Two nights on new 420E - comments, suggestions?

I just bought a GoodKnight 420E along with the Silverlining software. I'm still trying to learn the software. Usually when I just about give up on figuring something out, I find another button that gives me what I was looking for. Tooltips would be very helpful. I uploaded some output from the machine and I'm wondering if anyone has any suggestions.

The reason I bought the new machine (other than for backup purposes) was because my AHI has gone up quite a bit the last month or so. I went from 0-1 apneas a night to 4-6 apneas a night. That made me nervous. I think it's allergy related, but I wanted to try an APAP anyway.

Uploads:

1st night synthesis:
http://farm1.static.flickr.com/179/4494 ... 34a5_o.jpg

1st night detailed:
http://farm1.static.flickr.com/238/4494 ... 2135_o.jpg

Question:
Synthesis Report for the night shows 3 apneas, 2 apneas/CA. The detailed record shows 3 apneas and 4 apneas/CA. Two of those apnea/CAs peg with an apnea also. There in lies the difference?


2nd night synthesis:
http://farm1.static.flickr.com/203/4508 ... 0b51_o.jpg

2nd night detailed:
http://farm1.static.flickr.com/219/4508 ... d139_o.jpg

There is a nap thrown in there, too.

More questions:

Runs: 183 with a 23.8 index, and 196 with a 22.3 index. Should I be concerned? Do I have the runaway pressure problem associated with the runs? (That sounds really strange.) I'm waking up frequently again.

I don't understand the concept of cycles, like what is an Intermediate cycle?

I'm also not finding information regarding how long the apneas are. I've shown a few apneas over 30 seconds on my S8, and I'm wondering how long these on the 420E are lasting.

Other details: I was titrated at 11, although the RT changed it to 13 for some reason. I changed it back, and actually ended up closer to 12 when all the adjusting was finished. Due to fighting masks, I do more back sleeping now than I did in the past. I am still using my Optilife mask. With added strappage, I don't have to fight it, but I just got into the habit of sleeping on my back some.

Over all impressions of the 420E and Silverlining -- not nearly as user-friendly or intuitive as the S8/Autoscan. I'll deal with though, and it is getting better already. I'd much rather have a smart card, but once I make up a longer cable, it will be OK. It is a quiet puppy though. The first night, the SO came in to get ready for work, and asked why I was lying there with the mask on and the machine turned off. It was on.

Thanks.

Hi Daffney,

I'm not a doctor, but looking at the way the pressure is running up over and over again, I'd turn off IFL1. You can turn off IFL1 through the "Advanced" settings of the software. When in the Advanced settings, leave IFL2 on and leave "Command on apnea" set at 10. Turn off only IFL1.

Without the software, IFL1 can also be turned off through the menu of the machine itself. (IFL1 is called just "FL" in the machine display window.)

The Synthesis page and especially the Detailed graph you posted are the exact areas I look at when I use my 420E.

I bet things will settle down a lot when you turn off IFL1. Many people have had to do that with the 420E. Thanks to -SWS looking at my 420E data three years ago, I found out I needed it off.

Your reports show your AHI to be only 0.8 or better? Can't get much better than that, but AHI isn't the only factor you need to look at.

SNORES appear to be what is driving up your pressure, that and Runs as you already mentioned. You also have a few Central Apnea showing up and some align vertically with Apnea above indicating they may be Mixed apnea.

IF you want to lower the number of Runs seen (FL) then try disabling FL1 parameter from the Advanced "Settings" menu (unchecking the FL1 box) and see if that lowers your pressure from running up so much.

I disagree with your comparison of Silverlining to S8/AutoScan. Maybe it is because you are unfamiliar with SL, but AutoScan doesn't even compare to information provided by SL.

With AutoScan, you would NOT be seeing:
those Central Apnea found on your report on line 2 or
that those CA's align with an Apnea above making them "Mixed" apnea or
those Acoustical Vibrations or snores are what is driving up your pressure at
specific times.

