CPAPtalk.com

Pugsy wrote: ↑

Tue May 31, 2022 9:15 am

kkwitter wrote: ↑

Tue May 31, 2022 8:59 am

Hi,
I just switched from AirSense 10 to AirSense 11 Autoset using the same Airfit P10 nasal pillows, and all of a sudden MyAir (I have no SD card) is reporting leaks above 25 and saying I have to check my mask fit -(it's fine), when the Airsense 10 had leaks around 10. I've tried the AirSense11 for 2 nights - night 1 at the same CPAP 8 pressure of my Airsense 10, and night 2 with the Autoset for Her, which reported a pressure of 10.4. The screen on the Airsense 11 machine says "great mask fit" for both nights - so I am wondering whether I should just ignore the MyAir warnings. The P10 manual says acceptable leaks for my pressure range are over 20, so I am confused about the disagreement in the MyAir report from the 2 machines. Thanks for any insight!

Leaks can vary widely from night to night anyway.

Use OSCAR to see exactly what is going on with leaks.
OSCAR https://www.sleepfiles.com/OSCAR/
http://www.apneaboard.com/wiki/index.ph ... stallation
http://www.apneaboard.com/wiki/index.ph ... rpretation
http://www.apneaboard.com/wiki/index.ph ... ganization organize and how to do screen shots.
wiki/index.php/Oscar:organize Wiki

http://www.cpaptalk.com/viewtopic/t1585 ... eview.html

kkwitter wrote: ↑

Tue May 31, 2022 8:59 am

so I am wondering whether I should just ignore the MyAir warnings.

Exactly what are the warnings saying?

MyAir just says "Adjust mask fit"

Also, do I need an SD card to use OSCAR? I don't have one - where to get?

kkwitter wrote: ↑

Tue May 31, 2022 9:21 am

Also, do I need an SD card to use OSCAR? I don't have one - where to get?

Yes, to get the detailed data available you need a SD card as well as a computer that can read the SD card...either a slot available or use one of the USB ports and an adapter.

WalMart or similar store. Any generic SD card will work. No need for one of the fancy really high capacity SD cards either.
8 GB is more than enough but getting hard to find. Last time I was at Walmart 16 GB was the smallest I could find.

Bear in mind the SD card HAS to be in the machine to get the detailed data so you won't get the past data.

Also bear in mind that for mask fit reporting on the machine's LCD screen in the morning and the sleep report from last night that Mr Smiley will show up until you spend 30% or more of the night above 24 L/min. It takes a lot of leak to get Mr Smiley to change to Mr Frowny.

I have no idea what amount of leak will trigger a "adjust your mask" warning from MyAir. So I don't know how bad your leaks were or weren't and can't comment on whether you should ignore the warning or not. Maybe someone who actually uses MyAir might know.

Do mask leaks ever wake you up during the night?

Pugsy wrote: ↑

Tue May 31, 2022 9:29 am

kkwitter wrote: ↑

Tue May 31, 2022 9:21 am

Also, do I need an SD card to use OSCAR? I don't have one - where to get?

Yes, to get the detailed data available you need a SD card as well as a computer that can read the SD card...either a slot available or use one of the USB ports and an adapter.

WalMart or similar store. Any generic SD card will work. No need for one of the fancy really high capacity SD cards either.
8 GB is more than enough but getting hard to find. Last time I was at Walmart 16 GB was the smallest I could find.

Bear in mind the SD card HAS to be in the machine to get the detailed data so you won't get the past data.

Also bear in mind that for mask fit reporting on the machine's LCD screen in the morning and the sleep report from last night that Mr Smiley will show up until you spend 30% or more of the night above 24 L/min. It takes a lot of leak to get Mr Smiley to change to Mr Frowny.

I have no idea what amount of leak will trigger a "adjust your mask" warning from MyAir. So I don't know how bad your leaks were or weren't and can't comment on whether you should ignore the warning or not. Maybe someone who actually uses MyAir might know.

Do mask leaks ever wake you up during the night?

