Wife Struggling...Suggestions?

[jucs]

My wife said she was having trouble even breathing normally with the mask (swift fx) and going to sleep (not an issue before for falling asleep). I looked at the data for the very short period of time (1.5 hrs) and the AHI was nearly 11. Seal was good. She has an S9 autoset and it is a ramp from 6-12. The EPR is 3. I never had this issue myself to any degree so I am not sure where to go on this. I was thinking the EPR could actually be screwing things up for her by letting off on the exhale or trying to and shutting it off.

Any other ideas where to go from here?

[Pugsy]

With EPR of 3 and settings of minimum 6 cm pressure that means during every exhale her pressure drops to 4 (won't go below 4) so really only using EPR of 2 until pressures get to 7 cm for the 3cm to kick in and with 4 cm added in the mix perhaps she is simply not getting enough perceived air movement.
Feels like suffocation..even though we aren't.
AND...the S9 smart start needs 7 cm or so for it to function properly with nasal pillow masks. This is mentioned in the manual.
So even with EPR turned off it still might not function well at the minimum of 6 cm starting pressure.

AHI 11...what is the event category break down? How much of it is centrals?
To offer any ideas about this...we need more information...like the detail report image.
Don't know how to post images of reports?
viewtopic.php?f=1&t=81072&p=737779#p737779

[robysue]

jucs,

As pugsy indicates, it may be that with an exhale pressure of 4cm your wife feels like there's not enough air coming through the mask. But even at these very low pressures, she could also simply be feeling overwhelmed by the sensation of having any air blown down her throat. Or she could be picking up the subtle increases and decreases in pressure from the EPR algorithm and that sensation is bothering her.

So it's important for your wife to figure out exactly what she means when she tells you that she is "having trouble even breathing normally" when she's put the mask on.

In other words, does she feel like she's suffocating because there seems to be too little air coming through the mask and so inhaling is difficult? Or does she feel like she's can't properly exhale because of all the air being blown down her throat even though the exhale pressure is only 4cm? Or does she feel like the machine is somehow "rushing" her to inhale (or exhale) before she is ready to?

Each one of these three problems is described by newbies as "I can't seem to breath normally", but their causes and their fixes are quite different. And increasing the min pressure will fix "I can't inhale properly", but it may make "I can't exhale properly" and "the machine is rushing me to inhale (or exhale) before I'm ready to" even worse. Complicating things even more, these three problems are not mutually exclusive. So take some time to try to help the wife figure out exactly what kind of problem she's dealing with when she says she can't breathe normally with the mask on.

[jucs]

Well, crud. SleepHead doesn't seem to want to display any graphs. The summary shows up fine. Under details there is a scroll bar, but no graphs! Ugggh. This is my first time using sleephead. Install was easy too.

[Pugsy]

In the machine's clinical set up menu....go check Sleep Quality and see if it is set to "usage" or "On"....
If it is set to "usage" that's the problem with lack of graphs. Change it to "On".
If it's already set to On...we have more detective work to do but let's try simple and easy first.
Default from factory is for "usage" and that only gives you the summary stuff. Needs to be set to "On" to get the detailed data.
I assume you know how to get to the clinical setup menu??

[jucs]

In the machine's clinical set up menu....go check Sleep Quality and see if it is set to "usage" or "On"....
If it is set to "usage" that's the problem with lack of graphs. Change it to "On".
If it's already set to On...we have more detective work to do but let's try simple and easy first.
Default from factory is for "usage" and that only gives you the summary stuff. Needs to be set to "On" to get the detailed data.
I assume you know how to get to the clinical setup menu??

Bingo. Set to "on" now. We are using an S9 autoset in case I forgot to mention this.

I'll reply back with what my wife's feedback is on her breathing.

Thanks again so much for the help. If it wasn't for this forum, I would never be where I am at today with effective CPAP therapy!

Now, to help her get there!

[jucs]

She says the issue is on the exhale. She takes long exhales...it won't allow her to exhale as she normally does and it then feels like she is suffocating. She has to consciously change her exhale even when trying to fall asleep.

We should now be able to get some graphs tonight.

[Lazer1234]

I have previously written about the ResMed S9:

"I have used both models now and prefer PR 560. And it is mainly because of the way it senses apner. ResMed S9 sends a series of air puffs too fast in my opinion. Respironics sends a larger air puff but waiting a little longer before sending it. As I breathe very slowly so disturbed me by ResMed's puffs."

[Pugsy]

There should be a setting in the clinical setup menu for the speed of the EPR cycle. Default from factory is Medium if I remember right.
Play with the choices to see if that helps or makes her situation worse.
I don't remember what the setting choice is called but I think it is right below the setting 1, 2 or 3 line in the menu.
I remember seeing "Medium" though...I don't have a S9 now to check to be sure.
I never messed with this setting as I was happy with what the default was and I only did cpap with EPR a couple of nights to test EPR because I had the VPAP and mainly concentrated on the bilevel aspect and EPR was only available in straight CPAP mode for me.

[jucs]

Should I set the minimum pressure to 7 instead of 6 as well as see what happens?

EPR is either full time, ramp only, or off.

Setting 1 = mild comfort (1 cm H20)
Setting 2 = medium comfort (2 cm H20)
Setting 3 = maximum comfort (3 cm H20)

I can see if it was setting 3 and lowest pressure is 6 and ramp starts at 4...that it could be causing an issue.

I am shutting EPR off tonight fully and that way it clears the clutter so to speak for data.

[jucs]

Made the adjustment of EPR off and then increased ramp time from 10 to 35 minutes. HUGE difference. After making that setup change, I still get no graphs or can't see them per say on my computer. It may be something on my computer.

Here is a screen capture of what I am seeing in sleepyhead. Note I cannot see any graphs anywhere. Even moving the scroll bar down and there are no graphs there even with the scroll bar moved down????

[Pugsy]

Hmm..the left side is the left half of the detailed tab and the right side is the right half of the statistics tab.
I have no idea what happened or how you managed to do that. I have never had that happen to me.
I assume you have tried closing SleepyHead and opening it back up to see if that fixes it??

This is what a typical detailed report looks like. I just now tried fiddling with mine and I can't duplicate what you have.

Let me see if I can duplicate what you have done and how to undo it.

[Pugsy]

If SH is still stuck showing this image..try going to Preferences...Appearance tab and remove the check mark next to "use pixmap caching"...close SH and then re open again and click on the daily detailed tab again.

If that fails (and it's a long shot) the only thing I can think to do is uninstall SleepyHead and reinstall it again. It won't affect the data that has already been downloaded as it is stored in the SleepAppData folder in your MyDocuments folder and it is untouched when we do an uninstall.

BTW...Leaks are excellent and looks like primarily Central apneas and not many of those and most likely either tossing and turning central or sleep onset central.
I can get that from the data provided on the left side of the image.

How did your wife do with the increase to 6 cm minimum pressure in terms of comfort?

[jucs]

I actually just set EPR to off completely and increased the initial ramp from 10 min to 35. It made a huge difference she said. No more fighting like the first night!

I tried that one fix. No go. I will uninstall and reinstall SH again and see what happens.

[jucs]

I tried the re-install. Same issue. Very strange indeed.

It just displays like in my post yet again.