If you want to see that Run index go down, try disabling FL1 from the Advanced settings and unchecking the box. Then run another report, you can always put it back. You should see pressure response settle down and less stair stepping of pressure as currently shown.

If you are feeling differently as of late, it may be due to the mask change.

If you want to learn more about Silverlining, click on the ? mark from the menu and select Help, it will explain what all the things are found in the report. Actually its help screens are pretty good at explaining details about the reports (except for Cycles, have no idea what that means but it is related to Flow Limitation).

Thanks to both of you. I was wondering about the FL1. I'll give it a try. I didn't want to do that without running it by those with more experience.

SD, my AHI was going up before I got the 420E when using the S8. That was the reason I bought the 420E before I had originally planned. Specifically, the AI was going up. It is still higher with the 420E than it had been in the past, but I imagine there is some scoring differences between the two machines. I am happy overall with the AHI with the 420E, and my main concern now is waking up often. I would rather see the AI come down regardless of the AHI. That could be unrealistic, but I liked seeing the zeros.

I suppose the Optilife could figure into it, but I went from a Swift to the Optilife. I had lower AHI during the first month on the Opti, and then it shot up. Given the crap I went through last spring pre-xPAP, I really think it's tree allergies causing most of the problem. My doctor assured me repeatedly last year that I had allergies while I kept denying it. She finally convinced me when it got better with allergy meds. I'm fighting the congestion right now though.

I know your opinion of Autoscan, and I won't argue that it gives the same info. It doesn't. In the beginning, it gave me all I needed to know as I was doing well at the time. I found Autoscan much easier to install and function from the start. I remember being a bit lost with it in the beginning also, but not to the same level I am with Silverlining. I keep having to read the manual. <gasp> I'll get used to it soon enough. I think the most frustrating thing is those diagonal lines on the detailed report. I wished I had never touched that button. I have no regrets about buying the 420E, and I doubt that I will in the future.

Mixed apneas.... I'll start reading about those now. Thanks for giving them a name for me. I didn't score any of those on either PSG, so I haven't looked into them much, or at all.

Thanks for the feedback. I really appreciate it.

[quote="Daffney_Gillfin"]Thanks to both of you. I was wondering about the FL1. I'll give it a try. I didn't want to do that without running it by those with more experience.

SD, my AHI was going up before I got the 420E when using the S8. That was the reason I bought the 420E before I had originally planned. Specifically, the AI was going up. It is still higher with the 420E than it had been in the past, but I imagine there is some scoring differences between the two machines. I am happy overall with the AHI with the 420E, and my main concern now is waking up often. I would rather see the AI come down regardless of the AHI. That could be unrealistic, but I liked seeing the zeros.

I suppose the Optilife could figure into it, but I went from a Swift to the Optilife. I had lower AHI during the first month on the Opti, and then it shot up. Given the crap I went through last spring pre-xPAP, I really think it's tree allergies causing most of the problem. My doctor assured me repeatedly last year that I had allergies while I kept denying it. She finally convinced me when it got better with allergy meds. I'm fighting the congestion right now though.

I know your opinion of Autoscan, and I won't argue that it gives the same info. It doesn't. In the beginning, it gave me all I needed to know as I was doing well at the time. I found Autoscan much easier to install and function from the start. I remember being a bit lost with it in the beginning also, but not to the same level I am with Silverlining. I keep having to read the manual. <gasp> I'll get used to it soon enough. I think the most frustrating thing is those diagonal lines on the detailed report. I wished I had never touched that button. I have no regrets about buying the 420E, and I doubt that I will in the future.

Mixed apneas.... I'll start reading about those now. Thanks for giving them a name for me. I didn't score any of those on either PSG, so I haven't looked into them much, or at all.

Thanks for the feedback. I really appreciate it.

