Resmed 10 and "Events Per Hour"

General Discussion on any topic relating to CPAP and/or Sleep Apnea.
Sluggish
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Re: Resmed 10 and "Events Per Hour"

Post by Sluggish » Wed May 30, 2018 8:52 pm

Pugsy wrote:
Wed May 30, 2018 8:33 pm
Can you or have you tried a different size nasal pillow?
Your leak last night went to hell about 2:20.
Sometimes a different size nasal pillow ends up being more stable and more forgiving when tossing and turning.

Do you have the fleece wraps for the side frame? I found that adding the fleece wraps helped stabilize this mask when I tried it.
I am using a medium. I have not tried a small or large. I don't imagine I would be a large though. Yes I am using the fleece wraps and they seem to be getting looser and looser.

Do you know what advantage turning off EPR might have?
Do you know what would cause large areas of no data at all like on the night before last? Is that the machine turning off?

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Pugsy
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Re: Resmed 10 and "Events Per Hour"

Post by Pugsy » Wed May 30, 2018 9:05 pm

Turning EPR off effectively increases the overall average pressure just a little bit since you were only using EPR of 1.
EPR at 1 means the pressure drops 1 cm during exhale.
If you turn it off then the pressure doesn't drop during exhale.....so a little more consistent pressure.

Yes, the blank areas the machine was turned off.
I did this myself when I was new to therapy...turn the machine off and not even wake up. Sometimes it was off the rest of the night and sometimes I must have turned it back on and not remembered doing it.

If you have SmartStart turned ON the it's possible if the leak is really, really massive the machine will turn itself off but right before the machine turned off the leak didn't appear to be that massive. You had other leaks that were larger and the machine didn't turn off.

If you are already using the fleece wraps and the mask still wants to move around too much (and you are darn sure those leaks are mask movement and not mouth breathing....you have to tape your leaps to for sure eliminate mouth breathing) then you need to snug up that back strap just a tiny bit to better prevent mask movement when you start tossing and turning.

And do try a different size pillow...might help. Try both sizes if you have them. Small one night and large the next night.
It might be that you need the smaller frame...the package comes with the medium frame but there is a small frame available and that would also help with mask movement. I had to use the small myself because nothing I did with the medium kept that mask from moving all over the place.

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Sluggish
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Re: Resmed 10 and "Events Per Hour"

Post by Sluggish » Wed May 30, 2018 9:24 pm

Pugsy wrote:
Wed May 30, 2018 9:05 pm
Turning EPR off effectively increases the overall average pressure just a little bit since you were only using EPR of 1.
EPR at 1 means the pressure drops 1 cm during exhale.
If you turn it off then the pressure doesn't drop during exhale.....so a little more consistent pressure.

Yes, the blank areas the machine was turned off.
I did this myself when I was new to therapy...turn the machine off and not even wake up. Sometimes it was off the rest of the night and sometimes I must have turned it back on and not remembered doing it.

If you have SmartStart turned ON the it's possible if the leak is really, really massive the machine will turn itself off but right before the machine turned off the leak didn't appear to be that massive. You had other leaks that were larger and the machine didn't turn off.

If you are already using the fleece wraps and the mask still wants to move around too much (and you are darn sure those leaks are mask movement and not mouth breathing....you have to tape your leaps to for sure eliminate mouth breathing) then you need to snug up that back strap just a tiny bit to better prevent mask movement when you start tossing and turning.

And do try a different size pillow...might help. Try both sizes if you have them. Small one night and large the next night.
It might be that you need the smaller frame...the package comes with the medium frame but there is a small frame available and that would also help with mask movement. I had to use the small myself because nothing I did with the medium kept that mask from moving all over the place.
I know for sure I am not manually turning off the machine. I have always used the AUTO ON/OFF feature. Im guessing that it turns itself off somehow and then I evntually wake up and re-adjust the mask and resume breathing which turns it back on.

The small frame doesn't come too close to your eyes on the sides?

