1st night with S9 VPAP Auto, not great

[aaronk]

Hi, Wondering if anyone can shed light on my data here. Help me interpret and give me some advice for my new S9 settings?

HISTORY: Been on a Respironics Bipap Auto M in Auto mode for about 5 years. (I'm 62) My pressure has been Max IPAP 13, Min EPEP 5. (we call this 13/5 I think). I've averaged a not so great 5.5 AHI, but it jumps around a lot night to night. I feel ok, but wonder if I can do better. Insurance won't help so I just bought myself an S9 VPAP Auto. Don't feel as good after first night with S9, but see my temporary pressure change for getting started below.

So the link below to my screenshots are my first night scrolling through the Sleepyhead screens (3 images). The last image is 10 months summery of my old Auto M from Encore Basic.

Lastly, I compared the two machines and noticed the S9 seemed to "feel" like more pressure, especially near the end of the inhale I get a sort of a bigger bubble of air that I've not noticed with my old machine. Because of this, I set the pressure on the S9 a little lower on the top end just for this night. 11/5 instead of my 13/5 sleep study. Both have differential set to 4.

Thanks ... Aaron

Here is the DropBox link to the screenshots

https://www.dropbox.com/sh/o03zjk88z16y ... IY0vu37jya

[Pugsy]

Are you waking often during the night? Spending any time in the middle of the night awake while mask is on? Or are you sleeping soundly?

[aaronk]

Are you waking often during the night? Spending any time in the middle of the night awake while mask is on? Or are you sleeping soundly?

Thanks for checking in! I'm sleeping soundly including last night. I wake in the 5-6am range for a bio break, and it takes 20 minutes or so to fall asleep again like last night. (I think that may be a natural wake point for me, I've usually had 7 hours at that point)

I feel a little less rested this morning than my average, but I might have a cold on the way. I feel pretty good in general. Nose is clear so no issue with the nasal pillows. ... Aaron

[Pugsy]

When you have time go ahead and update your equipment profile with your new machine and humidifier please.
It will help avoid confusion later.

I don't know what to make of your report from last night. I was hoping we could blame those CAs (centrals) on awake breathing but since you say you slept soundly then I guess we can't use that as an excuse.

When you do your screen shots there is no need to try to get all the graphs.
AHI graph and mask pressure graphs aren't needed. You can turn them off in the Preferences/graphs tab but just removing the check mark.
Main graphs using SleepyHead...the left side AHI category breakdown graphs and on the right side
Events
Flow rate
Pressure
Leak
Flow limitation and snores only if they so a lot of activity.

The centrals concern me. Too many of them to suit me since we can't blame awake/semi awake breathing.
They do seem to occur when the maximum IPAP is reached. So I am scratching my head on this one.
The OA/hyponea index is borderline acceptable. Makes me wonder if by chance the centrals are post arousal centrals (even though you don't remember awakening). Of course they could also be a response to the higher pressures shown when the machine is increasing trying to prevent further OAs.

If it were me I would back up a bit on the IPAP max and raise EPAP minimum just a little since EPAP is normally what we use for OAs. See if maybe a little higher EPAP will help prevent the airway collapse in the first place and thus maybe not need the higher pressures. But you already have a tight range anyway....and that doesn't leave much room for auto adjusting but if those centrals are related to the pressures then maybe we don't want it auto adjusting much.
Maybe 5.5 or 6.0 EPAP
Keep PS at 4
Maybe maximum IPAP at 10 or leave it alone at 11 and see if just increasing the EPAP helps.

[aaronk]

When you have time go ahead and update your equipment profile with your new machine and humidifier please.
It will help avoid confusion later.

I don't know what to make of your report from last night. I was hoping we could blame those CAs (centrals) on awake breathing but since you say you slept soundly then I guess we can't use that as an excuse.

When you do your screen shots there is no need to try to get all the graphs.
AHI graph and mask pressure graphs aren't needed. You can turn them off in the Preferences/graphs tab but just removing the check mark.
Main graphs using SleepyHead...the left side AHI category breakdown graphs and on the right side
Events
Flow rate
Pressure
Leak
Flow limitation and snores only if they so a lot of activity.

The centrals concern me. Too many of them to suit me since we can't blame awake/semi awake breathing.
They do seem to occur when the maximum IPAP is reached. So I am scratching my head on this one.
The OA/hyponea index is borderline acceptable. Makes me wonder if by chance the centrals are post arousal centrals (even though you don't remember awakening). Of course they could also be a response to the higher pressures shown when the machine is increasing trying to prevent further OAs.

