Not such a goodknight

MrPaul · Post by **MrPaul** » Sat May 26, 2007 6:12 am

Hi All,

So I tried using my goodnight 420E for the first time last night with not such good results. I fully expect this to be user error on my part but not sure what I did wrong.

First what's the best way to post data from Silverlining?

I thought things were OK until hour 2 when the machine went into overdrive blasting me with what I'm guessing is its max pressure rate and keeping it there. I tried breathing normally while it was doing this to see if it would settle down but it didn't. I hit the ramp button which seemed to stop if for a while but soon afterwards it started up at full blast again.

I switched masks to my old standard mask and switched to CPAP mode to try to get some sleep and had a totally different but equally annoying result. The machine would cycle up start putting pressure and then temporarily shut off with a message of (I think) In 1 on the display.

Sorry if I'm a little incoherent I didn't get that much sleep. [/img]

Daffney_Gillfin · Post by **Daffney_Gillfin** » Sat May 26, 2007 7:19 am

The easiest way to post info from Silverlining is to capture screenshots, save to jpg, and post them on a free site, and then link to them here. One can do screenshots manually by pressing Alt + Print Screen (assuming Windows), and then pasting into an image program. Or there is screen capture freeware available. You can find many through a google search. One that I have used in the past and liked is mwsnap at http://www.mirekw.com/winfreeware/mwsnap.html

Free photos sites
http://www.photobucket.com
http://www.flickr.com
http://www.picturetrail.com/
http://www.tinypic.com

The most helpful screens to post are the Synthesis report along with the detailed data (press the magnifying glass at the bottom to expand the detail screen). You can see which I'm talking about at http://www.flickr.com/photos/daffneygillfin/ . I have also posted the night calendar because I like all the pretty colors. No really, I just like to see the pressures over time.

tillymarigold · Post by **tillymarigold** » Sat May 26, 2007 8:30 am

It was my first night with it too, it was noisy but other than that the machine was fine; my problem was my mask! It logged 7 hours of being on and only 4 of sleep. My dang masks (all 3 of them--CL2 both with Pillows Cushion and Direct Seal Cushion, and the Hybrid) just wouldn't stop leaking.

Adrian · Post by **Adrian** » Sat May 26, 2007 9:52 am

ln 1 means large leak. I get this message when I turn the machine on without putting the mask.
For the settings I would suggest you to lower the maximum pressure to titration pressure +1. Also turn off IFL1 and see the result.
If you have the software you can monitor the activity very well.
There are some good topics regarding 420E. You can search for 420E.

Adrian

MrPaul · Post by **MrPaul** » Sat May 26, 2007 2:41 pm

Hi All,

OK I knew this was user error, I did something totally stupid in setting up the machine, so pretty much my fault.

I was able to go back to sleep for a few hours with the machine properly setup and got the below. Does everything look OK? Are the leaks and number of apneas acceptable? Any suggestions on setting changes?

tillymarigold · Post by **tillymarigold** » Sat May 26, 2007 3:10 pm

MrPaul wrote:Hi All,

OK I knew this was user error, I did something totally stupid in setting up the machine, so pretty much my fault.

I was able to go back to sleep for a few hours with the machine properly setup and got the below. Does everything look OK? Are the leaks and number of apneas acceptable? Any suggestions on setting changes?

Did you forget to plug in the pressure-sensor line? I got that error when I did that.

Personally I'm planning to sleep with mine a few more times before making any changes.

Your numbers look good, although you are snoring, and your FLs are pretty high.

As to leak rate, depends on your mask. Your average was about 33lpm (.55lps*60), what's the projected leak rate on your mask for your pressure?

Snoredog · Post by **Snoredog** » Sat May 26, 2007 7:34 pm

the tiny sensor line needs to be connected to the barb next to the main hose outlet. You don't have to push it on that far.

Via Silverlining software, select the center connection option then select "Settings", click on the Advanced button and "uncheck" the iFL1 box (top one).

I would put your Minimum pressure 1cm below your titration pressure not 1 above it.

rested gal · Post by **rested gal** » Sat May 26, 2007 9:09 pm

I don't think I'd turn IFL1 off quiiiite yet. I'd set the range at 7 - 17 or 8 - 17.

MrPaul, can you post a screenshot of the "Detailed" report after your next download...specifically a picture of the most recent session on the 96 hour graph after you hit the magnifying glass icon below the graph to increase the size of the graph.

Thanks.

MrPaul · Post by **MrPaul** » Sun May 27, 2007 10:31 am

First thanks for all the help.

Here's what I have from yesterday. The first set of Data from the detailed report is bogus since I screwed up the connection of the pressure sensor line.