I think I'm a medium for sure but when I get more $$ I may try different size mask and/or pillow. As far as the tightness of the strap.. this has been a struggle. Tightening the strap to where it stays when I turn on my side seems to require so much tension that it forces my entire nose up on my face and makes it impossible to fall asleep on my back. Also, too much tension pulls the frame into a different shape and closes the airways a bit.

Currently I think I have it as tight as it can go comfortably to allow me to fall asleep on my back. Sadly, when I turn on my side it's all over. I love this frame concept. I hope I can make it work.

As for leaks.. I was sleeping with heavy gaff tape over my mouth for the first few days. After that I noticed that I was not needing it so much anymore. The folks at the sleep data place said that the nasal mask would eventually train me to keep my mouth closed. Is this true?? Since I have stopped taping my mouth I notice that I always wake up with my mouth closed in the morning but who knows what's happening during the night?

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Pugsy
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Re: Resmed 10 and "Events Per Hour"

Post by Pugsy » Wed May 30, 2018 9:35 pm

Try taping tonight just to make sure that the leaks are mask movement or not.

If you can't get the mask to not move without it being horribly uncomfortable then time to look at a different mask.
Maybe this one just isn't a good fit for your face and head.

And no...the small frame doesn't come anywhere close to my eyes.

Make sure we are looking at mask movement leaks here before worrying about a different mask or more adjustments with this mask.
So for one night...tape.

And sometimes people learn to keep their mouth shut and sometimes they don't. I know a forum member who never could keep her mouth shut and has been taping for years and years. It took me about 3 months of taping for the habit of mouth opening to pretty much stop.

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Sluggish
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Re: Resmed 10 and "Events Per Hour"

Post by Sluggish » Thu May 31, 2018 7:07 pm

Last night was awful. I was cat sitting so I didn't have my gaff tape to seal my mouth. I can't really tell what's going on but it looks like lots of leaks again. The mask seal emoji was a red sad face in the morning. FWIW here it is:
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Sluggish
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Re: Resmed 10 and "Events Per Hour"

Post by Sluggish » Thu May 31, 2018 7:12 pm

Came back home from cat sitting earlier this morning. Trying to read and falling asleep by noon as per usual. Decided to hook up the machine and tape my mouth for a "nap". Here are the results:
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So much for getting anything done today.
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Pugsy
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Re: Resmed 10 and "Events Per Hour"

Post by Pugsy » Thu May 31, 2018 7:18 pm

Ouch....ugly indeed.

Mr Red Frowny face shows up when you spend 30 % or more of the night above 24 L/min. Obviously you were well above that 30% number.

Nothing can be done about it now and of course it totally messes up any evaluations when there is that much prolonged large leak.

Tonight will be better....hopefully. :lol:

Edit...the nap. So your mouth was taped and there was still some large leak so some of your large leak is probably mask moving and some is mouth breathing. The amount of large leak during the nap that is mask movement. Not horrible and I have let worse slide myself.

Looks like you probably need to tape for a while longer to get in the habit of keeping the mouth shut. We might let 10% mouth breathing large leak slide but you can't really let 30 % or more slide and expect to have anything near effective therapy because when you go into large leak territory sometimes you go really deep.
If the worst it was might have been 30 L/min maybe let a little more slide but you were way past that fairly often.

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I may have to RISE but I refuse to SHINE.

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Sluggish
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Re: Resmed 10 and "Events Per Hour"

Post by Sluggish » Thu May 31, 2018 7:29 pm

I must admit I'm a little unclear on the pie chart (among other things),
Some nights I have mostly 'Hypoapnea', other nights mostly 'Unclassified Apnea', and last but not least on occasion some 'Obstructive' which oddly enough is what I thought my diagnosis was.

Perhaps with so much leakage these aren't accurate readings?

My plan tonight..

