Swift FX dummie question

[John_Jason]

Today I returned the Opus 360 to the DME and came home with a Swift FX instead. Tonight will be the first night with it. The hose on my machine is 22 mm, but the bit of hose on the Swift FX looks like 15 mm. I remember seeing something in the machine's user manual about changing the setting in the machine from 22 mm to 15 mm if using a 15 mm hose. The DME didn't mention anything about this. I was there with my machine and its hose, and he just plugged the narrower hose of the FX onto it and sent me out the door with a pat on the back and a prayer that I won't keep bringing back more masks.

According to my dim recollection of high school physics the air will just go faster through the narrower portion of the hose, since it is all about the pressure. I see I can get a 15 mm hose for $15 from CPAP.com, but I need one right away. Should I change the setting on the machine? Will my nose explode if I don't? 'Cause I'm kind of attached to my nose.

[Papit]

Hi John. My machine is from ResMed, another CPAP manufacturer, so I don't have a Respironics Remstar machine manual. But my DME gave me a 6-foot Resipironics air hose that I keep as a spare. I just tried it to check and see whether my Swift FX air tube would fit into the Respironics air hose and it fit just fine. It's supposed to be a bit tight to make a good air-tight connection. So you should be ok and have no trouble fitting it to the end of the main 6-foot air hose (which I presume has rubber-like couplings on its ends that are similar to the one I have). It should connect up just like the Opus did.

Check your manual for what size your main air hose is. It may be a special heated air hose made to work with your humidifier. See what size diameter the manual says it is. If your machine requires you to tell it what size main air hose you're using, then enter the correct hose size per the instructions in your Respironics manual. Check to determine whether you really have a heated hose or a regular standard hose. They may be different size diameters.

Now as far as water getting into your nose, something must, and can, be done about that. First, make sure your CPAP machine is positioned at least a few inches lower than the surface of your mattress. That's a safety rule when humidifiers are used and it is probably in your manual. Second, if it's cold in your bedroom, you should get what's called a cozy for your mask air hose ("short hose"). Sometimes, especially in a cool room, our warm breath causes condensation in the short tube that can then run down the tube into our nose. It happened to me. If your main hose is a heated hose (ResMed's humidifiers come with heated hoses), the hose is specially made to prevent condensation so that should not be a problem. If you're not using a heated hose with your humidifier, then that hose should be wrapped with cloth to make a cozy for it until you get a heated hose. You can do that easily by taking the sleeves off an old shirt, threading the 6-foot hose through it, and taping the ends in place.

Hang in there, buddy. We all go through this series of adjustments and tweaks. Smile and consider it part of the "culture"! You're going to do just fine. If you have more questions, I'll be up for a half-hour yet. I'm a night owl, like you it seems. --papit

[Pugsy]

The hose setting on the machine is for the long hose. So leave that along unless you get the slim hose.
The short smaller diameter hose on the Swift FX mask is a total none issue. The end will adapt to the end of the regular diameter hose. It is not enough to matter and most mask's short hoses will be smaller in diameter than the long hose anyway.

The regular PR S1 machines don't have a heated hose option..regular hose is it. Now the new PR S1 60 series machines do have a heated hose...to have that feature means a brand new machine and humidifier because the units are not backwards compatible.

Rain out may or may not be a problem...Typically more so in winter than warmer times but it can happen year round depending on several factors. There is a stand alone heated hose that will work just fine with the PR S1 machine should rain out be a problem. I have one myself that I used last winter with my PR S1 machine. Sometimes there is condensation in the nasal pillows themselves due to the moisture in our own breath...there are options available for various forms of rain out...Cross that bridge if you come to it.
I happen to need lots of humidity to keep my nasal mucosa happy...so I have crossed the rain out bridge many times and have tried many measures to limit rain out.

