help interpreting my sh graphs.

My numbers from last night. I changed the ps to 3. the epap to 11. And I turned the ramp off. It all felt good but the data is still about the same.???

[/url[url=http://imgur.com/c8a9Eas]

Either you are mouth breathing with a nasal mask or your PS needs increasing. It looks like mouth breathing because of the low minute ventilation and an OK breathing rate. I would switch to a FFM while you are trying to set up the machine.

Standard titration protocol is to increase epap till the OA come into line.
page 35
https://www.resmed.com/us/dam/documents ... lo_eng.pdf

ajack wrote:Either you are mouth breathing with a nasal mask or your PS needs increasing. It looks like mouth breathing because of the low minute ventilation and an OK breathing rate. I would switch to a FFM while you are trying to set up the machine.

Standard titration protocol is to increase epap till the OA come into line.
page 35
https://www.resmed.com/us/dam/documents ... lo_eng.pdf

Thank you. I changed my ps from 4 to 3 for one night to see what happened. I prefer the nasal masks but keeping my mouth shut is really hard and I have tried about every suggestion, some at same time. I had no luck with full face masks. I don't know if they have created any in recent years the improved over the quartto, but never could get that one to shut up. I read the reviews on all the ffm and it seems many people have leak issues and I know I walked away from cpap for years because I could not find a comfortable mask that LET me sleep.

you don't really have a choice, you have to get a FFM working for you.
If you are insurance funded, the gun mask at the moment is the f20 with the memory foam, but it doesn't have the life of the silicon.
I use the silicon f20 and find it works better than the quattro air/f10 cushion and more than happy with it. it doesn't have the 2 piece skirt that caused me trouble, It's a single piece silicon

palerider wrote:

lliann wrote:

palerider wrote:

Pugsy wrote:Hey PR...where else do we turn on category flagging besides the lower left Flag area? She says that CA is green but they sure aren't showing up.

file/preferences/events 'clear airway' could be unchecked.

Pugsy wrote:I know where PR is going with the idea to reduce PS though...there's a very small percentage of people who get centrals simply from bilevel pressures and his idea is worth trying.
I personally know one person who gets around 15 Centrals per hour with PS of 4 but maybe 1 per hour with PS of 3...go figure that one.
Surprised the heck out of me when I saw it for my own eyes.

Yup. It's an easy thing to check for.

looked under preferences, looked under file. Maybe because my sh is for Mac it is different? Under preferences all items are checked (including centrals)/ All my flags are green and all my event flags are green.

You can upload your entire zipped up SD card to https://www.dropbox.com/request/0LalWvEsijRIgX8sdM7H if you like and I can take a look at it, make sure it's working here.

So I tried to compress the file and it says it can't due to an unrecoverable error. (?). My son helped me and he could not figure it out (and he works for apple) Sigh

You do have a choice. You don't have to use a full face mask if you don't want to and besides...there's no proof that a FFM would fix anything and there isn't even enough proof that a full face mask is even needed.

There's no way to know for sure if that 4 % of time in large leak is for sure all mouth breathing or mask movement or a combination of both.
If you taped your mouth...then we know it's mask movement and full face masks can and will move just like any mask.
If you didn't tape your mouth or the tape came off...we have no way to know for sure what caused the large leak.

Even if it was for sure 100% mouth breathing...4 % of 5 1/2 hours is 13 minutes....big whoopie. Sure won't get me to go buy a mask I don't want to use and doesn't guarantee that mask movement leaks won't happen and is likely to disturb my sleep from a comfort level.

You made a very small change in the settings last night...trying to see if the centrals reduced and trying to see if the obstructive stuff reduced. And both did but very marginally but this is one night...and it was a very small change...can't really expect much from a small change. Need more nights to evaluate the effect because there is a lot of truth to the "give it time" thing when it comes to evaluating any changes in settings.

So...one quick question here...what are your goals or what are you trying to fix here?
Is it better quality sleep because your sleep isn't what you would like?
Is it just numbers that you need to see lower for "proof" that you are doing the best you can?

