The more I try, the worse it gets.

General Discussion on any topic relating to CPAP and/or Sleep Apnea.
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robysue
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Re: The more I try, the worse it gets.

Post by robysue » Wed Apr 16, 2014 7:51 am

lliann,

Now that you are using an AUTO range for the pressure, we need to see the pressure graph, the leak graph, wave flow, and the events table. We don't need the respiratory rate graph.
lliann wrote:Here are the readings from last night.

This was the scenario. I took 1/2 a doxepin because I was still in itch mode. It helped with falling asleep. Had a little hangover this morning but its going away much faster at the lower amt.

The cats were with me the first half of the night. I have to accept that they probably are responsible for some of my events because they move around. And Eli found the tubing and I think he was starting to chew on it. So that was the stop as I got all the cats out of the room.
The centrals settle way, way down after the break. Is the break in the data when you kicked the cats out of the room?
The pressure did seem a lot more and I have to read your description again. Maybe it didn't go to 14 (the air I recognized) because the machine decided in auto mode that I just need all of 17 if not more. (is this a usable theory?)
I need to see the pressure graph before I can comment on this.
I fiddled with the nose pillows a fair amt. It felt like there was air coming through. I could try the larger size tonight or switch to the zest?
Your choice. Base it on comfort.

Other impressions:

Leaks are very problematic during the last 40 minutes of the night, but are acceptable during the rest of the night. Did you tape or use a chinstrap?

The number of OAs is way, way down. So the pressure must have been doing something. We need that pressure graph.

The number of CAs is way, way up, but you say there were cats in the bed with you during the break, and the cats were doing enough cat stuff for you to notice. And the centrals almost disappear completely after the break. Hence those CAs in the first part of the night may be cat-related restless WAKE/SLEEP transition stuff that wouldn't normally be scored on a sleep test. As an experiment ban the cats from the bedroom at the BEGINNING of the night tonight. I'm willing to bet a donut or two that "no cats" will make the overall number of centrals look more like the number in the second half of the night rather than the first half. And that may be enough for you to finally see an AHI < 5.0 for the night.

I'd make the following recommendations for now:

1) Leave the pressures where you set them last night for the next week or so. That gives you several days of data to see what's really going on with these pressure settings.

2) Ban the cats from the bedroom for the full night every night. You need to convince yourself that "no cats" reduces the number of scored centrals. It's tough to ban our furry friends from the bedroom, but sometimes we have to.

3) Experiment with the mask if you want, but keep track of which nights use which mask.

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lliann
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Re: The more I try, the worse it gets.

Post by lliann » Wed Apr 16, 2014 7:55 am

I will include the rest of the stats. I cut off some.
ResMed
S9 VPAP Auto
Mode: Bi-Level
EPAP: 10.0 IPAP: 14.0 cmH2O
PS: 4.0
Date Sleep Wake Hours
4/15/14 23:19 05:15 05:29:05
AHIApnea / Hypopnea Index 10.39
HypopneaHypopnea 0.36
ApneaUnspecified Apnea 0.36
ObstructiveObstructive Apnea 3.46
Clear AirwayClear Airway Apnea 6.20

Event Breakdown


Statistics
Channel Min Med 95% Max
EPAPExpiratory Pressure (cmH20)
W-Avg: 11.15 4.44 11.32 12.84 12.98
IPAPInspiratory Pressure (cmH20)
W-Avg: 15.15 8.44 15.32 16.84 16.98
Minute Vent.Minute Ventilation (L/min)
W-Avg: 5.16 0.00 4.88 8.00 10.50
Resp. RateRespiratory Rate (breaths/min)
W-Avg: 14.27 0.00 14.00 19.20 36.20
Resp EventsRespiratory Events
W-Avg: 0.00 0.00 0.00 0.00 0.00
Flow LimitFlow Limit Graph (0-1)
W-Avg: 0.00 0.00 0.00 0.01 0.20
LeaksLeak Rate (L/min)
W-Avg: 5.17 0.00 0.00 24.00 43.20
SnoreSnore (unknown)
W-Avg: 0.04 0.00 0.04 0.08 0.14
I:EInspiratory:Expiratory (ratio)
W-Avg: 41.77 7.00 41.00 61.00 105.00
Insp TimeInspiratory Time (seconds)
W-Avg: 1.24 0.00 1.24 1.54 1.80
Exp TimeExpiratory Time (seconds)
W-Avg: 3.13 0.00 2.98 4.52 8.10
Tidal VolumeTidal Volume (ml)
W-Avg: 362.74 0.00 340.00 540.00 700.00

Machine Settings
Pr. ReliefPressure Relief Easy-Breathe x1

Session Information
SessionID On Date Start End
CPAP Sessions
1397618350ResMed CPAP 2h, 54m, 2s 4/15/14 23:19 02:13
1397630422ResMed CPAP 2h, 35m, 3s 4/16/14 02:40 05:15

So this concludes the 17 ipap setting with a 4 ps does show up at 14. Is there any reason why I would feel the 14 in fixed and 14 in auto felt different? To be sure, I felt comfortable with the air, but it was noisier and I perceived that my mask was having issues.

