HELP needed for 13-yr CPAP user!

General Discussion on any topic relating to CPAP and/or Sleep Apnea.
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JoyD.
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HELP needed for 13-yr CPAP user!

Post by JoyD. » Thu Nov 03, 2022 10:53 am

It's been several years since I've posted on CPAPtalk . . . so hello old friends and current members!

Since the early days when I monitored my results daily with Encore software on my old Phillips-Respironics APAP, I haven't been using software for several years since I was consistently doing well. Three years ago I bought "ResMed's AirSense 10 Autoset for Her" and have only been noting very basic info shown on the machine itself.

Two nights ago I noticed that an AHI of 6 was reported, then last night the AHI was 9.7 . . . which put me in a small panic, and prompted me to look at accumulated results over the last 6 months. Here is what my machine reports:

. . . . . . . . . . . . Pressure -- Leak (L/min) -- AHI -- Total AI -- Central AI

1 Day . . . . . . . 10.3 -------- 20 -------- 9.7------ 9.7------ 9.4
(Nov 2)

Week . . . . . . . 10.2 ---------20 ------- 4.8------- 4.6 ------ 4.5

1 Mo . . . . . . . 10.1--------- 25 -------- 2.8 ------ 2.5 ------ 2.2

3 Mos . . . . . . . 10.2 -------- 25 -------- 2.3 ------ 1.9 ------ 1.6

6 Mos . . . . . . . 10.3 -------- 26 -------- 2.1 ------ 1.8 ------ 1.4

So, it looks to me like I was getting 1-2 scores before the last couple days skewed the week/month accumulated results. I have continued using a Zest Nasal mask for 5 yrs+, being the most comfortable mask I've tried over the years. I'm assuming air leak is not the problem since it has not increased over 6 months of accumulated readings. Any ideas why, all of a sudden, my AHI has shot up to 9.7 ?? Nothing about my daily life has changed that I can tell.

I plan to download OSCAR, but DuckDuckGo (which I'm having trouble uninstalling) is preventing me from installing OSCAR. So until I get rid of DDG, I won't be able to use OSCAR.

Any ideas or suggestions regarding my increased events the past couple nights? Or advice on what to do next??

Thanks,
Joy

_________________
Machine: AirSense 10 AutoSet with Heated Humidifer + P10 Nasal Pillow Mask Bundle
Mask: Zest Nasal CPAP Mask with Headgear
Additional Comments: Pressure:10.2min-17max; ClimateLine Heated Hose; OSCAR 1.4.0; BACKUPS: AirFit P10 & Evora Hybrid FF; Respironics-Remstar Auto M-Series.
CPAP Accessories:
Pur-Sleep Pillow, Wellue O2 Ring
___________________________________________________________________________
"In the depths of winter, I finally learned that within me there lay an invincible summer." ~ Albert Camus

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zonker
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Re: HELP needed for 13-yr CPAP user!

Post by zonker » Thu Nov 03, 2022 11:08 am

why, hello. hope we can help you out.

firstly, does duckduckgo have user configurable options so you can tell it it's okay to dl oscar?

if not, you may want to give skeephq a go. it's web based and shouldn't get your browser in an uproar. link here-

https://sleephq.com/

then you link the charts here much like you would for oscar.

**NOTE** i don't have personal experience with sleephq. i'm merely going by what i've seen posted here.

good luck!
"the world is full of good people. if you can't find one, be one."-sleepgeek(avatar)

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The sinners are much more fun
You know that only the good die young"-billy joel

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ChicagoGranny
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Re: HELP needed for 13-yr CPAP user!

Post by ChicagoGranny » Thu Nov 03, 2022 11:13 am

JoyD. wrote:
Thu Nov 03, 2022 10:53 am
Any ideas or suggestions regarding my increased events the past couple nights?
It could be a myriad of things.
JoyD. wrote:
Thu Nov 03, 2022 10:53 am
Or advice on what to do next??
We need to see some details from OSCAR. I hope you figure out how to download OSCAR. Can you not just use a different browser?

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robysue1
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Re: HELP needed for 13-yr CPAP user!

