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Re: Do you ever have trouble pulling in air?
Posted: Mon Apr 09, 2018 6:27 pm
by zonker
welcome to the forum!
just jumping in to assure that you don't need to become an expert in the sleepyhead software to treat your apnea. i've been doing this for almost 3 years and i don't have a great knowledge of the software.
but i DO have enough understanding of the software to post images here of the graphs it generates. and there are people here, many of whom have responded already, who DO have an understanding. once they see these graphs, they can help you to make adjustments that will improve your therapy.
hang in there and you'll soon know enough to treat yourself properly!
Re: Do you ever have trouble pulling in air?
Posted: Mon Apr 09, 2018 6:42 pm
by TedVPAP
zonker wrote: ↑Mon Apr 09, 2018 6:27 pm
welcome to the forum!
just jumping in to assure that you don't need to become an expert in the sleepyhead software to treat your apnea. i've been doing this for almost 3 years and i don't have a great knowledge of the software.
but i DO have enough understanding of the software to post images here of the graphs it generates. and there are people here, many of whom have responded already, who DO have an understanding. once they see these graphs, they can help you to make adjustments that will improve your therapy.
hang in there and you'll soon know enough to treat yourself properly!
Well said.
Re: Do you ever have trouble pulling in air?
Posted: Tue Apr 10, 2018 1:11 pm
by brightcrow
Thank you to those who have encouraged me.
I never got a titration study because I didn’t have enough apnea, so my original pressure prescription was a generic 4-16. In retrospect I question whether I was right in asking my doctor that I lower the max to 10. It may have been mask leaks that made me feel like there was way too much “wind”.
While being aware of some controversy here, most people have suggested a higher minimum pressure, and it seems sensible to do so. If I understand correctly, some have also suggested that a higher maximum might be more effective. I’m not sure how much maximum pressure is prudent, but I think I should do that gradually.
I have increased the minimum pressure from 4 to 6, have set starting ramp pressure to 5, and have kept auto-ramp. I have increased maximum pressure to 11 for now.
The photo of nasal pillows is also my understanding of their placement. But because there is a taper, a portion of that is within the nostril, and appears to be pulled in too far on occasion, as Pugsy has also experienced.
Re: Do you ever have trouble pulling in air?
Posted: Tue Apr 10, 2018 1:20 pm
by Ron AKA
brightcrow wrote: ↑Tue Apr 10, 2018 1:11 pm
While being aware of some controversy here, most people have suggested a higher minimum pressure, and it seems sensible to do so. If I understand correctly, some have also suggested that a higher maximum might be more effective.
I’m not sure how much maximum pressure is prudent, but I think I should do that gradually.
I have increased the minimum pressure from 4 to 6, have set starting ramp pressure to 5, and have kept auto-ramp. I have increased maximum pressure to 11 for now.
You should be fine with those changes. With the maximum setting it higher is the safe direction, and then lower it later. With the minimum it is best to start moderate and then increase or decrease. To go further without SleepyHead would be like shooting in the dark. You are just guessing until you can see when events are occurring and at what pressure.
Re: Do you ever have trouble pulling in air?
Posted: Tue Apr 10, 2018 1:28 pm
by palerider
Ron AKA wrote: ↑Tue Apr 10, 2018 1:20 pm
brightcrow wrote: ↑Tue Apr 10, 2018 1:11 pm
While being aware of some controversy here, most people have suggested a higher minimum pressure, and it seems sensible to do so. If I understand correctly, some have also suggested that a higher maximum might be more effective.
I’m not sure how much maximum pressure is prudent, but I think I should do that gradually.
I have increased the minimum pressure from 4 to 6, have set starting ramp pressure to 5, and have kept auto-ramp. I have increased maximum pressure to 11 for now.
You should be fine with those changes. With the maximum setting it higher is the safe direction, and then lower it later. With the minimum it is best to start moderate and then increase of decrease. To go further without SleepyHead would be like shooting in the dark. You are just guessing until you can see when events are occurring and at what pressure.
Keep in mind that Ron can't manage his own therapy, so he shouldn't be giving "advice" to anyone else.
Re: Do you ever have trouble pulling in air?
Posted: Tue Apr 10, 2018 8:32 pm
by TedVPAP
brightcrow wrote: ↑Tue Apr 10, 2018 1:11 pm
Thank you to those who have encouraged me.
I never got a titration study because I didn’t have enough apnea, so my original pressure prescription was a generic 4-16. In retrospect I question whether I was right in asking my doctor that I lower the max to 10. It may have been mask leaks that made me feel like there was way too much “wind”.
While being aware of some controversy here, most people have suggested a higher minimum pressure, and it seems sensible to do so. If I understand correctly, some have also suggested that a higher maximum might be more effective. I’m not sure how much maximum pressure is prudent, but I think I should do that gradually.
I have increased the minimum pressure from 4 to 6, have set starting ramp pressure to 5, and have kept auto-ramp. I have increased maximum pressure to 11 for now.
The photo of nasal pillows is also my understanding of their placement. But because there is a taper, a portion of that is within the nostril, and appears to be pulled in too far on occasion, as Pugsy has also experienced.
Very glad to see that you are moving forward and trying some good suggestions.
You may need larger pillow if you feel it entering too far. Trial and error is the only way to know.
