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General Discussion on any topic relating to CPAP and/or Sleep Apnea.
vidiot
 
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SleepyHead analysis needed for Newbie

Postby vidiot on Sat Sep 14, 2013 8:57 pm

I would like to ask an expert in reading SleepyHead graphs to look at the image below. I am a newbie and this is from my third night. I am having a lot of leaks that are waking me up. From what I read, this may not be unusual. If so, just tell me so. But perhaps here in the data is something useful you can tell me that I can change. Or maybe just tell me I'm doing everything I can. I did read the post on leaks from Pugsy, but let's just say I am still on CPAP overload and not all of it makes sense right now. If you would like to see my journey so far, which isn't exactly stellar, nor encouraging, look at my post at http://www.cpaptalk.com/viewtopic.php?f=1&t=92179&p=849920#p849920

Anyway, here's the image. Analyze away.
Image

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Stormynights
 
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Re: SleepyHead analysis needed for Newbie

Postby Stormynights on Sat Sep 14, 2013 9:18 pm

I think if you raised your minimum pressure to 6 it would be an easy enough adjustment. Try that for a night or 2 and then go from there.

_________________
Mask: AirFit™ P10 For Her Nasal Pillow CPAP Mask with Headgear
Humidifier: S9™ Series H5i™ Heated Humidifier with Climate Control
Additional Comments: Pressure EPAP 5.8 IPAP 9.4-21.8 PS 3.6/16 S9 Vpap Adapt ASV

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Pugsy
 
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Re: SleepyHead analysis needed for Newbie

Postby Pugsy on Sat Sep 14, 2013 10:17 pm

Have you read Janknitz's hints on taming the Quattro? If not, take a look to see if something there might help you with the leaks.
http://maskarrayed.wordpress.com/taming ... e-quattro/
Also have you seen the fitting video in case there is something there that might help?
http://www.cpaplibrary.com/full-face-masks.html

Your sleep is obviously extremely fragmented due to the leaks waking you up.
The leaks aren't horrible in the sense of being extremely large except that one time frame where it was pushing 60 L/min and even that is not quite into large leak territory but the fact that the leaks are waking you up even if small creates a problem.
Maybe try a mask liner?

Be sure to check the sizing guide to make sure you have the correct size. There's a template you can print off to use to check size.
http://www.resmed.com/us/assets/html/ma ... lates.html

Finally...the Quattro may not be the right mask for you. Normally DMEs will all mask swapping within the first 30 days of therapy...actually the mask manufacturers offer the 30 days per mask but most DMEs opt to make their own in house rules.
Check with your DME to find out what their policy is and make use of it. Try a different mask...don't spend a huge amount of time on this mask....you can always come back to it. Don't use up all your mask swapping time with one mask trying to make it work.

I suspect that the events showing on the graph have a good number of awake events flagged because the machine doesn't know if you are asleep or not. For this reason with all the wake ups and fragmented sleep it makes it difficult to know if what we see is worth worrying over or not.

You are using APAP mode with auto adjusting pressures. The changing pressures also makes it difficult to get and keep a good seal. You fit it for 5 cm and later it goes up to 8 or 9 and full face masks are just harder to keep a good seal due to the area that needs to be sealed...add in changing pressures and it makes things worse.
You might try increasing the minimum just a little to see if the pressure will stabilize a bit and lessen the chance that the pressure increases are making the leaks worse.

So limit the range a little...try a mask liner...try fitting the mask to say 8 or 9 cm pressure instead of 5...try a different mask.

_________________
Machine: PR System One REMStar 60 Series BiPAP Auto with Bi-Flex
Mask: TAP PAP Nasal Pillow CPAP Mask with Improved Stability Mouthpiece
Humidifier: PR System One 60 Series Heated Tube Humidifier with Heated Tube
Additional Comments: S9 Adapt SV being tried now...not available as menu choice
SleepyHead download site
http://sleepfiles.com/SH/
Pugsy's Pointers Collection (has both software hints and data tutorial links)
http://www.cpaptalk.com/viewtopic/t8900 ... ction.html
Robysue's SH install
http://tinyurl.com/knaqaxh

jweeks
 
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Re: SleepyHead analysis needed for Newbie

Postby jweeks on Sat Sep 14, 2013 10:20 pm

Hi,

If you look closely at the pressure level when each of the events occurs, notice that the majority of events happen when the pressure is at 5, and events mostly stop happening after the pressure goes up to as little as 6. This suggests that your lower pressure is too low. If this was my data, I would consider moving it up to 6 or 7.