[John_Jason]

Well, I survived the first night with the Swift FX. There is good news and bad news. The bad news is that my AHI is up a lot (6.01 vs usually under 3.0). The good news is no pain in my nose and no nose bleeds. I am trying to figure out what SleepyHead is telling me about the data from last night. I need to study what all the terms mean. I do know that I woke up about 5:45 and the air pressure was enormous and it felt like the mask was leaking. The pressure is what woke me up. I hit the Ramp button on the machine, readjusted the pillows, and eventually went back to sleep. I can't figure out what was going on. Here is the data from sleepyhead:



(If the image didn't make it, the URL is http://picpaste.com/Screenshot_-_041320 ... x2ytV9.jpg

The fellow at the DME sent me home with the Swift FX with the large pillows installed, but he also gave me the medium pillows in case I wanted to try them.
The large pillows felt fine, but I had the feeling they were leaking. I'll have to experiment with adjusting the straps and perhaps trying the medium pillows. Meantime, I'm curious about what happened from 5:00 to 5:45.

[Pugsy]

I'm curious about what happened from 5:00 to 5:45

For some reason at that time you had a truckload of events that needed more pressure to be killed.
You woke up because there was a hurricane (nearly 15 cm of pressure) going up your nose.

The Respironics APAP machines don't go from 4 cm to 15 in a blink of an eye. They don't even go from 9 to 15 in a blink of an eye. Instead the pressure is increased in stages and with each stage the machine stops and tests things..oops needs more pressure so another increase...another stop to test things...and so on.
These increases take a few minutes and the events can come and go before the machine finally gets to where the events would have been prevented..unfortunately a number of them have come and gone during the increase.
This is why we say the minimum pressure is critical..your 4 cm minimum...the machine simply takes too long to get to the pressure that is needed to be effective.

Now why the ugly mess between 5 and 5:45...Two suspects...supine sleeping or REM staged sleep events..or a combination of both. We have more REM and longer REM stages in the wee hours of the morning and your 5 AM would sure go along with that.

I used to have little clusters like you had only mine needed 18 cm to kill them. I am documented REM sleep worse in regards to my OSA. Not every REM cycle needed the higher pressures..but sometimes they did and not every night even.
I think if you will increase your minimum a bit..you will see the obstructive component of your AHI reduce and be more stable. Most of the time you don't need that higher pressure but sometimes you do for whatever reason. Give the machine a better head start and it will get there in time to stop the bulk of those events.

[John_Jason]

Thanks for the input. You are correct about the hurricane at 14+ cm. Definitely that is what woke me up. I have never had that much pressure since I started this nine days ago.

I'm trying to learn all the terminology and abbreviations in SleepyHead. I need to be able to read the data and understand them. I see the leak graph, but I don't understand why there are two lines and whether the leaks were significant or not. I need to educate myself more.

In the meantime I will continue using the Swift FX. At least it doesn't seem to hurt my nose.

[Pugsy]

There is a glossary for the terms in SleepyHead..not easy to find but there is a link in SleepyHead but I also have it in my signature line.

The dual lines in leak. Some of us have/had them and some do not. Don't know why.
The bottom line is what the line would look like if reporting only excess leak (like a ResMed machine reports) and the top line is the Total Leak reported (so it includes the vent rate) This is the way Encore software shows the leak.

All those other graphs...tidal volume and stuff..the definitions are in the glossary...norms vary too much to list them but you can google the terms and read the web Wiki definitions and get an idea what the normal range is. They vary widely....physical stature....male or female...tall or short...altitude.

As you look at the reports more and more you will be able to see correlations.
The main parts....event graphs....flow graph....leak graph...pressure graph when in auto mode.
Not sure what all are available with your working OS. In the details tab on the left under the colored AHI bars...click on Events tab...then click on a category of events and you should see the events listed by time. The number in parenthesis is very close to the duration in seconds of the event. If you click on a single event...the flow graph should go directly to that event and you should be able to see it up close second by second.

[John_Jason]

Thanks for the info about SleepyHead. I plan to spend some time studying up on it today.

Last night with the Swift FX was better:



If that didn't work, here is the link: http://s1260.photobucket.com/albums/ii562/john_jason1/

(I just created an account at Photobucket hoping that it would display here - because Picpaste images do not.) EDIT: Dammit, it still does not display.

