My First Night! Sorta!

Actually my Husband "123.Shawn T.W." is writing this for me! (from my perspective)

Just for some background, I have not had a sleep study, and recently got a S9 AutoSet, we set it to 6-12 - EPR3 - Ramp 45 min because I had low SP02:


We went to bed about 8 pm and of course had trouble falling to sleep, actually when we both got up around 10 to pee, I did not think I had slept at all! After that it seemed like I was not getting enough air and suffocating!

Here is a shot of my report, Shawn seems to think that I did fall asleep around 9ish . . .


Here is a zoomed in view:


As you can see the leak, came after the pressure rise, not the machine chasing the leak ...

However, both of us are not sure why after we went back to bed, I could not get pressure more than 6, and I seem to feel like I'm suffocating at 6, and just lay there. . .

Shawn thinks we should shorten the ramp time down to 5-10 area, and increase the min at least 1 cm ...

Were unsure of how to proceed, any suggestions?

Don't use the ramp at all. It is dropping the pressure to 4 cm and yes, it sure feels like we are suffocating at that low of a pressure for many of us.

When you have a minimum pressure of 6 cm and use 3 EPR the machine is dropping to 4 cm anyway on exhale (it can't go below 4)
and you should be able to easily breathe at that setting with EPR. You shouldn't even need ramp at that minimum pressure.
Raising the minimum won't change ramp 4 cm unless you also raise the ramp starting pressure.
From your reports you don't seem to need more minimum pressure.
When you use ramp it starts at 4 cm unless you change the ramp starting pressure. We could tell you to change ramp to 5 or 6 for comfort. Might as well turn ramp off and just use 6 to start with and let EPR help with exhale.

What I don't understand is why it never went over 6 after we got up at 10?

She did not think she was asleep until after midnight when she took the mask off ... But the graphs show snoring ...

123.Shawn T.W. wrote:What I don't understand is why it never went over 6 after we got up at 10?

Are you talking about the first session with the large leaks and the pressure all over the place and comparing it to the second session where pressures never went above 6 cm and the leak was non existent?
Looks almost like it was set at straight cpap. I can't see the events graph but from the AHI on the left side bar information it looks like not much went on and I would assume the machine didn't think it needed to do anything and that is why no increase in pressure unless you accidentally changed the settings to CPAP mode. If it is in APAP mode and the pressure didn't go up it is because it didn't think it needed to.

I suspect that the first session with the erratic pressures and leak line was more from the machine being fooled because of leaks and maybe erratic breathing from getting used to the mask and machine. This was the very first time using a mask and machine wasn't it?
If something was sensed during the first session and that was what triggered the increase in pressure to 10 it is also possible that whatever happened the first session simply didn't happen the second session. Maybe something positional or even in REM sleep related. It is possible to have an entire night with no pressure changes and the next night to have the pressures change all over the place. We don't sleep the same each night.

That second session looks great. Other than making the awake time adjusting to initial air movement more comfortable by not using 4 cm ramp, I wouldn't change anything.

Trust the machine to do its job.

I just checked her machine, it is still in Auto mode.

If you look at the zoomed in screen shot it shows that the pressure went up prior to the leaks, as at first I thought the she had leaks, then the pressure spike, but for some reason she had the pressure rise, then had trouble controlling the leaks ...

The last half of the useage she was awake as she was frustrated that she could not breathe because her mean stubborn husband (me) told her she had to leave it on till midnight unless it was a serious problem ... Tonight I'll try to be nicer!

123.Shawn T.W. wrote:If you look at the zoomed in screen shot it shows that the pressure went up prior to the leaks, as at first I thought the she had leaks, then the pressure spike, but for some reason she had the pressure rise, then had trouble controlling the leaks ...

The last half of the useage she was awake as she was frustrated that she could not breathe because her mean stubborn husband (me) told her she had to leave it on till midnight unless it was a serious problem ... Tonight I'll try to be nicer!

Well heck, if she was awake that second session no wonder it looked so darn good.
These newer machines aren't really known for chasing leaks so I didn't really think that the leaks were caused by the pressures. I think that likely it was a coincidence.

