Too much for one post?

ChicagoGranny · Post by **ChicagoGranny** » Fri Jul 30, 2021 7:47 am

Bentley'sDad wrote: ↑
Fri Jul 30, 2021 7:04 am
Also, I noticed that I can not set the graph sizes in MacBook Pro. Any clues on how to do that? I manually adjusted them.

I'm not sure what you mean. It looks like your machine was blowing momentarily around 16:00. You can go to the bottom of the left column and turn off that session. Then, the session beginning at 23:00 will fill up the X-axis.

GrumpyHere · Post by **GrumpyHere** » Fri Jul 30, 2021 7:53 am

Bentley'sDad wrote: ↑
Fri Jul 30, 2021 7:04 am
Also, I noticed that I can not set the graph sizes in MacBook Pro. Any clues on how to do that? I manually adjusted them.

Sorry step 4 above was a bit confusing - I will edit it.

It should be in the File Menu -> Preferences -> Appearance Tab

This allows you to set the default height. If you want individually sized graphs, then it's a manual process.

4. Set Graph Height in File Menu -> Preferences -> Appearance Tab
The default should be 180.

On my setup, when set to 80, I get really squished up graphs.

At 192, the 5 graphs (flags, flow rate, pressure, leak, flow limit) are nicely spaced out.

At 160 I also get snores as the bottom graph.

5. Reset Graph Heights in View menu. This step may not be always necessary.

Bentley'sDad · Post by **Bentley'sDad** » Sat Jul 31, 2021 7:11 am

: Screen Shot 2021-07-31 at 9.04.05 AM.png (208.88 KiB) Viewed 1695 times

I think I found al the settings. This is last nights data. I slept 2 hours after ending the session and felt like crap when awakening. As you can see I am getting used to leaks (not good I think) and learning to ignore them as I sleep instead of wakening to fix them. Last night the wife came into my room and woke me because she heard the leaks (still in separate rooms from my snoring and now from the machine

: Screen Shot 2021-07-31 at 9.04.05 AM.png (208.88 KiB) Viewed 1695 times

). I try and remember to break the seal on themes for several seconds when I waken to adjust the mask. At least I can see when it happened by the spikes.

Julie · Post by **Julie** » Sat Jul 31, 2021 7:23 am

Unless you get bad aerophagia, I'd raise the max pressure by 5, but most definitely address the leaks... they're not good and spoiling your therapy.

Bentley'sDad · Post by **Bentley'sDad** » Sun Aug 01, 2021 9:20 am

So far I have tried several changes in mask equipment to no avail. I have changed the headgear and mask sizes, have changed brands of mask. I know that I sleep mouth open at times and now I find that with the F20 (s,med, small and med headgear) or the dreamwear FF(med, med/wide small and med headgear) I will open my mouth past the mask and get parchment mouth. I have tried rigging a chin strap as a test but that does not seem to change the leaks, even if it lessens parchment mouth.
I sleep both sides as well as supine. It seems that when I sleep on either side it causes leaks. When my facial muscles totally relax I get leaks. At first I would wake and adjust the mask but as time goes on I seem to be able to ignore the leaks (as an aside I have tinnitus and have an ability to block the sounds and have always been able to mentally block pain, so it makes sense that I can block the leaks in my sleep).
I tried higher pressures and found that my mask leaks can not be controlled at higher pressures, unless I over-tighten the headgear. The leaks are bad enough that resmed sent me an email telling me to adjust my mask and suggesting I watch some vids. Yeah, like I haven't done that already?
I had aerophagia really bad in the beginning and lowering the pressures seemed to help a lot but I still feel bloated at times.
I set titration based on 95% values using the original settings of 4/20 cmH2O. It seemed that the machine was chasing upward a lot (to 20cm) but that the 95% value was around 13.8 so that is where I placed it. I always awoke and actually tore the mask off at some pressure above 15-16. I figured for now (until all the issues are worked out) I can compromise. My AHI average is below 5 and I have had a couple nights below AHI1. As I said my sleep seems worse than before APAP most of the time.
I guess I should say that I had a LOT less leaks when I first started. I think that is because I was maintaining muscle tone of my cheeks (tension). Now that I relax them, I get the leaks really badly. When I relax my face the leaks flap my cheeks and or leak from the corners of my mouth (smile=leak).

Last night I tried paper tape at the mask seal. That seemed to make a difference in the mask test but I still had leaks all night long.

