First night

I don't think I really have any questions at this point, so I guess this is more of a journal type of post, just to get my experience down.

I got my equipment yesterday, so last night was my first night. It was rough. I think I only slept for a total of about 2-2.5 hours and spent the rest of the time so focused on my breathing that I couldn't sleep. I had to unlock the machine and turn flex on because on exhale it felt like I was breathing out through a straw that someone had their finger over. I set it to C-flex 3 which was a bit better. When I woke up in the middle I hit the ramp button to reduce the pressure, and boy was that a mistake. Suddenly going from ~12cm to 4cm made it feel like I couldn't breathe. Fortunately, after a minute or two I adjusted to it and it was tolerable again. The next time I woke up I just left the pressure alone. I also turned the temperature setting down to 1. It was starting to make my face sweat under the mask, and that seemed to help a bit.

The first image is the whole night. The second is the first time I fell asleep, for around 1-1.5 hours. The third I can't quite remember exactly when I fell asleep or woke up, but it's somewhere in there, for maybe 30-45 minutes or so. It seems to have flagged a lot of events while I was awake, so I'm not too concerned about those. I know I do a thing occasionally where I catch myself not inhaling after I exhale, while awake. I'm not sure what that is, but I'm sure the machine flags it as an event. There were also plenty of times while awake where I'd stretch or change positions or yawn or whatever else, which all involve changes in respiration pattern, so it probably flags those also. Like I said, I'm not too concerned about events when I know I'm awake, and when I know I was asleep, it looks like the machine eventually caught up and got them under control for the most part. Once I eventually get used to sleeping with this darned thing and get the pressure settings optimized, it'll probably work out for me.

I do need to come up with something for hose management. Right now I have the hose draped around the post of the headboard, which works well until I need to change positions. Then I either need to push the some of the hose up and over to remove the slack from my side, or it pulls the hose around to give me more slack. The biggest problem really is that since the hose is corrugated, it makes that wonderfully loud washboard noise in the middle of the night. Since my wife decided not to wear earplugs last night now that I have the machine, I was very sensitive to not making noise lest I wake her up.

As far as adjusting settings, the RT said that they do monitor and review the data and make adjustments as needed. I'm not sure what frequency they do this, but he assured me that they are watching and will call me to discuss if needed. I figure I'll give it at least a few days to a week without changing the pressures myself to see how I adjust to it and if they actually do anything.

Mask fit was good. Only very tiny leaks if I'd lay on my side and the pillow would start pulling/pushing on the headgear and slightly unseat a bottom corner of the mask. The leak rate graph is so low though that it's probably not a concern.

Raise your low pressure from 4 to e.g. 7 and see what difference that makes for a couple of nights... to me that's the obvious first thing to try, then if it doesn't make a real difference, we'll see what else to address, but it's best to try one thing at a time.

Most people have a problem feeling air starved at 4 cm. We won't suffocate at that low of a pressure but it can sure feel like it.
I would express your discomfort to your DME and/or doctor and see about getting your starting minimum pressure increased (or do it yourself if you are comfortable doing it).
It will also help hold the airway open better and better prevent the airway from collapsing when it doesn't have to travel so far to get its job done.

Not really enough time to get a good feel for what you are going to need as a minimum but probably something up around 7 or 8 cm minimum since once you go to sleep and the machine increases the pressure it tends to stay up there in that area anyway.

The settings 4 min and 20 max are the default settings from the factory. They work well if someone ends up only needing 8 or 9 cm pressure but not so great if a person starts going over 10 with their pressures. I wouldn't wait too long on this...if you can't get comfortable breathing it makes it difficult to fall asleep and this stuff is hard enough at first without having something like that making it worse when it is so easily fixed.
I think you are going to need more minimum not only for comfort but for effective therapy. These machines go up slowly and go down slowly and sometimes while they are going up the airway closes and opens back up again before the machine can get to where it needs to be to prevent the collapse. So we have to give it a head start with more minimum.

You are most likely correct in that the bulk of your events are awake/semi awake breathing irregularities and can be removed from the evaluation process. Our awake breathing is much more irregular and the machine only measures flow rate so the irregular flow from being awake is likely to get flagged in some manner and usually it's Clear Airway/Central events but can also be OAs and hyponeas.

