Newby Question

[beepsilver]

Thanks Pugsy! Will report back results tomorrow.

[palerider]

Thanks! Unless I get feedback to the contrary, I may be so bold as to go for 8 tonight. Flow limitation was also way down last night.

See those spikes in the pressure? that means the machine thinks you were sleeping great... where there's no spikes, there's room for improvement. I think 8 would be worth it... and I'll cross my fingers that you didn't just have a better than average night last night.

Sleep does vary from night to night, (and, obviously, hour to hour) which is one of the biggest problems with titration tests, one night in an alien environment, all wired up, and then they find something that works for an hour, *maybe* of good sleep... and say "there ya go!"... only, you get home, different bed, different conditions, different sleep, and the pressure's wrong... *shrugs*.

So, that's why, when you're fine tuning, you never want to go by just one night's sleep... but I don't think you're quite to the fine tuning state... so I'd say 8 tonight too.

[beepsilver]

"See those spikes in the pressure? that means the machine thinks you were sleeping great... where there's no spikes, there's room for improvement."

Great feedback, thank you! Already set to 8 for tonight. If you can please, can you expound on why the spikes in pressure are good...or why it does spike to begin with. I do see the Hypos pop up where there are no spikes...so that's something

[OkyDoky]

Those spikes are Pulse Pressures where Respironics Machines sends out a little quick pressure increase to check out the patency of the airway. So you will see it " just checking" to make sure there is no obstruction. You will see them listed also on the left in the colored strips.

[Pugsy]

Those spikes are Pulse Pressures where Respironics Machines sends out a little quick pressure increase to check out the patency of the airway. So you will see it " just checking" to make sure there is no obstruction. You will see them listed also on the left in the colored strips.

You are confusing pressure pulses with the test pressure probes.
Those spikes aren't nearly as rapid as they look on the graphs and they aren't the little very brief "puffs" used to determine open vs closed airway.

If you can please, can you expound on why the spikes in pressure are good...or why it does spike to begin with. I do see the Hypos pop up where there are no spikes...so that's something

They aren't really as "spikey" as those increases appear on the graphs. They look like a faster increase than they are. If were were to zoom in on one of those spikes you would actually see the pressure goes up very slowly and back down just as slowly.

As to why the pressure probes mean you are probably sleeping decently...it's the way that Respironics does their algorithm. It's just testing things to see...what it looks for...beats the heck out of me.
Did you get the provider manual? It explains some of this stuff quite nicely. The user manual does not.
You can get it via email from here if you don't have one.
https://www.apneaboard.com/adjust-cpap- ... tup-manual

None of these auto adjusting machines will respond during any sort of apnea event. They will all sit by and twiddle their thumbs while the apnea event happens and then afterwards it decides (again that algorithm that they never tell us exactly what all is involved) based on what has been going on what it might need to do to prevent something from happening again.
It's never going to be able to totally prevent everything. A lone hyponea that occurs without much of anything else happening 10 minutes before or 10 minutes afterwards probably means the machine will ignore it.
Flow limitations and snores are the primary driving force for pressure changes and you may not see evidence of those so much on the reports. Clustering of apnea events will impact the driving force but random here or there apnea events not so much UNLESS they are also accompanied by some snores or flow limitations.

If you were thinking that the airway collapses and the machine thinks "OMG the airway has collapse so I increase the pressure right now to stop it and prevent it from happening again"...doesn't work that way. It can't respond fast enough to blow the airway open anyway. It does its best work preventing the airway from collapsing in the first place and being able to get to a higher pressure in a timely manner should something be causing a higher pressure. That's why the minimum pressure setting is the most critical setting.
Not how high it can go but the starting point at which it climbs.

[palerider]

"See those spikes in the pressure? that means the machine thinks you were sleeping great... where there's no spikes, there's room for improvement."

Great feedback, thank you! Already set to 8 for tonight. If you can please, can you expound on why the spikes in pressure are good...or why it does spike to begin with. I do see the Hypos pop up where there are no spikes...so that's something

So, here's my totally unsubstantiated theory, based on observation of many respironics pressure traces...