If it were me I would back up a bit on the IPAP max and raise EPAP minimum just a little since EPAP is normally what we use for OAs. See if maybe a little higher EPAP will help prevent the airway collapse in the first place and thus maybe not need the higher pressures. But you already have a tight range anyway....and that doesn't leave much room for auto adjusting but if those centrals are related to the pressures then maybe we don't want it auto adjusting much.
Maybe 5.5 or 6.0 EPAP
Keep PS at 4
Maybe maximum IPAP at 10 or leave it alone at 11 and see if just increasing the EPAP helps.

Seems like sound judgment to me. In fact this is why I bought a more capable machine. Talking with my doctor and looking at my history of pressure changes, I've done the best with low pressure as higher pressure bumps me into centrals. I used to put a digital recorder on my mask then look at the sound waves next morning. I saw a lot of stopped breathing with no evidence of obstruction. Lots of 20 to 30 second events. I also have a recording oximeter I could put to work tonight if you think that would help.

I wonder if I DO partially awake, I'm concerned about side versus back sleeping during the night. I'm suspicious I might be partially waking for side to side, or side to back turning. The reason for concern is that my lowest AHI have been forcing myself to side sleep. I got weekly averages around 4.0 AHI doing that. But I really "want" to sleep on my back especially after rolling left to right side and back.

My initial titration only had me at 8 AHI. One doctor recently told me that you can't correlate a titration AHI with a home machine, that an 8 AHI at a lab is more like a 16 on a home machine. Hmm.

Thanks again. I'm going to try your pressure setting tonight and see how it goes. Fixed my profile and thanks for the suggestiong on what graphs to post.

... Aaron

[Pugsy]

Fix your humidifier choice in equipment menu too...the H4i won't work with the S9.

With the history of centrals then I doubt we can blame all those uglies on awake events being flagged by mistake.
Probably should proceed with the assumption that they are the real deal. Figuring out if they are strictly related to pressure as opposed to occurring anyway may be more difficult.
If they are related to the pressure (assuming that there's a point where above so and so pressure you have centrals and below it you don't) supine sleeping making the obstructive apneas worse and needing more pressure isn't doing you any favors but I understand the need/want to sleep in any position you want to sleep in and not have to worry about forcing a restriction which in itself can cause sleep disruption issues.

You can wear the pulse ox if you wish but if it is going to disrupt sleep I wouldn't do it just yet.
I would still want to improve on that report even if the pulse ox didn't show anything exciting. Up to you what you want to do though.

[aaronk]

Fix your humidifier choice in equipment menu too...the H4i won't work with the S9.

With the history of centrals then I doubt we can blame all those uglies on awake events being flagged by mistake.
Probably should proceed with the assumption that they are the real deal. Figuring out if they are strictly related to pressure as opposed to occurring anyway may be more difficult.
If they are related to the pressure (assuming that there's a point where above so and so pressure you have centrals and below it you don't) supine sleeping making the obstructive apneas worse and needing more pressure isn't doing you any favors but I understand the need/want to sleep in any position you want to sleep in and not have to worry about forcing a restriction which in itself can cause sleep disruption issues.

You can wear the pulse ox if you wish but if it is going to disrupt sleep I wouldn't do it just yet.
I would still want to improve on that report even if the pulse ox didn't show anything exciting. Up to you what you want to do though.

Thanks again, Fixed the profile. Don't see SleepyHead on the software list. Quick question, how do I add comments within your quoted text? Is there an easy way or do I have to cut and paste the quote= things for start and stop quote?

My previous oximeter use showed expected 02 drops in parallel with my events, so I agree to put it aside for now. Those 02 dips were no that horrible looking to me. Didn't seem to hit that critical mark very often, or for very long. (sorry, forgot the %02 the critical mark was set to)

I'm going to try avoiding supine, and see what happens with the pressure you suggest. I don't think I can do much wrong right now and it's a good time to experiment. ... Aaron

[Pugsy]

Don't see SleepyHead on the software list

You won't. Software choices shown are just links to past software that cpap.com offered for sale. Everything in the equipment menu has to be tied some how to cpap.com inventory either past or present. There's no need to choose the software...isn't nearly as important as which machine/humidifier.

