Need Some Advice

Pugsy · Post by **Pugsy** » Thu Jan 09, 2020 5:36 pm

I can see all I need with Encore anyway. Don't worry about OSCAR.

Yes, last night was bad in general. It happens. See if increasing Flex is more comfortable or not. I always tell people to try all the settings (including off) and simply choose the one that is the most comfortable and feels more natural and doesn't matter what setting it ends up being. Whatever feels better to you.

The snores...could very well be related to the nasal stuff going on. Let's not change anything just yet except the Flex and concentrate on getting you some halfway decent sleep first so that we can best evaluate the setting results.
You are probably going to still need more minimum EPAP but you can sneak up on it to make the adjustment process easier if you wish.
You can even go up in 0.5cm increments if you need to.

Pugsy · Post by **Pugsy** » Thu Jan 09, 2020 5:48 pm

I would like for you to give Classic Mode humidification a try.
You need to go into the clinical setup menu and turn off the "new system One humidification" mode and choose Classic and when chosen it lights up a big C in front of the number setting for the humidity. I would like for you to try Classic 4 setting.
No rush to do it tonight though...just sometime in the sort of near future to see if it helps with the nasal congestion.

Maiden72 · Post by **Maiden72** » Thu Jan 09, 2020 6:07 pm

I found the classic mode humidification and it is on C4 now and bi-flex 2. I will leave minimum epap on 12 for now.

Maiden72 · Post by **Maiden72** » Fri Jan 10, 2020 8:30 am

Still had some leakage, but not as severe. I felt both the change to humidification and flex helped tremendously. I could breathe much better. AHI is 3.1. Feel much better today.

Pugsy · Post by **Pugsy** » Fri Jan 10, 2020 9:13 am

Finally some positive news. I was hoping that more humidity might help. Classic mode is just the machine humidifier heating up all night long to crank out the moisture without the ambient humidity sensor messing with things. It's the way humidity was delivered for years and years until the System One or ResMed S9 machines came along with humidity sensors.
You have one more choice of 5 if you find you want to try a little more at some time in the future.
Condensation is a risk though but there are ways to deal with it if that happens. I started my cpap therapy 10 years ago back before humidity sensors and heated hoses. People managed well enough back then if condensation in the hose or mask occurred. There are some options available.

AHI of 3 and feeling better. I will take it for now. Give yourself a few nights at the 12 cm minimum EPAP and see what happens.
Might end up wanting another 0.5 or 1.0 cm but see what happens over a few nights first.

Pugsy · Post by **Pugsy** » Fri Jan 10, 2020 9:46 am

Next time you go to the store pick up a nasal product similar to Simply Saline and use it frequently during the day as well as generously an hour or so before bedtime.
Sounds like your nasal mucosa are like mine in that they just want lots of hydration. I use the generic equivalent a lot even during the day.
When I lived in Las Vegas, where it is horribly dry, I never went anywhere without it and this was even before I was ever diagnosed with OSA and needed the cpap machine.

Maiden72 · Post by **Maiden72** » Fri Jan 10, 2020 4:04 pm

I have used the generic simply saline a couple of times. It did help. It is a little pricey. So I currently use a saline in a squeeze bottle every night. Not quite as effective as pressurised can, but it helps

Maiden72 · Post by **Maiden72** » Sat Jan 11, 2020 9:13 am

AHI 5.2. Not used to having this many OA or CA. Also, the FL is being calculated into the AHI #. Would we consider the AHI over-inflated because of that? I feel good. This is the 1st time that I have ever had no large leaks. I assume you are going to want me to up the EPAP. Also, with the classic humidity at 4, I would run out of water if I turned it up to 5. So, leaving it at 4 for now. So, the EPAP is at 12 now. If 90% of the time, the EPAP was at 16, does that indicated I should raise the EPAP? VS is way down.

Pugsy · Post by **Pugsy** » Sat Jan 11, 2020 9:32 am

FLs aren't being added into the AHI
OA 0.6
CA 1.4
Hyponea 3.2

add them up and you get 5.2 AHI

FLs are never part of the AHI though sometimes at a glance (like this time) it appears like it.

The bulk of the AHI is hyponea....general rule of thumb is IPAP for hyponeas and EPAP for OAs. There is more than one way to get more IPAP....either more PS or simply more EPAP so that IPAP gets pushed up by default.....or maybe a little of both.

You have several options.
1...Allow PS to move around a bit and see if the machine will deal with the hyponeas with more PS by setting PS with a range...like 4 minimum and 5 maximum. I am suggesting this cautiously because of the headache issue that may have been related to your prior too high PS of 7. Most people won't have a problem with PS of 5 though. Or maybe just change to fixed 5.
2...Increase minimum EPAP by either 0.5 cm or 1.0 cm...leave PS the same..this also increase IPAP by whatever you change minimum EPAP by default.
3...Increase both minimum EPAP little bit AND let the machine try auto adjusting PS with a small range in PS like 4 to 5.