I also discovered something crucial last night. When I woke up about 5:45 it felt as if the Swift FX was leaking. I couldn't get it to stop leaking no matter how I fiddled with the pillows. Finally I decided to take it completely off and put it back on. And then I discovered that the rear (fabric) strap was completely over the top of my head and loose. No wonder it was leaking. I wonder if it was leaking the previous night for the same reason.

Once I put the rear (fabric) strap back where it belonged the leak stopped. But now I need to figure out how to stop it from sliding up during the night. The ideal solution would be to drive a nail into the back of my head so I could hook the strap over it. But maybe someone here has a better idea.

[MJKelleher]

Once I put the rear (fabric) strap back where it belonged the leak stopped. But now I need to figure out how to stop it from sliding up during the night. The ideal solution would be to drive a nail into the back of my head so I could hook the strap over it. But maybe someone here has a better idea.

Don't know if this would be a quick solution or something you'd have to wait on - I have the back strap under my hair, which holds it in place nicely. Much more comfortable than driving a nail, and already having long hair helps a lot! If you've got very short hair, maybe some tape?

[NateS]

If that didn't work, here is the link: http://s1260.photobucket.com/albums/ii562/john_jason1/

(I just created an account at Photobucket hoping that it would display here - because Picpaste images do not.) EDIT: Dammit, it still does not display.

When you hover over your image in Photobucket, click on the IMG copy option, not the URL option.

Regards, Nate

[robysue]

The dual lines in leak. Some of us have/had them and some do not. Don't know why.
The bottom line is what the line would look like if reporting only excess leak (like a ResMed machine reports) and the top line is the Total Leak reported (so it includes the vent rate) This is the way Encore software shows the leak.

It's important to realize that JediMark himself says the "unintentional leak" graph for PR machines running in Auto mode is very primitive: In SH 9.2 on the PC, that "leak" graph for PR machines is found by simply subtracting off the lowest leak rate for the night off all the data. So if your pressure goes up drastically (like from 4 to 15), that "unintentional leak" graph is going to be artificially high since it's subtracting a minimal leak rate at 4cm from all the leak data. But Jimbo's Mac build for SleepyHead 9.2.2 version does provide a more sophisticated statistical model option for computing the "excess leak graph". So it's important to know what version of SH and what platform you're using before saying too much about that "unintentional leak" graph.

So it's usually better on the Auto PR machines to stick with the upper total leak graph and compare to the expected leaks as posted in the user guide.

So---for a Swift FX, here's the expected leak rates graph:

At 4cm, the expected leak rate is about 20 L/min; at 15 cm, the expected leak rate is about 41 L/min; and at 20 cm, the expected leak rate is about 49 L/min. In the "total leak rate" graph for a person using the System One Auto in a range of 4-20 where leaks are not a big issue, it's reasonable to assume that the total leaks will be close to 20 when the pressure is down near 4, but the total leaks should rise up to the neighborhood of 41 L/min once the pressure hits 15cm.

Given the wide variety of pressures in John_Jason's data, it's best to look at the total leak curve (the top one) and compare it to the pressure curve. Notice the the first big bump in the leak curve happens around 3:50-4:30. And there's a corresponding bump in the pressure curve from roughly 6-7 cm of pressure to 9-11cm of pressure. We'd expect the leak rate to go up from around 25 L/min to up around 31-33 L/min. Since the total leak graph is between 40 and 55 L/min during this time, we know that there's some significant leaking going on---the unintentional leak rate during this time ranges from 10 L/min (40 - 30) to 30 L/min (55 - 25). When the pressure tops out at 14 cm around 5:30-5:45, we'd expect the leak rate to be about 40 L/min. The total leak curve shows a total leak bouncing between 40 and 50, so there's some minor leaking going on at this point---maybe up to an unintentional leak rate of 10 L/min.

