CPAPtalk.com

Bobby269 wrote:Has there been a fix for this problem?

My understand is that the double session bug has been fixed but not released. That was what I was told anyway by someone who knows how to go get the build and sort of update it manually. I lack the skills or time and patience to do this.
I don't know when this particular fix will be released nor do I know why they are waiting unless other problems popped up.

[quote="Lizistired"]Extreme headache and my tinnitus was off the charts when I woke up.
[quote]

The only "cure" for Tinnitus is hearing aids to stop the brain from issuing those signals to the ears.


Other options with masking:

Litening to Classical Music, all day, here:

http://theclassicalstation.org/listen.shtml

The following sound maker could be helpful in a pinch but it is made too chip. There are others in Walmart and Target.

I am new to this, but the idea of reading my own data is intriguing. I have an s9 and here is what the medical supplier has told me: I am not allowed to access my data. I might break my machine (which I own). After downloading data for my doctor from my card, I do not need to get my card back. They won't do it for me more than once, so they get to keep the cards! (Can you imagine taking my photos in to print and having them keep the card!?) I am doing "great" on the machine with 75% compliance and a leak factor of only 7. (Reality - I have only used it the first 3 out of 6 weeks of pure torture. All the masks I have tried leak as soon as the pressure goes up, which is just when I hit rem sleep and at which point it stops leaking because I turn the #@!*&% thing off! I am beyond exhausted as a result.
QUESTION: How do I get the software and so forth? I'm done with these fools!

Grandma Lynn wrote:QUESTION: How do I get the software and so forth? I

Check your private message box. I sent you links for ResScan 4.1 and the video tutorial.
If the DME kept your SD card you can get another one. Any generic SD card will work.
2 GB Sandisk from Walmart works just fine.

Burkebang wrote:

Lizistired wrote:

zoocrewphoto wrote:I've liked ResScan from the start. Easy to use. Sometimes a bit slow, but not bad.

I don't like sleepyhead graphs. When people post their sleepyhead reports here, they don't make sense to me. Dual lines on some of them. I supposed if I sat down and really studied them, they would make sense to me, but they look overwhelming to me. I really like the reports produced by ResScan. They are easy to understand at a glance, and they just make sense to me.

I'm with you. When I see SH graphs, I don't follow the thread, which makes me feel bad for not trying to help, but I just don't want to spend the time trying to figure out the graphs. I think ResScan is simpler. Like you said, at a glance.

I don't understand this at all. A graph is a graph.

Here is one from Resscan:


Here is the same graph from Sleepyhead:


Your telling us that the difference is SO dramatic that its overwhelming enough that you don't even follow the thread or try to help the people posting them?

Question,

Burke, what is the blue graph in SH, and why is it not parallel to the green graph? The blue graph is chopped off at the bottom. Is it b/c the pressure does not go below 4 cm ? Also, is it possible that your graphs show untreated snoring b/c the set-up pressure is too low?

I use both. I find SH much easier to use and navigate to find things. If something doesn't look right in SH, I'll go to ResScan and see what it shows.

Most of the SH problems I've seen have been obvious like the example above where the pressure line is squished down to zero or the double session stuff.

avi123 wrote: Question,

Burke, what is the blue graph in SH, and why is it not parallel to the green graph? The blue graph is chopped off at the bottom. Is it b/c the pressure does not go below 4 cm ? Also, is it possible that your graphs show untreated snoring b/c the set-up pressure is too low?

The blue line is my exhalation pressure. It's cut off at the bottom when the pressure is down to 4 cm/h2o, the machine cannot deliver lower pressure than that and is unable to give me the 3 cm/h2o reduction my EPR is set to. If you look at the beginning of the graph, the two lines are completely togeather when the machine starts at my minimum pressure.

APAP machines are very quick to respond to snoring, so there should be no reason to set a higher minimum pressure because of snoring. When it occurs, the machine will increase the pressure to treat it. I know many people in this forum believes in high minimum APAP pressures and narrow pressure ranges, but this is not how it's done in Norway. I was told that the whole purpose of an APAP is to constantly be in a state of regulation by the machine, giving us only the pressure that is actually needed to treat events when they occur, to this we need as wide pressure range as possible. Low minimum pressures also makes many more people able to be compliant and tolerate the treatment.

Burke, I am talking about the top pressure of 8 cm that I see here:

http://dl.dropbox.com/u/56364909/Sleepy ... 012012.pdf

Why the pressure is not above 10 cm to get rid of the snoring that is showing?

Re ; tininnitus

I wont claim to be cured, but since i started therapy for my apnea, the volume has been reduced.

We used to run out tv volume around 12 for me to hear the tv. These days the tv volume rarely reaches 8.

Dave

avi123 wrote:Burke, I am talking about the top pressure of 8 cm that I see here:

http://dl.dropbox.com/u/56364909/Sleepy ... 012012.pdf

Why the pressure is not above 10 cm to get rid of the snoring that is showing?

I don't know why the machine did not increase the pressure further, maybe it was not needed? The IntelliPAP was unrestricted by me, it was set to APAP mode with a pressure range of 5-20, so this is the machines choices that you see here. I don't know what the numeric value of the snore graph is, so it's possible that the "strength" of the snoring actually was very low. Sleepyhead will adapt the scales to fit the values, which might make the level of snoring look worse than it really was. You also see that the machine responded to the snoring. This was one of my first nights on CPAP and all I remember that is of any interest is that my bedpartner was totally amazed that I no longer snored.

The REALLY great thing about Sleepyhead reports with oximetry is that you can clearly see that my therapy was very effective, I had no desats and mostly nice and stable pulse rate the whole night through. So the IntelliPAP certainly did its job well.