When you zoom in on the flow rate, and it's very regular and even, the respironics machine starts raising and lowering the pressure... Someone previously hypothesized that it's to see if the machine can make things better (but, says I, they're already great)... if it doesn't see any improvement (in already great breathing) then it lowers the pressure back down. Theoretically, if it does see improvement, then it'd leave the pressure there for a while.

HOWEVER... (and this is where my thinking disagrees)... If your sleep is less regular, then the machine *DOES NOTHING*, (allegedly to avoid disturbing already disturbed sleep)... it seems to me that someone programmed things backwards, some little check in the software should have been < but they typed > or something like that.

The end result is, on your type of machine, if you've got great looking even smooth breathing, the machine gets restless and bored and wants to "help", when none is needed.. fiddling with the pressure, up and down... . but when you're not sleeping great, and a little more pressure could help, it just sits there with it's figurative thumb up it's .... and does nothing...

Makes no sense to me.

[palerider]

Those spikes are Pulse Pressures where Respironics Machines sends out a little quick pressure increase to check out the patency of the airway. So you will see it " just checking" to make sure there is no obstruction. You will see them listed also on the left in the colored strips.

Pressure pulses don't show up on the pressure line, the pressure reporting on the respironics isn't good enough to show that.
Like Pugsy says, these are pressure 'probes', and I offer my theory about their existence above.

[OkyDoky]

Those spikes are Pulse Pressures where Respironics Machines sends out a little quick pressure increase to check out the patency of the airway. So you will see it " just checking" to make sure there is no obstruction. You will see them listed also on the left in the colored strips.

You are confusing pressure pulses with the test pressure probes.
Those spikes aren't nearly as rapid as they look on the graphs and they aren't the little very brief "puffs" used to determine open vs closed airway.

I guess I am confused because I thought I was getting this description from you and Robby Sue on this thread. www.cpaptalk.com/viewtopic/t67085/Press ... -mean.html

Was it the wrong name on the old thread also? Anyway I knew it was "just testing".

[Pugsy]

I guess I am confused because I thought I was getting this description from you and Robby Sue on this thread. www.cpaptalk.com/viewtopic/t67085/Press ... -mean.html

Was it the wrong name on the old thread also? Anyway I knew it was "just testing".

That thread is a bit confusing but let me give you something that might help.

Presser probes...that's where the spikey sawtooth looking things show up...those have nothing to do with the airway patency checks to determine if a reduction in air flow is central or obstruction. These are just the machine going about it's routine business most often when nothing is happening. They are up to a 1.5 cm increase (they can be less if the machine can't go higher) and decrease that takes several minutes to complete if it doesn't get side tracked and stay up for a little while.

Pressure pulses...you can't see them on the pressure graph. You can see them on the flow rate graph and they are just little dots when seen. SleepyHead will also report them if they happen unless someone has that event flag turned off. You have to look really really hard to spot the tiny dot. I forget what color they are. They are very, very brief puffs that won't even be enough to change the pressure graph itself. Think blow out one candle..that kind of puff of air. That's all it is. The machine looks for an echo of sorts.
If the airway has collapsed the puff bounces back to the sensors and the airway is obstructed...if it doesn't bounce back it's open and a central.

Help you clarify things??

[OkyDoky]

I guess I am confused because I thought I was getting this description from you and Robby Sue on this thread. www.cpaptalk.com/viewtopic/t67085/Press ... -mean.html

Was it the wrong name on the old thread also? Anyway I knew it was "just testing".

That thread is a bit confusing but let me give you something that might help.

Presser probes...that's where the spikey sawtooth looking things show up...those have nothing to do with the airway patency checks to determine if a reduction in air flow is central or obstruction. These are just the machine going about it's routine business most often when nothing is happening. They are up to a 1.5 cm increase (they can be less if the machine can't go higher) and decrease that takes several minutes to complete if it doesn't get side tracked and stay up for a little while.