Snoredog wrote:

3. 9cm minimum pressure. Are you comfortable with that minimum pressure? My experience is lower pressure can be better for avoiding those centrals that wake you up during the night. Your goal should be to have zero CA's seen on those 96hour detailed reports. Disabling FL1 will help that a lot, I don't think your snores are a real problem mine are much higher. If you are comfortable with 9cm then leave it, but if not you could lower it to 8cm, then use how you feel as the determining factor to leave it there. A low AHI is only one aspect to look at, CA & MA is not included in AHI although the obstructive apnea would be included.

Did you also wake up with your S8 machine?
Was that machine a Vantage (auto) or an Elite? what pressure settings was it set to?

My suggestions:

As RG mentioned, Turn the FL1 off and see what happens, if no improvement in eliminating those CA's, then lowering the Command on Apnea parameter from 10cm to 9cm (if you had the same awakenings on your Resmed machine). Resmed also has command on apnea set to 10cm.
___

I'll do that. I've tried to find something explaining the "Command on Apnea" parameter. What does that do?

As far as dropping down to 8cm minimum, I can do that, but that's borderline low for me. That was my low for ramp on the S8 (Elite, btw) set at 11.8cm with EPR=0 or 1. I was back to EPR=0 thinking that might be a problem, but it didn't make a difference. Any lower than that I started getting clausterphobic. I have no problems breathing against higher pressures. I haven't tried the 420E at 8cm, but I will see how it goes. Set at 9cm minimum, the 420E seems to be hanging closer to 10-11 most of the time so far.

When things were good, I had gotten down to only one wake-up on the Elite, if any. It was rare that I didn't wake up at all, but I managed to do that from time-to-time. Most nights were somewhere around 3am, and I would usually go right back to sleep. The last month, it was more like 2x a night.

Thanks again for the advice.

Daffney_Gillfin wrote:

Snoredog wrote:

3. 9cm minimum pressure. Are you comfortable with that minimum pressure? My experience is lower pressure can be better for avoiding those centrals that wake you up during the night. Your goal should be to have zero CA's seen on those 96hour detailed reports. Disabling FL1 will help that a lot, I don't think your snores are a real problem mine are much higher. If you are comfortable with 9cm then leave it, but if not you could lower it to 8cm, then use how you feel as the determining factor to leave it there. A low AHI is only one aspect to look at, CA & MA is not included in AHI although the obstructive apnea would be included.

Did you also wake up with your S8 machine?
Was that machine a Vantage (auto) or an Elite? what pressure settings was it set to?

My suggestions:

As RG mentioned, Turn the FL1 off and see what happens, if no improvement in eliminating those CA's, then lowering the Command on Apnea parameter from 10cm to 9cm (if you had the same awakenings on your Resmed machine). Resmed also has command on apnea set to 10cm.
___

I'll do that. I've tried to find something explaining the "Command on Apnea" parameter. What does that do?

As far as dropping down to 8cm minimum, I can do that, but that's borderline low for me. That was my low for ramp on the S8 (Elite, btw) set at 11.8cm with EPR=0 or 1. I was back to EPR=0 thinking that might be a problem, but it didn't make a difference. Any lower than that I started getting clausterphobic. I have no problems breathing against higher pressures. I haven't tried the 420E at 8cm, but I will see how it goes. Set at 9cm minimum, the 420E seems to be hanging closer to 10-11 most of the time so far.

When things were good, I had gotten down to only one wake-up on the Elite, if any. It was rare that I didn't wake up at all, but I managed to do that from time-to-time. Most nights were somewhere around 3am, and I would usually go right back to sleep. The last month, it was more like 2x a night.

Thanks again for the advice.

Snoredog wrote:

Make only 1 change per night, that way you can determine if it made an improvement or not. At this point all you want to do is uncheck that FL1 box.

OK. I have changed the FL1 and left the rest the same. I'll post again tomorrow with results.

Thanks a bunch!

I thought I had posted this already this morning, but either it got lost, or I posted it to the wrong thread, or just didn't post it at all.

Anyway, night number three results ....