Again...too much information? Too many variables. I started the 14th(wish) of June.

Pugsy · Post by **Pugsy** » Sun Aug 01, 2021 9:45 am

95% pressure statistics just mean you were at or below that number for 95% of the time.
It is NOT an overall average of any sort and it is NOT necessarily a number where someone should be setting the minimum pressure when using auto adjusting mode.
It's just a number and in most cases means nothing.
It is easily skewed to the high side by a relatively short period of time at the higher pressures.
It is NOT the holy grail of anything.

Looks like flow limitations are driving the pressure upwards....are you experiencing any nasal congestion at all?
If not, either supine sleeping or REM stage sleep or maybe chin tuck is altering the airway and making the flow reduce and causing the need for higher pressures.

Leaks are definitely a problem and need to be addressed before screwing with pressures all that much.
When leaks aren't an issue (like first part of the night) there aren't any real events happening but later when leaks appear then they are bad enough to allow sub optimal therapy. Big leaks are happening even at the lower pressures so not necessarily related to higher pressures (see 04:40 segment).

I am sorry but I am zero help with dealing with full face mask issues. Never used one.

Do you by any chance have facial hair of some sort?

Bentley'sDad · Post by **Bentley'sDad** » Sun Aug 01, 2021 10:56 am

I understand that the 95% pressure is only a statistic, however it did give me a starting point and still allowed AHI<5, so acceptable for now. I used the 95% as the upper pressure. I noticed that I had few to no incidents above the 95% in early therapy. On the few nights with negligible leaks I was able to obtain AHI<=1.5. One night was .25
As I stated ,it seems that when I first started I was keeping my facial muscles tight at night. Now that I am relaxing them the leaks happen all night. Also early on when facial muscles tight the pressure would wake me and even cause me to abandon the therapy. Usually at around 16-18cm.

Right now I am looking at chin straps and considering nasal mask instead of FF. Not sure how my HMO is going to take this as I have changed masks a LOT. The entire system seems broken with regard to how to get a mask that actually works. Any recommendations for best chin strap?
Thinking of Phillips premium chin strap?

I shaved my mustache and gotee the second night as I realized it would be problematic. My facial hair grown slowly so I do not shave but once a week or so. Do you think that mild stubble might be an issue?

Pugsy · Post by **Pugsy** » Sun Aug 01, 2021 11:22 am

I don't use a chin strap...never have really. Brief trial with one taught me it caused more sleep quality issues than it fixed.
So I can't really recommend one.

I don't know about the stubble but it is possible. Maybe try shaving once a day (maybe even at bedtime) for a few nights to see if it makes any difference or not.
I do know that the least little thing can impact seal on a full face mask just because of the real estate involved that needs to stay sealed when it comes to a full face mask.

My point about the 95% numbers....they really shouldn't even be used for much of anything and I for sure wouldn't be using it as a max pressure setting number. The machine went higher than the 95% number for 5% of the night for a reason and by limiting the max you are potentially setting yourself up for apnea events that need higher pressures to be prevented.
The machine only goes up to where it thinks it has a good reason to go and is needed. There was a reason it spent 5% of the time higher.

ChicagoGranny · Post by **ChicagoGranny** » Sun Aug 01, 2021 12:01 pm

Bentley'sDad wrote: ↑
Sun Aug 01, 2021 10:56 am
As I stated ,it seems that when I first started I was keeping my facial muscles tight at night.

They might have been tight when you were awake, but they relaxed when you were sleeping. A sleeping brain cannot control muscles.

Bentley'sDad wrote: ↑
Sun Aug 01, 2021 10:56 am
Right now I am looking at chin straps and considering nasal mask instead of FF. Not sure how my HMO is going to take this as I have changed masks a LOT. The entire system seems broken with regard to how to get a mask that actually works. Any recommendations for best chin strap?
Thinking of Phillips premium chin strap?

You might want to tape your lips with a sensitive-skin tape or Somnifix. Taped properly, this could keep your jaw from dropping and causing leaks. You don't have to tape the mouth air proof - just enough to keep the chin from dropping.

If the lower straps on your FFM lead just under the ears and across the center of the cheeks, they should help with chipmunk cheaks.

