First Bad Night with APAP

[KCDC]

Hi guys.

I cannot begin to express my appreciation for this group.

I had my first bad night.

I've been using it for 10 days now, and so far so good, except that I was noticing that my nose had dried blood in the next morning. So, what I did was ramp up the humidity temperature from 71 degrees to 74.

Number 1, I'm not even sure how temperature of the humidifier is related to how humid the air I need. Is there some calculation or can someone explain that to me?

But I think my nose started running, and the seal of my nasal pillow got bad and somewhere in the middle of the night, I must have ripped it off my face. Because I looked at the machine the next morning, it was only used for 1.5 hours.

Also, how do you guys make yourself sleep longer? Before the APAP, say it took me 14 hours to feel "x" in the morning. Now it only takes like 4 hours with the APAP to make me feel "x". So I automatically wake up after 4 hours!!! I would certainly love to sleep 8 hours and feel BETTER than "x". Do you see what I mean?

Thanks again

[Pugsy]

When using the ClimateLine hose set to "automatic" in the clinical setup menu and you change the temperature...that's all you are changing. Increasing the temperature when using automatic humidity delivery doesn't increase or decrease the amount of humidity delivered. When set to "automatic" and the only choice you have is temperature with the ClimateLine hose the humidifier delivers 80% humidity no matter what the temperature.

If you are wanting to increase the amount of humidity delivered you have to switch it over to manual ClimateLine mode which lets you choose temperature and a setting 1 through 6 for humidity delivery with 6 being the highest. I don't know how much higher than 80 % those settings of 5 or 6 are going to deliver.

If you think your nasal mucosa are dried out I would suggest getting something like Simply Saline and use it frequently during the day and especially right before bedtime.

In regards to sleeping longer....it took me probably 3 months to get from 4 hours to 5 hours on a consistent basis and another 3 months to get to 6 hours. How long it will take you to get to where you sleep longer is anyone's guess as this is another one of those things that come with the YMMV sticker.
Staying asleep longer can be a challenge for sure. Do you take any meds that might be a factor?

[Nick Danger]

Actually, Pugsy, the temperature does affect the absolute amount of moisture. Relative humidity of 80% at 81 degrees has more moisture than relative humidity of 80% at 80 degrees. Sludge's graph in this thread makes the point: viewtopic.php?f=1&t=98808&p=917790&hili ... se#p917790

[Daydream Believer]

I was "non compliant" for the first time last night too. I must have removed my mask after about 3 and a half hours although I don't remember doing it.

Do you nap during the day? I'm finding that I have to carefully balance my day vs. night sleep time. If I'm too exhausted when I go to bed at night I invariably have a bad night. I also learned that avoiding dairy for several hours before sleep tends to help me with congestion in general. I haven't had to deal with nosebleeds - thank goodness. I live in a humid area so setting higher than 2 feels oppressive to me.

Good luck with your quest for a great night's sleep. You're in good company!

[Nick Danger]

One indication of too much humidity is a stuffed up nose.

Don't let one little setback discourage you. Go back to the settings that were working and, if you decide to try changes, make smaller changes. The experiment was worth trying and now you know it didn't work!

For me, longer sleep came over several months. I also started at around 4 hours (my goal was to become compliant - and I reached that goal), then increased my target.

Good luck

[Pugsy]

Actually, Pugsy, the temperature does affect the absolute amount of moisture. Relative humidity of 80% at 81 degrees has more moisture than relative humidity of 80% at 80 degrees. Sludge's graph in this thread makes the point: viewtopic.php?f=1&t=98808&p=917790&hilit=heated+hose#p917790

I am just reporting what ResMed tech support told me and what others told me about how the Climateline works in automatic mode. The key is automatic mode.
The goal is to deliver 80% humidity at no matter what the temperature.
Big long discussion about this in the past which I don't have time to go find the thread.
Bottom line was that increasing the temperature setting, whenusing Automatic humidity delivery, only increased the air temperature and not the amount of humidity delivered.
Can warmer air hold more moisture? Sure it can but that doesn't mean that more moisture is being delivered.
The humidity sensors in the S9 want to maintain 80% when using automatic mode selection...now does it? Beats me as I don't have the inclination to verify as that's too much work and not all that important.

Now switch to manual mode where temperature and humidity delivery are independent settings the that's a whole different situation.

FWIW....my nose prefers LOTS of added moisture so I am using automatic mode but it's too hot to want to use much heat so my Climateline temp is set to 60 degrees. My nose hasn't suffered any of the typical nasal mucosa dried out symptoms that I would get if the humidity levels were greatly reduced and if the humidity were reduced I know it would suffer (ran tank dry a few nights by accident).

[Nick Danger]

Read the article linked at the bottom of Sludge's graph. It makes it clear that the ClimateLine Control Algorithm maintains constant relative humidity at all temperatures. Constant relative humidity means DIFFERING absolute moisture. This article was published by ResMed.

On page 4 under "Description of Climate Control": "This is to maintain a target AH [absolute humidity] at the mask equivalent to a RH [relative humidity] of 80% at the user set temperature."

As also noted in the paper, with relative humidity held constant, the higher the temperature the higher the absolute humidity.

My nose is similar to yours and likes lots of moisture

[KCDC]

Hello all, I had no idea people replied to my post. I used to get notification by e-mail but that sort of stopped.