Not often, and not in the last 2 nights. I should also add that the machine itself reported a leak of 29 last night (don't know what %-ile, etc. that means...) and the sleep report window said "Your mask fit was great last night." So the argument seems to be between MyAir and the machine itself. I found an SD card around the house and will download OSCAR and see what tomorrow brings!

kkwitter wrote: ↑

Tue May 31, 2022 9:45 am

I should also add that the machine itself reported a leak of 29 last night (don't know what %-ile, etc. that means...)

The machine's report of leak rate is what we call a 95% number and all that is by definition is a number where you were AT OR BELOW for 95% of the night.
Most likely you spent the bulk of the night below 24 L/min which is ResMed's line in the sand for large leak territory

95% numbers are easily skewed to the high side by a relatively short period of time at the higher number.

I have a good example in this thread.
viewtopic.php?f=1&t=108724&p=1036669&hi ... t#p1036669

My personal opinion...as long as the leaks don't wake me up...and I stay below 30/35 L/min for most of the night...I shrug my shoulders and move on. The machine can actually compensate for leaks better than ResMed lets on above 24 L/min.
I use 30 L/min as where I might start looking at the results and if my time above 30 L/min isn't prolonged then I don't worry about it.

Short periods of time deep into large leak territory isn't the end of the world. 5 or 10 minutes...not a big deal.
Now if you see a lot of time in large leak...like 50 minutes above 35 L/min then I would start thinking about trying to fix the leaks if possible.

So 2 things we evaluate when it comes to leak....how deep into large leak territory we go AND how long we stayed there.

Much better results this AM - I set it back to CPAP 8. Leak was 11, Total Ahi 1.1.

I got an SD card and put it in the machine, which accepted it. When I tried to mount it on my Mac, it said "Not readable by this Mac" - (10.13.6 High Sierra, and also tried on another Mac running Monterey). So I erased the SD card, reformatted it as ExFAT, but then the AirSense 11 couldn't read it. I reinserted it in the Airsense 11, which must have formatted again it to its liking, and the card is now again unreadable by my Mac. So my question is, how do I format the card so that it's usable by both?

UPDATE: I reformatted it in my Mac as FAT32 and the AirSense11 seems to accept it. Whew! My next questions will undoubtedly be about OSCAR, which I have never used before...

Pugsy wrote: ↑

Mon May 02, 2022 6:27 pm

palerider wrote: ↑

Mon May 02, 2022 5:09 pm

Pugsy wrote: ↑

Mon May 02, 2022 10:31 am

Long, thoughtful detailed response to a twit.

I might have missed it in what you said, but another aspect of setting the min pressure too low is that the machine spends the whole night trying to get back to that min pressure, thus causing repeated cycles of pressure too low, bad sleep, increases in pressure.

You didn't miss it. I didn't go into that part.
But....from what I have seen I don't think it matters much.
I guess I "perceive" things differently and all those journals and papers that I did take the time to read are all wrong.
Not to mention nearly 13 years on auto adjusting pressures of some sort.

When I get essentially told to go pound sand...That's pretty much what I will do but I will remember and save myself some typing the next time.
The F list just grew again. Thankfully will save me some reading as well as responding. Won't be wasting my time again.
I am a quick study.

But maybe someone else will learn something from what I wrote since it was essentially for everyone and not one person anyway.

I am off to make a new voodoo doll. I can sure see it being needed.

FYI, I learned a lot from what you wrote here but am still trying to learn if my settings are the best for my treatment. The gal at the sleep doc wasn't overly helpful. Kinda like she didn't know how to interpret the data. I really want to learn how to do this.

Thanks for taking the time and know that someone out there saw your well reasoned reply and appreciated it.

ChrisD wrote: ↑

Wed May 04, 2022 7:17 am

Tec5 wrote: ↑

Tue May 03, 2022 8:11 pm

Dog Slobber wrote: ↑

Tue May 03, 2022 4:16 pm

Just trying to follow up with an honest question. Given that ChrisD is changing machines, is there harm in beginning his settings at 4-20 versus 11-14 ?
Previous reply suggested that a delay involved with increasing the pressure based on need (i.e. automatic increases) was problematic.
My question related to the length of that delay.

Mine is not just a idle curiosity. I have my settings set to 4-20, even though I tend to top out at approximately 14 -15. I obviously let the automatic pressure increase algorithm do it's job - raising when FL increases, decreasing when not needed.