GrumpyHere · Post by **GrumpyHere** » Sun Aug 01, 2021 8:02 pm

Bentley'sDad wrote: ↑
Sun Aug 01, 2021 9:20 am
I find that with the F20 (s,med, small and med headgear) or the dreamwear FF(med, med/wide small and med headgear)

Bentley'sDad wrote: ↑
Sun Aug 01, 2021 10:56 am
Not sure how my HMO is going to take this as I have changed masks a LOT. The entire system seems broken with regard to how to get a mask that actually works.

Reporting trial of 2 different FF masks at various sizes isn't a lot, especially in light of fit pack availabilty ( DreamWear).

Some people report many more mask changes.
IIRC someone reported changing once a month over one year before finding the acceptable one.

booksfan wrote: ↑
Mon Jun 28, 2021 6:48 pm
I had an awful time trying to find a mask that I could tolerate the first 14-15 months I was on CPAP! I went through at least that many masks, many on my own dime, after the first month. I was buying a new mask probably every month...it drove my husband crazy! Not the expense so much (he wanted me to find a mask I was comfortable using), but he just could not understand WHY it was so difficult, because he is so happy with the P10...best mask ever according to him (he made me try it several times but it was a dismal failure for me).
All that to say, the 2 I kept going back to were the Nuance Pro and the Brevida. They were the least objectionable. For the last 2+ years, though, I have been as happy with the Bleep as hubby is with the P10!

FFM are harder to seal.
You already believe your face shape changes when you're asleep.
So the FFM can't conform enough to seal.

Is there a reason to being attached to FFMs?

Bentley'sDad · Post by **Bentley'sDad** » Mon Aug 02, 2021 6:24 am

Ok, so I received the small headgear (thanks Okie Bipap). It seemed to fit a lot better so I changed back to F20 to test. The first night was horrid. Yesterday I "played" with the mask all day and kept making adjustments. Last night I had a pretty good night sleep including actual dreams (very unusual for me). Here are the graphs. Something happens near the end of the nights when the events happen more often. I do not remember the times that the machine was off (meaning I removed the connection from the looks of it. My wife happened to be awake in the 2AM segment when the pressure raised. I was supine. I did find a strange sequence I will post it as well.

Bentley'sDad · Post by **Bentley'sDad** » Mon Aug 02, 2021 6:28 am

Is this sequence about me falling back to sleep after an interruption? It seems very precise as far as its repetition and I want to understand it.

Pugsy · Post by **Pugsy** » Mon Aug 02, 2021 8:05 am

If you want to understand flow rate better you need to learn how to zoom in and understand what you are seeing.
http://freecpapadvice.com/sleepyhead-free-software

Bear in mind that while it talks mainly about central/CA apneas with arousal flagging that it isn't limited to centrals...we can have false positive OAs and hyponeas as well.

Bentley'sDad · Post by **Bentley'sDad** » Tue Aug 03, 2021 7:53 pm

I looked through graphs and it seems that many of the incidents are natural arousal related. That helps a lot with the numbers. I am trying to figure out several other things I noticed.
1. There was one night in particular that I had a .3 AHI. I want to relate that to something and I have no data as to why. Are there nights that are just about perfect without reason or relatable cause?
2. There are nights that my leak rate goes sky high and usually near the last 1/3 of the night. I want to understand this. Am I causing it in how I sleep? how do I figure it out?
3. Last night I had a very strange night with AHI 3.65. A lot was positional related but I noticed something "new". The first half of the night I had a "normal (for me) flow rate graph. Then about halfway through the night it degraded and changed completely. I have not noticed this before.
Does anyone have any information about this? These were examples but the entire rest of the night was just very strange breathing then returning to normal rhythm and changing again.
It looks like the first half of the night there was almost no "flat" in the flow rate curve. As the night went on the flat became longer, sometimes quite long. There also seems to be double breaths in a single cycle, as if stopping exhale and inhaling slightly then exhaling or occasionally the reverse. Like some kind of double triggering. Should this be worrying?

Pugsy · Post by **Pugsy** » Tue Aug 03, 2021 8:28 pm

Bentley'sDad wrote: ↑
Tue Aug 03, 2021 7:53 pm
There also seems to be double breaths in a single cycle, as if stopping exhale and inhaling slightly then exhaling or occasionally the reverse. Like some kind of double triggering. Should this be worrying?

Looks like ballistocardiographic artifacts to me. Nothing to worry about.

https://www.cpaptalk.com/search.php?key ... diographic

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