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Re: The more I try, the worse it gets.

Post by robysue » Wed Apr 16, 2014 8:05 am

lliann wrote: So this concludes the 17 ipap setting with a 4 ps does show up at 14. Is there any reason why I would feel the 14 in fixed and 14 in auto felt different? To be sure, I felt comfortable with the air, but it was noisier and I perceived that my mask was having issues.
In FIXED mode, your IPAP never increased above 14.

In AUTO mode, your IPAP was allowed to range from 14 to 17 cm H20 and your IPAP was AT or ABOVE 15 cm H20 for at least 50% of the night because your median IPAP pressure is 15.32 cm H20. Your IPAP was AT or ABOVE 16.5 cm H20 for at least 5% of the night because your 95% IPAP pressure is 16.84 cm.

That's why the settings feel different.

By the way: Are you using the ramp? And how long is the ramp set for?

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Re: The more I try, the worse it gets.

Post by Pugsy » Wed Apr 16, 2014 8:08 am

lliann wrote:Is there any reason why I would feel the 14 in fixed and 14 in auto felt different? To be sure, I felt comfortable with the air, but it was noisier and I perceived that my mask was having issues.
Are you referring to what you feel while awake? Or in general through the night?
If while awake it might be related to those other little settings (Ti Max, Ti Min, trigger and cycle).
I still wouldn't go changing those from the defaults though...not now unless you weren't comfortable.
The noise...I don't know. Are you hearing machine noise on inhale or exhale? Or is it mask noise?
More pressure is going to equal more noise to some extent...both machine and venting. Again are you talking about what you sense while awake?? While awake your pressure should change to the higher pressures.

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Re: The more I try, the worse it gets.

Post by robysue » Wed Apr 16, 2014 8:14 am

Re the noise: Did you notice the noise more with or without the cats in the room?

If you noticed the noise more after you kicked the cats out, it may just be that the room was quieter. So the machine noise that's always been there seemed louder.

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Re: The more I try, the worse it gets.

Post by lliann » Wed Apr 16, 2014 9:14 am

I think, but not positive..
I may have started the night without tape on my mouth and with the cats. The doxepin allows me to settle into some good sleep(side benefit even tho it's intended for itch relief). When I did my last sleep study, I did it without tape on my mouth but perhaps a chin guard.(hopefully I will get some memory back someday)

What is happening in my world is that I live on Lake Champlain, the snows have melted, we had 2 nights of bad rainstorms and I have one cat that acts out when he cant get to his pack alpha(me). So I was sort of testing how they would act and its obvious they affect my wake arousals. So yes, the second half, there were no c ats and I think I taped my mouth then. I remember some big air accummulations in my mouth and I finally did take the mask off when they were keeping me awake. But also, I am on high alert for potential flooding of the lake.

My very original settings when I got this vpap in 2012 was 19 ipap 15 epap (theres that 4 difference) (vauto mode) We started to lower it because I said I wanted to try nasal. I think they changed it to 15/10. (s mode)After my last sleep study(maybe late feb), with a wisp, a chin strap, they said I could change my settings to 13/8. From the time we changed it, all hell broke loose with my ahi's. Plus even during the study, I felt like I was fighting too hard to get a full breath. I was going to mention it to the dr but they had to cancel my 4/8 appt and pushed it to 4/23.. I sent them a little red flare phone call and there has been no response so I will definitely have that be part of the conversation when we meet. (like how can you tell me to not fiddle with my machine if you are not going to respond to my calls?) Altho to be fair, I was complaining more about my asthma but at some point all this is related oxygen wise.


anyways...I forget what else you ask for so here the new graphs:

Image

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Re: The more I try, the worse it gets.

Post by lliann » Wed Apr 16, 2014 12:23 pm

robysue wrote:Re the noise: Did you notice the noise more with or without the cats in the room?

If you noticed the noise more after you kicked the cats out, it may just be that the room was quieter. So the machine noise that's always been there seemed louder.
The noise was the sound of me breathing .

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Re: The more I try, the worse it gets.

Post by robysue » Wed Apr 16, 2014 12:32 pm

lliann wrote:
robysue wrote:Re the noise: Did you notice the noise more with or without the cats in the room?

If you noticed the noise more after you kicked the cats out, it may just be that the room was quieter. So the machine noise that's always been there seemed louder.
The noise was the sound of me breathing .
Same thing: It may have always been there, but with the cats to distract you, you just didn't notice it as much.

