Brand New to CPAP and STRUGGLING

[robysue1]

I have a Resmed app to check my progress with the cpap and I am curious as to what constitutes an event. I had the mask on for 1.46 hours last night and registered 6.1 events. I don’t think I even dozed while I had it on.

Your Resmed AirSense can't tell if you are awake or asleep. Since the device is designed to be used while sleeping, all of the programming for event detection is based on normal sleep breathing patterns and what goes wrong with normal sleep breathing when a respiratory event (an obstructive apnea, a hypopnea, or a central (clear airway) apnea occurs.

In other words, the machine is programed to score an apnea of some sort if it detects that is little or no air going in and out of your airways for at least 10 seconds. Resmed machines use an algorithm (called FOC) to determine whether the airway appears to be clear (i.e. open) or obstructed (blocked). The FOC algorithm uses small, rapid oscillations in pressure to determine the patency of the airway. If the results of the FOC are not clear, the event can be scored as an "UA"---undetermined/unknown type apnea.

The machine will score a hypopnea if there is a significant (sudden) reduction in airflow that lasts at least 10 seconds. By sudden, I mean that the bit of flow rate that is labeled a hypopnea shows a significant reduction in airflow as compared to the breaths that immediately precede it.

Since OAs, CAs, and Hs are scored by your machine solely based on what the machine is detecting in the wave flow data, they get scored even if you are wide awake and using the machine.

Now, a lot of people might ask---why would my wake breathing patterns contain something that could be mistaken for an OA or a CA or an H by the machine?

The answer is essentially that wake breathing is a lot less regular than sleep breathing is. We may unconsciously hold our breath for a few seconds (even 10 seconds or more) while we're concentrating on something. Or we may take a few deep, cleansing, relaxing breaths and then skip a breath or two because we exhaled a bit too much CO2, and that reduces our urge to "breath". Or after taking some deep breaths, our breathing may become shallow because we've blown off a bit too much CO2 during the deep exhalations. If we hold our breath and at the same time allow our epiglottis to close off our windpipe (like when we swallow), the FOC algorithm might very well conclude the stoppage of breathing looks like an OA and thus the machine scores it like an OA.

Now some people find that when they're awake and using the machine, they get a whole lot of events scored---those events are not real because the person was awake when they happened. And the person's normal wake breathing pattern is just so much more "ragged" than normal sleep breathing is, that the machine scores events since the machine has no idea that you're awake when you are using it. We just ignore the data that is recorded when we're actually awake.

[robysue1]

It is also strange that the cpap is there to correct these issues. I have a long way to go I suppose.

The cpap is there to prevent as many of the events as possible by making it more difficult for the airway to collapse in the first place. When xPAP therapy is optimized, most people have very few detected events: Many people on this forum consistently have treated AHI numbers that are bewtween 0.0 and 1.0. Almost everybody manages to get their treated AHI to be consistently less than 3.

If you are using an APAP with a pressure range, the machine will respond to events after they are over by increasing the pressure in an effort to make it more difficult for the airway to collapse. But even at an APAP's maximum pressure, it does not generate enough pressure to force a collapsed airway to open.

APAPs will also typically increase the pressure when they detect flow limitations and snoring since these are indications that the airway may be at greater risk of collapsing. A flow limitation is a distortion in the wave flow data that indicates the airway may have a very slight restriction---i.e. the airway may be starting to collapse, but has not yet collapsed very far. Snoring is detected by certain wave flow patterns that are known to be associated with snoring---the machine does not have a microphone so it cannot "hear" your snoring. Snoring can indicate the airway is unstable and is in danger of collapsing and that is why APAPs will increase the pressure when they detect wave patterns shapes that are associated with snoring.

[ykf7b0]

I have a Resmed app to check my progress with the cpap and I am curious as to what constitutes an event. I had the mask on for 1.46 hours last night and registered 6.1 events. I don’t think I even dozed while I had it on.

Your Resmed AirSense can't tell if you are awake or asleep. Since the device is designed to be used while sleeping, all of the programming for event detection is based on normal sleep breathing patterns and what goes wrong with normal sleep breathing when a respiratory event (an obstructive apnea, a hypopnea, or a central (clear airway) apnea occurs.

In other words, the machine is programed to score an apnea of some sort if it detects that is little or no air going in and out of your airways for at least 10 seconds. Resmed machines use an algorithm (called FOC) to determine whether the airway appears to be clear (i.e. open) or obstructed (blocked). The FOC algorithm uses small, rapid oscillations in pressure to determine the patency of the airway. If the results of the FOC are not clear, the event can be scored as an "UA"---undetermined/unknown type apnea.

The machine will score a hypopnea if there is a significant (sudden) reduction in airflow that lasts at least 10 seconds. By sudden, I mean that the bit of flow rate that is labeled a hypopnea shows a significant reduction in airflow as compared to the breaths that immediately precede it.

Since OAs, CAs, and Hs are scored by your machine solely based on what the machine is detecting in the wave flow data, they get scored even if you are wide awake and using the machine.

Now, a lot of people might ask---why would my wake breathing patterns contain something that could be mistaken for an OA or a CA or an H by the machine?