Synthesis is at
http://farm1.static.flickr.com/226/4521 ... 6361_o.jpg

Details at
http://farm1.static.flickr.com/197/4521 ... b02f_o.jpg

I think the night went better overall. I looked at the clock at 12:08 and I think that corresponds to the CA at 12:05. I woke again around my normal 3am-ish. I did have a CA at 02:53, but I'm not sure if that's woke me or not. I know there was one other time that I tossed and turned a few times, but I don't know what time that was. I think sometime between the two others.

Unless there is something crying out to be changed, I'm going to leave it as is for the next few nights. Sunday nights are bad as I never get to sleep early enough, and Mondays are bad as I babysit two rowdy granddaughters in the evening, and it takes a while to wind down and get to sleep. Since the alarm goes off at 4:15, those are some short nights. Tuesday is usually my catch up night, so I will probably leave things as they are through Tuesday night.

Thanks.

That's a good idea to leave things as they are w/this change for more than one night. Usually we are told a week at a time between any changes as well as only one change at a time. Of course, I"m just parroting what I've been reading on the forums. SnoreDog is an "old timer" and I'm just a "babe in the woods" w/CPAP. Nyah, nyah, SnoreDog!!!!

Daffney, the "third night" results (session 4), with IFL1 turned off, look a little better as far as how high the pressure went up.

If it were me (I'm no doctor) I think I'd keep IFL1 turned off and perhaps set the lower pressure at 10, or even 11, to see if that might knock out the remaining "acoustical vibrations" (usually snores) and smooth out the pressure more.

I wouldn't worry one bit about the few random, scattered Ca's that show up on the data.

Another thought...
Looking back through your earlier post in this topic, I wonder if the allergy congestion you wrote about might be a factor in the way the pressure keeps having to run upward abruptly so often:

"Given the crap I went through last spring pre-xPAP, I really think it's tree allergies causing most of the problem. My doctor assured me repeatedly last year that I had allergies while I kept denying it. She finally convinced me when it got better with allergy meds. I'm fighting the congestion right now though."

Congestion, inflammation, swelling of tissues in upper airway. Yeah...irritated swollen tissues could be having an impact on the way an autopap "reads" you and treats you.

By chance, have you ever been diagnosed with acid reflux disease or GERD?

Dental Device. One like the SilentNite could initially be used in
conjunction with your 420e and then later you might find that
you have no need for the 420e. That's what happened to me.
It is so great to be able to have so many choices of different masks
and different machines to find the best combination for each
person. I learned so much from both the Autoscan and Silverlining
software. My Doctor didn't want me to see any data! He sure didn't
like me asking questions about my treatment options. I will never
understand why so many folks are so hung up with people knowing
that they actually have choices with treating their illness.

rested gal wrote:Daffney, the "third night" results (session 4), with IFL1 turned off, look a little better as far as how high the pressure went up.

If it were me (I'm no doctor) I think I'd keep IFL1 turned off and perhaps set the lower pressure at 10, or even 11, to see if that might knock out the remaining "acoustical vibrations" (usually snores) and smooth out the pressure more.

I wouldn't worry one bit about the few random, scattered Ca's that show up on the data.

Another thought...
Looking back through your earlier post in this topic, I wonder if the allergy congestion you wrote about might be a factor in the way the pressure keeps having to run upward abruptly so often:

"Given the crap I went through last spring pre-xPAP, I really think it's tree allergies causing most of the problem. My doctor assured me repeatedly last year that I had allergies while I kept denying it. She finally convinced me when it got better with allergy meds. I'm fighting the congestion right now though."

Congestion, inflammation, swelling of tissues in upper airway. Yeah...irritated swollen tissues could be having an impact on the way an autopap "reads" you and treats you.

By chance, have you ever been diagnosed with acid reflux disease or GERD?

Yes, I have had the sneaky silent GERD in the past. I have given that some thought, and I have been taking Prilosec the last 3-4 days. However, I didn't do my research *before* I went to the store, and I have since found that perhaps, Zantac would have been a better choice. Silent GERD was part of my problems last spring along with the allergy problems, and I took Protonix for a while. This year though, I have not had any of the chronic cough/sore throat that I had last year.

