One year -- whazzup with these numbers?

Wanted to make sure you saw this post by JDS74. Interesting...

JDS74 wrote:Since my ratio is inverse of normal, I.e., my expiration time is shorter than inspiration time, I did a search to see what that might mean. Mine is about 2:1 instead of the "normal" 1:2. Curious.

Found this site:
http://rtboardreview.com/public/tables_ ... meters.htm

What was especially interesting to me was:

In normal individuals, the I:E ratio ranges from 1:2 to 1:3 (expiration being about two to three times longer than inspiration). In patients with expiratory airflow obstruction (e.g., COPD patients), the expiratory time is typically prolonged. This results in lower I:E ratios, such as 1:4 or 1:5. A prolonged expiratory time and low I:E ratio is a cardinal sign of expiratory airflow obstruction.

The information discussed is related to ventilation and not CPAP stuff, but it is interesting all the same.

Thanks for pointing the post by JDS74, I saw it yesterday and I would have post it here also if you didn't beat me to it! Didn't have time to read the link yet but it is in my short term todo.

As for your last post related to your problem, here some comments. Don't forget that mask should not be too tight (pillow or others) because it can cause leak. By design most mask use pressure from xPAP to "complete" their seal, so if the mask is too tight that "effect" of xPAP pressure on mask seal is not possible. Sorry, If that sound weird but I don't know how to better explain this... Maybe it's better explain in some other thread or Pugsy can pinch in on that!

As for the pressure, there is still 3 weeks before your meet with the doc so we might be able to try something else before that but the chance to get a decent's night sleep look pretty slim at that point. But you should get at least a week at 13 before trying something else...

In the mean time you should look in thread for "tricks" to help you avoid supine during sleep. I saw some talking about "tennis ball" on your back to avoid going supine.

I'll check your last night graph when you'll post it and maybe add some more comments later today.

The last two nights, both at 12.5 / 12.5 pressure:

July 8


July 9



Those AHIs are very much hypopneas. 91 of them on July 8 and 84 on July 9.

Do you see anything here that might stop me from moving on to 13 / 13 pressure?

Thanks so much for taking time to check things out!

RubySnooze wrote:The last two nights, both at 12.5 / 12.5 pressure:

July 8


July 9



Those AHIs are very much hypopneas. 91 of them on July 8 and 84 on July 9.

Do you see anything here that might stop me from moving on to 13 / 13 pressure?

Thanks so much for taking time to check things out!

Need to control the leak. Full face mask is much better for that purpose.

Alright, what if it's not me but the machine? How do you know your machine is not completely whacked out?

Last night I woke up at 1:49 a.m. in the middle of one of the loud events hubs has been describing. Super high pressure, lots of noise. Before I could decide what to do, it abruptly stopped. In less than a minute, it did it again. I carefully felt my mask, my tape, my tube while the machine was blasting; I swear nothing was leaking. So I laid there quietly and it did a kind of hiccup (pressure and noise reduced for a moment with kind of a dull click sound), came back full throttle for a few seconds, did another hiccup, came back full throttle for maybe 45 seconds, then abruptly dropped pressure. I let it do it one more time, where I laid perfectly still, and it went through the same sequence.

Would the machine be making such drastic and abrupt pressure changes for a leak? Should it be making pressure changes at all, since it was set on straight 13 / 13 pressure? Do you see anything in my stats those last ten minutes or so to explain what was going on?

July 10
Pressure 13/13

RubySnooze wrote:Alright, what if it's not me but the machine? How do you know your machine is not completely whacked out?

Last night I woke up at 1:49 a.m. in the middle of one of the loud events hubs has been describing. Super high pressure, lots of noise.

no, you're NOT having "super high pressure". you're having a large leak. the pressure doesn't change. you've got it set to a fixed pressure.

when you have a leak, the FLOW increases to try and maintain the set pressure. the fan speeds up, the leak chart shows a leak, and it makes noise, the larger the leak, the more flow, the louder it is, and at some point, if it's enough leak, pressure starts to drop because the fan can't keep up.