Is that harmful or stupid?
I AM JUST TRYING TO LEARN.

BTW, good on you Chris D - wishes for continued success.

Tec5,

It's my opinion that the "wide open" setting of 4-20 can be 1) a diagnostic tool to see where your apneas are so the settings can be fine tuned later with continual monitoring. 2) a setting by sleep docs to set it and forget it, trusting the machine to find and fix the apneas as long as you are using the machine the minimum number of hours per night for insurance compliance.

During my initial overnight sleep study they slowly increased the starting pressure until the occurrence of apneas subsided. With my starting pressure set at 11, the machine is preventing the apneas from even starting. If I do have an apnea, the machine is already at a pressure that increasing it will not take too long or be that noticeable to me while I am asleep.

My rational in setting the new machine to near the old prescription was that with those settings my AHI was consistently below 1.0 To me, that says it is working very well and I didn't want to mess with that.

Curious as to what your #'s are with the 4-20? Have you ever tried bumping up the starting pressure to see if your AHI comes down?

Thanks. Same back at you.

Chris

What you say makes sense Chris.

I would like to find out how to fine tune my settings. I know I have to allow time for some data to be gathered but I feel like 6 weeks or so into this i want to get my numbers down lower than they are.

I thought about starting a new thread to ask this question but was not wanting to be a board hog or post inappropriately.

palerider wrote: ↑

Wed May 04, 2022 3:33 pm

ozij wrote: ↑

Wed May 04, 2022 7:50 am

Also worth mentioning, from the above site, my emphasis:
In addition, the algorithm provides more subtle changes in therapy pressure to minimise sleep disturbance. The AutoSet for Her algorithm also automatically adjusts the minimum AutoSet pressure if multiple apneas are occurring below a certain threshold.

While that's a great first step in an actual 'auto' machine that one can just set and forget and get good treatment from, even the For Her resets to whatever the program defaults are every time you start a session with hit. it's always a brand new night as far as the machine is concerned, it has no parameter memory from previous sessions to guide it's behavior.

Unfortunately.

If the machines had a mode where they remembered that the average needed min pressure from the last week was 12.5 (for instance) and started with a min pressure of 12.5 automatically, then they really would be 'auto, self titrating' machines, but there are no known machines on the market that do that.

Probably because sleep doctors don't want machines that smart.

Regarding the bold section-when looking at ones data the "average needed minimum pressure"-which data point is that? is that the 95% number or the 99.5% or the median number? Or some other listed value?

lynninnj wrote: ↑

Sat Aug 20, 2022 8:37 am

Regarding the bold section-when looking at ones data the "average needed minimum pressure"-which data point is that? is that the 95% number or the 99.5% or the median number? Or some other listed value?

I think PR means the average "locked" minimum the machine settled on after a week of use.
Does an AS11 report the "locked minimum" on the screen?
Of course, Oscar can show you that a machine has decided not to return to the set minimum.

I'm not sure "average machine set minimum" is the actually the best statistic, because averages are very sensitive the the extremes. A percentile of nights at the minimum locked pressure would be better from a statistical point of view.

But, user beware:
Here's an example of the mess caused when the algorithm locks the minimum too high, in a way that is no good for the patient
https://www.youtube.com/watch?v=_RdD9WmSgA8

ozij wrote: ↑

Sat Aug 20, 2022 10:26 am

lynninnj wrote: ↑

Sat Aug 20, 2022 8:37 am

Regarding the bold section-when looking at ones data the "average needed minimum pressure"-which data point is that? is that the 95% number or the 99.5% or the median number? Or some other listed value?

I think PR means the average "locked" minimum the machine settled on after a week of use.
Does an AS11 report the "locked minimum" on the screen?
Of course, Oscar can show you that a machine has decided not to return to the set minimum.

I'm not sure "average machine set minimum" is the actually the best statistic, because averages are very sensitive the the extremes. A percentile of nights at the minimum locked pressure would be better from a statistical point of view.