Are you using the heated hose or the regular hose?

You are correct...leaks are so low as to be no where near large leak territory (which is up around 70 to 80 L/min total leak and total leak is the top line on the graph). So leaks not a problem unless they wake you up. Anything that wakes us up is unwanted.

Hose management...you can buy something or make your own.
See this thread for some options and what some people in the past have come up with.
viewtopic.php?t=10640

I have the regular hose. No issues with rainout last night that I noticed, so for now I'll stick with that. It's probably less of an issue during the summer anyway since ambient room humidity and temperature is higher than the winter. The regular hose is probably better for breathing cooler air too, which I'm guessing is what your question was related to.

Actually the question about the heated hose use was related to the setting of 1 that you mentioned.
If the heated hose is NOT attached there is no hose air temp control at all...so that setting of 1 is for humidity only.
Just wanted you to know the difference in case you were thinking lowering that setting affected the air temp in the hose all that much.
It will affect it in a round about way...lower humidity setting will mean less heat applied to the water but heating the water doesn't really end up affecting the air in the hose temp all that much. The setting of 1 with these Respironics machines means very minimal amount of heat will be applied because it is a very low humidity setting.

It's okay if you are happy with that humidity setting. I just wanted to make sure you knew the function of that setting.

And yes, the heated hose comes in very handy in the winter if someone keeps a cold bedroom and happens to like a lot of humidity...pretty much a recipe for major rain out.
Though we can get condensation even in the summer if the conditions are just right. Heck I know people who get condensation in the mask from the moisture in their own exhaled breath and they don't use a humidifier at all.

Get a Snuggle Hose cover. That will eliminate the noise "click, click, click" when the hose rubs against the furniture. Get the one with a zipper, it is MUCH easier to get on and off.
http://www.snugglehose.com. It is made of blanket like material and covers the entire length of the long hose. It adds the feeling of comfort instead of feeling the plastic hose on your skin. But it definitely ends the noise the hose makes when it rubs on the furniture.

In the meantime, you can lay a thick towel across the headboard underneath the hose. That should help with the rubbing noise.
The other item I use is called "Cozyhoze BOSS". It holds the hose in place. http://www.cpap.com has them. If you travel, they are really great because they attach with those Command 3M strips- easy on and off.
Good luck.

SOOO much better. My wife also thought to put a towel over the headboard, so great minds I guess. Also, I ordered a hose cover yesterday (not a zippered one, but I'll give it a try), as well as a hose buddy type thing rather than the cozyhose boss. I also adjusted the minimum to 6cm which was definitely better. I was able to get to sleep relatively quickly, only woke up once to use the bathroom but was up for about an hour, and then slept for another 2 hours. Total of about 5 hours of actual sleep. I also need to try adjusting my mask slightly because it's making the underside of nose a little sore in the morning. It subsides after a few minutes and is worst immediately after taking it off and I "stretch it out" so to speak. It's more like a bruising pain than creating an open sore (though it's only be two nights), and I've seen this complaint by others, so I'll just try loosening the mask a bit to see if that helps without causing leaks.

On a side note, is there a feature in sleepyhead to mark awake times? It would be nice if you could mark it off and it would ignore those periods for calculations and maybe blank out the flags. Or maybe even just recalculate for the period you zoom in on. It makes it look so much worse when I was awake from 2-3am and had 21 or 22 CA, and likewise I was probably still awake until 23:15 with that cluster of them too. Also I woke up at about 5:00.

I might raise it to 7cm tonight to see if that helps any more. It's also interesting looking at the tidal volume chart, that apparently my breathing is much more shallow while asleep, which makes it pretty easy to tell my awake from asleep periods.

compujas wrote:On a side note, is there a feature in sleepyhead to mark awake times? It would be nice if you could mark it off and it would ignore those periods for calculations and maybe blank out the flags. Or maybe even just recalculate for the period you zoom in on. I

You can click and drag to highlight a specific time frame and the AHI will change up between the Events and Flow rate graphs to just reflect the time highlighted....it's in tiny letters and doesn't change the stuff on the left side.