-john-

_________________
Mask: Swift™ LT Nasal Pillow CPAP Mask with Headgear
Humidifier: HumidAire H4i™ Heated Humidifier
Additional Comments: Converted from M-Series BiPAP Auto To ResMed VPAP 25 Auto In March, 2010

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robysue
 
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Re: SleepyHead analysis needed for Newbie

Postby robysue on Sat Sep 14, 2013 10:32 pm

vidiot wrote:II am having a lot of leaks that are waking me up. From what I read, this may not be unusual. If so, just tell me so.
Overall, the leak line is pretty good. Except for the period between about 0:10 and 0:40, your leak line is pretty much right where it should be:

The upper (greenish) leak line is TOTAL leaks and this includes the intentional venting from the mask so that you do not rebreathe CO2. The TOTAL leak line is nice and flat except for than one 30-minute bump that starts a bit after midnight AND it's about where we would expect the TOTAL leak line to be for someone using your mask. Note that when the pressure increases, we expect a corresponding increase in TOTAL leaks because the built-in leak rate increases as pressure increases. The TOTAL leak increases between 3:00 and 3:20, between 3:30 and 3:55, between 4:00 and 4:20, and bewteen 4:20 and 4:45 all appear to be nothing more than "increased INTENTIONAL vent rates caused by the increase in pressure

The [i]lower
(purple) leak line is EXCESS leak (the bad kind). And except for that one 30-minute period, it's hovering right around 0.0 L/min.

So if it's UNINTENTIONAL leaks that are waking you up, then those leaks are for the most part small enough to NOT be flagged as significant amounts of UNITENTIONAL leaking. And even the largest and longest of your leaks---the 30-minute leak between between 0:10 an 0:40 is relatively speaking not all that large. If you looked at this night in Encore Basic, my guess is that Encore would not flag any of your leaks as Large Leaks---leaks that are large enough to cause the machine problems with its algorithms, both for increasing or decreasing the pressure AND for flagging events.

That's not to say that leaks might be causing you problems.

When a leak wakes you up, where is the leak coming from? Is it possible that what you're identifying as a "leak waking you up" is simply the increase in the exhaust flow once the pressure is starting to increase?

[quote]But perhaps here in the data is something useful you can tell me that I can change. [\quote]I'm working on the theory that it's the increase in pressure (or the increased exhaust flow that comes with the increase in pressure) that's waking you up. Which leads to the question: Why is the machine deciding you need more pressure and rather aggressively increasing the pressure?

In other words, I'd be interested in seeing a zoomed in version of the wave flow data, the leak data, and the pressure level data for the following time periods:

1) The big real leak that occurs at 0:10 to 0:40.

2) The pressure increase between 3:00 and 3:20. (There's a clear wake since you turn the machine off and on at the end of this period.)

3) The pressure increase between 3:30 and 3:55. (There's a clear wake since you turn the machine off and on at the end of this period.)

4) The pressure increase between 4:00 and 4:20. (There's a clear wake since you turn the machine off and on at the end of this period.)

5) The pressure increase between 4:20 and 4:45. (You don't appear to wake up at the end of this pressure increase. However, it looks like you may have been awake during most of this time period.

_________________
Mask: Swift™ FX Nasal Pillow CPAP Mask with Headgear
Humidifier: PR System One Heated Humidifier
Additional Comments: PR System One REMstar BiPAP Auto (Series 50). Max IPAP = 8, Min EPAP=4, and Rise time setting = 3

vidiot
 
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Re: SleepyHead analysis needed for Newbie

Postby vidiot on Sun Sep 15, 2013 11:52 am

jweeks wrote:Hi,

If you look closely at the pressure level when each of the events occurs, notice that the majority of events happen when the pressure is at 5, and events mostly stop happening after the pressure goes up to as little as 6. This suggests that your lower pressure is too low. If this was my data, I would consider moving it up to 6 or 7.

-john-
I'm not sure how to do that on my machine. I can't find a setting for it. Could it be disabled by my DME?

Thanks,
Vidiot

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kaiasgram
 
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Re: SleepyHead analysis needed for Newbie

Postby kaiasgram on Sun Sep 15, 2013 11:59 am

vidiot wrote:
jweeks wrote:Hi,

If you look closely at the pressure level when each of the events occurs, notice that the majority of events happen when the pressure is at 5, and events mostly stop happening after the pressure goes up to as little as 6. This suggests that your lower pressure is too low. If this was my data, I would consider moving it up to 6 or 7.

-john-
I'm not sure how to do that on my machine. I can't find a setting for it. Could it be disabled by my DME?

Thanks,
Vidiot

Good tutorial here (I believe your machine is the last one on the page, scroll down): http://www.cpaplibrary.com/machines.html
A little past the halfway point they demonstrate how to access the clinical menu where the pressure settings are. :)

_________________
Machine: S9 VPAP™ Auto BiLevel Machine
Mask: Aloha Nasal Pillow CPAP Mask with Headgear
Humidifier: S9™ Series H5i™ Heated Humidifier with Climate Control
Additional Comments: SleepyHead software on Mac OSX Snow Leopard
Video tutorials for most commonly used CPAP/APAP machines: http://www.cpaplibrary.com/machines.html
How to take a screenshot on a Mac: http://support.apple.com/kb/ht5775

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Pugsy
 
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Re: SleepyHead analysis needed for Newbie

Postby Pugsy on Sun Sep 15, 2013 12:04 pm

With as many wake ups that you are having it's nearly impossible to judge the effectiveness of your minimum pressure because we don't know if you were awake or not when the events were flagged. The machine doesn't know if you are awake or not.