Quick question, how do I add comments within your quoted text? Is there an easy way or do I have to cut and paste the quote= things for start and stop quote?

I prefer to do it this way. You can insert comments within a quoted section but they often get lost unless you change font color...example..here below...see the part I added after the 2nd question mark.

Quick question, how do I add comments within your quoted text? Is there an easy way or do I have to cut and paste the quote= things for start and stop quote?
you can insert reply here but unless you make it stand out it gets lost...especially if a long quoted comment

What I do is have my reply to box open and empty ready for text...then scroll down to review the past comments and I highlight only the section I want to reply to...then I hit the quote button...so then only the highlighted section gets the quote box. That way I don't have to have the entire post show up in quotes. My personal preference...I don't care to see a long quoted section and this way there is no doubt about what I am responding to.
It's not quite as much work to do it this way vs copying text and using the quote brackets from the forum editor and only slightly more work than just hitting the entire quote thing. I have done it so often now that it really is no work when I do it this way.
On occasion I will do this

sorry, forgot the %02 the critical mark was set to

depends on my mood....this is a highlight, copy, inserted in between the quote brackets from the forum editor.
BTW...I think the official critical mark is 88% but I personally like to think 90%. Main thing is how long it is low.
Short brief drops could easily be loss of contact artifacts.

[aaronk]

What I do is have my reply to box open and empty ready for text...then scroll down to review the past comments and I highlight only the section I want to reply to...then I hit the quote button

I think I'm getting the hang of it, but I only got the quotations, not the Pugsy like below where I cut and pasted it in.

BTW...I think the official critical mark is 88% but I personally like to think 90%. Main thing is how long it is low.
Short brief drops could easily be loss of contact artifacts

Thanks again. Aaron

[aaronk]

Wow, big changes night 2 with S9, much better AHI 3.4 which is a good for me. (compared to previous 13 AHI) See single screen shot below. (It's file file called 140612-13 night 2 S9.jpg) But CA still high comparatively. I worked harder to stay on either side and not on my back.

Any thoughts on pressure adjustments? First night was pressure 11/5, this second night was 10/5.4

Also, do you know if it's ok to remove the SD card when it's in cool down mode, or should I totally power it down? Also I get a "rewrite file" when I re-insert the card. Not sure what I should do with that screen.


https://www.dropbox.com/sh/o03zjk88z16y ... IY0vu37jya

[Pugsy]

Also I get a "rewrite file" when I re-insert the card. Not sure what I should do with that screen.

What exactly does it say? "invalid card..Erase card?"

What is the operating system on your computer? Mac or Windows 8.xx by chance?

Let's fix your pressure graphs...they are a bit whacko as the lines don't line up with the statistical numbers...go to Preferences in SleepyHead and the appearance tab and remove the check mark for "use pixmap caching. Close Sleepyhead...then open again and get me another screen shot of last night.

Don't change anything on your pressure settings at the moment. Last night was a good night...don't know if it was from the first night just being a typical first night or the pressure change made a difference but it worked last night so leave it alone if you are comfortable with current settings.

You can remove the SD card while in cool down mode. There is no need to unplug the power or power down.
I would wait at least 5 minutes after you initially remove mask and stop the blower before removing the SD card though...give it time for the machine to fully write to the SD card. Probably doesn't take that long but better safe than sorry. I messed up once by removing the SD card during the writing to the card process. Messes up the data for sure.

[aaronk]

Also I get a "rewrite file" when I re-insert the card. Not sure what I should do with that screen.

What exactly does it say? "invalid card..Erase card?"

What is the operating system on your computer? Mac or Windows 8.xx by chance?

Let's fix your pressure graphs...they are a bit whacko as the lines don't line up with the statistical numbers...go to Preferences in SleepyHead and the appearance tab and remove the check mark for "use pixmap caching. Close Sleepyhead...then open again and get me another screen shot of last night.

Don't change anything on your pressure settings at the moment. Last night was a good night...don't know if it was from the first night just being a typical first night or the pressure change made a difference but it worked last night so leave it alone if you are comfortable with current settings.

You can remove the SD card while in cool down mode. There is no need to unplug the power or power down.
I would wait at least 5 minutes after you initially remove mask and stop the blower before removing the SD card though...give it time for the machine to fully write to the SD card. Probably doesn't take that long but better safe than sorry. I messed up once by removing the SD card during the writing to the card process. Messes up the data for sure.

