pressure storms?

[papnapper]

Apart from minor leaks, it seem that every night I have up to three instances when I am woken by leaks and faffing sounds so strong that they cannot be fixed by tightening the straps. I can feel the pressure in my mouth. The machine is an ICON auto and said to be set to max at 20.

I suppose that I can request the max be set lower but fear that the machine is going so high e.g. to overcome e.g. "Centrals"

Thanks

[Alshain]

Doubtful that it goes that high for centrals. What pressure are you starting at? Without knowing more I would bet the range isn't set right. I had the same problem, except I wasn't even supposed to be in auto at all

[robysue]

Apart from minor leaks, it seem that every night I have up to three instances when I am woken by leaks and faffing sounds so strong that they cannot be fixed by tightening the straps.

It could be that tighteing the straps is making the bad situation worse. Have you read JanKnit's Taming the Mirage Quatrtro. Not your specific mask, but a lot of the tips would work for your mask too.

I can feel the pressure in my mouth. The machine is auto and said to be set to max at 20.

I suppose that I can request the max be set lower but fear that the machine is going so high e.g. to overcome e.g. "Centrals"

Thanks

You don't want the machine raising pressure for centrals. A couple things come to mind:

1) Mask leaks can lead to the machine pushing more air into the (leaky) system in an effort to maintain the correct therapeutic pressure. (It's rather like trying to keep a leaky bicycle tire at full pressure by continually pumping more air into the tire to overcome the air that's leaking out.) When a machine starts pumping more air into the leaky system, it can feel like the machine is simply increasing the pressure to the user. So an important question to answer is: Which comes first? The bad leaks (with the farting noises) or a real increase in pressure? The only way to determine that is to be able to look at the leak data and the pressure data together. Numbers on the Icon's LCD won't be enough. But, alas, near as I know, none of the Icon users have been able to obtain the software for their full data machines. You could ask your DME to download ALL available data and make a printout for yourself. Any Icon users know what the printed version of the data actually looks like?

2) If the pressure is increasing first (and that triggers the leaking), then what's triggering the increase in pressure? Obvious place to start is your AHI. How high is it on the bad nights? But even if the AHI is under 5, it's possible that you're having some kind of nasty clusters of events over a long enough time frame to cause the pressure to increase. Or it could be snoring or flow limitations that are triggering the pressure increase. But again, the only way to tell for sure is to look at the full detailed data that shows when the events for the night occur and when the pressure increases happened.

[Janknitz]

If the pressure is increasing first (and that triggers the leaking), then what's triggering the increase in pressure? Obvious place to start is your AHI. How high is it on the bad nights? But even if the AHI is under 5, it's possible that you're having some kind of nasty clusters of events over a long enough time frame to cause the pressure to increase. Or it could be snoring or flow limitations that are triggering the pressure increase. But again, the only way to tell for sure is to look at the full detailed data that shows when the events for the night occur and when the pressure increases happened.

Something RobySue did not mention is that the higher pressure could be caused by too-wide a pressure setting, causing your machine to always have to "chase" the leaks. If it's set 4 to 20, for example, it will try to stay at 4 unless you are having an event. But the pressure raises slowly, not abruptly, so as not to wake you. So if your pressure is 4 and you have an event that needs, say, 10 to stop it, by the time your pressure gets to 10 you could be having more events, and the pressure will go even higher to deal with them. You're always behind the 8-ball. So you should talk to your sleep doctor about narrowing the pressure range--some doctors don't understand this and think wide-open is the perfect setting because it will "catch everything". In reality it will NOT.

[robysue]

Something RobySue did not mention is that the higher pressure could be caused by too-wide a pressure setting, causing your machine to always have to "chase" the leaks. ...

I knew I needed to add something else, but couldn't remember what it was or how to describe it ...

Thanks for adding this tidbit that I should have included!

[Janknitz]

Roby Sue, you're slipping!

Must be that you're still in summer mode.

[robysue]

Roby Sue, you're slipping!

Must be that you're still in summer mode.

For four more glorious weeks

[papnapper]

Thanks everyone for your knowledgeable input. I have made quantum leaps in understanding.

I have been logging the ICON's screen data in a spreadsheet but I only have a week of data, and have been struggling to understand what is going on. e.g. one night I the AHI was 1 (ONE) which I seriously doubt as the others ranged between 31.8 and 5.3. I now know to examine the leak & pressure data and try to correlate.
Luckily I copied the data off the ICON usb immediately after I had one of the "pressure storms" so hopefully we can easily pinpoint what was going on to cause it. I am going to the apnea services people tomorrow so am looking forward to what their software reveals.