Thanks Burke, any chances that you could show SH Stats, and graphs of: events, pressure, snore, flow limitation, and leak for your present machine?

Burkebang wrote:

avi123 wrote:Burke, I am talking about the top pressure of 8 cm that I see here:

http://dl.dropbox.com/u/56364909/Sleepy ... 012012.pdf

Why the pressure is not above 10 cm to get rid of the snoring that is showing?

I don't know why the machine did not increase the pressure further, maybe it was not needed? The IntelliPAP was unrestricted by me, it was set to APAP mode with a pressure range of 5-20, so this is the machines choices that you see here. I don't know what the numeric value of the snore graph is, so it's possible that the "strength" of the snoring actually was very low. Sleepyhead will adapt the scales to fit the values, which might make the level of snoring look worse than it really was. You also see that the machine responded to the snoring. This was one of my first nights on CPAP and all I remember that is of any interest is that my bedpartner was totally amazed that I no longer snored.

The REALLY great thing about Sleepyhead reports with oximetry is that you can clearly see that my therapy was very effective, I had no desats and mostly nice and stable pulse rate the whole night through. So the IntelliPAP certainly did its job well.

Comment,

In the U.S. during sleep studies, the titration follows the AASM guidelines.

Excerpt:

The recommended minimum starting CPAP should be 4 cm, and for BiPAP, IPAP = 8cm and EPAP = 4 cm. The max CPAP should be 20 cm and for BiPAP 30 cm, for adults. CPAP (IPAP on BiPAP) may be increased if at least 3 min (for adults) of loud unambiguous snoring is observed.

CPAP should be increased by at least 1 cm H2O with
an interval no shorter than 5 min, with the goal of eliminating
obstructive respiratory events (Consensus)

check it here:

http://www.aasmnet.org/Resources/clinic ... 040210.pdf

avi123 wrote:The recommended minimum starting CPAP should be 4 cm, and for BiPAP, IPAP = 8cm and EPAP = 4 cm. The max CPAP should be 20 cm and for BiPAP 30 cm, for adults. CPAP (IPAP on BiPAP) may be increased if at least 3 min (for adults) of loud unambiguous snoring is observed.

CPAP should be increased by at least 1 cm H2O with
an interval no shorter than 5 min, with the goal of eliminating
obstructive respiratory events (Consensus)

Let me reiterate that this is the recommendation for sleep studies, like avi says. It's not the recommendation for APAP therapy.

Burkebang wrote:APAP machines are very quick to respond to snoring, so there should be no reason to set a higher minimum pressure because of snoring. When it occurs, the machine will increase the pressure to treat it. I know many people in this forum believes in high minimum APAP pressures and narrow pressure ranges, but this is not how it's done in Norway. I was told that the whole purpose of an APAP is to constantly be in a state of regulation by the machine, giving us only the pressure that is actually needed to treat events when they occur, to this we need as wide pressure range as possible. Low minimum pressures also makes many more people able to be compliant and tolerate the treatment.

If low minimum pressure works for you, that's fine. Use it.

However, even snoring may not cause the pressure to go up quickly. I believe my PRS1 machine will not increase pressure more quickly than 1 cm per minute. If you need 14 cm pressure and start at 4, you may not have any flow limitations or snoring until you fall asleep. You would then suffer from apnea for 10 minutes when you first fall asleep. This could be a significant problem. Many people might find it hard to fall asleep.

Many people also find that once they're used to CPAP, they feel like they're suffocating if they start at 4. Their brain is used to not having apnea any more, so the brain objects when the pressure is too low and hasn't adjusted up yet.

In support of archangle's points:

Burkebang wrote: . . . giving us only the pressure that is actually needed to treat events when they occur, . . . as wide pressure range as possible. . . .

That was the working theory behind the development of APAP, but in practice many patients have achieved lower home-machine-reported AHI--and, more important, more restful sleep--by raising their minimum. So when someone comes here with high AHI and not feeling rested when using an APAP, we pass on what has worked for us--raising the minimum pressure. It is surprising how many are helped by trying that.

. . . Low minimum pressures also makes many more people able to be compliant and tolerate the treatment. . . .

It is amazing how many doctors believe that. Doctors often think that since some find 20 cm difficult to tolerate, that must mean that the lower the pressure the better when it comes to any patient's tolerating treatment.

However, experienced users on this board have found that too low of a pressure can actually be a bigger problem with comfort than the pressure being too high. Many patients feel starved for air at 4 cm and adjust to therapy much easier at 6 cm, or even 8 cm. Doctors don't know that because they've never used CPAP themselves. Fortunately, members of this board are here to pass on things that doctors have yet to understand about PAP therapy. Docs make assumptions about PAP therapy all the time that RTs have to explain to the docs are not so, and sometimes we as patients have to respectfully do the same. Even docs who know the science may not fully grasp the application and especially have little understanding of the comfort aspect of the treatment. Medically speaking, PAP therapy for OSA is new, so few docs understand the nuts and bolts of day-to-day treatment. That is true of CPAP, let alone APAP.

As has been said, if someone feels great and has reasonable AHI with his auto-titrating machine set wide open with a 4 cm minimum, that is great. Stick with what works. However, many have found that those constantly changing pressures are disruptive to their sleep and so have benefited greatly from raising their minimum pressure setting, even during ramp. It is worth a try to see if it helps. It is sort of a way to get the benefits of APAP and the benefits of CPAP at the same time--making it so the machine only rarely has to adjust the pressures so that disturbance to sleep is minimized.