I'm on a road trip to northern Michigan today, but I'll work on it this evening. I'm using a Microsoft Surface which uses win8.1. Lots of apps have scaling problems with this. I'll try your fix tonight.

The dialog pops on the S9 LCD when I plug the SD card back into it. I'll look again next time, but I think the S9 was asking to re-write the machine data back onto the card which I did. It erased the card, then reloaded by data onto the card. It gave me an option to cancel this operation instead of re-write the data. But all data seems intact regardless.

Thanks! ... Aaron

[aaronk]

Also I get a "rewrite file" when I re-insert the card. Not sure what I should do with that screen.

What exactly does it say? "invalid card..Erase card?"

What is the operating system on your computer? Mac or Windows 8.xx by chance?

Let's fix your pressure graphs...they are a bit whacko as the lines don't line up with the statistical numbers...go to Preferences in SleepyHead and the appearance tab and remove the check mark for "use pixmap caching. Close Sleepyhead...then open again and get me another screen shot of last night.

Don't change anything on your pressure settings at the moment. Last night was a good night...don't know if it was from the first night just being a typical first night or the pressure change made a difference but it worked last night so leave it alone if you are comfortable with current settings.

You can remove the SD card while in cool down mode. There is no need to unplug the power or power down.
I would wait at least 5 minutes after you initially remove mask and stop the blower before removing the SD card though...give it time for the machine to fully write to the SD card. Probably doesn't take that long but better safe than sorry. I messed up once by removing the SD card during the writing to the card process. Messes up the data for sure.

I have better information now. After I load the SD cards data into SleepyHead, all is fine. When I plug it back into the S9 I get a message on the LCD that says. "Data Re-Writing to SD card, press yes to continue" If I select option NO, another screen says "Remove SD card and press start to begin therapy" If I say YES, the next dialog says "Erasing SD card data" Then it re-writes the data from the S9 to the card. Not sure why it wants to re-write to the SD card every time it's plugged back into the S9.

I did as you said and uploaded another screen shot after unchecking that box, then reloading SH. Seems like it may have improved a little, not sure though. The new file is named 140612-13 NITE 2 s9 REDO.jpg

Thanks ... Aaron

[Pugsy]

I did as you said and uploaded another screen shot after unchecking that box, then reloading SH. Seems like it may have improved a little, not sure though. The new file is named 140612-13 NITE 2 s9 REDO.jpg

It fixed it. Your IPAP pressure max is 10 or close to it...and the first image I saw showed the graph going to nearly 15 for IPAP max..I knew that wasn't possible and I also had a similar issue with my S9 VPAP a while back and fixed it with turning off pixmap caching....was hoping you would see the same fix and we did.

Windows 8.0 and 8.1 seem to sometimes write a little file of some sort to a SD card that gets inserted into the computer. Not normally a big deal as it is a nothing file but the S9 doesn't like it when the SD card has stuff on it that it doesn't expect to see or it doesn't like it if the files are out of order (I did that once) and if it doesn't like it....it will give you the invalid card message and prompt for erasing the card. I had to do it myself once. I accidentally changed the file order on the SD card..moved a file out of normal position.

Anyway, this used to be a problem mainly with Mac users but now with Windows 8.0/8.1 we are seeing more Windows users having this happen.

Solution is simple...just slide the write protect tab on the SD card to lock it so that the computer can't add anything to the SD card. If you forget to unlock it after you are done and stick in in the S9 it will tell you that it is locked...so just watch the screen to make sure the S9 is happy camper with the SD card.

[aaronk]

Solution is simple...just slide the write protect tab on the SD card to lock it so that the computer can't add anything to the SD card. If you forget to unlock it after you are done and stick in in the S9 it will tell you that it is locked...so just watch the screen to make sure the S9 is happy camper with the SD card.

Oh, that lifts the fog. Makes sense, good solution!

I'm going to keep uploading screenshots to that same DropBox location. Last night for example showed lots less centrals and the second reasonable night in a row.

I wonder, how LOW can one set the pressure on an S9 and still get a useable report? It would be interesting to see what happens to my central vs OA at very low pressures. Wonder if it would match my original sleep study that was only 8 AHI.

Still getting used to SleepyHead. I'll read your tutorial and the built in help. Love that app. Any reason to give the ResMed app a try?

Thanks again for everything. Maybe one day I can get my AHI averaging <3. It's never been below 5 for any length of time. ... Aaron