Newbie's first night ... with SH data

[bpvegas]

So I finally got my machine yesterday and had my first night with it.

First, I'd just like to say thank you to all the posters on this site. I felt very prepared because of everything I've read/learned on this site over the last couple of weeks.

I was prescribed CPAP with a pressure of 8, but I changed it to APAP with a range of 8-12 and A-flex. I also used the heated tube humidity with the default setting of 3.

I think last night went well for my first night. I do remember waking up several times, but not more than normal.

Here is my SH data from last night. Any immediate suggestions, or should I leave it be for a few nights?

[Pugsy]

Nothing screams out on the report. It's actually very good for a first night.

Any idea what might have caused the wake ups? Uncomfortable with anything or just maybe the newness of having the alien strapped on your face. It does take a bit of time for the body to adjust to having the mask on the face even when we have zero issues with it comfort wise. I think it took me a month to not wake up just to feel the mask on my nose and make sure the machine was on and I had no issues at all with the mask or comfort. It was mainly the brain waking me up to tell me "Hey,dude....do you know there's an alien on your nose"

Now if you are having issues with comfort or breathing...there are things that can be done to reduce those issues.

[bpvegas]

Thanks for the quick reply.

I think it was just the alien strapped to my face.

I started out with the ramp feature, but turned it off after about 2 minutes. Likely just anxiety, but didn't feel like I could get enough air.

I do remember a couple of times waking up thinking there was a lot of moisture in the mask. However, I took the mask off to check and nothing there. Maybe it was just a little alien slobber on my chin. I did notice that my nose and mouth weren't as dry as they normally are in the morning, so that was nice.

I don't really remember much leaking, but did notice that my mask seemed to ride up on my nose a bit during the night. Probably just need to work on figuring out adjustments, or look at a smaller mask.

I think I'll go a couple of more nights and see how things change before looking at any other adjustments.

[Pugsy]

There's nothing on the report itself needing adjusting at this time in terms of settings.

Feeling suffocated on the ramp...not necessarily just "nerves"...the ramp starts out at 4 cm and gradually works up to your minimum of 8 cm and that 4 cm can be suffocating feeling for sure. While we won't suffocate it sure feels like it. Simply not enough air moving around. Most people have difficulties like that with 4 cm...6 cm starting pressure seems to be more comfortable starting point for those people who need the ramp but if you are comfortable starting at 8 cm without using the ramp then there's no need to even bother with ramp. I never really had the need ramp myself. You don't have to use it if you don't need or want it but if you want to use it...you can increase the ramp starting pressure to 6cm and it will likely be more comfortable.

[bpvegas]

So I just noticed that the tubing type was set incorrectly on my machine. The DME tried to give me non-heated humidifier and non-heated tubing yesterday when I picked up the machine. When I pointed out that I wanted heated humidifier and tubing they switched it out; however, they gave me 15mm heated tubing and didn't change the machine from 22mm tubing.

My first thought is that this would likely screw with the pressure readings, but not positive. Anyone know the affects this would this have on therapy and machine function?

P.S. I have since changed the setting.

[Pugsy]

The machine should have auto detected the heated hose and changed itself.
Are you sure that you have everything needed for the heated hose?

Heated hose has a black end and a little coupling thing that has to plug into a special place on the humidifier swivel thing.
You also need and 80 watt power supply...so look on the brick power thing and see if it says 60 or 80 watt.
Without all these the heated hose won't work.

If for some reason something is missing and you have the heated hose but it can't be auto detected and it was stuck on 22 cm...it will not make a huge effect on your therapy. Not the end of the world.

[bpvegas]

I do have the correct hose with the proper connector; however, my power brick is only 60W.

Just noticed that SH is also reporting that I DO NOT have heated tubing.

Guess I'll be contacting the DME on Monday to switch the power brick.

Thanks!

[Pugsy]

That's why it didn't auto detect the heated hose. You need a different power brick.
Some machines come with everything and some don't...If it has the electric connection thingy on the swivel for the heated hose electric connection.....makes me wonder why the 60 watt brick is there...odd that it would be partly heated hose adaptable. It's usually all or nothing.

Did you confirm with the machine hours that the machine was new and not used which could mean that they have pirated some stuff from the box to go with another machine?
Do you know how to check machine hours vs therapy hours? Therapy hours can be reset to zero and past user data can be removed from the machine and the SD card but machine hours can't be reset to 0.

Normally the 560 is shipped either of 2 ways.
1....with the Respironics white performance 22 mm hose...regular swivel on the humidifier lid and the 60 watt brick.
2....with the Heated hose with the black end....special lid with the connection to make the circuit with the heated hose and the 80 watt power brick.

they don't usually mix and match them from the factory.

Also...make sure you understand your options once you do get the heated hose up and running.
https://www.cpap.com/productpage/pr-sys ... ifier.html

Right now with the heated hose essentially non working that setting of 3 is the default "new system one humidification mode"....
once the heated hose is recognized you have 2 things to set....one in the clinical setup menu only and that's the amount of humidification to be delivered..1 is 70% and 2 is 80% and 3 is 90%. With the heated hose attached the humidity is NOT what you are selecting with the knob on top of the machine if you aren't in the setup menu...that is for temperature only...settings 1 through 5...see link above.
Changing the settings with that knob doesn't do anything to humidity delivered unless you are actually in the clinical setup menu when the heated hose is attached and detected. DMEs often don't tell people about that and people assume that it changes the humidity...but it doesn't unless you are in the clinical menu.

Now if the heated hose is NOT used or detected..yes, humidity is affected by the settings on the machine.

[bpvegas]

Thanks for all the great information!

It is a new machine. I asked during my orientation at the DME and did verify the machine blower hours were zero.

However, they initially unboxed the 560 with just a passover humidifier and the 22mm hose. When I challenged this, they switched out just the humidifier and hose, but not the power brick.

I'll have to play with the other settings once I get the new power brick on Monday.

[Pugsy]

To be honest I don't know how much of an impact the 22 mm setting on the 15 mm hose might make.
I don't see it making much difference on the software report itself...maybe a little difference.
Might make difference on how the air flow is perceived.
Besides...nothing we can do about it anyway. No sense in worrying about it now. Just move forward.

[bpvegas]

Just finished my fourth night on CPAP. Will have to say that this is the first morning that I noticed a difference in how I felt, and that being that I felt a little more alert and energetic that normal.

I will have to say that when I set my hose size properly it made quite a bit of difference on how therapy pressure was perceived -- breathing seems much more natural now than it was my first night.

I had some nasal congestion issues over the weekend, but turned my humidity down from 3 to 2 and that seemed to help last night. Still getting some moisture in the mask, but I think that may be taken care of once I get my heated hose turned on. The DME was unresponsive to my request to switch my power supply yesterday so will keep working on that today. I'm also going to work with the DME to try a medium instead of large mask. Although I'm not aware of any major leak issues, the mask seems to ride up on my face during the night and causes some pressure near my eyes.

I've posted my SH data from last night. Although my overall AHI appears to be decent, it appears that have more events later in the night -- maybe that's related to deeper/REM sleep -- not sure.

Any suggestions on settings or any other advice?