me because I might not always be here or Ted or anyone else.
I prefer to teach you to fish so you can feed yourself as opposed to supplying you with food.
So that's why I take the time to try to explain the "why" I am suggesting so and so.
I do understand that it can take some time for all this information to sink in so you actually understand it.

I think that there is a good chance you would benefit from a little more EPAP but I don't like seeing just one report and then change something.
I like 3 to 5 nights at a setting...and then decide what is maybe needed.

Reducing PS to 3 will/should cause EPAP to come up higher at times during the night.
So will just increasing EPAP minimum.

I would still like to see what my original idea of 8 minimum EPAP with PS 3 and max IPAP of 15 would do.
And I always want to know how you slept and how you feel in addition to the "numbers" because the numbers don't mean squat if you slept like crap and feel like crap.
I may have to RISE but I refuse to SHINE.

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Re: Maybe need a pressure increase?

Postby Ruinednose on Sun Jan 07, 2018 10:58 am

Pugsy wrote:I got all I needed from the graphs.
Ted wanted the leak graph.

You are making changes nightly and that's faster than I prefer unless there is an urgent need (and there isn't in your case) and I don't really like to tell someone what to do without explaining why...so that you get educated and don't have to rely on me because I might not always be here or Ted or anyone else.
I prefer to teach you to fish so you can feed yourself as opposed to supplying you with food.
So that's why I take the time to try to explain the "why" I am suggesting so and so.
I do understand that it can take some time for all this information to sink in so you actually understand it.

I think that there is a good chance you would benefit from a little more EPAP but I don't like seeing just one report and then change something.
I like 3 to 5 nights at a setting...and then decide what is maybe needed.

Reducing PS to 3 will/should cause EPAP to come up higher at times during the night.
So will just increasing EPAP minimum.

I would still like to see what my original idea of 8 minimum EPAP with PS 3 and max IPAP of 15 would do.
And I always want to know how you slept and how you feel in addition to the "numbers" because the numbers don't mean squat if you slept like crap and feel like crap.


I do feel a little better ever since the changes, definitely less awakenings in the early morning.

I will do min epap 8 with PS 3 and iPap 15 and report back daily for a few days. I appreciate all of you and the awesome help

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Ruinednose
 
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Re: Maybe need a pressure increase?

Postby Ruinednose on Mon Jan 08, 2018 9:26 am

Pugsy wrote:I got all I needed from the graphs.
Ted wanted the leak graph.

You are making changes nightly and that's faster than I prefer unless there is an urgent need (and there isn't in your case) and I don't really like to tell someone what to do without explaining why...so that you get educated and don't have to rely on me because I might not always be here or Ted or anyone else.
I prefer to teach you to fish so you can feed yourself as opposed to supplying you with food.
So that's why I take the time to try to explain the "why" I am suggesting so and so.
I do understand that it can take some time for all this information to sink in so you actually understand it.

I think that there is a good chance you would benefit from a little more EPAP but I don't like seeing just one report and then change something.
I like 3 to 5 nights at a setting...and then decide what is maybe needed.

Reducing PS to 3 will/should cause EPAP to come up higher at times during the night.
So will just increasing EPAP minimum.

I would still like to see what my original idea of 8 minimum EPAP with PS 3 and max IPAP of 15 would do.
And I always want to know how you slept and how you feel in addition to the "numbers" because the numbers don't mean squat if you slept like crap and feel like crap.



PS is min 3

Epap is min 8
Ipap max is 15


I feel so so. Definitely better quality sleep. I did have lots of awakenings this morning, more CAs, i do hold my breath when flipping and turning

Here is screenshot

https://imgur.com/a/56Adb


Any changes I should make?

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Re: Maybe need a pressure increase?

Postby Pugsy on Mon Jan 08, 2018 9:37 am

Did the awakenings seem to start more along the lines of the 6 AM to 7 time frame? Start waking around 6ish and lay there and go back to sleep for a bit and wake up and go back to sleep type of thing???

Or did they seem to happen all night long?

How many awakenings do you sort of remember? Doesn't have to be an exact number.

What is your usual go to bed time and your usual get up time and thus how many hours of actual sleep are you averaging?

Last night was nearly 1 AM before you went to bed. Is that your normal?

No....don't change anything else yet. Just answer these new questions.
I may have to RISE but I refuse to SHINE.

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Re: Maybe need a pressure increase?