Hyponeas are normally fairly easy to deal with without big changes because they are like baby OAs....just haven't grown up yet.
Flow reductions due to partial closure of the airway vs the 100% or almost 100% closure that earns the OA flag.

I am on the fence as to which one to try next.
I think if it was me I would try a simple 0.5 increase in the minimum EPAP first and then if that didn't give me the results I wanted I would add in letting PS maybe help out with a range of PS...so PS min of 4 and max of 5 and see if the machine even utilizes the available PS. If it doesn't then add in another 0.5 cm to minimum EPAP.
I tend to be overly cautious and not make big changes quickly unless there is an urgent need.
It's hard to know what to do because of the nightly variations we normally see in data anyway.

Maiden72 · Post by **Maiden72** » Sat Jan 11, 2020 10:43 am

I thought I felt OK, but now that headache is back. Not as bad as it was though. Prior to reaching out on this board, it was 24/7 for a couple of months. I do think it is a combination of sinus blockage along with pressure. The longer I sleep, the worse it is. Usually worse on the weekends when I get close to 8 hours of therapy. On weekdays, I only get about 5 hours of therapy. I was thinking the FL was included in the total, now I see it is not. The headache just started a couple of months ago. I had been on the settings I had since June and was doing OK until the headaches started. I just looked at encore report from one night in July where I had 8 hours of therapy, no large leak. AHI was 1.0. All Hypopnea. The headaches just started right about the time the seasons changed. I know my sinuses are always bad in winter. So, I think my headache issues are all related to sinus issues. I can increase by EPAP by .5 for tonight and then change PS to 4/5 after that.

Pugsy · Post by **Pugsy** » Sat Jan 11, 2020 10:52 am

Your headaches very well could be related to sinus/nasal issues. That would actually make more sense than blaming them on the higher PS....but I still don't want you using more than 6 PS because I do know that the higher PS can cause centrals.
Lots of things can cause headaches and they are totally unrelated to sleep apnea or cpap. I have one cause myself...a bad arthritic neck and if I sleep with head/neck in a weird position I wake up with a headache.

Maiden72 · Post by **Maiden72** » Sun Jan 12, 2020 8:28 am

I went ahead and made several changes. I increased EPAP to 12.5, Increased PS to 4-5 and increased humidity to 5. Flex increased to 3. I think this was a pretty good night. Had just enough water to handle the humidity level. Did have some leakage though

Pugsy · Post by **Pugsy** » Sun Jan 12, 2020 8:40 am

Let's fix that time over red line statistic.
It's based off a ResMed leak threshold number and that number is way too low for your Respironics machine.

Go to Preferences/CPAP tab and look on the right for the red line threshold number...see the 24 L/min that's a ResMed red line number and ResMed machine report leaks different so that red line number of 24 is way too low for a Respironics machine.
Respironics doesn't have a fixed red line...the line varies between pressures used and mask used. The top leak line is the total leak line which is the vent rate plus any excess leak. More pressure means more vent rate.

I can't tell exactly where your actual threshold is because for some reason the large leaks aren't being flagged or shown like we would expect. The time it went to close to 140 L/min should be flagged and gray but it isn't. Check over on the bottom right corner where it says events and see if the LL for large leak is green or red. It needs to be green. Click on it to change color.

Anyway...change the 24 to around 90 L/min or turn off that particular statistic and just use the LL line on the events graph to monitor leaks. It's not perfect since the number varies so much but it's close and a conservative line at your pressures.

Maiden72 · Post by **Maiden72** » Sun Jan 12, 2020 9:22 am

Ok. I can make those changes in oscar later. Oscar so very rarely has my stats, but it did last night. Not sure why it was able to report last night. Maybe because i started session, then turned it off , changed flex and restarted. Dream mapper respironcs app says 74% mask fit.

Pugsy · Post by **Pugsy** » Sun Jan 12, 2020 9:28 am

I had a similar problem when I was using the 960 and SleepyHead in that sometimes it would work fine and sometimes it was useless.
I knew it was related to some setting adjusting I made but I could never isolate which setting adjustment resulted in the software working.

Your leak reported from DreamMapper (or Encore) shows roughly 25% of the time in large leak and that correlates to the leak graph.
That one hour block from roughly 5:40 to 6:40 in for sure large leak and there may be some brief sporadic spikes after 6:40.

The time up to 5:40 I am confident none of it was in large leak.

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