I know your sleep quality is less than optimal...5 1/2 hours tells me that but is it possible that sleep apnea isn't the cause? Other issues going on?

We can clean up the AHI with more pressure. That's fairly easy to do and keep one eye on the centrals while doing it.
But more pressure could increase the visits from the aerophagia monster....and he is an unpleasant dude.
Which is worse...seeing a few more apnea events or a visit from the unpleasant dude?

If you can figure out how to get the SD card contents uploaded PR can look to see if the centrals are "real" or not. If not real we ignore them in the AHI evaluation. If real we can still try to kill more of the obstructive stuff but just have to keep a closer eye on the centrals while doing the killing....all the time trying to avoid a visit from the unpleasant dude.
I know you are a bit computer challenged. Later on today I will see if I can find some instructions on how to do on a Mac what needs to be done...or maybe a Mac user will chime in and give you step by step instructions. I have never used a Mac so I have to look up stuff.

Nope I stand by getting a ffm. The guy can't fix his mouth leak, the tidal volume and minute vent is low and breathing rate is ok. he's mouth breathing.
he is never going to be able to adjust the PS for his need... the nasal mask isn't working, taping up the mouth is an option..not a good idea to me..

ajack wrote:Nope I stand by getting a ffm. The guy can't fix his mouth leak

And I am going to respectfully totally disagree for several reasons but the main one is you don't know for sure that mouth breathing is what is going on here...and 4 % of the night even if it was mouth breathing 100% isn't enough of a reason to go buy a mask that someone doesn't want and I totally disagree with your minute volume stuff.
The data from these machines isn't suitable for that type of evaluation...need more and better data pertaining to lung issues before going down that road. She needs to see a doctor for that stuff.

Believe what you wish. RobySue has already challenged you on the other forum over your thoughts along the volume angle.
So I won't go there since I know it would be a waste of my time anyway.

340 is so far below normal, the minute vent of 4.75 is also well out of range. Either the person is in respiratory failure with a repressed breathing rate or there is mouth breathing. Unless you have another reason for the stats and the machine not reading flow.?
you can also mouth breathe without leaks.

from memory robysue was a discussion in flow limit where her assertion was that it wasn't obstructive cause,

Tidal volume shows median 340...that's median average and not overall average and tidal volume "normals" vary widely among individuals.

Her numbers are actually better than mine if you just go by the numbers which mean nothing without taking into account all the other variables....gender, height, weight, build, location (as in altitude), etc.
Most recent in SH tidal volume numbers
my median was 340
my 95% was 440
my max was 990

Are you telling me that I have lung issues without knowing what is normal for me? You saying I need to fix it with a full face mask?
Got news for you...I have used a full face mask (Amara View) and it didn't change anything and if I have time I will go dig out the reports to prove it. And I also don't have lung issues or health issues but I am 4 ft 11 and female with very small bone structure and this is normal for me.

What you say might be true for a 6 ft 2 in man but isn't true for everyone because tidal volumes vary widely...and if there was a question I would say go to a lung specialist to see just how much of a problem there might be and explore options with him. Just changing masks won't fix it.

Lliann is female for one thing. Females typically have lower tidal volume norms than men simply due to stature among other things.

Believe whatever though...but you need to understand variations in norms among the population before saying someone is low without knowing all the particulars.

ajack wrote:340 is so far below normal, the minute vent of 4.75 is also well out of range. Either the person is in respiratory failure with a repressed breathing rate or there is mouth breathing. Unless you have another reason for the stats and the machine not reading flow.?

ajack wrote:340 is so far below normal, the minute vent of 4.75 is also well out of range. Either the person is in respiratory failure with a repressed breathing rate or there is mouth breathing.

I'm an example of someone who has an average tidal volume of around 330, and a minute vent of around 4.88 to 5, and the reason is because I'm a small woman standing all of 4ft 11 3/4" tall and weighing 110 pounds, not because I'm in respiratory failure! Based on this info from SH there is no way that you can jump to the conclusions that you have, esp regarding resp failure, so I just want to reassure Liliann here.

