My first screen shots

[cnl390]

I have only used my machine for about a month now and am having problems adjusting to it. I can wear my mask for an average of about 2 hours before I have a problem and take it off. My main problem is I wake up to an enormous (or I perceive it to be) amount of air rushing in the mask and my ear really hurting and feeling full.
My first screen shot is from last night and the second is from 9-23-14, a night that I actually wore it for over hours.

09-29-2014


09-23-2014

[Pugsy]

I can't see the numbers...image too small and I can't seem to make it larger.
Where is the pressure line? The pressure line is more important than the inspiration line because you are using auto adjusting pressures.

[cnl390]

I can't see the numbers...image too small and I can't seem to make it larger.
Where is the pressure line? The pressure line is more important than the inspiration line because you are using auto adjusting pressures.

I used the snipping tool on a full screen image, uploaded to Photobucket then copied the image to the post. Not sure how to make it larger. I can try using the screen shot function nut I don't know how to use it.

[Pugsy]

Can you include the pressure line graph for the 9/23 night?

I don't know why it isn't larger. If I go to the image location I can't enlarge it.
Something is making it smaller.
I use the snipping tool on full size and photobucket and my images don't go tiny.

Off hand without seeing more/better details, it appears that your minimum pressure is not sufficient to prevent the OA events.
So the machine keeps trying to "fix" things with more pressure up around your maximum pressures (likely explains some of your pressure issues at higher pressures).
There's a good chance if the minimum pressure was more optimally set that the machine wouldn't need to go to those higher pressures in an attempt to fix something after the fact. Meaning if the pressure did a better job preventing the airway collapse then maybe it wouldn't go so high later.

Hard to say for sure but if your minimum was increased to maybe 8 or 9....the airway should stay open better and then the machine wouldn't (hopefully) need those 14 or 15 cm higher pressures.
It's not the maximum pressure that needs adjustment....it's the minimum pressure that is the most critical starting point.

We had a similar situation with a new forum member MyJanine. Her starting point was too low and her maximum pressures were quite high. She increased the minimum from 6 (I think it was) to 9 and it made a world of difference. Now it barely goes to 12 instead of 95% numbers being at 17 or so.
You might take a stroll through here posts to see what I mean.

[cnl390]

Can you include the pressure line graph for the 9/23 night?

I don't know why it isn't larger. If I go to the image location I can't enlarge it.
Something is making it smaller.
I use the snipping tool on full size and photobucket and my images don't go tiny.

Off hand without seeing more/better details, it appears that your minimum pressure is not sufficient to prevent the OA events.
So the machine keeps trying to "fix" things with more pressure up around your maximum pressures (likely explains some of your pressure issues at higher pressures).
There's a good chance if the minimum pressure was more optimally set that the machine wouldn't need to go to those higher pressures in an attempt to fix something after the fact. Meaning if the pressure did a better job preventing the airway collapse then maybe it wouldn't go so high later.

Hard to say for sure but if your minimum was increased to maybe 8 or 9....the airway should stay open better and then the machine wouldn't (hopefully) need those 14 or 15 cm higher pressures.
It's not the maximum pressure that needs adjustment....it's the minimum pressure that is the most critical starting point.

We had a similar situation with a new forum member MyJanine. Her starting point was too low and her maximum pressures were quite high. She increased the minimum from 6 (I think it was) to 9 and it made a world of difference. Now it barely goes to 12 instead of 95% numbers being at 17 or so.
You might take a stroll through here posts to see what I mean.

Your answer hit me like a 2x4 up the side of my head. It makes perfect sense. The Doc should have increased the minimum and not bothered with the maximum. I am going to increase the minimum as soon as I get home. What would you recommend I go up too. I know you are not a doctor and I take full responsibility for my own actions, so don't worry.
Man this is a freaking awesome forum, and you are an awesome member!

[palerider]

I can't see the numbers...image too small and I can't seem to make it larger.
Where is the pressure line? The pressure line is more important than the inspiration line because you are using auto adjusting pressures.

you have to right click and 'view image' which gets you to the photobucket page, then you have to click on the magnifying glass (which they moved) to get to a bigger image, then you have to right click and view image AGAIN, to get to the real pic..

and then you get these:

http://i31.photobucket.com/albums/c391/ ... g~original

http://i31.photobucket.com/albums/c391/ ... g~original

blech.

[Pugsy]

It's hard to say for sure even when seeing many detailed reports with lots of pressure lines to get a feel for what might be a better optimal minimum but I always try to suggest that people increase the minimum slowly if that's what they want to do and by going up slowly it's and easier adjustment process than making a big 3 cm change in one night...plus we might get lucky and not need as much minimum as first thought.