Post by robysue1 » Thu Nov 03, 2022 11:26 am

JoyD. wrote:
Thu Nov 03, 2022 10:53 am
Two nights ago I noticed that an AHI of 6 was reported, then last night the AHI was 9.7 . . . which put me in a small panic, and prompted me to look at accumulated results over the last 6 months. Here is what my machine reports:

. . . . . . . . . . . . Pressure -- Leak (L/min) -- AHI -- Total AI -- Central AI

1 Day . . . . . . . 10.3 -------- 20 -------- 9.7------ 9.7------ 9.4
(Nov 2)

Week . . . . . . . 10.2 ---------20 ------- 4.8------- 4.6 ------ 4.5

1 Mo . . . . . . . 10.1--------- 25 -------- 2.8 ------ 2.5 ------ 2.2

3 Mos . . . . . . . 10.2 -------- 25 -------- 2.3 ------ 1.9 ------ 1.6

6 Mos . . . . . . . 10.3 -------- 26 -------- 2.1 ------ 1.8 ------ 1.4
The bulk of the increase is in what your machine is flagging as central apneas.

So the question becomes: In the last couple of nights, have you been a lot more restless in bed? In other words did you spend a lot of time in bed kind of just dozing instead of actually falling into a real sleep?

Posting the detailed data for the last night would help folks like Rubicon and Pugsy sort out whether a whole bunch of those CAs are or are not likely to be real events.

_________________
Machine: DreamStation BiPAP® Auto Machine
Mask: Swift™ FX Nasal Pillow CPAP Mask with Headgear
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JoyD.
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Re: HELP needed for 13-yr CPAP user!

Post by JoyD. » Fri Nov 04, 2022 1:50 pm

Thank you Zonker, Granny & robysue for expressing the offers to help. YES!!. . . I FINALLY figured out how to install & use OSCAR 1.4.0. I also registered on IMGUR to post some screenshots of my OSCAR results from last night, 11/3/2022.

Here are the links to my OSCAR screenshots posted on Imgar:

DAILY STATISTICS FROM 11/3/22 https://imgur.com/MPvX83X
DAILY VIEW (PG 1) FROM 11/3/22 https://imgur.com/Cko7n7r

* It looks to me that my AHI's are mostly hypopneas. I'm assuming that's better than apneas ??

* I bought my AirSense directly 3 yrs ago & set it up myself:
1) I've had the Ramp at 15 minutes, but today I turned it off. (I don't think I need it).
2) I've had EPR set at 2 -- I think I read that EPR may increase Centrals in some people, so the other day, 11/2/22, I turned OFF EPR.
3) I'm thinking of narrowing the pressure range, by lowering it from 20 where it is now, but I won't be changing the pressure range until I monitor daily results for a
while, and at that point I may be back to ask for suggestions.)

* This one daily report says my % of Time in Cheyne Stokes Respiration was 5.28%. Is that significant? I have no idea, but I'll be watching that each day. I'm 81 years old & am under the care of a cardiologist for increased PVCs and moderate regurgitation of my tricuspid valve monitored by ECHO yearly. (So far, no mention has been made of congestive heart failure, and he's put me on no meds.) -- Does anyone have comments on this particular CSR result from this one daily report?

I would greatly appreciate mention of anything anyone might notice that needs to be called to my attention. Thank you.

JoyD.

PS - I can't figure out how to take a screenshot that shows all of OSCARS 14 graphs. Is that even possible?

_________________
Machine: AirSense 10 AutoSet with Heated Humidifer + P10 Nasal Pillow Mask Bundle
Mask: Zest Nasal CPAP Mask with Headgear
Additional Comments: Pressure:10.2min-17max; ClimateLine Heated Hose; OSCAR 1.4.0; BACKUPS: AirFit P10 & Evora Hybrid FF; Respironics-Remstar Auto M-Series.
Last edited by JoyD. on Sun Nov 06, 2022 2:04 pm, edited 5 times in total.
CPAP Accessories:
Pur-Sleep Pillow, Wellue O2 Ring
___________________________________________________________________________
"In the depths of winter, I finally learned that within me there lay an invincible summer." ~ Albert Camus

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ChicagoGranny
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Re: HELP needed for 13-yr CPAP user!

