Newbie to CPAP - Welcome advice and comments!

[avaholic]

These up and down AHI readings are kind of frustrating. AHI 4.59 Friday night, 8.10 Saturday night, 2.49 Sunday night, and then back to 8.93 on Monday night. I notice that under the Session Information section there are multiple sessions listed for most nights. For instance, last night there are 4 shown; 1 - 47m, 2 - 33m, 3 - 2h13m, 4 - 3h1m. Is there an explanation for this session section? How about a legend for the colors shown? I did get up at 10:23 and 10:57 to adjust my mask but I know that I was asleep at some point during the middle yellow section lasting 2h13m. Why the break in those last 2 sessions? I did not get up during the middle of the night at 1:13 am.

I also notice I have a tremendous leakage problem. I've ordered one of the Eliminator neck supports from Amazon to hopefully help with this issue. Any tips on correcting this huge leakage problem?

Finally, I have developed a pretty large open wound on the bridge of my nose. I've seen several different 'bridge of the nose' products available; ResMed Gecko, Respironics LiquiCell, etc. Do any of these actually work to protect the nose while keeping a good seal? I'm fairly sure my leak is at the bottom of my jaw not on my nose so I don't want to add to any leakage.

Thanks,

Chris

Sunday

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Monday

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[SoftwareDev]

1. Believe it will work and trust your brain to breathe.
2. Expect some weird experiences. You will get past them.
3. Press tongue against roof of mouth to stop mouth air. It will be weird at first but become natural. At 1 week my throat felt weird. It passed.
4 Use just a nasal pillow if you can. It is much less obstrusive and worth the practice.
5 use all good sleep habits. Bed on time, good pillow to allow positioning, low or no light, TV off, comfortable clothes, no food or drink just before bed except as needed to calm stomach.
6. Practice making mask comfortable. Breathe through just the short end piece to adjust.
7. Get a CPAP with good flex so it stops pressure as you breathe out. If they give you a cheap unit with continuous force, tell them the problems it causes to justify a good one. I’m using an older model DreamStation and plan to buy my own.
8. I am comfortable making small adjustments like experiment with .5 and 1 cm H2O higher. Not really a recommendation. But not a sin.
9. Verify tubing and mask are set right. Mask setting is written on mask, such as “x2”. Delivering agency had mine set wrong.
10. Learn to clean it.
11. Use fresh distilled water daily. Pour it out every AM. Remove mask and let both dry. Clean before bed. I clean nightly with HOT distilled water.

[avaholic]

Last night I had a little better leak rate. I also notice there is a break in the sleep session again. I was definitely asleep at 1:14 am. Is there a setting in the software that splits the sessions at a certain time of night?

There is bunch of stuff going on in all of these sessions. Am I doing something wrong?

Tuesday

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[Jas_williams]

There have been users of the Philips machines who have had random session breaks. Can you try unplugging and plug back in ? Beyond that I don't have any suggestions it seems to be a machine issue rather than sleepyhead.

[avaholic]

The machine is unplugged everyday when I wake up in the morning because I don't want it powered on all day long. So I have an issue with the device?
Note that the session has no empty time when it breaks while I'm asleep. For instance, it broke at 1:14:09 and then came back at 1:14:10.

[Pugsy]

Is there a setting in the software that splits the sessions at a certain time of night?

No setting that is doing this.

There have been a few Respironics machines doing this multiple session thing when the person for sure didn't turn the machine off.
We never could figure out what the problem was or a solution. It seems to be related more to a software issue and I have seen machines record as many as 30 to 50 sessions and totally messed up. The one I personally had my hands on ended up going back because of warranty issues because it started also dropping old data long before it was supposed to be dropped.

I would notify whomever you got the machine from that there is a potential problem here. The only time it should start a new session is when the user turns the machine off....or the machine turns itself off if auto off is enabled and the user removes the mask...this normally takes about 60 seconds after mask removal.

While it may not be a critical issue I always felt that if a machine had a software issue recording correct sessions...I wondered what else might not be recorded properly or correctly. Makes me doubt the machine's reported data of any kind.

And yes...your machine is doing what all the others did with the multiple sessions...that one second break.
When we first saw it we wondered about brown outs or electrical power blips but if the other stuff in your hose isn't showing it...like the microwave clock needing to be reset...can't blame power brown out or surges.

Yours isn't as bad as some that I have seen but I don't like any of it myself. These machines shouldn't be doing this for what we pay and expect from them. I would be bitching to the supplier.

[avaholic]

I figured out my leak problem. It was the mask. Wednesday I visited my DME once again to check for proper fitment of the Air Fit F10 I was using and the tech I worked with gave me the Air Touch F20 to try. WOW! I noticed a big difference immediately. With its memory foam cushion, I have a complete seal around my face and for the past 3 nights have had negligible leakage! Yeah!

I'm still having wildly fluctuating AHI readings and I'm also still seeing the one second drop of the CPAP unit while asleep. Wednesday night I slept fairly well and felt pretty good on Thursday. Thursday night was horrible. I woke up at 1 am on the dot after a bad dream. Looking closer at the Flow Rate graph just prior to 1 am, it looks similar to the images I've seen of Cheyne–Stokes respiration. What do you think?

