Awakening frequently

[tan]

A general purpose question:

From all my readings I see that, e.g., Resmed S9 VPAP Auto's algorithm will detect CSA and possibly suppress that.
I might or might not have CSA ...
What if I just switch from my current S9 Auto to S9 VPAP, use it for a few weeks & see what happens? No harm, correct?

Thx.

Your first charts shows that you have Autoset, not VPAP, which is already in auto-mode. If I were you and didn't have those centrals, I would start increasing the initial pressure without question. But those centrals require some caution, I should think.

[Pugsy]

, Resmed S9 VPAP Auto's algorithm will detect CSA and possibly suppress that.

It will detect centrals..or CSA centrals but not necessarily suppress it and in fact if the centrals were related to pressure it could possible make them worse. Though I don't think that is going on here.
You would need the S9 VPAP Adapt and not the regular Auto to treat the centrals optimally.
Sometimes the S9 VPAP Auto can be used to treat people who have pressure triggered centrals by finding a nice compromise between a pressure that will fix the obstructive components and not make the centrals worse but for real Central Apnea usually the Adapt or some sort of ASV machine is the ideal machine.

You can make your AutoSet behave a little like a VPAP Auto by using EPR...EPR set to 3 is like pressure support of 3 on the VPAP.
Right now you aren't using EPR at all. If you decide to try EPR you will likely need to adjust that minimum pressure upwards a little more to compensate for the EPAP drop when EPR kicks in.

Should pressure increase happen to cause a marked increase in centrals...stop, back down and we re-evaluate things but I don't see it being hugely likely at this time...because you have time where the pressure goes up to max and no centrals present themselves.

Central Sleep Apnea is treated with some sort of ASV machine.
Sometimes Complex Sleep Apnea can be treated with the VPAP but sometimes not.

[unknown12345]

Question is: Why is the machine decreasing pressure when "LL" block starts? Shouldn't machine be increasing the pressure as leak increases to compensate for the leak?

why would the machine *increase* pressure?

1) that would be bad because you don't need more pressure because of a leak. the flow will increase to maintain pressure.

2) if the leaks are bad enough, the machine will decrease pressure in an effort to get the mask to seal again. however, that behavior isn't evidenced in your chart.

Below is directly from the S9 manual:

AutoSet treats and prevents
apneic events
Because AutoSet responds to flow
limitation, and flow limitation often
precedes snoring and apneas, AutoSet
is able to preemptively treat apneic
events and prevent more serious,
subsequent events from occurring.
The algorithm also monitors and
compensates for unintentional leak

"The algorithm also monitors and compensates for unintentional leak", to me, means, increase the pressure ... doesn't it?
I thought the fundamental property of all CPAP machines was their capability to increase pressure to compensate for leak!!

[palerider]

I think Sludge said FL below 0.40 wasn't horrible..._Please correct me if I am remembering incorrectly...the higher the spikes on the FL graph the worse it is..I know that.

well, ... er... how about: buckle up... the ride's about to get bumpy:

viewtopic.php?f=1&t=103098&st=0&sk=t&sd ... 30#p968326

the things you miss while on sabbatical.

[tan]

I think Sludge said FL below 0.40 wasn't horrible..._Please correct me if I am remembering incorrectly...

As far as I remember, he said that above 0.4 is bad, which doesn't mean that below 0.4 is not bad. But you know there are some other people that say FLs should better be eliminated... and they may be right

[palerider]

"The algorithm also monitors and compensates for unintentional leak", to me, means, increase the pressure ... doesn't it?
I thought the fundamental property of all CPAP machines was their capability to increase pressure to compensate for leak!!

didn't I already say "no"?

if you have a leak, and you increase pressure, you're just going to make the leak worse.

again, you thought wrong.

go back and read what I said about pressure and flow and leak.

[Pugsy]

"The algorithm also monitors and compensates for unintentional leak", to me, means, increase the pressure ... doesn't it?
I thought the fundamental property of all CPAP machines was their capability to increase pressure to compensate for leak!!

Compensate doesn't mean increasing the pressure like you think it does. It doesn't work that way.
In fact these new machines often will reduce the pressure in the presence of a really big leak in an effort to get things settled down.

It can compensate quite well for leaks up to 24 L/min and starts not being able to do a good job after 30 L/min and after 35 L/min pretty much all bets are off. There is a reason there is a red line at 24 L/min on ResScan reports.

[unknown12345]

Hi,

I was wondering if anyone can comment on the below chart:

http://imgur.com/ZjaNaD0

Question is: Why does machine start to increase the pressure (at about 8:30 AM) when the leak is very low (2.4) and "Event Flags" chart shows no events at all?
(Which caused me to wake up @ about 9:00 ... I turned off/on the machine & went back to sleep)

Same situation from 9:48 AM - 10:09 AM ... why is the pressure pretty much at the highest while charts show no events?

This is a recurring thing that I see on my charts that, for whatever reason(?) machine ramps up the pressure even though leak is very low and chart shows no events which causes me to wake up.

Any comment is appreciated.

Thx.

[Pugsy]

Why does machine start to increase the pressure (at about 8:30 AM) when the leak is very low (2.4) and "Event Flags" chart shows no events at all?

