SleepyHead questions

[Downtwoner]

1. I forgot to set SD card to read only and connected it to my MAC. I deleted the files OSX added, but they are now in the Trash folder of the card, which I can't move or delete. When I put the card in the Resmed 10, I get no error message even when running the machine. Is there anything I should do?

2. Newbie. 2 nights.
Night 1 I was very conscious of mouth breathing, Leak rate was reasonable perhaps, but sleep was anxious.
Night 2 I relaxed about mouth breathing, but air leaks were very high for 39% of the night. Air flow was significantly reduced during this period. But there were no event flags. Does this mean that the mouth breathing made it impossible to tag events? Is this a problem that needs to be addressed.

Thanks for any suggestions.

[Pugsy]

The warning to lock the SD card was mainly for ResMed S9 users. The S9 machine wouldn't accept the SD card with the added file.
Apparently the AirSense 10 machines don't care and neither do the Respironics machines.
I wouldn't worry about it if your machine has accepted the SD card and isn't prompting you to erase the card because it doesn't like it.

[Downtwoner]

Thanks, Pugsy

[Downtwoner]

Here is the report that confuses me. Why are there no events during high leak periods. Does it mean that the machine is coping, or does it mean that the machine cannot register events when the leaks are this strong?

https://www.dropbox.com/s/mfxyqx11ghxp0 ... 6.jpg?dl=0

Sorry, I'm a newbie and can't figure out how to make images display here, so I inserted a link.

Thanks,

Frank

[PEF]

I have forgotten to put my card in lock mode on both my Resmed S9 and Dreamstation several times, but never had a problem. I still think it is a good idea to do so.

[Pugsy]

Your image won't load for me.
If your large leak was beyond 35 L/min then the absence of any events could be from the machine simply missing something that happened.
Up to around 30 to 35 L/min and the machine can usually sense something but it may not know what to call it and you might get some "unknown apnea" flags.
Between 25 and 30 L/min the machine is still fairly accurate.

So it depends on how far into large leak territory you went how accurate the machine will be.

Dropbox can be problematic for hosting images.
I would suggest imgur for a screen shot hosting website. It's less problematic.
https://sleep.tnet.com/reference/tips/imgur

[palerider]

Sorry, I'm a newbie and can't figure out how to make images display here, so I inserted a link.

read ALL THREE pages:
https://sleep.tnet.com/resources/sleepyhead/shorganize

[Downtwoner]

Imgure image:

http://imgur.com/FTSRyFT

[palerider]

the 'printouts' from sleepyhead are pretty much crap, go back, read the first, and second web pages I liked, and please try again.

[Downtwoner]

OK. Sorry. I think I've followed the instructions. The only thing I worry about is that I have a large monitor and it may not show well on smaller screens. So let me know if that's a problem.

Day 1: http://imgur.com/OmgOl1y

Day 2: http://imgur.com/wH0VvS4

I only realize just now that the y scales for the two days are very different for the two days for both Flow Rate and Leak Rate. Ouch. I assumed they'd be the same. That means I misread them completely. I guess that's the price of being a newbie.

What can you teall from the leak rate and the event Flags?

Thanks.

[Pugsy]

How come you have limited the maximum pressure to 12? Any special reason?

The report with all the big leaks....you can't really put much stock in what it shows due to the amount of large leak.
The other one with just a small amount of time in large leak is probably accurate. I don't think that small of an amount of large leak is going to impact the data reported very much.

Are the leaks waking you up?

[Downtwoner]

My sleep doctor specified pressure of 4-12 on the prescription. I've found the ramp up too long, and shortened it to 5 minutes so far. His MO is just to send the prescription to a DME. I insisted on picking up the prescription in person (he does not use email, just fax). I gained 2 weeks by buying my gear from cpap.com.

I'm going to ask for the results of my sleep study to see how many AHI's there were.

So are you suggesting that there is no reason not to set the maximum pressure higher? What do people use? I don't know anything.

I woke up a number of times the first night, when I was anxious. I think I woke up only once, when mouth breathing, the second night.

I got used to an ineffective mandibular device I got from my dentist after wearing it for several months. I think I might try it tonight, and see what effect it has on the leaks.

[Pugsy]

You are spending a good bit of time with the pressure maxed out at the 12 cm. I suspect it is because of the flow limitations since the OAs and hyponeas are low.
There's no urgent need to increase the maximum at this time. You are new to therapy and it's something you might consider at a later time.