95% numbers aren't much help when looking at them short term and they are too easily skewed with brief high spikes to be all that reliable. People tend to forget the "or below" part of the definition anyway.

You have some significant clusters of OAs on this one report. If this is typical to what you see on other nights then we suspect that during those periods of time you needed the more minimum pressure pretty badly but on other parts of the night that pressure kept the airway open fairly well. The 2 most common suspects for marked pressure need differences are sleeping on your back or REM stage sleep. So when I faced this situation myself some 5 years ago I was 8 cm minimum and I gradually went up to 10 cm minimum. It broke up the clusters and that was really all I was trying to do....not totally eradicate every event. For me to do that I would have needed much higher pressures all night long and I really didn't want to go down that road. If this one report is typically what you see...I suspect that a minimum of 8 or 9 cm is probably what is needed to keep those clusters from being so ugly. Up to you how quickly you want to get there but maybe 1 cm increase in minimum for a couple of nights...then another and maybe another or if you get real close then 0.5 increase or smaller since your machine will do 0.2 cm increments.

I suspect that if you have a higher minimum that the times you see the pressure going so high and causing problems will either be eliminated or greatly reduced to the point they are no longer much of an issue.

When I was doing all this (as a newbie) I used to spend a lot of time at 16 cm with the 8 cm minimum but with the 10 cm minimum most of the time I was at 12 with only an occasional spike up to that 16 to 18 mark. Since I slept well anyway I just let the machine go to where it was needed but if I had been in your shoes then I would have limited the maximum in an effort to curtail the unwanted issues that you are having at higher pressures.
With the more optimal minimum preventing the bulk of the events should an event happen to need pressures over that limit..well one here or there isn't that big of a deal. Sometimes we have to make compromises.

I also can't tell with this graph if you are using EPR...and if you are that also affects how that minimum pressure is working and why sometimes we have to increase the minimum a little to offset the drop that EPR causes.
People can turn off EPR if they wish....or if they like the comfort then just increase the pressure a little to make up for that drop. Either way the job gets done.

When the minimum is set optimally....there really shouldn't be huge wide frequent prolonged pressure changes.
Just an occasional sometimes high spot for some really stubborn events that doesn't last long and really doesn't cause a problem is all people should see.
95% number will come down...overall averages will come down and the pressure line itself will be much more stable.

[Pugsy]

you have to right click and 'view image' which gets you to the photobucket page, then you have to click on the magnifying glass (which they moved) to get to a bigger image, then you have to right click and view image AGAIN, to get to the real pic..

I did go to photobucket and looked and looked but couldn't find the magnifying glass. Normally it is easy for me to spot but this time...it went "poof".
I get absolutely nothing that I can alter...can't click on the image or anything.

That's okay...though. For now I can see what I need to see.

[palerider]

you have to right click and 'view image' which gets you to the photobucket page, then you have to click on the magnifying glass (which they moved) to get to a bigger image, then you have to right click and view image AGAIN, to get to the real pic..

I did go to photobucket and looked and looked but couldn't find the magnifying glass. Normally it is easy for me to spot but this time...it went "poof".
I get absolutely nothing that I can alter...can't click on the image or anything.

That's okay...though. For now I can see what I need to see.

they moved it up above the pic into a floaty hidey bar with other things.

[sc0ttt]

Yeah, 6cmwg is probably way too low for a minimum.

Is it possible the rushing of air that wakes you up is actually leakage?

[Pugsy]

they moved it up above the pic into a floaty hidey bar with other things.

View image trick doesn't give me anything except a black screen at photobucket.
I can't see any sort of floaty hidey bar...nothing...just blank screen and I can't change a damn thing anywhere on it.
Believe me...move that damn cursor everywhere.
Tried reducing screen, tried enlarging the screen...nada, zilch.
I quit.

But thank you for your links...with those I was able to find the magnifying glass...
I can read the numbers
EPR doesn't appear to be turned on.

I don't know why it got resized...mine don't do that. Scratching head and wandering off.
And "no, I am not in the mood to go try imgur at this time"

[cnl390]

It's hard to say for sure even when seeing many detailed reports with lots of pressure lines to get a feel for what might be a better optimal minimum but I always try to suggest that people increase the minimum slowly if that's what they want to do and by going up slowly it's and easier adjustment process than making a big 3 cm change in one night...plus we might get lucky and not need as much minimum as first thought.

95% numbers aren't much help when looking at them short term and they are too easily skewed with brief high spikes to be all that reliable. People tend to forget the "or below" part of the definition anyway.