Anyway, that you all again for trying to help me with the humidity part. Yeah, I was kinda lost reading your posts, but all I know is that it works one way with the climate hose and it works another way if you use a plain hose. Right now, I'm using straight out of the box climate hose. So, I get to dial up and down the temperature of the water. I was also reading the clinician's manual, which I only know of from here (thank you again!!!), how to get to the clinician set up page. I was completely scratching my head on that one.

Regardless of how the humidity works, I've dialed up and down the temperature and i'm not even sure now empirically what is causing a bad night. Like last night, I think I had a bad night. Out of 16 days now, I was only compliant 10. So, I am also understanding from the software now that a day is only considered compliant if the AHI is > than 5.0. Am I correct on this? My AHI was 12 last night. Ick.

I actually am starting to think that whether I have a bad night or not depends on how the nasal pillow is seated in my nose. What do you guys think about that theory? Like last night, it felt like I had to push out my nose really hard to exhale, waking me up a few times. It's like the nasal pillow was in my nose, and my nose felt vacuumed up, hence squishing the nasal pillow opening making the APAP think to blow more air at a higher pressure. Because when I pull the nasal pillow out of my nase a little then I feel like a vacuum popped and I can breath again. And after waking up for real this morning, my nose was filled with mucus. Not blood, but thick mucus. Like the feeling of being stopped up. Does this make any sense whatsoever my explanation? LOL.

So, if my theory holds any water, is this problem only PARTICULAR to nasal pillows? Like if I used a full mast, none of this nose pinching action will go one? Should I use a smaller nasal pillow or a larger one in this case?

I've attached 3 screen prints of my report from last night, wondering if anyone can help decipher them.







Let me know what you guys think.

Thanks

Kenny

[Pugsy]

Compliant has to do with hours of use and not AHI. "Compliant" is usually 4 or more hours of use a night.
You want your AHI to be less than 5 and not more than 5.0 for acceptable therapy in terms of apnea prevention.

When you do images of your reports could you do the daily detailed report instead of the general report? Daily detailed makes for a much easier quick glance.
Don't need AHI or mask pressure graphs on the daily detailed report either...just turn those graphs off in Preferences/Graphs tab.

So that you report images look like mine below.
All we need is the AHI on the left side and these graphs on the right side.
Events
Flow rate
Pressure
Leak
Flow limitation only if it looks very active.

It's hard to say for sure but the green apneas on your report usually mean unknown apneas and you seemed to have a big leak right about the same time as the cluster of green apneas so I suspect leaks allowed the therapy pressure to be compromised and the airway collapsed.

[Mykale]

Hi guys.

I cannot begin to express my appreciation for this group.

I had my first bad night.

I've been using it for 10 days now, and so far so good, except that I was noticing that my nose had dried blood in the next morning. So, what I did was ramp up the humidity temperature from 71 degrees to 74.

Number 1, I'm not even sure how temperature of the humidifier is related to how humid the air I need. Is there some calculation or can someone explain that to me?

But I think my nose started running, and the seal of my nasal pillow got bad and somewhere in the middle of the night, I must have ripped it off my face. Because I looked at the machine the next morning, it was only used for 1.5 hours.

Also, how do you guys make yourself sleep longer? Before the APAP, say it took me 14 hours to feel "x" in the morning. Now it only takes like 4 hours with the APAP to make me feel "x". So I automatically wake up after 4 hours!!! I would certainly love to sleep 8 hours and feel BETTER than "x". Do you see what I mean?

Thanks again

I had an adjustment period when I first started that included increased congestion and problems with traces of blood in my sinus. Two things solved my problem. The first was finding the right amount of humidity. Too much humidity increased congestion for me. I settled on a setting of "2" on my machine that seemed to be just enough. The thing that helped the most with congestion was a couple of sprays in each nostril, both morning and at bedtime, of Ayr saline nasal mist. Since I have been using Ayr, I have had no blood traces and have had few episodes of congestion while using my APAP.

[KCDC]

Hi guys,

Yes, I've been using just the CVS nasal moisturizing spray. Is that ok?

So, attached is my simplified graph. Does this help more?



Thanks

Kenny

[Nick Danger]

You talk about pulling the nasal pillows out of your nose. I wonder if maybe your mask is too tight. The pillows should fit "comfortably" against your nose - only the very tip should be inside the nostril. The video at this link talks about fitting the Swift FX nasal pillows: https://www.youtube.com/watch?v=gut4Kbbc-iM

[KCDC]

Goodness Nick Danger..... I have it completely assembled wrong and way too tight. maybe that's been my problem the whole time.......

[Nick Danger]

I hope it works better when you reassemble it and loosen the straps!!!

Nasal pillows work well for me and the Swift FX were the most comfortable nasal pillows I've used. I switched to the Airfit P10 to get rid of the stream of cold air that comes out of the vent - kept waking my partner when I turned over toward her, but I find them a little less comfortable than the Swift FX (the P10 was too tight at first with no real way to adjust other than manually stretching the straps).

[KCDC]

I hope it works better when you reassemble it and loosen the straps!!!

Nasal pillows work well for me and the Swift FX were the most comfortable nasal pillows I've used. I switched to the Airfit P10 to get rid of the stream of cold air that comes out of the vent - kept waking my partner when I turned over toward her, but I find them a little less comfortable than the Swift FX (the P10 was too tight at first with no real way to adjust other than manually stretching the straps).

I had no idea just the pillows barely touching the nose is good enough. I think ive been jamming in the pillows into the nose, thinking better seal, but instead it squished up.

Btw, can u guys help me with the interpretation of my chart?