RubySnooze wrote:Before I could decide what to do, it abruptly stopped. In less than a minute, it did it again. I carefully felt my mask, my tape, my tube while the machine was blasting; I swear nothing was leaking.

you wouldn't be the first person unable to find where the mask was leaking...

RubySnooze wrote:So I laid there quietly and it did a kind of hiccup (pressure and noise reduced for a moment with kind of a dull click sound), came back full throttle for a few seconds, did another hiccup, came back full throttle for maybe 45 seconds, then abruptly dropped pressure. I let it do it one more time, where I laid perfectly still, and it went through the same sequence.

does your machine give a mask pressure trace on sleepyhead? if so, what's that look like?

Palerider, thanks for the detailed explanation. I get what you're saying.

I don't have a mask pressure trace on SH and don't see it in preferences; is there a way to add it? For a PR machine?

My leak rate is low during the time of the episodes. And it doesn't look like I'm having any apneas then. Which makes sense, since I was awake from 1:49 on.

AHI peaks at 18 and stays there from 1:45 to 2:00 a.m., then drops sharply right before I turn off the machine.



How do you fix a major leak that you can't even find?

RubySnooze wrote:Palerider, thanks for the detailed explanation. I get what you're saying.

I don't have a mask pressure trace on SH and don't see it in preferences; is there a way to add it? For a PR machine?

My leak rate is low during the time of the episodes. And it doesn't look like I'm having any apneas then. Which makes sense, since I was awake from 1:49 on.
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How do you fix a major leak that you can't even find?

the ahi graph is, to me, the most useless graph in SH. .

some PRs1 machines offer the mask pressure data, some don't, I guess yours doesn't.

the leak rate is an average over some number of breaths, not an instant reading, so brief bad leaks may not show up as such. you are having extended periods of large leak though.

as to finding it... I don't know, I usually just mashed around on the mask seal till it got quiet

I suppose there is a chance that your machine is going crazy, but the only way to tell for sure would be to rig up a manometer to it. you can buy one for cheap off ebay, or make one out of some tubing, water, and a ruler.

palerider wrote:the ahi graph is, to me, the most useless graph in SH. .

some PRs1 machines offer the mask pressure data, some don't, I guess yours doesn't.

the leak rate is an average over some number of breaths, not an instant reading, so brief bad leaks may not show up as such. you are having extended periods of large leak though.

as to finding it... I don't know, I usually just mashed around on the mask seal till it got quiet

I suppose there is a chance that your machine is going crazy, but the only way to tell for sure would be to rig up a manometer to it. you can buy one for cheap off ebay, or make one out of some tubing, water, and a ruler.

Ha...I know you pros don't bother with the AHI graph. I was confused how it could show a sustained AHI of 18 when I was not having any events. I had 17 hypopneas and 1 CA the entire time I was asleep. None of them during the 15 minutes of AHI=18.

I may be off track because last night's stats are for only an hour-and-a-half, instead of the five-ish hours I'm normally looking at. So I'm seeing everything a lot closer than usual.

Mashing the mask sounds good. Actually, stomping on it with my foot sounds even better!

My sleep-deprived brain is finding it all very challenging...

RubySnooze wrote:I was confused how it could show a sustained AHI of 18 when I was not having any events. I had 17 hypopneas and 1 CA the entire time I was asleep. None of them during the 15 minutes of AHI=18.

the AHI graph is a moving average over the last hour, so if you have a bunch of events, it won't get back down to zero until an hour after the last one. the resmed software is even weirder, it resets the graph to zero each hour... so it's a continual sawtooth if you're having a busy night.

one person said of the sleepyhead ahi chart "well, it helps me spot clusters" ... to which I pointed out "well, I can see 'em right there on the events flags chart "

RubySnooze wrote:I may be off track because last night's stats are for only an hour-and-a-half, instead of the five-ish hours I'm normally looking at. So I'm seeing everything a lot closer than usual.

you can zoom in and move around on the chart easily with sleepyhead

RubySnooze wrote:Mashing the mask sounds good. Actually, stomping on it with my foot sounds even better!

caution, stomping on the mask can be hazardous to your nose... please remove mask first.