The answer is essentially that wake breathing is a lot less regular than sleep breathing is. We may unconsciously hold our breath for a few seconds (even 10 seconds or more) while we're concentrating on something. Or we may take a few deep, cleansing, relaxing breaths and then skip a breath or two because we exhaled a bit too much CO2, and that reduces our urge to "breath". Or after taking some deep breaths, our breathing may become shallow because we've blown off a bit too much CO2 during the deep exhalations. If we hold our breath and at the same time allow our epiglottis to close off our windpipe (like when we swallow), the FOC algorithm might very well conclude the stoppage of breathing looks like an OA and thus the machine scores it like an OA.

Now some people find that when they're awake and using the machine, they get a whole lot of events scored---those events are not real because the person was awake when they happened. And the person's normal wake breathing pattern is just so much more "ragged" than normal sleep breathing is, that the machine scores events since the machine has no idea that you're awake when you are using it. We just ignore the data that is recorded when we're actually awake.

Thanks for that great explanation!!! Now it makes sense to me.

[ykf7b0]

I have another question if I may.? I see in the manual sent with my new cpap machine that an Exhale Relief Pressure is an option but it is not on my cpap machine’s drop down menu. Is it possible to download this feature onto the machine?

As other posters have suggested, you need to include your equipment in your profile.

If you happen to have the Resmed Airsense 11, you go to the home screen and tap and hold both of the upper icons. The one on the right says sleep view iirc and I forget the other. It will turn grey and you can change settings there. When done hit exit and it goes back to original appearance. While you are in there select "advanced view" so you can at least see more info on your main screen when you return to regular function.

You should put an SD card in there and start monitoring your data. The myair app is crap. If you really want help you need to figure out how to upload some of the data. Use a fake name if you want and use either SleepHQ or Oscar. Someone here has a link to show you how to use Oscar and plenty of videos on youtube on how to UL to Sleephq.

HTH

Thanks a lot! I will give that a try tonight.

[ykf7b0]

I hit a new high last night with my therapy. I have been using a pillow mask for the past three nights and tolerating it a bit more. A good friend gave me an Ambien to try, and I actually slept 4.33 hours before my wife woke me up because the cpap air line was gurgling and water had somehow gotten into it. I will be using the pillow again tonight, but I don't have another Ambien to take.

[ChicagoGranny]

cpap air line was gurgling and water had somehow gotten into it

You can and should prevent that. It's called rainout. Read this wiki - wiki/index.php/Rainout

[robysue1]

I actually slept 4.33 hours before my wife woke me up because the cpap air line was gurgling and water had somehow gotten into it.

The water was from condensation of the humidity provided by your heated humidifier: As the warm moist air traveled through the tube, it got cold enough for some of that water vapor to condense. And the condensed water gathered in the lowest spot of the tube.

When this happens in the middle of the night the fix is to lift the entire hose up above the level of the humidifier tank so that the condensed water can flow back towards the humidifier chamber.

The long term fix is to prevent the condensation from happening in the first place. How to do that depends a lot on whether you are using a heated hose.

If you are using a heated hose, you can turn the hose temp up a bit as long as the additional warmth of the air does not bother you. If the additional warmth in the air temp is not comfortable, then you'll need to turn the humidifier down. As long as your nose is happy enough with the slightly less moist air, you're good to go.

If you are using a non-heated hose, you can try the following things:

• Turn the humidifier down a bit. As long as your nose is happy, this should help prevent the problem.
• Put a hose cozy on the hose. This helps insulate the hose and prevents the air inside from getting cold enough to trigger the condensation. A side benefit is that the hose cozy covers the hose in cloth so you no longer have all that plastic stuff touching your skin.
• Run the hose under your blankets. Your body's warmth will heat the hose and help prevent condensation.
• Hang the hose over head so that if there's condensation, it can run back down to the machine. The down side of this is that if the condensation happens on the mask side of the highest point in the hose, the condensed water will run down the hose and into your mask and hit you in the face. That can be worse than the gurgling sound.

Obviously you can combine these approaches. For me, my nose insists on having the humidifier set to its highest setting and I sleep in a pretty cold bedroom and use an unheated hose. But keeping the hose in a hose cozy and running my hose under the covers minimizes the problems I have with rainout. I maybe wake up every once in a while to a gurgling hose. This happens when there's a low spot in the hose between the bed and where the hose goes under my covers. I turn the machine off, lift the hose up higher than the machine, the water flows back into humidifier, and I lie back down and turn the machine back on. The whole thing takes less than a minute. As an extra prevention measure, I try to remember to make sure there's no a low spot in the hose when I go to bed. But moving around in bed sometimes allows that one part of the hose that is between the nightstand (with the machine) and the edge of the bed to sag.

If you are using a heated hose, you should read its instruction manual to find out if it's ok to put a hose cozy on or to find out if it's ok to run the hose under the covers. I can't tell you that because I don't use a heated hose.

If these simple things don't seem to fix the problem and you're getting rainout on most nights, then you may need to think about increasing the ambient humidity and/or ambient air temperature in your bedroom. If you're using forced air heat, adding a room humidifier will make the air in the room more moist and so your humidifier won't have to add as much moisture to the hose. If you like a super cold bedroom, you may need to turn the thermostat up a degree or two.

[ykf7b0]

Thanks ChicagoGranny and Robysue1!!!