New-ish User, Terrible Results Taking a Nap

The hose selection choice is important to the function of the machine and it pertains to the diameter of the hose and not whether it is a heated hose or not.

The heated hose has a smaller diameter size so it is a "slimline" per the machine. Standard hose diameter is 22 mm and slimline is around 15 mm I think. Just because you don't turn on the heat doesn't mean you should change the hose selection. It will affect the way the machine operates and it's a negative. With the heated hose plugged in the machine will recognize it and default to the correct setting. You can't change it to standard and you don't want to anyway.

Also....there are non heated hoses that qualify for the slimline choice as well. It's all about hose diameter.
Not all non heated hoses are "standard" diameter. Not all non heated hoses are the "standard" diameter.

When people have used the incorrect hose diameter selection the machine doesn't blow the air properly. It's not a good thing either.
If you are using a heated hose (whether you are using heat or not) the correct choice is "slimline".

decker12 wrote: ↑

Mon Oct 31, 2022 9:22 pm

If I'm not using the heated hose, should I turn off slimline and change it to Standard? Any idea what the difference is? I have the heated hose, I just haven't used it yet.

A slimline hose is skinnier---its diameter is 15mm. The typical unheated Resmed hose is, in fact, a 15mm SlimLine hose.

A standard hose is wider---its diameter is 22mm. This is the size of an old-fashioned CPAP hose from 10-12 years ago. They are still around, and often the generic hoses you see in a drug store are going to be 22mm hoses.

Setting your machine to the correct setting helps the machine to more accurately determine the pressure. My guess is that you've got a typical unheated Resmed slimline hose in addition to your heated hose.

As far as the ramp up, you're right, if I'm at an 8 minimum pressure, and it's set to ramp up starting at 8, mine as well not be using it. According to my graph, I'm pretty much immediately ramped up to an 8 as soon as the machine detects I'm falling asleep. I'll keep it on anyway for a couple of nights and see.

While the machine is not going to "do" anything special in terms of having both the starting ramp pressure at 8 and the min pressure at 8, continuing to have the ramp will let you experiment later on (if you want to) with the idea of increasing your min pressure above 8cm, but still allow you the comfort of starting the night at 8cm, which you find comfortable.

Pugsy wrote: ↑

Mon Oct 31, 2022 9:33 pm

Also....there are non heated hoses that qualify for the slimline choice as well. It's all about hose diameter.
Not all non heated hoses are "standard" diameter. Not all non heated hoses are the "standard" diameter.

Slimline hoses are lighter more flexible, in addition to having a smaller diameter.
I can't imagine using my CPAP without a heated hose - but if you prefer a simple, non-heated hose, then go for a Slimline.
A Resmed heated hose is recognized as Climateline when you connect it to an AS10.

I may try the heated hose eventually. The one thing I absolutely did NOT like was the warm air from the non-heated hose (it as just the room's air) blowing into my nose over the summer. It bugged me to the point that I thought the warm air was going to be the thing that kept me from using the machine. I either got used to it, or the weather ended up getting cooler before it bugged me. I currently run my machine on a humidity of 5, after trying 1 through 4 over the period of a couple weeks. As I said I may eventually try the heated hose just to see if it makes any difference (I live in California so my bedroom never gets below 64 degrees at night). I am definitely using the typical 15mm Resmed hose that came with my mask so I'll just keep using that.

Heated hoses are not there to heat the air we breathe.
I mean, they do that, but we need them only if the ambient temp. makes the amount of humidity we need condense in the non-heated hose, and then we get what is know as "rainout". Water gurgling in our hose or beginning to spray into our nose. Very unpleasant.

When the hose is heated, it lets more humidity be carried in the air inside it, without the condensation.
You'll know your "anyhose" temp is too low and preferred humidity too high if you get water instead of pleasantly humidit air.

That's when you have to start thinking of changing something.
If you can do with less humidity - fine.
I you can't, you either cover your hose with a hose cosy, or buy a heated hose - and see which adjustment fits you best: you could try Auto (a sensor automatically adjusts end temp and humidity based on the environment) or you could try setting temp and humidity manually to whatever feels best in winter conditions.

One of your results showed the min. setting to be 5 (not a huge improvement from 4, the default low setting) and the max at 15. We can help you make changes (such as e.g. setting the min. to 7 and the max to 20) which should help a bit to lower your events, if not by a huge amount, possibly enough to make the difference in results - the min. setting's the one that 'does the job' of dealing with apneas, and keeping the max too low could 'cap' the min. when it needs to go higher at times.....