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Friday night was a great night and I felt really good today.

I guess its one day at a time until my 1 month check up...

Thursday

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Friday

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[Pugsy]

I think that the bulk of the flagged events shown on that first zoomed in section pretty much look like they are all SWJ events.
No where near looking like Cheyne Stokes Respiration to me.
Essentially awake events and thus they don't count in the grand scheme of things.
You have to be asleep for the events to be real and matter.

[avaholic]

Thanks! I didn't understand what you were referring to at first but then found:
viewtopic/t114600/A-classic-example-of- ... thing.html.

Moving the timeline a little further to the left shows I actually awoke between 12:05 and 12:10. Correct?

Not Cheyne–Stokes just SWJ.JPG (73.94 KiB) Viewed 2337 times

Whew! I now feel much better about that!

[Pugsy]

Moving the timeline a little further to the left shows I actually awoke between 12:05 and 12:10. Correct?

That's what it looks like to me. You may or may not have been aware or remember the awakening/arousal.

Here's a good example in an easy to see report of asleep and awake breathing and events associated with the arousals.
I ran this person's reports by a sleep tech to see if I was missing something...He agreed...pretty much all SWJ and not real events.
It does go along with this person's sleep study which actually said AHI less than 1.0 so no OSA diagnosis but a lot of spontaneous arousals which mean no known cause...crappy sleep quality but don't know why.

[avaholic]

Gotcha. Appreciate the further details.

Last night was OK i guess. One question I do have regarding the first part of the night. From 10:30 pm until about 10:55 pm, I was awake but in the dark and trying to sleep. I got up at 11 pm to go the restroom, laid right back down and did not get up for the rest of the night. Is it better to DISABLE that first non-sleeping session to get a better graph of my real numbers?

Do you have any suggestions on getting my AHI lower than 4-6? That seems to be the best average I've landed so far.

Also, usually when I wake up there is a small bit of water in the bottom of the humidifier bin. Is that something that I should be concerned about?

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Saturday

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[Pugsy]

I would turn off that first session so that the overall numbers won't include known awake flagged events. Will help lower the numbers a little.

For the others...you have to remember that if those events aren't real and are instead awake flagged events they don't count and you can't do anything about them short of trying to fix the problem of being awake and causing them to get flagged in the first place. Often easier said than done.

So first thing you have to figure out would be are those flagged events asleep events and maybe fixable with more pressure...or are they awake/arousal flagged events.

To help you learn to figure out awake vs asleep breathing.
http://freecpapadvice.com/sleepyhead-free-software

Then you have to remember that CA/Central apnea events aren't fixable with more pressure with your machine...so you sort of have to mentally set those events aside. You can't do much about them anyway if they are real or not other than if you were awake then again work on why you were awake.

With the RERAs..and the OAs, hyponeas and flow limitations...assuming they are real and you were asleep...more minimum pressure is needed.

I looked at a report of mine the other day where the AHI was 1.6 over 5 hours I think it was. A mixture of centrals and OAs...but every single one of them was definitely a post arousal/awake event flagged after awake breathing was seen. They weren't real and actually probably reflected a poor night of sleep in general...lots of back pain...lots of tossing and turning and remembered arousals...and ended up being a short night because I simply couldn't sleep anymore.
To fix the problem I need to deal with what is causing the crappy sleep and it's not the OSA...it's the other health issues causing the back pain.

When you decide to fix a problem...make sure the problem is fixable with whatever you are planning to do to try to fix it.
More pressure won't fix centrals unless you move up to one of those special high end machines that can breathe for you.
More pressure won't fix awake flagged events.

If you are unsure as to status of flagged events awake vs asleep...you can simply try more minimum pressure and see what happens. Remember...only OAs, hyponeas, RERAs, Flow limitations and snores can be expected to reduce in numbers (assuming asleep flagged events) and you really aren't going to impact centrals/CAs with more pressure.
If you can turn off known awake sessions...turn them off (click on the session to change it from green/black to red/black) so at least those numbers aren't muddying up the evaluation.

[Pugsy]

There shouldn't be any water in the humidifier bin where you put the water chamber.

[avaholic]

There shouldn't be any water in the humidifier bin where you put the water chamber.

Hmmm. There pretty much has been a few drops in the bin like the above pic every night I've used the machine. I put water in the chamber and let it sit for an hour or so during the day to see if there was leak somewhere but it produced nothing. Where could this water be coming from? Could water get pushed out of the chamber if I cough or exhale really hard while the mask is on?

[Pugsy]

Might be some condensation happening on the outside of the water chamber similar to a can of soda or beer that "sweats" on my nice wood table which ends up getting someone in trouble for making a water ring on my nice wood table.
If just a small maybe teaspoonful...maybe just wipe it out with a paper towel or something....and keep one eye on things.
I have never had that happen to me with my Respironics machines but then I have never used a DreamStation either.
You might ask your DME about it just to alert them to the fact just in case something ever happens and it's a lot more than a teaspoon.