Post by ChicagoGranny » Fri Nov 04, 2022 3:45 pm

I hesitate to analyze that Daily View until you get the leaks under control. Look at the LL (large leak) flags. You have many throughout the night. As a result, the Event report might not be correct. Find your mask on youtube and carefully watch some videos on fitting and adjusting. Are you having dry mouth at times?
JoyD. wrote:
Fri Nov 04, 2022 1:50 pm
1) Should I turn off the Ramp (I don't think I need it)?
This is personal preference. Some like ramp; some don't.
JoyD. wrote:
Fri Nov 04, 2022 1:50 pm
2) I have EPR set at 2 - does this setting for pressure relief have any effect on events?
EPR helps reduce Flow Limitations in some people. You might want to add the FL graph the next time you post a Daily View.
JoyD. wrote:
Fri Nov 04, 2022 1:50 pm
3) I can't find my notes on how to change the settings.
You can find short videos on youtube demonstrating how to easily change the clinician's settings.
JoyD. wrote:
Fri Nov 04, 2022 1:50 pm
This one daily report says the % of Time in Cheyne Stokes Respiration was 5.28%.
This is a small amount and usually of no concern. You might mention it to your cardiologist.
JoyD. wrote:
Fri Nov 04, 2022 1:50 pm
I would greatly appreciate mention of anything anyone might notice that needs to be called to my attention.
Your auto pressure is spending most of the night near 10.0 or higher. Your minimum pressure of 7.0 might be too low. I would not change it until the leaks are under control.

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JoyD.
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Re: HELP needed for 13-yr CPAP user!

Post by JoyD. » Fri Nov 04, 2022 4:23 pm

ChicagoGranny wrote:
I hesitate to analyze that Daily View until you get the leaks under control. Look at the LL (large leak) flags. You have many throughout the night. As a result, the Event report might not be correct. Find your mask on youtube and carefully watch some videos on fitting and adjusting. Are you having dry mouth at times?
Wow, thanks Granny!! Such an obvious thing (the large leaks), and I wasn't paying attention to it! I have my Zest nasal mask adjusted very snugly . . . I'm wondering if I need to use a new silicone seal for it, perhaps the one I've been using (I use a "baby wipe" to clean daily) is just getting old. Yes, I do have a dry mouth occasionally . . . so perhaps I'd better try a chin strap or tape (hate taping). How are people taping these days? What are they using? I'll work on this. Thanks for pointing it out!

I forgot that I actually DID turn OFF the EPR the day before - so the EPR was OFF the night of the DAILY VIEW you were looking at.

Do you happen to know how to take a screen shot of all 14 of the graphs at once?

Thanks again,
JoyD.

_________________
Machine: AirSense 10 AutoSet with Heated Humidifer + P10 Nasal Pillow Mask Bundle
Mask: Zest Nasal CPAP Mask with Headgear
Additional Comments: Pressure:10.2min-17max; ClimateLine Heated Hose; OSCAR 1.4.0; BACKUPS: AirFit P10 & Evora Hybrid FF; Respironics-Remstar Auto M-Series.
Last edited by JoyD. on Wed Nov 09, 2022 4:54 pm, edited 2 times in total.
CPAP Accessories:
Pur-Sleep Pillow, Wellue O2 Ring
___________________________________________________________________________
"In the depths of winter, I finally learned that within me there lay an invincible summer." ~ Albert Camus

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ozij
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Re: HELP needed for 13-yr CPAP user!

Post by ozij » Fri Nov 04, 2022 9:17 pm

JoyD. wrote:
Fri Nov 04, 2022 4:23 pm
Do you happen to know how to take a screen shot of all 14 of the graphs at once?
viewtopic/t172378/Sticky--Newbies-PLEAS ... STING.html
4...If you want member input on your detailed software results...and want to share images of your reports
PLEASE read this thread.
[...]
viewtopic/t158560/How-to-post-images-for-review.html
Use the format I have shown in the examples. Don't do snippets unless requested...Don't include a gazillion graphs either.
Just do the basics...and if someone needs or wants another graph they can just request it.
Don't make the graphs tiny...we can't evaluate tiny graphs...don't shrink your report images...it blurs the num6bers any my eyes are bad enough without trying to squint to read blurred numbers.

_________________
Machine: ResMed AirSense™ 10 AutoSet™ CPAP Machine with HumidAir™ Heated Humidifier
Mask: Bleep DreamPort CPAP Mask Solution
Additional Comments: Machine: AirSense??? 10 AutoSet??? For Her CPAP Machine with HumidAir??? Heated HumidifierSoftware: Oscar; alternating masks
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ChicagoGranny
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Re: HELP needed for 13-yr CPAP user!