Try Philips nasal cushion instead
Tape mouth
Turn ramp off or maybe like 3 mins
Leave EPR off (sadly)

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Pugsy
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Re: Resmed 10 and "Events Per Hour"

Post by Pugsy » Thu May 31, 2018 7:38 pm

The pie chart is just a visual aid for showing a percentage of type of event.
If your AHI was 20 with 10 OAs and 10 hyponeas per hour average the pie would be half OAs and half hyponeas.
If your AHI was 2 with 1 OA and 1 hyponea per hour average it would still be half and half.
When your leaks exceed maybe 40 L/min then the machine might be missing some events so we don't know if the fact that nothing is flagged is because nothing happened or the machine just missed them due to big leaks.

You don't necessarily just have to give up EPR if you don't want to.
If using EPR allows more obstructive apneas to happen on exhale it's easily fixed with just a little bit more minimum to offset that drop.
If using EPR cause centrals (which I really doubt in your case) sometimes there is a workable compromise where a few centrals are allowed to slip past the defenses so that the person can sleep better in general.

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Sluggish
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Re: Resmed 10 and "Events Per Hour"

Post by Sluggish » Fri Jun 01, 2018 11:59 am

Last night was bad again. Very frustrating.... On a plus, the nasal cushion is far more comfortable than the nasal pillows IMO.
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Jas_williams
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Re: Resmed 10 and "Events Per Hour"

Post by Jas_williams » Fri Jun 01, 2018 12:16 pm

Most of your events last night was CA’s your machine can’t do anything about those let’s monitor for a few days

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Sluggish
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Re: Resmed 10 and "Events Per Hour"

Post by Sluggish » Fri Jun 01, 2018 3:44 pm

Jas_williams wrote:
Fri Jun 01, 2018 12:16 pm
Most of your events last night was CA’s your machine can’t do anything about those let’s monitor for a few days
Am I to understand this chart shows an improvement?

I'm not sure what a proper chart is supposed to actually look like. Is it normal to see all the spikes in the "flowrate" row?

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Pugsy
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Re: Resmed 10 and "Events Per Hour"

Post by Pugsy » Fri Jun 01, 2018 4:04 pm

The flow rate graph is pretty much useless in this compressed form. Flow rate needs to be evaluated on a breath by breath scale to really be meaningful.

It's at the zoomed in level breath by breath where you try to figure out awake vs asleep flagged events.

If those centrals are awake breathing flagged events...they don't count.

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Jas_williams
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Re: Resmed 10 and "Events Per Hour"

Post by Jas_williams » Fri Jun 01, 2018 11:17 pm

Sluggish wrote:
Fri Jun 01, 2018 3:44 pm
Jas_williams wrote:
Fri Jun 01, 2018 12:16 pm
Most of your events last night was CA’s your machine can’t do anything about those let’s monitor for a few days
Am I to understand this chart shows an improvement?

I'm not sure what a proper chart is supposed to actually look like. Is it normal to see all the spikes in the "flowrate" row?
Your leaks were better and as the CA’s may diminish as you settle into the the treatment I see no reason for further changes based on that chart.

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Sluggish
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Re: Resmed 10 and "Events Per Hour"

Post by Sluggish » Sat Jun 02, 2018 7:20 am

I thought I was using setting 9-20 as a way to zero in on a more precise setting in the future. Are you saying I should just leave it at 9-20?

Last night was terrible. Regardless of what my chart might say (I’ll load it later) I am waking up just as often if not more than before my diagnosis. I don’t think I’m getting any sleep at all. I really miss sleep. I want to call in sick every day but don’t want to lose my job. When I get to work I can barely function. I can’t make any plans on my days off because I’m tired by noon every day. I can’t believe I’ve had this for over 8 years. This morning when I tore the gaff tape off my mouth it took portions of my skin with it so now I have huge raw red patches around my mouth. Blue masking tape is no match for my jaw. I’m not looking forward to tonight but considering I can’t tape my mouth until I heal, I’m likely to leak all night again. I’m considering just not using anything “therapy” tonight at all. I wouldn’t wish this on anyone.