Last night was not a restful night. I was awake often, much tossing and turning, and much messing with the mask. I can't seem to get it through my sleepy mind that just because the Optilife makes noise, does not mean it is leaking. It's just the noise created when there is something in line of the exhaust. I have been given a used Hybrid, but I haven't been given the headgear yet.

Silverlining output for last night:
http://farm1.static.flickr.com/206/4537 ... 5f58_o.jpg
http://farm1.static.flickr.com/193/4537 ... cfe6_o.jpg

I am thinking most of my snores are nasal in origin. I'm going to throw in some Breathe Right strips if they don't mess with the seal on the mask.

meister wrote:Dental Device. One like the SilentNite could initially be used in
conjunction with your 420e and then later you might find that
you have no need for the 420e.

I have been using a DIY mouthguard. At one time, I had it reduced down to just a small piece, but since my AI jumped, I made another full sized one, and it hasn't made a difference. Someday I would like to get a professionally made dental device, but given the nasal problems, I just don't think it's going to help much right now.

Slinky wrote: That's a good idea to leave things as they are w/this change for more than one night. Usually we are told a week at a time between any changes as well as only one change at a time.

That sounds suspiciously like something they call patience. I have no stinkin' patience!

I am trying though.

Thanks all for your time.

it is obvious your condition hasn't really improved with increased pressure seen. If you look at therapy hour between hours 26.5 and 28.5 where your pressure was at or above 12cm, you still had just as many Flow Limited "Runs" as before.

If you look at the periods where your pressure was down at 9cm, you actually had fewer flow limited "Runs". That is what you want to see, fewer tics on the "Runs" line.

Just after 27hr, you had a "mixed" apnea. If you look at that event you will see where the Apnea and the Apnea/CA "align" with each other. I'm NOT seeing any arousal in front of those CA's other than a Flow Limitation, so I would say they are not post-arousal centrals.

Looking at that report, I'd say you woke up 2 times last night, first time just before hour 26h and the second time just after hour 27h. FYI: SL missed counting 1 of the 2 CA's seen last night's synthesis report.

Disabling the FL1 didn't really do much from what I can tell. Your snores have lessened a small amount but you don't feel any better. We can see better what the pressure is responding to, that helps.

I would leave FL1 disabled, BUT I would also try disabling the second Advanced parameter: FL2 (unchecking its box also). Let's see what happens when it totally ignores Flow Limitation.

I would still like to see what happens to those FL's when your Minimum pressure is lowered to 8cm if at all possible. Pressure only seems to aggravate your condition more by increasing the frequency of FL's seen. Where your pressure is at the bottom FL's nearly go away.

Another way to test if lower pressure would help you:

1. Set Initial pressure to 9cm (where you have it now).
2. Set Ramp pressure lower to 8cm and the timer to 30 minutes.

Then just before you fall asleep hit the Ramp button, pressure will drop from 9cm to 8cm for 30 minutes. The machine will still record, what we would want to see is a 30-minute period in the beginning with much fewer "Runs".

When you look at it you don't really have that many "obstructive" events being logged. Last night in 6.5hrs you had 5ea Apena, 2e Centrals and only 2 Hypopnea. You actually had MORE apneas in last night's session than you did the first night.

Yet you don't feel any better. You only have to be aroused from sleep a couple times to get that result.

So at this point I would try:

1. Disabling the 2nd Advanced parameter FL2 (let's try ignoring the flow limitations).
2. Try Ramp using the above settings. The reason is to see if those Runs reduce in frequency with lower pressure, after 30 minutes you should return to where you are now.

Quite a few people on the message board have reported needing IFL1 turned off.

I wouldn't turn off IFL2, though. I think it's important for the machine to be able to handle "regular" flow limitations... I'd keep IFL2 on.