Post by ChicagoGranny » Sat Nov 05, 2022 7:20 am

JoyD. wrote:
Fri Nov 04, 2022 4:23 pm
Do you happen to know how to take a screen shot of all 14 of the graphs at once?
Don't do that. The graphs will be too small. All the graphs that are usually needed are Events, Flow Rate, Pressure, Leak, Snore and Flow Limitations - six graphs.
JoyD. wrote:
Fri Nov 04, 2022 4:23 pm
I have my Zest nasal mask adjusted very snugly

Watch the youtube videos. Masks should not be adjusted too tightly.
JoyD. wrote:
Fri Nov 04, 2022 4:23 pm
Yes, I do have a dry mouth occasionally . . . so perhaps I'd better try a chin strap or tape (hate taping). How are people taping these days? What are they using? I'll work on this.
Dry mouth is an indication you may be leaking out the mouth. It's possible your mask is not leaking. My favorite mouth tape - https://www.amazon.com/dp/B08PBJZJWL. With any tape, it's important to turn the lips in slightly as the tape is applied and keep them taped that way.
JoyD. wrote:
Fri Nov 04, 2022 4:23 pm
I forgot that I actually DID turn OFF the EPR the day before - so the EPR was OFF the night of the DAILY VIEW you were looking at.
I noticed that on the other chart where the settings changes are listed. You can check your Flow Limitations at different EPR settings. Some users have no problems with FLs, but like to use EPR because it seems easier to breathe. Others don't like to hear the machine cycling up and down.

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Re: HELP needed for 13-yr CPAP user!

Post by JoyD. » Sat Nov 05, 2022 10:42 am

Thanks for your recent comments, Granny. I already ordered from Amazon: a pack of Scunci's, a Velpeau Soft Cervical Collar & Nexcare Sensitive (blue) tape. I'll also order the tape you recommended - thanks. (Last night I rigged up a "cervical collar" by rolling up an ace-bandage then tying it under my chin with a piece of stretchy tights material.)

On my 12" Macbook Air, I seem to be able to visualize only 4 graphs for a screenshot. If there's a way to get 6 graphs on there, I'd like to know how. (I'm still in learning mode, and am reading all I can to figure everything out about using Oscar, searching the site, and following directions from the moderators. It's been so long ago that I was an active part of this community, that I'm having to basically start from scratch as a "newbie".)

Here's the results of my unsuccessful attempts to correct my Large Leak problem:
https://imgur.com/JCV1VQa

Here are my notes from last night:
1. I used a different silicone seal for my Zest mask in case the previous night's results had to do with an old seal.

2. Because of last night extremely high Large Leaks, I TAPED MY MOUTH SHUT all night with Painters Tape (folding my lips inward) & also rigged up a "neck brace" tying a rolled up ace bandage under my chin. This didn't seem to help since I still had very Large Leaks continuously from approx. 2:30 - 5AM in the 2nd session.

3. I didn't actually go to sleep at all in the first session even though it shows events happening! In the 2nd session, although I went back to bed at about 1:30, I didn't fall asleep for between 30-45 min. -- So it it when I actually fell asleep that the LLs happened.

When I got up to go to the bathroom at the end of my second session, I saw that my APAP reported a RED FACE with the words "MASK SEAL". Therefore, I changed seals once again & also tightened my headgear straps very tight. (In the morning I had marks around where the pillow sat.) This APPEARED to help since I had fewer large leaks in session 3 (??) Note: in the past, I had always tightened my headgear until it was snug, but comfortable (with good AHIs & minimal leaks).

4. As to how I've been feeling . . . I'm never feeling bad or wiped out. I've been feeling okay for years since going on CPAP in 2009.

5. I don't know how valid the Statistic event numbers are since there is still a LEAK problem SOMEWHERE . . . but I was interested to see that there were NO Cheyne-Stokes Respirations reported this time. I'm assuming that yesterday's were not real since I had zero last night.

6. I AM thinking it may be time to try a different mask. My nares don't seem to fit with ANY size pillows I've tried with various pillow masks. (I've always had more events reported with pillow masks.) I have a ResMed AirtFit P10 mask that only size Med pillows "come anywhere close" to fitting my nares, but the straps just don't stay in place no matter how I place them (with or w/o using the gadget to tighten). I was never able to use it successfully, but, being desperate, I MAY give it a shot tonight anyway. I HOPE I don't need to go to a full-face mask since I have an aversion to them (claustrophobia?). I'm open to suggestions re a different Nasal Mask (my experience with several pillow masks has been discouraging - I think my nares are not "built" for them).