I would suggest that you get yourself educated and concentrate on understanding what you are seeing on the reports first and then think about if anything needs to be changed.
Right now the only thing standing out are the leaks and that's something we always have to fight.

While the pressure being maxed out at 12 means the machine wants to go higher it doesn't necessarily mean that there is a critical need to go higher.

How are you sleeping? Soundly or waking often? If waking often any idea why?

Flow limitations are flow reductions that don't meet criteria for an OA or hyponea. They are one of the things that will drive the pressure up but sometimes just because the machine thinks it needs to go higher doesn't mean that it is urgent that it go higher.
Normally I would suggest you talk to your doctor about increasing the minimum before necessarily increasing the maximum but with your minimum it doesn't stay there long so I don't know that increasing the minimum will do much in your situation.

When is your follow visit scheduled with your sleep doctor?

[Downtwoner]

I see my sleep doctor on 10/31. I only had a simple home sleep study. There was no titration study. Until 10/31, I won't know how he came up with the pressure numbers.

I gather from looking around here that I can do my own titration easily enough. But I'm sure I have to get comfortable with cpap therapy first. The fact that my AHI's are lowish, even if not fully accurate, eases my anxiety about the pressure setting. So I'll take your advice and give it a little time.

The key thing for me is to get the apnea question stabilized so my cardiologist can see where I stand in my recovery from heart failure. It's the last piece of the puzzle, and has taken far too long. I can't at this point meet with my cardiologist and discuss lowering my meds until the apnea is under control.

But I'm sure your right about the need to educate myself. I'm reading Sleep Interrupted, and its not really telling me what I need to know. Can you suggest anything that is more technical and relevant to cpap therapy. I find that the more advanced and professional the presentation of information the easier it is for me to understand it. I know that's a little unusual, but that's my style. So what I would like to know about are the manuals that techs learn from, medical textbooks, original studies, things at that kind of level, you know, both practical and academic, or anything on the Internet that goes into greater depth and/or practicality. I'm learning a lot from this site BTW.

And, I gather I should work on mouth breathing (already bought chin strap and tape to try) and sleeping through the night.

[Jay Aitchsee]

Can you suggest anything that is more technical and relevant to cpap therapy. I find that the more advanced and professional the presentation of information the easier it is for me to understand it

Top left of the page, see viewtopic/t88637/CPAP-Basics----Table-of-Contents.html plenty of technical references. Use Google site specific (Key Word site:cpaptalk.com) to search this forum rather than the provided search function.

Mouth Breathing? See viewtopic.php?f=1&t=112758&p=1085906#p1085906 to determine. Could be plain old mask leaks as well. I'm going to guess (wildly) those periods of high leak are related to position. Either back sleeping and your chin drops out of your mask or you are exhaling from your mouth with a nasal mask, or side sleeping and the mask is dislodged. I lean toward the former. You don't say, or I haven't found, what kind of mask you are wearing. Please go to the user Control Panel (top left), Profile, Edit Equipment and enter the equipment you are using.

The leaks of mouth breathing (exhaling from the mouth) and subsequent therapy degradation can be controlled with a Full Face Mask or tape. In my opinion (and other's), chin straps are not very effective. Consider that one can still exhale through the mouth with teeth closed. Chin straps also tend to move the chin backward tending to exacerbate the conditions which cause obstructive apnea.

You are spending a great deal of time in high leak, but just because the machine doesn't register any events, doesn't mean it's not working. The machine wants to go higher than the set 12 maximum due to Flow Limitations. Flow Limitations above about 0.05 will cause the machine to attempt an increase in pressure. More pressure, a soft cervical collar, and/or a nasal mask tend to reduce Flow Limitations. The machine acts on Flow Limitations because they are seen as a precursor to hypopneas and obstructive apnea.

And, I gather I should work on mouth breathing (already bought chin strap and tape to try) and sleeping through the night.

Absolutely, Your first priority is to get comfortable with the therapy and sleep through the night. If leaks are waking you, you need to work on them first. After you are comfortable with the therapy, further adjustments, if required, can be made.

P.S.

I only realize just now that the y scales for the two days are very different for the two days for both Flow Rate and Leak Rate. Ouch. I assumed they'd be the same. That means I misread them completely. I guess that's the price of being a newbie.

Right click in the label area of the graphs to "override" the Y axis auto scaling.