But, user beware:
Here's an example of the mess caused when the algorithm locks the minimum too high, in a way that is no good for the patient
https://www.youtube.com/watch?v=_RdD9WmSgA8

If you look at this example; https://sleephq.com/public/22ef1f04-882 ... df26ce0d88

I have my settings listed as 6-14. The stats on the right are min, med, 95% and 99.5%. I am trying to determine what the best settings will be for me given data like this. My longer term picture is pretty close to this, when looking at data over several weeks.

For example, my initial settings were practically the default 8->16 (ramp up from 4).

The median pressure was 8.1 95% was 9.1 and max was 9.7. Those numbers made me question if I shouldn't lower the low end of the range to 6->14. (the sleep HQ one I posted above).

I am trying very hard to find the sweet spot on the ranges.

Mr. Nomenclature Specialist whom I quoted above will hopefully provide his usual concise suggestion on data points that best help find that sweet spot.
Or anyone else in the know.

I just have a generalized therapy report for the first month and since adding an SD card I have somewhat broken data but hopefully I can figure that out as well.

Also, since starting, I have had 3 nights total over 3 AHI and two were the first two days of therapy. Everything else since was under 3 with my best night at .27 (i want more of these please!)

In general I prefer to start with the median average pressure number when evaluating where to put a minimum pressure for optimal results when using auto adjusting mode. That’s my starting point anyway. It may or may not be near the 95% number for various reasons which I evaluate on a case by case basis.

It’s a starting point……
I always try to incorporate what variables might be involved and never rely on just one set of anything numbers as being the end all numbers because of that YMMV thing.

I always try to look at the big picture if possible.

Pugsy wrote: ↑

Sat Aug 20, 2022 11:43 am

In general I prefer to start with the median average pressure number when evaluating where to put a minimum pressure for optimal results when using auto adjusting mode. That’s my starting point anyway. It may or may not be near the 95% number for various reasons which I evaluate on a case by case basis.

It’s a starting point……
I always try to incorporate what variables might be involved and never rely on just one set of anything numbers as being the end all numbers because of that YMMV thing.

I always try to look at the big picture if possible.

My median pressure was obviously going to be higher when the pressure settings were higher.

Because the median pressure was just above the minimum pressure, I wanted to try lowering it a bit just to see what the response was. Now the median pressure is a little bit lower but I am not entirely sure I have the correct settings yet.

lynninnj wrote: ↑

Sat Aug 20, 2022 8:37 am

palerider wrote: ↑

Wed May 04, 2022 3:33 pm

average needed min pressure

Regarding the bold section-when looking at ones data the "average needed minimum pressure"-which data point is that? is that the 95% number or the 99.5% or the median number? Or some other listed value?

How do you cognitively get from "average" to "95/99.5" which is effectively the MAX pressure?

palerider wrote: ↑

Sat Aug 20, 2022 3:06 pm

lynninnj wrote: ↑

Sat Aug 20, 2022 8:37 am

palerider wrote: ↑

Wed May 04, 2022 3:33 pm

average needed min pressure

Regarding the bold section-when looking at ones data the "average needed minimum pressure"-which data point is that? is that the 95% number or the 99.5% or the median number? Or some other listed value?

How do you cognitively get from "average" to "95/99.5" which is effectively the MAX pressure?

sir, I quoted you:

If the machines had a mode where they remembered that the average needed min pressure from the last week was 12.5 (for instance) and started with a min pressure of 12.5 automatically, then they really would be 'auto, self titrating' machines, but there are no known machines on the market that do that.

To which I asked for clarity wrt your use of the term “average needed minimum pressure “. I am trying to determine which oscar provided data point would provide that value and listed those that were available.

Asking for clarity doesn’t equal a jump/conclusion.

lynninnj wrote: ↑

Sat Aug 20, 2022 3:12 pm

To which I asked for clarity wrt your use of the term “average needed minimum pressure “. I am trying to determine which oscar provided data point would provide that value and listed those that were available.

Asking for clarity doesn’t equal a jump/conclusion.

What word did I use? "average", not Max, (which is what the 95% or 99% effectively is, so why do you make the leap to something completely different from what I said?

A reasonable person would start with "average" if you weren't just trolling, which seems to be your modus operandi lately.

Without compelling evidence that you're not simply being a troll, I'm done with answering your questions about a months old post.