7. I'm wondering if there could be a leak in my AirSense's ClimateLine Hose, so today I plan on removing it & running water through it to see if I can detect any leak.

AS ALWAYS . . . I welcome eagerly any input, ideas, or suggestions. Thank you so much for your time & interest in helping others succeed in their CPAP journey!
JoyD.

_________________
Machine: AirSense 10 AutoSet with Heated Humidifer + P10 Nasal Pillow Mask Bundle
Mask: Zest Nasal CPAP Mask with Headgear
Additional Comments: Pressure:10.2min-17max; ClimateLine Heated Hose; OSCAR 1.4.0; BACKUPS: AirFit P10 & Evora Hybrid FF; Respironics-Remstar Auto M-Series.
Last edited by JoyD. on Sun Nov 06, 2022 1:59 pm, edited 1 time in total.
CPAP Accessories:
Pur-Sleep Pillow, Wellue O2 Ring
___________________________________________________________________________
"In the depths of winter, I finally learned that within me there lay an invincible summer." ~ Albert Camus

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Re: HELP needed for 13-yr CPAP user!

Post by ChicagoGranny » Sat Nov 05, 2022 11:29 am

JoyD. wrote:
Sat Nov 05, 2022 10:42 am
I'm wondering if there could be a leak in my AirSense's ClimateLine Hose, so today I plan on removing it & running water through it to see if I can detect any leak.
I would think if there were a leak in the hose (or a leak due to the humidifier tank not being seated well), you wouldn't have those long periods of no leak. If you are not getting significant dry mouth, I'm not sure the problem is from mouth-breathing. Five minutes of mouth-breathing while using a nasal-only interface causes a very dry mouth for most people.
JoyD. wrote:
Sat Nov 05, 2022 10:42 am
I didn't actually go to sleep at all in the first session even though it shows events happening!
The machines are designed to report events while users are sleeping. The reporting is not accurate when the user is awake. Awake-breathing and sleep-breathing are very different processes. On the other hand, there have been periods when I thought I had zero sleep. After looking closely at OSCAR, I began to think that maybe I did doze a bit.
JoyD. wrote:
Sat Nov 05, 2022 10:42 am
On my 12" Macbook Air, I seem to be able to visualize only 4 graphs for a screenshot. If there's a way to get 6 graphs on there, I'd like to know how.
There is a chance this issue might be addressed here ---> http://www.apneaboard.com/wiki/index.ph ... #For_macOS

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Re: HELP needed for 13-yr CPAP user!

Post by JoyD. » Sun Nov 06, 2022 8:54 am

ChicagoGranny wrote:
I would think if there were a leak in the hose (or a leak due to the humidifier tank not being seated well), you wouldn't have those long periods of no leak. If you are not getting significant dry mouth, I'm not sure the problem is from mouth-breathing. Five minutes of mouth-breathing while using a nasal-only interface causes a very dry mouth for most people.
I thought of that too, Granny . . . the fact that a hose leak would show a constant leak on the report, so I didn't bother to check the hose with water. I'm STILL baffled as to JUST WHAT is causing such large leaks! Last night . . . using a DIFFERENT MASK altogether (my "ResMed AirFit P10", using the MED pillow - I DID change my setting from nasal to pillow on my machine) my EVENTS IMPROVED but the LEAKS WERE STILL HORRID! (Since the Events were improved last night, I may try the size SM pillow tonight).

Here is last night's Oscar report, posted on Imgur: https://imgur.com/a/wBnfRJp

So, can anyone suggest other ideas on what is causing this LARGE LEAK problem of mine??

I've tried taping + cervical collar + changing the silicone seal on my Zest nasal mask. Then last night I used a different mask altogether, a P10 pillow mask (didn't tape until the short Session 3 . . . but I don't think mouth breathing is my problem. I'm NOT getting significant dry mouth. Also, I wear a bite guard for TMJ and it encourages me to keep my mouth clamped down on it which I think I do (at least I find myself clamped down on it whenever I wake up). I'm happy to tape if I need it.

Thanks all, for any input, ideas, or suggestions! I appreciate your help and guidance.