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Re: The more I try, the worse it gets.

Post by lliann » Wed Apr 16, 2014 12:33 pm

robysue wrote:
lliann wrote: So this concludes the 17 ipap setting with a 4 ps does show up at 14. Is there any reason why I would feel the 14 in fixed and 14 in auto felt different? To be sure, I felt comfortable with the air, but it was noisier and I perceived that my mask was having issues.
In FIXED mode, your IPAP never increased above 14.

In AUTO mode, your IPAP was allowed to range from 14 to 17 cm H20 and your IPAP was AT or ABOVE 15 cm H20 for at least 50% of the night because your median IPAP pressure is 15.32 cm H20. Your IPAP was AT or ABOVE 16.5 cm H20 for at least 5% of the night because your 95% IPAP pressure is 16.84 cm.

That's why the settings feel different.

By the way: Are you using the ramp? And how long is the ramp set for?
Wow, so looks like 15-17ish may be my effective number? I was using the ramp at 5 but I put it up to 10 last night. 5 isn't giving me enough time with my probably new cpap insomnia(?) I will try the pillows for a few more nights to get some kind of steady stats and then maybe switch to a nasal mask just to see if the added pressure just works better for me with a nose cone.<g>

I am beginning to see with my different issues how trial and error this is but I am thankful for the help. I will not give up until I can find a happy meeting ground for whatever my body is throwing at me. Its making me feel old before my time and I am not ready for that. Still a lot of things to do, people to see, places to go.

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Re: The more I try, the worse it gets.

Post by lliann » Wed Apr 16, 2014 12:41 pm

Pugsy wrote:
lliann wrote:Is there any reason why I would feel the 14 in fixed and 14 in auto felt different? To be sure, I felt comfortable with the air, but it was noisier and I perceived that my mask was having issues.
Are you referring to what you feel while awake? Or in general through the night?
If while awake it might be related to those other little settings (Ti Max, Ti Min, trigger and cycle).
I still wouldn't go changing those from the defaults though...not now unless you weren't comfortable.
The noise...I don't know. Are you hearing machine noise on inhale or exhale? Or is it mask noise?
More pressure is going to equal more noise to some extent...both machine and venting. Again are you talking about what you sense while awake?? While awake your pressure should change to the higher pressures.
I believe I noticed when I was awake. That breathing through the mask, tube just was louder. Could be because I was sending more air through? I definitely noticed in the beginning until I fell asleep and then when I would wake up but I do not believe it woke me up or prevented me from falling asleep and yes, maybe the venting was lower. This was just using the nuance. Maybe it would be different with say the Airfit10. I wonder too about the size of the pillows. I alternate between med and large. Its not that I have a giant nose but my nares flare(its a thing I do like I curl my toes incessantly till I fall asleep. I am very annoying to myself ) I used med pillows last night. I will try the large tonight and see if the air at higher pressure moves more quietly.(?)

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Re: The more I try, the worse it gets.

Post by Pugsy » Wed Apr 16, 2014 1:13 pm

I "hear" my own breathing all the time. This is a different "noise" from the mask venting or the machine itself. Hard to describe but it's sort of "in my head" as I can plug my ears with my fingers and I still hear it pretty much the same. Probably some type of conducted noise between the machine, the bed mattress, the hose and the mask attaching to my face.
It becomes a non issue though as long as I don't fixate on it.

That's a different breathing noise from the venting noise though. If you can get a chance try the AirFit P10 nasal pillows. The vent noise is pretty much non existent. Some masks are just noisier than others.

Sometimes it's hard to pinpoint just exactly what the noise is coming from and even harder to explain it.
If you can pin point the cause then maybe something can be done to lessen the annoyance of it.

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Re: The more I try, the worse it gets.

Post by robysue » Wed Apr 16, 2014 6:16 pm

lliann wrote: Wow, so looks like 15-17ish may be my effective number?
Yep. The machine wants your IPAP between 15 and 17 for at least 50% of the night. And it wants your EPAP between 11 and 13 for at least 50% of the night.

And that goes a long way in explaining why your OAs have been so numerous and your OAI has been so high on the fixed IPAP = 14 and EPAP = 10 settings.

Let's cross our fingers that the number of CAs returns to something reasonable tonight.

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Re: The more I try, the worse it gets.