I will get a printout. If it appears to be valid I will post. (I had one of a few days before but it was suspect as the usb data appeared to be corrupted, so we started over, which is what I have now.)

Having your own software seems a basic to me and it is a shame the ICON does not cater to this as I like the machine's heated humidifier tube. The services people readlily offer other machines (and masks) to trial so perhaps I will return with a Resmed 9.

[archangle]

Look at the display and note the pressure whenever something strange happens.

[papnapper]

I expected to get my results on 29th July but it didn't happen until the 11th AUGUST.

You were all probably correct.
I do not get "centrals"
I was getting clustering of leaking corresponding to high pressure when I had the storms.
Re-examining my titration report I realised that events are more than double when on my back. Since avoiding that position I have had ZERO storms.
As I like to lie on my back I will ask the specialist (in October) about the narrowing-the-range idea. Up until two days ago it was 5 to 20 on the ICON and presently it is 5 to 15 in an attempt to reduce leaks and that is on a Resmed9 which I am trying. The Resmed 9 display does not show actual leak data (only a smiley or grumpy face). I will know if we achieved anything in a few days.

As an aside, although the low setting was 5 for the ICON too, the Resmed doesn't seem to be blowing at all for a lot of the time whereas I was always conscious of the ICON.

[robysue]

Up until two days ago it was 5 to 20 on the ICON and presently it is 5 to 15 in an attempt to reduce leaks and that is on a Resmed9 which I am trying. The Resmed 9 display does not show actual leak data (only a smiley or grumpy face).

To see the more detailed data you need to get into the Full Sleep Report list. You do that by first getting into the Short Sleep Quality report (where you see Mr. Green Smiley Face or his brother Mr. Red Frowny Face). Then hold both the double check mark button and the info button down simultaneously for about 3 seconds. The screen will flicker. You then need to use the round knob to go down on in the menu that's currently showing and click----if I recall correctly. (It's been six months since I used the Resmed and that final step is getting a week bit fuzzy.) The correct procedure is described in the user manual (if you got one) as well as in the clinician's manual (available from Uncle_Bob). For overnight data, you have to access this screen before NOON on the S9's internal clock. It resets the daily data to 0's at that time each day.

As an aside, although the low setting was 5 for the ICON too, the Resmed doesn't seem to be blowing at all for a lot of the time whereas I was always conscious of the ICON.

Could be you're getting used to cpap. Or it could be that the S9's APAP algorithm and EPR algorithms just suite you better---that is if the "S9 doesn't seem to be blowing at all" feeling is not disturbing to you.

[papnapper]

To see the more detailed data you need to get into the Full Sleep Report list. You do that by first getting into the Short Sleep Quality report (where you see Mr. Green Smiley Face or his brother Mr. Red Frowny Face). Then hold both the double check mark button and the info button down simultaneously for about 3 seconds. The screen will flicker. You then need to use the round knob to go down on in the menu that's currently showing and click----if I recall correctly. (It's been six months since I used the Resmed and that final step is getting a week bit fuzzy.) The correct procedure is described in the user manual (if you got one) as well as in the clinician's manual (available from Uncle_Bob). For overnight data, you have to access this screen before NOON on the S9's internal clock. It resets the daily data to 0's at that time each day

.
Thanks robysue. You guessed right .. I did not get a User Manual (only a Welcome Guide which is very sketchy). I have requested a Manual. Luckily I am reading your reply before noon, and if not for you I would have missed last night's data

As an aside, although the low setting was 5 for the ICON too, the Resmed doesn't seem to be blowing at all for a lot of the time whereas I was always conscious of the ICON.Could be you're getting used to cpap. Or it could be that the S9's APAP algorithm and EPR algorithms just suite you better---that is if the "S9 doesn't seem to be blowing at all" feeling is not disturbing to you.

Once again I reckon you are on the money. I am getting to grips with papping (as is "the dreaded".. I mean that in the nicest possible way). I changed from the ICON to the C9 hoping that its " rhythms " might suit better and it looks to be the case as I have had AHIs of 1.7 - 3.0. The feeling is disturbing, but only in a good way.

Yesterday, I tried a one hour late afternoon nap only on my back and the AHI was 12, accompanied by some mask faffings i.e. the first pressure storm for weeks. I hope more pressure-range tweaking can fix.