Limiting the max to 10 was definitely a mistake but an understandable one.
Not getting titrated is OK as the expertise on this forum, coupled with results (numbers and your assessment), will lead to great treatment.
Increasing the min will likely help you breath more comfortably. Raising the max will help us better understand what the machine thinks you need.
The downside of using ramp is that the mask seal may be great at 6 but terrible when you get up to your true pressure needs. It is best to know that the mask is not sealing when at full pressure when you are still awake.
Re: Do you ever have trouble pulling in air?
Posted: Tue Apr 10, 2018 9:45 pm
by brightcrow
TedVPAP wrote: ↑Tue Apr 10, 2018 8:32 pm
The downside of using ramp is that the mask seal may be great at 6 but terrible when you get up to your true pressure needs. It is best to know that the mask is not sealing when at full pressure when you are still awake.
Wouldn't this show up in My Air as a lowered score for mask seal? Can I have confidence in a high mask seal score?
Re: Do you ever have trouble pulling in air?
Posted: Tue Apr 10, 2018 9:52 pm
by Julie
Most of us (great majority) stop using ramp the first week or so... no matter what machine, etc. we have. Don't confuse it with pressure settings or any connectiion to the mask. I think I understand what he's getting at but maybe should not have tried... it's not an issue with any software either.
Re: Do you ever have trouble pulling in air?
Posted: Tue Apr 10, 2018 9:59 pm
by Pugsy
brightcrow wrote: ↑Tue Apr 10, 2018 9:45 pm
Wouldn't this show up in My Air as a lowered score for mask seal? Can I have confidence in a high mask seal score?
You can trust the mask seal score. If it scores you high your excessive leaks were minimal.
You get dinged on mask seal score when your leak exceeds 24 L/min...be it 25 L/min or 55 L/min...same ding and the rest of the score is duration of the excessive leak. You get a small ding for say 10 minutes over 24 L/min and you get a bigger ding (lower score) for say an hour over 24 L/min.
Re: Do you ever have trouble pulling in air?
Posted: Tue Apr 10, 2018 10:04 pm
by TedVPAP
brightcrow wrote: ↑Tue Apr 10, 2018 9:45 pm
TedVPAP wrote: ↑Tue Apr 10, 2018 8:32 pm
The downside of using ramp is that the mask seal may be great at 6 but terrible when you get up to your true pressure needs. It is best to know that the mask is not sealing when at full pressure when you are still awake.
Wouldn't this show up in My Air as a lowered score for mask seal? Can I have confidence in a high mask seal score?
Yes, but...
The problem with mask leaking is that it takes MAJOR leaking to effect the accuracy of your data, while a small leak MAY disrupt your sleep.
It all depends on you.
If you awake due to mask leaking once asleep, then make sure you get the mask seal set properly while still awake.
If possible, I recommend getting comfortable with your pressure while awake so you do not become uncomfortable when you are asleep and the pressure arrives.
Re: Do you ever have trouble pulling in air?
Posted: Tue Apr 10, 2018 10:28 pm
by Pugsy
Your MyAir score is accurate in terms of leak scores.
Now if you were talking about AHI ...that's a different story. I thought you were being specific about mask leak scores on MyAir.
AHI can be impacted in the face of big prolonged leak but then your mask score should also reflect a prolonged large leak.
Re: Do you ever have trouble pulling in air?
Posted: Wed Apr 11, 2018 4:34 am
by prodigyplace
MyAir scoring is focused too much on usage hours.
70% of the score is usage. 7 hours or more for full score, 1 or less for 0
20% of the score is "mask seal" or leakage. 16 L/minute or less for full score. They recommend adjusting mask fit if > 24.
5% of the score is "events per hour" or AHI. 6 or less for full score, 19 or more for 0
5% of the score is "mask on/off". 2 or less for full score, 6 or more for 0.
I do not know if their leakage score is an average or the maximum value from a session. I assume it is the average. One value cannot provide much insight into 7 hours of usage.
Re: Do you ever have trouble pulling in air?
Posted: Wed Apr 11, 2018 6:15 am
by Pugsy
prodigyplace wrote: ↑Wed Apr 11, 2018 4:34 am
I do not know if their leakage score is an average or the maximum value from a session. I assume it is the average. One value cannot provide much insight into 7 hours of usage.
I am thinking that the 95% number is used a lot....Resmed is big on relying on that 95% leak number which to me is next to useless except for generalities. The "or below" part of the definition leaves the door wide open for all sorts of stuff and it's too easily skewed to the high side to make things look a lot worse than they are.
I had a 95% leak number a while back of 37 L/min and the only time I was over 24 L/min was 25 minutes at 40 L/min when the nasal pillows popped out a bit. Horrible numbers but when looking at the graph...actually a quite decent leak graph.
Re: Do you ever have trouble pulling in air?
Posted: Wed Apr 11, 2018 4:11 pm
by brightcrow
TedVPAP wrote: ↑Tue Apr 10, 2018 10:04 pm
If possible, I recommend getting comfortable with your pressure while awake so you do not become uncomfortable when you are asleep and the pressure arrives.
How would I do that, with max pressure? (Edited)
Re: Do you ever have trouble pulling in air?
Posted: Wed Apr 11, 2018 4:26 pm
by Julie
Just wear it while awake, maybe watching TV, etc.