JoyD.

_________________
Machine: AirSense 10 AutoSet with Heated Humidifer + P10 Nasal Pillow Mask Bundle
Mask: Zest Nasal CPAP Mask with Headgear
Additional Comments: Pressure:10.2min-17max; ClimateLine Heated Hose; OSCAR 1.4.0; BACKUPS: AirFit P10 & Evora Hybrid FF; Respironics-Remstar Auto M-Series.
Last edited by JoyD. on Wed Nov 09, 2022 4:55 pm, edited 1 time in total.
CPAP Accessories:
Pur-Sleep Pillow, Wellue O2 Ring
___________________________________________________________________________
"In the depths of winter, I finally learned that within me there lay an invincible summer." ~ Albert Camus

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Re: HELP needed for 13-yr CPAP user!

Post by Pugsy » Sun Nov 06, 2022 9:04 am

If that were my report the first thing I would do is try a different hose. I have had a hose with a teeny tiny hole in it and it doesn't always manifest itself constantly.

Leaks....either mouth opening or mask movement or a hole somewhere that there shouldn't be a hole.
Mask: Bleep no headgear mask.. https://bleepsleep.com/
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JoyD.
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Re: HELP needed for 13-yr CPAP user!

Post by JoyD. » Sun Nov 06, 2022 9:46 am

Pugsy wrote:
If that were my report the first thing I would do is try a different hose. I have had a hose with a teeny tiny hole in it and it doesn't always manifest itself constantly.

Leaks....either mouth opening or mask movement or a hole somewhere that there shouldn't be a hole.
Thanks for your input, Pugsy! (I remember you back in the 2009+ era when I was active on the forum.) Well, taping + cervical collar didn't work - so I've ruled out mouth opening. Re. mask movement, I've tried both my ZEST Nasal mask & my AirFit P10 pillow mask (which DID improve the events, but NOT the leaks). I'm currently looking at trying a new mask or two. After watching some of your friend Lefty's videos on youtube (he mentioned your name in one of his videos, thanking you for the loan of a mask) . . .I'm currently looking at these masks which he listed as among "his" top personal favorites: the BLEEP which he & so many of you rave about (can't imagine sticking adhesive around my nostrils), ResMed's Swift Fx NANO an older mask which he personally loves & comments that it seems almost leak-proof, Dreamware "under the nose" Nasal Mask which he says is great for side sleepers which I am, and ResMed's Air Touch N20 that he says stays in place better than most masks which I seem to need. ~ I realize what some people love, others may hate . . . but any comments re. these masks (or others) are welcomed!!

Based on your comment on a hose with a teeny tiny hole doesn't always manifest itself constantly on OSCAR . . . I will definitely pursue this. I may order a cheaper non-heated hose to try on my AirSense 10. Thank you for that idea!

JoyD.

_________________
Machine: AirSense 10 AutoSet with Heated Humidifer + P10 Nasal Pillow Mask Bundle
Mask: Zest Nasal CPAP Mask with Headgear
Additional Comments: Pressure:10.2min-17max; ClimateLine Heated Hose; OSCAR 1.4.0; BACKUPS: AirFit P10 & Evora Hybrid FF; Respironics-Remstar Auto M-Series.
Last edited by JoyD. on Wed Nov 09, 2022 4:56 pm, edited 1 time in total.
CPAP Accessories:
Pur-Sleep Pillow, Wellue O2 Ring
___________________________________________________________________________
"In the depths of winter, I finally learned that within me there lay an invincible summer." ~ Albert Camus

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ozij
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Re: HELP needed for 13-yr CPAP user!

Post by ozij » Sun Nov 06, 2022 12:56 pm

Horrid is certainly the right word for those leaks.
I can't add anything to what Pugsy suggested.
We'll all be smarter after you try a new hose.

_________________
Machine: ResMed AirSense™ 10 AutoSet™ CPAP Machine with HumidAir™ Heated Humidifier
Mask: Bleep DreamPort CPAP Mask Solution
Additional Comments: Machine: AirSense??? 10 AutoSet??? For Her CPAP Machine with HumidAir??? Heated HumidifierSoftware: Oscar; alternating masks
And now here is my secret, a very simple secret; it is only with the heart that one can see rightly, what is essential is invisible to the eye.

Antoine de Saint-Exupery