If you had the presence of mind to turn the machine off and back on again to sort of "mark" known awake times you can then turn off the known awake sessions but you have to create a different session.. Scroll way down below the statistics and you will see "sessions" ...if you click on a session it will turn from green to red and it's off and the AHI and statistics will change to reflect that session being omitted from all the statistics.

The machines don't/can't tell us when we are sleep or awake. SleepyHead can only report what the machine reports. What we can do is manipulate the calculation period...either by just zooming in on the known asleep time and not including the awake time or if you can create the different sessions you can turn off a session.

I knew I could zoom in, but I never noticed the AHI recalculation on the flow rate graph. That's handy. I still think it would be a neat feature if Sleepyhead let you mark known awake periods so it could adjust the calculations for the entire night, but this is a start.

compujas wrote: I still think it would be a neat feature if Sleepyhead let you mark known awake periods so it could adjust the calculations for the entire night, but this is a start.

Yeah but remember that SH can only report what the machine reports and the machine can't tell anything about sleep vs awake.
And most people don't/won't know for sure known awake times like you know about.
The best we can to is either do the zoom in thing or create sessions that you can turn off.

I think I know what you mean though. Be able to manually omit certain time frames from the calculations. Probably could be done with some coding maybe but the person who came up with SleepyHead is hit or miss or working on it and even though it is open source software no one else has wanted to take up the code and work more on it.

Once you get the awake time reduced it won't matter so much anyway.

Pugsy wrote:Be able to manually omit certain time frames from the calculations.

Exactly.

Pugsy wrote:Once you get the awake time reduced it won't matter so much anyway.

Good point. I guess that is the goal after all.

compujas wrote:I ordered a hose cover yesterday (not a zippered one, but I'll give it a try), as well as a hose buddy type thing rather than the cozyhose boss.

When you put the hose cover on, place a small plastic bag over the end of the hose to keep it from snagging. I used the bag the filters came in.

Although eighteen is still too high, you're clearly moving the right direction. The hose was an issue when I started, but somehow it's a non-issue now (almost eighteen years later).

I see that you set the max to 20. Sometimes, the higher pressures are associated with the central (a.k.a. clear airway) events, but I'm not sure that's the case here.

For the soreness issue, try soaking the piece in question in 50% vinegar solution for two hours. If the vinegar odor is objectionable, wash it thoroughly after soaking. That seems to cut down on the allergic properties of the mask. Several have knocked it, but it works very well for me.

D.H. wrote:Although eighteen is still too high, you're clearly moving the right direction. The hose was an issue when I started, but somehow it's a non-issue now (almost eighteen years later).

I see that you set the max to 20. Sometimes, the higher pressures are associated with the central (a.k.a. clear airway) events, but I'm not sure that's the case here.

For the soreness issue, try soaking the piece in question in 50% vinegar solution for two hours. If the vinegar odor is objectionable, wash it thoroughly after soaking. That seems to cut down on the allergic properties of the mask. Several have knocked it, but it works very well for me.

It's only been 2 nights so far, so I'm not too concerned about being at 18 still, especially since my hst report said 35 to 40. Like you said, it's moving in the right direction.

I don't think the upper limit is causing a problem at the moment since it's only maxed out at 13 anyway. As far as the central, they're almost exclusively during known awake times, so it's likely misclassified, but I will certainly keep an eye on it and keep it in mind.

As for the mask, I don't think it's an allergy issue, but more sore like a bruise, so maybe just too tight. I'll have to play with it tonight and see if I can get it better.

This reminded me of my first night of cpap...I tried to get to sleep for about an hour, no luck. So I gave it up for the night, and got a prescription for Ambien from my sleep doctor the next day. Used that for a week, and then things went on from there. Worked well for me, otherwise I would have either given up or not gotten enough sleep. My day job required attention to detail, so having a good night's sleep was a requirement *smile*.

I also felt like I wasn't getting enough air at 4cm, which is where the DME had configured my cpap to start its ramp...turning off the ramp and starting at 8cm H2O happened very early on, and really helped on the comfort end of things. Really not very far from where I started at this point. I started at 8 -> 10cm, and have ended up at 10 -> 12cm several years later. There were a several stops in between, have done the usual tuning of cpap parameters using my sleep data over time.