I think the leaks are OK, the mask says it should be around 29-31, so I don't think I'm too far off there (I'm guessing 10-20% isn't a big deal there). My wife did say I was blowing a lot of air out of my mouth if I was sleeping on my back but that I didn't snore. Does that show up on the below? One of the things I'm concerned about is finding out if I need to either get a full face mask or a chin strap, does the data show that as being needed? Also given the below #s are the number of Apneas/Hyponeas something to be concerned about?

MrPaul · Post by **MrPaul** » Mon May 28, 2007 6:09 am

OK Here's a report of an actual full night's sleep (actually I hardly ever sleep more then 7 hours, but decided to go to bed real early last night). So on these reports (and if this is explained somewhere feel free to tell me to RTM), Are there a total of 10 Apneas (6 Apneas + 4 Apneas/CA) or just a total of 6? Same question for Hypopneas. What's considered an acceptable number of Apneas/Hypopneas in a night? And any suggestion on how to improve the numbers?

Daffney_Gillfin · Post by **Daffney_Gillfin** » Mon May 28, 2007 7:29 am

MrPaul wrote:OK Here's a report of an actual full night's sleep (actually I hardly ever sleep more then 7 hours, but decided to go to bed real early last night). So on these reports (and if this is explained somewhere feel free to tell me to RTM), Are there a total of 10 Apneas (6 Apneas + 4 Apneas/CA) or just a total of 6? Same question for Hypopneas. What's considered an acceptable number of Apneas/Hypopneas in a night? And any suggestion on how to improve the numbers?

Do you feel like you got a good night's sleep? Did you wake up often?

The two detailed reports that you posted look suspiciously similar. At the bottom of the detailed report page are a set of arrows. Push the > or >| (I hope that doesn't turn into an emoticon) to get to the right section of the details. There will be 96 hours of details once you use it that long. You're showing the first 12 in both screenshots.

Anything less than 5.0 AHI is considered normal. Your acceptable number may be a different number dependent on how you feel.

I'm jealous if that was 10 straight hours. I haven't been able to do that in years.

MrPaul · Post by **MrPaul** » Mon May 28, 2007 12:08 pm

I'll see if I can get a better graph, I just used did a Print to PDF and had hoped it'd get the entire 96 hour graph, but apparently not.

I think it was 10 hours straight, I'm sure I got up for a few seconds here and there during the night but don't remember any big periods of being awake.

I really like the new machine vs my old HC220, having the ability to actually see that its working is pretty cool. I haven't even unpacked the humidifier yet and it hasn't bothered me, so not sure if that's because its been extra humid here lately or the lower pressure (because of the APAP) is making my airways dry out less.

MrPaul · Post by **MrPaul** » Mon May 28, 2007 2:24 pm

Here's the corrected detailed report for last night

So if I understand things correctly I have a relatively few number of events spread out through-out the night, but a lot of snoring and Runs? What exactly are Runs and should I be concerned about them?

tillymarigold · Post by **tillymarigold** » Mon May 28, 2007 4:07 pm

MrPaul wrote:Here's the corrected detailed report for last night

So if I understand things correctly I have a relatively few number of events spread out through-out the night, but a lot of snoring and Runs? What exactly are Runs and should I be concerned about them?

A run is a series of 3-4 Flow-Limited breaths. For many people, it's due to an obstruction; for some, the machine is misinterpretnig normal (but shallow) breathing as a flow limitation. So maybe you should and maybe you shouldn't, in other words.

Not being a doctor, I couldn't begin to guess which ones you have; though my general feeling on the subject is, if raising the pressure *slightly* ends the run, then it's probably obstructive; if the pressure keeps going up and up and the FL never ends, it's probably just the machine misinterpreting your normal breathing patterns.

BTW that misinterpretation is supposed to be a fairly common problem with P-B machines; however, FLs are my main breathing problem with my UARS (with the machine, my AHI is usually about 1 and my run index is usually about 5-6), and the machine is responding to them perfectly.

tangents · Post by **tangents** » Tue May 29, 2007 7:23 am

Hi Mr. Paul,

I'm not medically trained, so the following is just my opinion, and I'm not a veteran papper, either, so take it for what it's worth.

I think your graphs show a pretty wild night. I would narrow your pressure settings - raise the lower at least, to your titrated pressure minus 2. I would also consider another mask or a modificaiton to your current mask arrangement, as yours is leaking on and off throughout the night, causing the machine's pressure to go wonky. You want to reduce the number of "Runs" you get during the night, as that's going to give you a more restful sleep. Just my opinion. I get your sort of graph when I use the hybrid mask, which I really like, but when I switch back to my nasal pillows everything "flatlines" again, so that's a better interface for me.

Good Luck,
Cathy