Hi RobySnooze,

Palerider gave a good explanation of what's happening when the machine detect leaks. What could happen is that your mouth open while in sleep and that may be the cause of the flow increase and the loud noise (no leak anywhere in the system except from your mouth). When you wake up, you instinctively close your mouth and the machine decrease the flow back to normal rapidly. When it did it again few minutes later, maybe you where just falling asleep and your mouth open again, your machine increase the flow, it wake you, you close your mouth again and just didn't realize you were falling asleep since you were awake just a few minutes ago (you might not even realized you opened you mouth)... You can try your machine while awake with your husband beside you and open your mouth and relax your tongue so the air can pass through and ask your husband if that the kind of noise he ear during the night. Try this for a few minutes (not easy while awake! ) and look at your data in SH to see how your leak graph looks like. It might also be that your machine is crazy but the only way I know how to check it yourself is with a manometer as suggested by palerider. You can also try to watch TV during the day for a couple of hours with your mask on to see if your machine will do it while fully awake and mouth close.

As for your AHI in the last few days with pressure of 12.5 (except July 10), no they're not good numbers... And the fact that they're still mainly hypopneas doesn't help us really much... And if those are central in nature, higher pressure won't help either. If it wasn't for the leaks I would strongly believe that those are central. The reason I still think you should go to a pressure of 13 is because in your titration part of your sleep study, that's the only pressure you had absolutely no event (AHI=0) and that's also the longest time you spent in any pressure. You had 29.5 min of TST at that pressure, the next longer was at pressure of 10 for 20 min TST with an AHI of 18. Your next best AHI was 4.6 at pressure of 11 but only for 13 min TST. All the titration part of the night was in supine sleep position, so that eliminate some speculation. But since your AHI is often not constant during the night (they often come in cluster), it might also just be that you had no cluster in those 29.5 min (meaning that even without a mask you wouldn’t probably have any event either during that time). Only way to know is to try that pressure (13) for a few nights with acceptable leak to see how you do.

But I also think we don't see the real/whole story with your sleep study because ALL of the events where hypopneas (no apnea during the whole night) and you had zero stage 3 or REM sleep during that night with 156.5 min TST during study and 112 min TST during titration part. Your new sleep doc will probably want a full night PSG before doing a titration.

Thanks for continuing my apnea education, Palerider and OSAHell!

Wanted to post this SH info before I forget what I was doing. Last night I slept for about four hours with NO tape over my mouth. I have been using tape previous nights, but wanted to see how it impacts leaks. Just after 5 a.m., I taped my mouth shut and slept another two hours. Clearly, tape was better than no tape.

Also, a pressure of 13 isn't magically stopping all events. Ratz.

July 11
Pressure 13 / 13

RubySnooze wrote:Also, a pressure of 13 isn't magically stopping all events. Ratz.

why are you doing the straight pressure thing, instead of taking advantage of the auto feature? I think I missed something in there.

Hi palerider,

It's a long story (pretty much all in this thread) but basically she's been on APAP wide open for 7 months with bad results. I'm talking about pressure here, not her avatar...

OSAHell wrote:Hi palerider,

It's a long story (pretty much all in this thread) but basically she's been on APAP wide open for 7 months with bad results. I'm talking about pressure here, not her avatar...

well, I never recommend anybody be on wide open apap for more than a day or two, to get an idea of lower pressure... then raise it. all I saw was one of avi's ill advised suggestions, then she was on straight pressure...

if it were me, I'd set the min pressure to 13 tonight, and max at 20, and see what the data looked like.... but, that's just me