The ramp is used (tho' most of us don't bother at all) to time how long you need to reach the min. setting as a few people have trouble adjusting to any air delivered from the beginning, though usually get used to it quickly except in a case of e.g. someone whose min. setting is much higher and needs a bit of easing into reaching it vs 'just' going to it right away after masking.

Here's the graph for my Minimum 8 I set last night, with Ramp set on Auto but at an 8 as well.

https://sleephq.com/public/79cca5d4-b72 ... b0995f58b8

I was able to get to sleep, but it was definitely different. My inhales were something new to get used to as yeah, it's blasting me twice as strongly. I was okay with it though but after 30 minutes of trying to fall asleep, I did consider switching it to a 6 - instead I just stuck with 8 all night and eventually fell asleep. My exhale felt.. easier? Smoother? Tough to explain but it was distracting because it was different from what I was used to. The only other difference I noticed is at the very end of every exhale, right before inhaling, I had a brief sensation like you get when you go down a dip on a roller coaster. Like that slightly weightless feeling you get in your body when you drive fast down a hill?

Before changing this setting, with Auto Ramp enabled at set to 4's, my exhale during the period before sleep, it felt like I had to push harder. Like I was fighting against the air coming into my mask when I exhaled and I did not notice that with it set to 8. Note that those are the only two settings I changed for last night - set min pressure to 8, set Auto Ramp Min Pressure to 8.

Thanks for any insight anyone may have!

decker12 wrote: ↑

Tue Nov 01, 2022 11:10 am

Here's the graph for my Minimum 8 I set last night, with Ramp set on Auto but at an 8 as well.

https://sleephq.com/public/79cca5d4-b72 ... b0995f58b8

I was able to get to sleep, but it was definitely different. My inhales were something new to get used to as yeah, it's blasting me twice as strongly. I was okay with it though but after 30 minutes of trying to fall asleep, I did consider switching it to a 6 - instead I just stuck with 8 all night and eventually fell asleep. My exhale felt.. easier? Smoother? Tough to explain but it was distracting because it was different from what I was used to. The only other difference I noticed is at the very end of every exhale, right before inhaling, I had a brief sensation like you get when you go down a dip on a roller coaster. Like that slightly weightless feeling you get in your body when you drive fast down a hill?

Before changing this setting, with Auto Ramp enabled at set to 4's, my exhale during the period before sleep, it felt like I had to push harder. Like I was fighting against the air coming into my mask when I exhaled and I did not notice that with it set to 8. Note that those are the only two settings I changed for last night - set min pressure to 8, set Auto Ramp Min Pressure to 8.

Thanks for any insight anyone may have!

How do you feel otherwise? Do you feel better? After a few days of getting used to it you will be able to better assess if tweaking is needed.

Do you fall asleep on your back?

Leaks look decent and weirdly your max hovers just below 14 but good that it has room to move if need be.

Does it feel like success?

The auto ramp should be set from 4, not 1, as 4 is the default low of things, where it all starts from... so setting at 8 gave you a '4' relief, not 8. You could not have set it to 4 initially as it would be pointless.

Julie wrote: ↑

Tue Nov 01, 2022 11:35 am

The auto ramp should be set from 4, not 1, as 4 is the default low of things, where it all starts from... so setting at 8 gave you a '4' relief, not 8. You could not have set it to 4 initially as it would be pointless.

?

He originally had his ramp at 4 but moved it to 8.

I actually feel a little bit phlegmy this morning, like I've had to clear my throat more times per hour than I've had to in the past. I feel fine, not like holy god amazing what a fix, but not much different. I'm pretty sure I did not fall asleep on my back, probably fell asleep on my right hand side. I was out in the cold air walking with my kids last night for Halloween so that could have been part of my phlegmy throat. We had a COVID exposure warning at work yesterday so I think I slept poorly because I'm worrying about that, so I need a couple more days at these settings to see if it makes a difference.

Looking at last night's data it does seem that once I'm asleep I'm not dipping below that 8 which I changed in the machine. However looking at the charts from the past week or two, the lowest my dips go is actually around a 6. That seems to indicate that I should change the minimum to a 6 (and probably should have started at a 6 last night after all!)

Does that make sense?

Nope- no sense. And I say that kindly and without snark.

It just doesn’t go below your low setting.

If you change anything to 6 make it the ramp pressure so you lay down at 6 and then gradually go to your low setting of 8. If it were me I would ramp for 5-10 minutes and then full go at 8 but that’s just me. I’m comfy at my low setting. The whole point is not to have the low pressure sitting so low your machine can’t touch a collapsing airway because it has to jack it up quickly.