When she fitted the mask at pressure...did she fit it with ramp on or the pressures that she likely would be using?
That would account for some of the leak if she fitted it at ramp pressure. Also possible that if some sort of event precursor drove the pressure up that the actual change in pressure disturb her sleep a bit and perhaps causes some body movement or restlessness which allow the mask to move around. Or turn over and have the mask just slide out of position.

So fit the mask at 6 cm and see if it doesn't leak as much with pressure increases. Is she using the Swift FX nasal pillows? Watch for open mouth thing too. I woke up in the middle of the night and one of my nasal pillows was blowing in my ear.. I kid you not and you know what? Surprising the leak spike wasn't near anything like I thought it would be. They can slide out of the nose and not have the leak go off the charts like we would assume.

FWIW...I screened my sister with my machine and wanted to use 4 cm as baseline because all I wanted to do was establish the need for cpap and she absolutely would have no part of it. She tore that mask off in about 30 seconds telling me I was trying to suffocate her. Using ramp at 4 cm could very well be extremely uncomfortable for your wife. I ended up using a 6 cm minimum starting pressure for my sister's screening. She really didn't like 5 cm either. Let your wife try each one and see what is more comfortable for her. Gotta be comfortable to get to sleep....

I believe she had it at 4 when she fit the mask we will make sure that it is good at atleast 6 tonight.

Yes she is using the Swift FX nasal pillows, she picked that from our stock pile, as it has a smaller face print, less headgear ... she seems to be OK with it, and did not complain of any nostril soreness today, even when I asked her

I did have her open her mouth, just to see what it was like ... But it is possible she had mouth leaking, she did not notice the pillows dis-lodged, I of course was sleeping!

I bought a PapCap ... But she thinks it "looks funny" and of course would mess up her hair! Women!

We set the machine up last night with only 5 minutes of ramp starting at 5cm, min setting of 6, max at 12, ERP at 1 she did not have it on for the full night, but it is a start!





There was some light snoring, so I think she got some sleep.

She did real good on the leaks fir most of the night! (Just a little bit a talking at the beginning ... )

Last night she left it on for longer! YAY!

Good job.

Hey, could you do the unplug from electric source for her S9 ...wait a minute...plug back in? 2 nights in a row with absolutely zero events of any kind...not impossible but sometimes the S9 gets stuck reporting a number and 0 seems to happen.
Let's make sure that the zeros are from the machine doing its job and not a stuck data point.
Hurts nothing to do it. This forces the machines firmware to reboot and clear out any cobwebs just like we do with our computers. Won't hurt a thing to do it. Have to wait till after tonight to see if anything changes.
Just want to make sure the zero events isn't a machine reporting glitch.
Needs to be an unplug from the electric outlet though. Power down isn't enough.

It was unplugged for over an hour, we decided to take a nap .. . my leaks look good, to me anyways ... always seems to want more pressure, but not flagging any events ... any ideas why it wants to increase pressure?



I do have a few little snores, do you think that is why it is increasing the pressure?

Looks Great!
You can zoom in on the flow line and see if there was any delayed breathing.

Blessed2BeeAlive wrote: I do have a few little snores, do you think that is why it is increasing the pressure?

Probably.
Also could be increasing the pressure in response to flow limitations. Flow limitations are reductions in the air flow that are less..maybe not as much reduction or maybe not long enough in duration to meet the criteria for a Hyponea or obstructive event.
The machine actually works to prevent the collapse of the airway and it uses snores and flow limitations as something to tell it that a maybe collapse of the airway is about to happen.
So when we see events get flagged on the reports those are the events that got past the defenses that the machine wasn't able to ward off. Once an event is actually occurring the machine doesn't really do any thing. It won't try to blow the airway open.
It's whole purpose is to prevent the collapse.

If you zoom in on some of the times where the pressure is increasing then you might see where your breathing rate has diminished a bit compared to other times. That is what Liz was asking about.

If you have unplugged the machine recently then I would assume that the zero events just means that the machine is doing a great job. Nothing is slipping past the defenses. The fact that it increased the pressure means it sensed something that it felt like was an indication of a possible collapse of the airway tissues. Whatever it sensed...we don't really know but it stopped the whatever event from becoming a full fledged event that might get scored if it slipped past the defenses.

A full night!

Looks good. Now leave her alone for a week. It really does take time to get used to sleeping with this crap.