newbie needs help interpreting sleepy head data

Hi

I am new to CPAP and have been placed on CPAP about 28 days ago after my first sleep study and titration study. They sent me home with an Phillips Reprionics System One Remstar Auto with Aflex (with humidifier). The mask ways a resmed medium sized swift fx nasal pillows. The script was pretty open with a pressure of 4 to 20, which I presume they are using to re-tritrate my pressure at home.

My first couple of nights on CPAP were like the best sleep I had had in years. Now I just wake up like my tired old self. So I am wondering if I have been doing something wrong.

I have finally found you guys (yay) and found out about sleepyhead (yay). But I dont understand my reports. Can someone have a look at these reports and tell me what they think. I have my next appointment with my sleep physician in about a weeks time and it would be nice to have a heads up.

thanks in advance, Caprica.

Here is my data from thrusday night and my summary:

Welcome to the forum!

I'm sure others will chime in but this is my take. Looking at the pressure, flow and event and flags in the 23:15 - 23:30 time span, the machine ramps up from its lower limit to 9 cmH2O in responses to snores (VS and VS2). Then a few Obstructive Apneas (OA) cause it to ramp up even more to 11+. A similar pattern shows up at 1:45

Being the analytical experimental type that I am, I might set the lower limit a bit higher, maybe at median of 7 or even something in the 8 to 9 range. That would probably eliminate most of the snoring and the machine would be able to step to 11 more quickly from a higher base. I have no medical training, I'm not advising you. I'm just say what I would do. You might want to look at several nights data to see where optimal lower limit lower limit should be.

Posting some of your earlier, more refreshing nights for comparison would be helpful.

Take a look at the SleepyHead Tutorial link in my signature line. See if some of your questions are answered there. If not, ask specific questions and we will try to clear things up.

Ditto on the minimum pressure increase thoughts. With a little better head start the machine can likely get to where it needs to be a little faster and do a better job. Though I wouldn't jump from 5 to 8 or 9 in one jump...I would do it more slowly. First of all it is easier to adjust to if you go up slowly and you might find that you get by with less than 8 or 9 to get the job done.

thanks everyone. When I had my sleep titration study, the sleep tech said that I needed about an 8 or 9, that was why I was surprised about the prescription for a 4 to 20 range. I guess when I see the sleep physician again, he will probably reduce the range down and increase the ramp speed based on the first month of data.

Also I have been struggling a fair bit with mask leak. I don't know what is normal or not, but there are some nights when the wife gives me a kick a few times to fix my mask (on the upside she prefers to kick me for mask leak, rather than snoring too loud .....).

I have been trying saline gel around the nose on my nasal pillows and fiddling around with the straps, but to no avail.

Can someone tell me if the following leak data is normal?

thanks, Caprica

I agree totally with increasing your minimum pressure, I'd just enter the clinical menu and bump it up to 7 if I where you.

I have quite a bit experience with the Swift FX mask and in my experience it seals very well. Since you leak more than you should with this mask, there is a few things you can try:

First of all, are you sure your pillow size is correct? This is important and if you have all the sizes, try the others and see if it feels better.

Is your headgear correctly adjusted? It should not be tight at all, it should only keep the pillows in place under/in your nose and the pillows will create the seal with the air pressure. If it's enabled in the clinical menu, you can hit the ramp button when your machine is off, then it will do a mask fit check that gives you the whole pressure range your're set up for, this is really helpful in checking if the mask is correctly adjusted.

Do you toss and turn at night? That will create leaks when the hose gets pulled around. Solution is some sort of hose management. I have a tiny hook in my ceiling above my neck and use a stretch cord like in the picture below to suspend the hose from the ceiling. This lets me move freely from side to side and there is never any pulling on the hose. I highly recommend hose management as it not only helps with leaks, it makes the whole "CPAP experience" so much more comfortable. There is also stuff like this https://www.cpap.com/productpage/flexib ... -lift.html available, but I love my stretch cord, it's very easy to take down in the morning, there is no poles anywhere and it holds the hose just perfectly with an unlimited range of motion

caprica wrote:Can someone tell me if the following leak data is normal?