You have some significant clusters of OAs on this one report. If this is typical to what you see on other nights then we suspect that during those periods of time you needed the more minimum pressure pretty badly but on other parts of the night that pressure kept the airway open fairly well. The 2 most common suspects for marked pressure need differences are sleeping on your back or REM stage sleep. So when I faced this situation myself some 5 years ago I was 8 cm minimum and I gradually went up to 10 cm minimum. It broke up the clusters and that was really all I was trying to do....not totally eradicate every event. For me to do that I would have needed much higher pressures all night long and I really didn't want to go down that road. If this one report is typically what you see...I suspect that a minimum of 8 or 9 cm is probably what is needed to keep those clusters from being so ugly. Up to you how quickly you want to get there but maybe 1 cm increase in minimum for a couple of nights...then another and maybe another or if you get real close then 0.5 increase or smaller since your machine will do 0.2 cm increments.

I suspect that if you have a higher minimum that the times you see the pressure going so high and causing problems will either be eliminated or greatly reduced to the point they are no longer much of an issue.

When I was doing all this (as a newbie) I used to spend a lot of time at 16 cm with the 8 cm minimum but with the 10 cm minimum most of the time I was at 12 with only an occasional spike up to that 16 to 18 mark. Since I slept well anyway I just let the machine go to where it was needed but if I had been in your shoes then I would have limited the maximum in an effort to curtail the unwanted issues that you are having at higher pressures.
With the more optimal minimum preventing the bulk of the events should an event happen to need pressures over that limit..well one here or there isn't that big of a deal. Sometimes we have to make compromises.

I also can't tell with this graph if you are using EPR...and if you are that also affects how that minimum pressure is working and why sometimes we have to increase the minimum a little to offset the drop that EPR causes.
People can turn off EPR if they wish....or if they like the comfort then just increase the pressure a little to make up for that drop. Either way the job gets done.

When the minimum is set optimally....there really shouldn't be huge wide frequent prolonged pressure changes.
Just an occasional sometimes high spot for some really stubborn events that doesn't last long and really doesn't cause a problem is all people should see.
95% number will come down...overall averages will come down and the pressure line itself will be much more stable.

I have couple more quick points and then I will get out of your hair.
1) I always slept on my side until I got the machine and the mask, now I have to sleep on my back because of the mask.
2) My original prescription was for a nose pillow, but when I picked up my machine the clinician said that with the 16 maximum the pressure would always be waking me up. So we went with the mask. At waht pressure will I be able to go with the nose pillow?

[palerider]

they moved it up above the pic into a floaty hidey bar with other things.

View image trick doesn't give me anything except a black screen at photobucket.
I can't see any sort of floaty hidey bar...nothing...just blank screen and I can't change a damn thing anywhere on it.
Believe me...move that damn cursor everywhere.
Tried reducing screen, tried enlarging the screen...nada, zilch.
I quit.

But thank you for your links...with those I was able to find the magnifying glass...
I can read the numbers
EPR doesn't appear to be turned on.

I don't know why it got resized...mine don't do that. Scratching head and wandering off.
And "no, I am not in the mood to go try imgur at this time"

*lol*

here's where I'm seeing it:

[palerider]

I have couple more quick points and then I will get out of your hair.
1) I always slept on my side until I got the machine and the mask, now I have to sleep on my back because of the mask.
2) My original prescription was for a nose pillow, but when I picked up my machine the clinician said that with the 16 maximum the pressure would always be waking me up. So we went with the mask. At waht pressure will I be able to go with the nose pillow?

1) sleeping on your side is better, you can do that with a full face mask, I did it for years side and front. just arrange the pillow so it's not mashing on the mask.

2) technicians are apparently idiots. I use nasal pillows and my pressure gets up to 20.

[Pugsy]

Oh heck, you are using a full face mask because the tech didn't think you could stand 16 cm up your nose. What a load of crap.
I use nasal pillows and routinely sleep through pressures over 20 cm.
It's not like using a full face mask at 16 cm never wakes a person up...geez.
There are people successfully using constant pressures over 20 cm with some sort of nasal mask....sure a bit of a challenge at those pressures to get a seal but it's not like there are zero issues with leaks with a full face mask..

Try a nasal mask of your choice now and sleep in any position you want to sleep in. People shouldn't be expected to give up what they have grown accustomed to unless absolutely necessary and I have yet to see it be absolute necessary to change position with the exception of maybe supine sleeping needs 18 cm and side sleeping needs 8 cm and the person used to sleep on their backs all the time. They could still sleep on their backs with 18 cm if they wanted to but 8 cm is much easier to use.

clinician said that with the 16 maximum the pressure would always be waking me up

maybe it would and maybe it wouldn't....that's an old wives tale about higher pressures and nasal only masks.

Besides....I don't think you are going to need 16 cm often if if you do it would be only for very brief time once that minimum pressure is more optimal.

Do you have a nasal mask of some sort available now?