Postby Ruinednose on Mon Jan 08, 2018 10:22 am

Pugsy wrote:Did the awakenings seem to start more along the lines of the 6 AM to 7 time frame? Start waking around 6ish and lay there and go back to sleep for a bit and wake up and go back to sleep type of thing???

Or did they seem to happen all night long?

How many awakenings do you sort of remember? Doesn't have to be an exact number.

What is your usual go to bed time and your usual get up time and thus how many hours of actual sleep are you averaging?

Last night was nearly 1 AM before you went to bed. Is that your normal?

No....don't change anything else yet. Just answer these new questions.


My awakenings are brief, in the mornings I remember about 5 or so times, just enough to gain consciousness then right back to sleep, but it's an awakening, sometimes because I sleep in my arm or maybe just apnea episodes.

But I do that most nights,
I go to bed around 1 am every night and wake about 9.30, but the last 2 hours of sleep are light, and many awakenings.
I get Ussualy about 7.30 hrs to 8.30 hrs of actual sleep most nights.



I feel marginally better ever since increasing pressure,

The machine looks like it reached 14! IPap anyway

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Re: Maybe need a pressure increase?

Postby Pugsy on Mon Jan 08, 2018 11:03 am

I don't know that your sleep quality is necessarily related to your sleep apnea totally nor if you would feel better if the AHI is lower or not.
I have been down that road myself and for some people a nice low AHI does mean they can actually feel the difference in terms of how they feel during the day but for others (like myself) a nice low AHI doesn't mean much.
I don't know which way you will go or be.

If the last couple of hours of your night is highly fragmented then those 7 to 8 hours of "sleep" may not necessarily be the "best" sleep quality.
So the overall total of good sleep hours may be less and thus impacting how you feel.
Example....7 hours of total overall sleep but 2 hours of highly fragmented sleep means about 5 hours of "good" sleep...and that's a low enough number of hours to impact how we feel during the day. If you "sleep" 10 hours but only 5 hours is "good" solid sleep...you will still feel like crap...see what I mean?

I don't know that is what is going on with you but it's possible.
It's also possible that the small evidence we see in the software reports of continued minor airway flow reductions could be impacting sleep quality.
It is also possible that you need to give these new changes a bit of time for the body and mind to adjust to. Trust me...I have seen it first hand.
When I first started bilevel therapy and was titrating to an "acceptable" AHI I had to pick something and stick with it and see where it went.
I picked something that gave me about what you are seeing from last night in terms of AHI and snores and Fls ...and stuck with it for 6 weeks with some good nights of better numbers happening occasionally and some nights which were "bad" and I really had to resist the urge to change something.
Over the 6 weeks I noticed that my AHI and the clutter (that stuff that isn't part of the AHI) slowly started to reduce and I started having many more good nights than bad nights. My overall AHI average at the end of the 6 weeks experiment for the last week was 1/2 what it was for the first week of the experiment.
My point....numbers can improve simply with time.

Give yourself a week at these settings and make special note each night (keep a diary) of how you feel and the number of awakenings, etc along with hours of total sleep vs "good" solid sleep.
See how things are going....then re-evaluate the possible need for another increase in EPAP.
Don't be afraid of more pressure...I don't see you being one of those people where Centrals are caused by pressure.
I think that the bulk of your centrals are likely centrals getting flagged while you are awake or semi awake...since most of them are happening during the last couple of hours of sleep where we know you had more awakenings. If you notice your pressure doesn't do much during that time frame anyway....because you are awake and the airway is open and the machine doesn't sense the need to do much.

Always....always... include how you feel and how you perceive your sleep quality in your evaluations of anything.
This sleep quality thing is very, very important and it isn't always something we can blame on OSA or the therapy. I wish it were that easy.
This is something I am fighting right now myself. My numbers are to die for good but I don't always feel those good numbers because I know that some nights my sleep quality or hours of good sleep is simply in the toilet.
Getting "good" numbers is the easy part...feeling them is a totally different story.

At the end of a week if the numbers hold pretty much the same and you are feeling pretty much the same then try another increase in the minimum EPAP and try it for a week and seen how you do.
We don't sleep the same each night so basing changes on what we see last night is really pretty much chasing our tails. Unless the results are horrible...give things a chance to settle in and let your body and mind get used to the changes.
Remember....the overall picture and not just numbers is hugely important. So how you slept and how you feel is very important.

At some point if you ever get in a position to get another machine....try to get a ResMed auto adjusting something (either apap or bilevel) because I really think that you might do a bit better with the ResMed algorithm.
I may have to RISE but I refuse to SHINE.

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