Post by lliann » Thu Apr 17, 2014 7:20 am

Last night felt like a real good move in the right direction. Not perfect but I think tweakable<g>

These were my impressions (that I can remember) I was tired, which is rare(prolly still some of the doxepin life) So I just called it a night. No cats.Baby humidfier going, air purifier going, ceiling fan going (I like it a little cool). Put on the AirFit 10 and my chin strap which is a white wide strap with a lot of stretch and velcro. Locked and loaded. Turn the air on (10 min ramp) and I said Ok, we got liftoff! And it was quiet!!!! Did not hear any of the sounds I mentioned last night with the nuance and all the settings were the same. Itried to remember my awake times. I remember needing to turn over from right side to left side. And not being able to settle down so I shut the machine off for a little bit. I think at 330 something woke me too...oh I know..aerophagia. Both awake were the aerohagia pooling in my midriff. It was definitely a little worse last night. The air would definitely pile up in my mouth and I had to open my mouth several times to expel. It was somewhat uncomfortable, but if I could have channelled it in both directions(you know what I mean) that might have helped. It wasn't the worse aerophagia but it was up from recent times.

Um, it seems I awake a lot on my own for all kinds of reasons. Maybe because I have not slept through a night in years and years(?) I will continue to try to remember what wakes me and see if they match central events.

Would you please explain each of these numbers and what the mean. The charts still don't make sense to me but that will be Cpap 102 I guess<g>.

Here it is:

AHIApnea / Hypopnea Index 6.41
HypopneaHypopnea 0.62
ApneaUnspecified Apnea 0.00
ObstructiveObstructive Apnea 1.41
Clear AirwayClear Airway Apnea 4.37

Event Breakdown


Statistics
Channel Min Med 95% Max
EPAPExpiratory Pressure (cmH20)
W-Avg: 10.59 4.44 10.62 12.22 12.94
IPAPInspiratory Pressure (cmH20)
W-Avg: 14.59 8.44 14.62 16.22 16.94
Minute Vent.Minute Ventilation (L/min)
W-Avg: 5.83 2.25 5.75 7.88 10.62
Resp. RateRespiratory Rate (breaths/min)
W-Avg: 14.35 4.00 14.40 18.00 22.00
Resp EventsRespiratory Events
W-Avg: 0.00 0.00 0.00 0.00 0.00
Flow LimitFlow Limit Graph (0-1)
W-Avg: 0.00 0.00 0.00 0.00 0.15
LeaksLeak Rate (L/min)
W-Avg: 2.64 0.00 1.20 9.60 16.80
SnoreSnore (unknown)
W-Avg: 0.04 0.00 0.04 0.06 0.14
I:EInspiratory:Expiratory (ratio)
W-Avg: 39.99 6.00 40.00 55.00 70.00
Insp TimeInspiratory Time (seconds)
W-Avg: 1.19 0.52 1.18 1.44 1.72
Exp TimeExpiratory Time (seconds)
W-Avg: 3.08 1.06 2.92 4.48 7.26
Tidal VolumeTidal Volume (ml)
W-Avg: 403.98 180.00 400.00 560.00 700.00

Machine Settings
Pr. ReliefPressure Relief Easy-Breathe x1

Session Information
SessionID On Date Start End
CPAP Sessions
1397702498ResMed CPAP 4h, 13m, 2s 4/16/14 22:41 02:54
1397718366ResMed CPAP 2h, 11m, 2s 4/17/14 03:06 05:17


Image

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Re: The more I try, the worse it gets.

Post by Pugsy » Thu Apr 17, 2014 7:38 am

lliann wrote:Would you please explain each of these numbers and what the mean.
Exactly which numbers? Which graphs?
The tidal and minute volume stuff...I don't even bother to look at.
The main important things to understand are
the AHI break down into categories and these graphs on the right side and their associated "numbers" from the statistics section on the left.
Events
flow rate
pressure
leak
and maybe flow limitation or snore graphs if they look exciting.

Tidal volume, minute volume, min exp press or whatever....all those things have a wide range of normals and aren't going to tell you much unless you have some sort of lung problem and using a cpap machine to monitor lung functions is far from optimal anyway.
There is a glossary that explains the definitions for the terms you are seeing.
http://sourceforge.net/apps/mediawiki/s ... r_Glossary
Check it out and then come back with questions about exactly which piece of data terminology you are having trouble understanding and we can try to clarify.

Yes...the AirFit is nearly totally quiet....that's the new venting system...at your pressures especially. The Nuance is a nice mask but it does cause more venting noise than the AirFit does. The vent noise may be what you heard the other night.
If the aerophagia persists...we may need to limit the pressures a little...I have a feeling that using the nasal pillows may give you some wiggle room in terms of pressure needs. Not down to the 8/13 but maybe just a little lower than what you are using now. Sometimes we compromise....let's see if the aerophagia persists...for sure don't go increasing anything.

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Re: The more I try, the worse it gets.

Post by lliann » Thu Apr 17, 2014 8:13 am

Yes, I have a lot of reading to do. I do feel like I finally have some energy today. It =feels= like the numbers improved and mostly I was wondering if an improvement was showing.

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