It's within acceptable limits. Respironics machines report total leak. Total leak is mask vent rate and your pressure plus any excess leaks. You don't show the pressure graph line...some of that upward leak line is likely from increased pressure. You would expect to see some increase in that leak line if your pressure increased. The more pressure that is used the higher the vent rate.

Large leak for a Respironics machine doesn't enter the picture until somewhere above 75 L/min. You are well below that line to avoid. SleepyHead tends to make the leaks look worse than they are due to scale.

Look at your leak line and look at the pressure line...I bet your pressure went up some around the time where the leak increased.
Might not all be related to pressure increases but I bet some of it is.
Regardless...if I had your leak line I would be happy with it.

Now if leaks (even minor) are disturbing your sleep that is a different story. Anything that disturbs sleep is unwanted.
Your leaks aren't anywhere near impairing your therapy though. So if you are sleeping well...I wouldn't worry about them unless that get up around 75 L/min and stay there for prolonged periods of time.

Unfortunately I cant change my settings at the moment as my machine is a rental machine and they have "locked it". I guess once I purchase it, they will unlock it and let me adjust the settings myself?

Also thanks for the tip on the hose hoist. I toss and turn and knock my mask around, so a hoist may be the solution.

Regarding lansinone and saline gel, which one is better to put on before sleep to help with mask's seal?

caprica wrote:Unfortunately I cant change my settings at the moment as my machine is a rental machine and they have "locked it". I guess once I purchase it, they will unlock it and let me adjust the settings myself?

Also thanks for the tip on the hose hoist. I toss and turn and knock my mask around, so a hoist may be the solution.

Regarding lansinone and saline gel, which one is better to put on before sleep to help with mask's seal?

It's unlikely that they will unlock it...but it is easy to do yourself.

Lansinoh ointment ...I found it offered a little better seal because it is a bit "tacky".
Try either or both and see which you like the best.

thanks

found the unlocking instructions here:

http://mukoq.com/data/remstar_auto_a_flex.pdf

sorry to keep on asking questions, but at my next visit to the sleep clinic they will probably want to sell me a machine. Should I be asking for a CPAP or APAP machine?

APAP...it is like 2 machines in one because it as APAP mode with auto adjusting pressures and it also has cpap mode with fixed pressure.

APAP mode is nice to have available even if you end up not wanting to use it all the time.

The regular CPAP machine only offers the one mode...fixed pressure.

Hi

I changed my pressure settings on the machine last night from the original script of 4 to 20, to a tighter range of 6 to 12 with a 30 minute ramp time.

I used lansinone on my nostrils. I still feel I am struggling with my mask seal at the higher pressures though. I probably need to adjust my straps more or improvise a hoist.

I still feel I have slept about the same. Here is last nights sleepy head report. There is still a big cluster of events at around 2 am and the machine ramps up to a pressure of 11. I am tempted to raise the minimum pressure to 7. What do you think?

caprica wrote: There is still a big cluster of events at around 2 am and the machine ramps up to a pressure of 11. I am tempted to raise the minimum pressure to 7. What do you think?

Looks like 2 AM would be about the time of REM stage sleep. Typically REM occurs about 90 minutes after sleep onset. Goes right along with that break in therapy and return about 12:30 AM.
It's common to see extra stubborn events pop up in REM stage sleep...and even supine sleeping.
So the machine tries to increase the pressure to deal with the stubborn events from whatever cause.
An increase to 7 cm would be something I would consider for sure if this were my report. Might need a little more but I wouldn't do more than 1 cm at a time.

APAP variations in pressure present an extra challenge to managing leaks. The better you can limit the variations the better chance you have in managing the leaks.

I also think you should go ahead and bump it up to 7. It looks like your machine is playing catchup and loosing. To get the best possible sleep, I think you need to get more of those events under control. If you don't see a good improvement tomorrow, bump it up to 8, but stop if you get too many CA's.

I would never tie my air hose like this b/c if the vertical section coming down from the hook would condensate into water and then the nasal pillows mask (if I used it) would fill up with water and either go into my lungs or choke me:



Besides, doing this arrangement with Resmed S9 products, is silly b/c the condensed water in the rising leg of the hose does not return to the humidifier tank but goes down to the floor of the humidifier. And there it collects and sounds acoustically, with knocking sounds, while the machine operates.