I do NOT see the event table nor the flow wave. And hence, I'm at a loss on how to really interrupt the AHI data, both in terms of whether the machine took too long to go from 4 cm to 15 cm and allowed to many events through AND in terms of just how bad the clusters of events actually are: While the AHI graph tells me that the hourly AHI figure topped out at 18 around 5:45, that doesn't really pin down when the events occurred and just how dense the clusters were. All it says is that between 4:45 an 5:45 a grand total of 18 events occurred. The overall shape of the curve tells me that the events in this hour were happening closer together than the events earlier in the night were. The overall shape in the curve also tells me that only about 2 events occurred between around 5:45 and about 7:00. The first of these two events occurred around 6:20 (the small uptick on the right side of the mountain in the AHI graph that peaks around 5:45); the second occurred around 6:45 (the little dip in the flat part of the AHI curve to the right of the mountain.) And then there's about 6 events that occur between around 7:05 and 7:15 (the left side of the next hill), but then not much happens (event wise) after that for the rest of the night: There's some kind of event around 7:45 and another at around 9:01.

The pressure curve clearly shows when you hit the ramp---the big vertical drop. My guess is that the fact that you woke up and hit the ramp may be part of the explanation why your sleep appears to be qualitatively different after hitting the ramp: You were going back to the process of getting to sleep again. And it could be that in light sleep you have less problems with OSA. The first increase in pressure after 6:30 (when the pressure goes from 5cm to 8cm) is likely due to snoring or flow limitations or RERAs, none of which affect the AHI graph, which is decreasing at this time. The next pressure increase (just after 7:00) is definitely tied to that cluster of events that seems to have occured between 7:05 and 7:15.

It is much, much easier to use the events table or the flow wave graph to pick out the detailed information about how many events are occurring in which clusters, how long the clusters actually last, how the machine is reacting to those events with (or without) pressure increases, and how much time is spent with no events or only very isolated events occurring. As a mathematician, I think the AHI graph is one of the toughest graphs to learn how to actually interrupt. And many newbies misinterpret this graph in a variety of different ways, many of which make the situation look much more dire than it actually is.

[John_Jason]

If that didn't work, here is the link: http://s1260.photobucket.com/albums/ii562/john_jason1/
(I just created an account at Photobucket hoping that it would display here - because Picpaste images do not.) EDIT: Dammit, it still does not display.

When you hover over your image in Photobucket, click on the IMG copy option, not the UIRL option.

The problem is that, whether getting the URL or the IMG link it says "copied," but then there is nothing in my clipboard. The only link I can get is to open the page displaying the image and copy and paste from the Firefox URL bar. Of course, that is the URL, not the IMG link. I also tried Opera, got the same results. After the Photobucket page says "copied" I also tried pasting into LibreOffice Writer, and there was nothing in the clipboard. I think there's something screwy with the flash on Photobucket. There are lots of flavors of flash. I have the latest, but who knows? I'd use Picpaste, but they don't have an IMG link option. Is there another place I could try?

[chunkyfrog]

Taming the Swift FX:
To keep the fabric strap down where it belongs, I stick a piece of sticky back Velcro (hook side)
to the back of the strap at the center, This grips my hair.
For men who sport the 'smooth' look, try a chunk of elastic that has the rubbery loops sticking out the back.
--An inch or so sewn to the back of the headgear strap ought to hang on to a smooth scalp.
A little girl's headband could contribute the right material--make sure it's not her favorite color.

[John_Jason]

Today I made a trip to a local store where I bought some 1/2 inch elastic for sewing. Tonight I will make a chin strap, attaching to the back band of the Swift FX just behind the ears with a couple of safety pins. Probably more comfortable than a nail at the base of my cranium.

[Papit]

Taming the Swift FX:
. . . To keep the fabric strap down where it belongs, I stick a piece of sticky back Velcro (hook side)
to the back of the strap at the center, This grips my hair. . . . .

John, as usual, she's right on the money. That's exactly what I did per another member's suggestion when I posted the same question. And it works beautifully in keeping the rear FX head strap from sliding up. Sewing is better, rather than pins. But, because I didn't want to sew, I used double sided sticky tape (available in hardware stores in rolls) to attach the velcro to the inner side of the head band. It goes on quickly.

I also do what MJKelleher does: I pull some of my hair up from under the properly placed rear head band and then over the band. So my hair additionally helps keep the band from riding up.

These both helped a lot in controlling leaks. --papit