Because it sensed something (some sort of flow reduction usually associated with an airway that is trying to collapse) it didn't like and it responded to it and prevented any further collapse of the airway when would need to meet certain criteria to earn a flag so you could see what the prevented something or other would have grown up to be.

Flagged events are just airway collapses up to the point of meeting the criteria to earn a flag...think of those as events that slipped past the defenses. The machine actually is designed to sense and prevent further collapses and we really have no way to know what all was actually prevented because they didn't grow up enough to earn a flag.

What you are seeing is just the machine doing its job....prevention.
Sometimes we can see the reduction that triggered the increase in pressure (if we zoom in real close on the air flow) but sometimes we can't see it with the naked eye because the air flow change is hard for us to measure...but the machine is able to measure it.

[palerider]

Hi,

I was wondering if anyone can comment on the below chart:

http://imgur.com/ZjaNaD0

Question is: Why does machine start to increase the pressure (at about 8:30 AM) when the leak is very low (2.4) and "Event Flags" chart shows no events at all?
(Which caused me to wake up @ about 9:00 ... I turned off/on the machine & went back to sleep)

showing both pressure and mask pressure charts is redundant, please pick one only.

also show the snore and flow limitation charts, I expect you'll find your answer there.

[Wulfman...]

Hi,

I was wondering if anyone can comment on the below chart:

http://imgur.com/ZjaNaD0

Question is: Why does machine start to increase the pressure (at about 8:30 AM) when the leak is very low (2.4) and "Event Flags" chart shows no events at all?
(Which caused me to wake up @ about 9:00 ... I turned off/on the machine & went back to sleep)

Same situation from 9:48 AM - 10:09 AM ... why is the pressure pretty much at the highest while charts show no events?

This is a recurring thing that I see on my charts that, for whatever reason(?) machine ramps up the pressure even though leak is very low and chart shows no events which causes me to wake up.

Any comment is appreciated.

Thx.

You didn't include the chart for the Flow Limitations. There are some noted in the "Statistics" section but the chart is missing. I would suspect that that's what drove up your pressures. If you don't like that happening, I'd suggest limiting the maximum pressure. Could be that you're subconsciously having changes (resistance) in your breathing as the pressure increases and the machine may interpret that as more flow limitations and keeps jacking up the pressure. It becomes a "self-feeding" scenario until it maxes out and you shut it off.


Den

.

[unknown12345]

You didn't include the chart for the Flow Limitations. There are some noted in the "Statistics" section but the chart is missing. I would suspect that that's what drove up your pressures. If you don't like that happening, I'd suggest limiting the maximum pressure. Could be that you're subconsciously having changes (resistance) in your breathing as the pressure increases and the machine may interpret that as more flow limitations and keeps jacking up the pressure. It becomes a "self-feeding" scenario until it maxes out and you shut it off.


Den

Below is another image with "Snore" & "Flow Limitation" ... what does it say/reveal?

http://imgur.com/LaiFqbc

Thx.

[Pugsy]

If you lose the respiration graph and include the pressure line graph I think you will see that the pressure increases are in response to the flow limitation activity on the FL graph.

These machines are designed to respond to an increase in flow limitations because FLs often indicate that the airway is trying to collapse.
Same thing with the snores but your snore graph isn't really all that remarkable but your FL graph is.

Want to see what a FL graph looks like that is totally boring without much activity on it?..here's one of mine and it's probably one of my worst ones because most of mine have even less activity on them.

[Wulfman...]

You didn't include the chart for the Flow Limitations. There are some noted in the "Statistics" section but the chart is missing. I would suspect that that's what drove up your pressures. If you don't like that happening, I'd suggest limiting the maximum pressure. Could be that you're subconsciously having changes (resistance) in your breathing as the pressure increases and the machine may interpret that as more flow limitations and keeps jacking up the pressure. It becomes a "self-feeding" scenario until it maxes out and you shut it off.


Den

Below is another image with "Snore" & "Flow Limitation" ... what does it say/reveal?

http://imgur.com/LaiFqbc

Thx.

Exactly what I surmised.
For whatever reason, your Flow Limitations and Respiratory Rate increased (and maybe a little snoring)......."dreaming", maybe......and then your pressure started chasing the FLs and you had a "runaway".


Den

.

[Pugsy]

If you are awakening frequently during the night with no know cause then it is possible that the machine's changing pressures in response to these flow limitations are a factor in your awakenings. Some people find that changing pressures are a disturbing factor and cause them to wake up or partially awaken. Going to a really tight apap range or even to cpap mode might help if that is what is happening in your situation.

It is also possible that the flow limitations themselves are causing awakenings and preventing their happening might improve sleep quality. If that is the case then usually we deal with flow limitations that are in the airway (and not in the nose itself) with a little more pressure and in this case it would be minimum pressure if someone wants to stay in apap mode.

I mention "not in the nose" because sometimes if a person is experiencing a lot of nasal congestion issues then the flow reduction/limitations shown on the graphs could possibly be in the nose itself and not necessarily in the airway (behind the tongue area) and if that is the case addressing the nasal congestion itself would be the thing I would try to fix first if at all possible....like whatever works to open up the nose.