Pressure pulses...you can't see them on the pressure graph. You can see them on the flow rate graph and they are just little dots when seen. SleepyHead will also report them if they happen unless someone has that event flag turned off. You have to look really really hard to spot the tiny dot. I forget what color they are. They are very, very brief puffs that won't even be enough to change the pressure graph itself. Think blow out one candle..that kind of puff of air. That's all it is. The machine looks for an echo of sorts.
If the airway has collapsed the puff bounces back to the sensors and the airway is obstructed...if it doesn't bounce back it's open and a central.

Help you clarify things??

Thanks, that does help. I had combined them into one machine response. I do see the little red marks at the top of the Flow Graph and it looks like they may be the Pressure Pulses.

[Pugsy]

One other little tidbit about pressure pulses for you Respironics users...you can have them without an event flag.
Sometimes the machine might do something like this...
there's a slight reduction in air flow...pressure pulse sent...but the event doesn't end up earning a flag because of duration most often.
Remember that to earn a flag the event (whatever kind it is) has to last at least 10 seconds and if the flow reduction that was on its way to earning a flag abruptly ends at 9 seconds...no flag.
So in theory it's possible to have a large number of pressure pulses with no event flag or very low event flag numbers.
I have seen reports from people with AHI of 1.0 with 100 pressure pulses noted. Not sure of the clinical significance of that but to my thinking that if there was something going on 100 times that the machine thought worthy of needing a pressure pulse..then maybe something is going on that even though the AHI is not much...might point to crappy sleep.

[beepsilver]

Thank you all for responding--truly helpful! I'm hopeful I can report a consistent pressure graph from tonight with fewer hypos. Those hypos bother me...and Sleepyhead reports one of them last night lasted 46 seconds....if that's accurate. Fingers crossed the bump to 8 helps achieve an even better rest--no bathroom last night and so far no midday tiredness (and it's just after 4pm). I'll do a mask fit test with the higher pressure before I head to bed.

[palerider]

They are very, very brief puffs that won't even be enough to change the pressure graph itself.

Best I remember, they're a 1cm, one second long pressure increase. I could hear it when I'd take my mask off, and the thing would blow for a minute longer, after a bit the airflow would increase a tiny bit for one second, every few seconds.

I think they're usually black dots on SH, but you've got to zoom in to where you can see individual breaths.... then you'll see them after a few seconds into an apnea.

Maybe the black dots are in encore, and the red tick marks Oky mentions are in SH... that sounds right.

[Pugsy]

Maybe the black dots are in encore, and the red tick marks Oky mentions are in SH... that sounds right.

Black dots in Encore sounds about right. We used to answer this question all the time "what are the black marks on my report" and I think that the Encore tutorial said they were black. It's been a long time and since we don't really mess with Encore much anymore I don't bother keeping that fresh in my mind.

It's actually a dark red and it's a hash mark coming down from the top of the box and it's really hard to see the color. Get 2 of them together and it's going to look black unless you zoom in.
See attachment below. I highlighted one of them and zoomed in. There's a couple more close by.

[beepsilver]

Oh my head, I don't think I've had a worse night's sleep in a LONG time--I'm not sure I can even recount what happened, but I'll try. I made the bump to 8 as discussed, but I also cut out the ramp. It seemed to take a couple of hours to get into a deep sleep and my perception at the time was that the pressure was too great--I woke up a couple of times early. At some point I woke up with a dry mouth and what seemed to be a stomach ache. In the middle of the night (after 3:20) I switched back to 7 and put the 5 minute ramp at 4 back on...to help get back to sleep quickly. Once I did that, I seemed to sleep better than I had earlier in the night, but not great. I think I'll keep the min pressure at 7 tonight so I eliminate the possibility of a repeat...I can bump it up to 8 once I get used to the increased pressure. I don't, it's possible the increased pressure comes too soon for me...I just don't know. I can say that I do like using the ramp; it gives me comfort and allows me to get to sleep right away without the force of higher pressure filling my head. Advice? Thoughts?

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