That said...if that 5 cm pressure is a tad too low and IF maybe you aren't feeling like you are getting enough air (comfort wise) a little increase in that minimum might help.
At this point with the number of wake ups that are shown we just don't know if what is being flagged is awake or asleep breathing and if awake breathing...it doesn't count.

I will send you a private message in a few minutes with a link to the provider manual for your machine so that you can know how the inner workings of your machine go.
There is no official "locking out" feature. It's just a matter of knowing the secret combination to getting into the clinical setup menu where all the setting choices are available.

Watch the video kaisagram suggested...it along with the manual should explain things sufficiently. If not...just ask.

_________________
Machine: PR System One REMStar 60 Series BiPAP Auto with Bi-Flex
Mask: TAP PAP Nasal Pillow CPAP Mask with Improved Stability Mouthpiece
Humidifier: PR System One 60 Series Heated Tube Humidifier with Heated Tube
Additional Comments: S9 Adapt SV being tried now...not available as menu choice
SleepyHead download site
http://sleepfiles.com/SH/
Pugsy's Pointers Collection (has both software hints and data tutorial links)
http://www.cpaptalk.com/viewtopic/t8900 ... ction.html
Robysue's SH install
http://tinyurl.com/knaqaxh

vidiot
 
Posts: 15
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Gender: Male

Re: SleepyHead analysis needed for Newbie

Postby vidiot on Sun Sep 15, 2013 2:58 pm

robysue wrote:
vidiot wrote:II am having a lot of leaks that are waking me up. From what I read, this may not be unusual. If so, just tell me so.
Overall, the leak line is pretty good. Except for the period between about 0:10 and 0:40, your leak line is pretty much right where it should be:

The upper (greenish) leak line is TOTAL leaks and this includes the intentional venting from the mask so that you do not rebreathe CO2. The TOTAL leak line is nice and flat except for than one 30-minute bump that starts a bit after midnight AND it's about where we would expect the TOTAL leak line to be for someone using your mask. Note that when the pressure increases, we expect a corresponding increase in TOTAL leaks because the built-in leak rate increases as pressure increases. The TOTAL leak increases between 3:00 and 3:20, between 3:30 and 3:55, between 4:00 and 4:20, and bewteen 4:20 and 4:45 all appear to be nothing more than "increased INTENTIONAL vent rates caused by the increase in pressure

The [i]lower
(purple) leak line is EXCESS leak (the bad kind). And except for that one 30-minute period, it's hovering right around 0.0 L/min.

So if it's UNINTENTIONAL leaks that are waking you up, then those leaks are for the most part small enough to NOT be flagged as significant amounts of UNITENTIONAL leaking. And even the largest and longest of your leaks---the 30-minute leak between between 0:10 an 0:40 is relatively speaking not all that large. If you looked at this night in Encore Basic, my guess is that Encore would not flag any of your leaks as Large Leaks---leaks that are large enough to cause the machine problems with its algorithms, both for increasing or decreasing the pressure AND for flagging events.

That's not to say that leaks might be causing you problems.

When a leak wakes you up, where is the leak coming from? Is it possible that what you're identifying as a "leak waking you up" is simply the increase in the exhaust flow once the pressure is starting to increase?

But perhaps here in the data is something useful you can tell me that I can change. [\quote]I'm working on the theory that it's the increase in pressure (or the increased exhaust flow that comes with the increase in pressure) that's waking you up. Which leads to the question: Why is the machine deciding you need more pressure and rather aggressively increasing the pressure?

In other words, I'd be interested in seeing a zoomed in version of the wave flow data, the leak data, and the pressure level data for the following time periods:

1) The big real leak that occurs at 0:10 to 0:40.

2) The pressure increase between 3:00 and 3:20. (There's a clear wake since you turn the machine off and on at the end of this period.)

3) The pressure increase between 3:30 and 3:55. (There's a clear wake since you turn the machine off and on at the end of this period.)

4) The pressure increase between 4:00 and 4:20. (There's a clear wake since you turn the machine off and on at the end of this period.)

5) The pressure increase between 4:20 and 4:45. (You don't appear to wake up at the end of this pressure increase. However, it looks like you may have been awake during most of this time period.

Thanks for taking a look at the graph for me! Here are the five zoomed in portions that you mention. However, they are "advanced" an hour, since I have had a time zone change now, that apparently SleepyHead doesn't account for.

Image

Image

Image

Image

Image


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