Just bear in mind that EPR of 3 takes 3 off your exhale pressure. If you start at 6 it can only go down 2 to the machine minimum of 4 so you might get a tiny bit of resistance compared to when it’s at 8 dropping to 5.

over the summer I was driving with the air conditioning in the car blasting away and it was aiming right up my nose. It reminded me a lot of the way that the Cpap feels. A relaxing pressure at my nose(cars blast paps don’t )

I am finding right now that with the leaves falling is really creating some congestion in my nose. Maybe it’s possible that walking around with the leaves and the kiddos is doing you in. I’m not that familiar with California weather, but I assume you guys have a fall? Hope it’s not covid.

Edited for crappy voice texting.

One more thought as I know you aren’t keen on warm air blowing through your mask.

Having a bit of warm air helps carry the moisture from humidifier to your nose.

If taking a steamy shower clears your nose you will likely benefit from heated hose plus humidifier. You can control both levels individually or just set it on auto and try it out sometime.

I had mine turned up too warm the other night after a rainout event and had to turn it back down because ick. But otherwise at a mere 2degrees lower it is imperceptible.

ymmv

decker12 wrote: ↑

Tue Nov 01, 2022 11:41 am

Looking at last night's data it does seem that once I'm asleep I'm not dipping below that 8 which I changed in the machine. However looking at the charts from the past week or two, the lowest my dips go is actually around a 6. That seems to indicate that I should change the minimum to a 6 (and probably should have started at a 6 last night after all!)

Does that make sense

No, not at all.
When your minimum pressure is 8 the machine won't ever go below that.
When you're asleep, you rarely stay at 8, something always happens to make the machine raise the pressure. Therefore, I'd say that even 8 as minimum therapy pressure is too low. You really want to set your minimum pressure where it prevents obstrucive events and their precursors. The machines only raise the pressure after something has happened. "Something" could be flow limitation, snores, hypopneas or apneas.
Don't make any changes yet - but keep it in mind that even 8 is a bit too low as your therapy pressure.

decker12 wrote: ↑

Tue Nov 01, 2022 11:10 am

Before changing this setting, with Auto Ramp enabled at set to 4's, my exhale during the period before sleep, it felt like I had to push harder. Like I was fighting against the air coming into my mask when I exhaled and I did not notice that with it set to 8.

If I remember correctly, ramp on 4 zoomed up to the stratosphere (OK, only up to 10) within 5 minutes or less of when you started. Now you had about 10 minutes of stable pressure at 8, and exhale pressure at 5 (that's inahle of 8 - EPR of 3 = exhale of 5).
At 4 the machine can't go lower to give you pressure relief. However, with the ramp at 8, you felt the differential, the exhale pressure relief with each breath. Normal human exhalation is a muscular relaxation that lets the air out (no effort) and EPR 3 made exhalation by simple relaxation much easier.

A word about Covid-19. I had a light case a few months ago. My AHI was dreadful - which is to be expected when we're ill. Don't let that phase you if it turns out you caught it. And don't expect to learn anything about your therapy for what happens when you're ill (true of any state of acute illness).
Hope you didn't get it.

Great to know about COVID and all bets are out the window with CPAP when I'm sick (cold, flu, whatever).

I'll try a Ramp starting at 6, for 15 minutes, and then keep Minimum at 8. Contemplating putting in the heated hose, however I do have a hose cozy thing already around the hose (was put there to avoid the scraping plastic noise from my side table), and have not had any moisture issues. When I was borrowing a different Phillips machine from my doctor for a week after my sleep study, it had that moisture problem which I definitely noticed and yeah it was icky. With my Resmed machine I haven't had any moisture problems at all, although I occasionally see some small droplets inside the hose, it so far has not actually made its ways to my nose.

That makes total sense about ramp being 4 and feeling like it was more difficult to exhale, because as you said, the EPR couldn't go any lower! That is why I immediately noticed it with a minimum of 8! Pretty neat.

Only other piece of info is that last night starting at an 8, I definitely felt "fuller" as I tried to fall asleep, kind of like the balloon was inflating too rapidly and stretching it out. Might just be something to get used to.

You mentioned that my minimum set to 8 is probably too low. What is the best way to determine how high the minimum should be set? Is the goal trying to minimize the amount of "jump" the pressure has to do to when I have an event? Meaning, look at the graphs on SleepHQ, and try to find a minimum pressure setting that is moth comfortable, and evens out the spikes with the valleys a bit more?