I have no leak problems either, or mouth breathing ... and my 6 month 90% leak rate in SH is zero.

I totally agree with Pugsy's comments and mask advice.

Just out of curiosity I checked mine. Now although I have lost 40 pounds, I still have 30 to go and I'm 5 foot 3. My tidal volume median numbers are from 280 to 330 over the last two years and min vent median is 5.5 to 5.75. No cardiac issues and no lung problems. I checked back to 2015 and these numbers are consistent all the way through. I always use a full-face mask (Hybrid).

obviously you can't help someone if you think it's not an issue because your average near median is also low.

I think you need to do some googling. most average peoples tidal volume is going to be around 500 average near median, unless you have a better explanation to why the tidal volume is low, I'll go with mouth breathing out.
a zoom in on the chart would help see what is going on

this is a typical target for tidal volume

ajack wrote:I think you need to do some googling. most average peoples tidal volume is going to be around 500 average near median, unless you have a better explanation to why the tidal volume is low, I'll go with mouth breathing out.

Go with whatever you wish but you have no way to know if it is the reason and as one full face mask user has stated...she has a low median average also.
Didn't seem to make any difference with her did it?

Numerous sources on the web...I pulled this one since it was front and center.

https://en.wikipedia.org/wiki/Lung_volumes

Standard errors in prediction equations for residual volume have been measured at 579 mL for men and 355 mL for women

Assuming the machine is spot on accurate and we have no way to verify accuracy of this data point...looks like I am pretty much normal and no where near the low side.
Lots of calculations needed to determine what is normal for one person and that doesn't mean it's going to be normal for the next person.
Too many variables to be making blanket statements like you are making based on the AVAPS protocol which is mainly used when people are having serious lung issues and needing extra ventilation.

You are shouting fire when there's not even any real smoke to see based on a standard that may or may not apply to someone and you have no way to know all the information needed to figure out what is normal for them or not.

ajack wrote:340 is so far below normal, the minute vent of 4.75 is also well out of range. Either the person is in respiratory failure with a repressed breathing rate or there is mouth breathing. Unless you have another reason for the stats and the machine not reading flow.?
you can also mouth breathe without leaks.

from memory robysue was a discussion in flow limit where her assertion was that it wasn't obstructive cause,

Well I still have a lot to learn, so I will stay open minded to approached.

Yes, I am a mouth breather. But not during the day and only towards the end of the night. The large leaks all seem to happen at the end of the chart. What happens then? The roommate gets up at 4-430 to get ready for work. The cat decide to visit me to tell me the food is not being presented fast enough to their liking. The sun is coming up and I have not been able to sleep any length of time for years. (hips hurt, neck hurts) Yes, I could keep my door close. If I want to hear 3 cats howling from abandonment fears. I have avoided that option but it may have to go on the table soon.

I have lived long enough that I am ok with being right or wrong. And when someone tells me I have no choice, I know I =always= have a choice so that does not bother me. Maybe its time to try a newer FFM to see if I have changed, it has changed or it all still sucks and I return it and go back to my other masks. I am willing to try anything and everything. Got nothing to lose since I am losing sleep anyway.

Pugsy, I was concerned this morning because I was very tired when I awoke and that was different. It surprised me because it felt like I slept well but I did not feel Doris Day perky this morning. (actually I never feel Doris Day perky. More like Maude on the Golden Girls) What I want is to not strain my heart with non breathing and to feel rested. But I do inhale shallow and exhale lengthy. Interspersed with great dramatic intakes and blow outs. Thats when I am awake. I think part of my readings show my style of breathing. I could be wrong because I do not understand tidal waves/volume and satuation points and other oxygen breathing mathematical equations(yet) but I think that is what I am aiming for. Not so much the pretty ahi numbers but to know I am at least getting the oxygen I need most of the time even tho I breathe weird. I guess we can adjust numbers to have the machine kick start me but yes, aerophagia and me are good friends and its tolerable now but too much more and it gets painful.

Thats what I know. Also I could copy my card and mail it/ Might be faster then me trying to learn how to compress.