Woken up by pressure?

Hello,

I have been diagnosed with severe sleep apnea in march.

I am using a resmed air11 with a philips respironics full face mask.
I feel much better but i still wake up in the night and remove it from time to time.

I have downloaded myAir on my phone a few months ago but i haven’t yet looked at the raw data through oscar.

Since three nights i am walking up because of pressure and didn’t wear it enough …

Of course it’s a long week-end and i won’t be able to call my provider until tomorrow.
It took me three days to realize why i was so tired.

Any help welcome.

Skimo wrote: ↑

Sun Nov 03, 2024 8:12 am

I have downloaded myAir on my phone a few months ago but i haven’t yet looked at the raw data through oscar.

??? myair and oscar are two different kettles of fish.

but we DO need to see that oscar data to see what's waking you up. and i'm fairly sure it isn't the pressure.

see here regarding oscar charts and posting and such-
viewtopic/t88983/Pugsys-PointersSleepyH ... Hints.html

good luck!

Welcome! To be able to help you, we'd love to get some data from you. This could either be Oscar, which is software you load onto your laptop or desktop, or SleepHQ, a platform on line where you can get a free account. I'd suggest you try SleepHQ, because when you send us a link to your SleepHQ charts, we can scroll through them ourselves to see what's going on.

https://home.sleephq.com/

Thank you both i will look into it.

I have just checked and the pressure was at 17bar which seems like a lot and i have no way to modify any settings by myself since i have to ask my provider for it…
I wonder when is the last time the settings were changed without any warning…

Skimo wrote: ↑

Sun Nov 03, 2024 4:35 pm

I have just checked and the pressure was at 17bar which seems like a lot and i have no way to modify any settings by myself since i have to ask my provider for it…
I wonder when is the last time the settings were changed without any warning…

I think you mean 17cmH2O. 17bar is nearly 250PSI. 17cm = .241psi And it's very easy to modify the settings on the AS11. There are a few youtube videos of how to do this. But first. Post those charts and read this forum before making big changes. Always write down your setting so you can return to them if it goes sideways.

I did lower it to 12 yesterday evening, called my provider this morning it was 7 previously, my only guess is that my toddler managed to change the settings while i need a youtube video to do it…
And i’ll get the data asap…

It was lowered to 7 but there is a Problem with the settings i did wake up again with a pressure at 12…
I haven’t found out yet how to get the sd card out safely… working on it with the brain cells i have left…

skimo,

It would help us help you if we knew exactly what the clinical settings on your machine currently are set to. But it also sounds like you have no real idea how the people who sold you the machine set it up in terms of the actual pressure settings. And that they told you little or nothing about the SD card or anything else except how to turn the machine on and how to fill the humidifier.

It also sounds like you have either watched or looked for videos that explain how to get into the clinical menu and reset the settings if desired.

So first things first: I think you need a copy of the written clinical manual as well as the videos. The clinical manual explains how you can check the settings (and change them if/when it becomes apparent that you need to), as well as how to check the data that is recorded on the machine's local "sleep view," which in many ways is a better snapshot of what's going on that what you see in MyAir, as well as how to check if there is an SD card in the machine and how to remove it for uploading data into software that gives you a comprehensive picture of what's going on each night when you use the machine.

So here's a link to the clinical manual for your machine: Clinical manual for Resmed AirSense 11. Even though the page has a login button, you will be able to see and download the manual (as a pdf file) without logging in.

And just for completeness, here are links to two short videos about getting into the clinical menu on your machine so that you can check how the machine is set up and how to change the settings if/when that becomes necessary:

How to Adjust Clinical Settings -- AirSense 11 by CPAPMyway. This video also explains what each setting is for.
AirSense 11 Clinical Menu -- How to Get to CPAP Clinical Settings by The CPAP Store.

So get into the Clinical menu and then write down what each of the following settings is set to and then post that information here.

Mode (This should read either AutoSet, AutoSet for Her, or CPAP)
Pressure Range (or Pressure is in CPAP mode)
AutoSet Response (if using AutoSet mode)
Ramp Time (Off, a numerical value, or Auto)
Starting Pressure (if your ramp is NOT turned OFF)
EPR (On or Off)
EPR type (Ramp Only or Full time)
EPR Level (1, 2, or 3 if EPR is On)

The next set of settings will depend on whether they've set you up with a ClimateLine (heated) hose or a SlimLine (unheated) hose.

If you've got a heated hose, the next set of settings should be:
Climate Control (Manual or Auto)
Tube Temp (only seen if Climate Control is set to Manual; this gives you the temperature the air inside the heated tube will be heated to)
Humidity Level (only seen if Climate Control is set to Manual; this will be a number between 1-8 or it will read Off)

If you have an unheated hose, you won't have a Climate Control setting or a Tube Temp setting, but you will still have a humidifier setting.

You'll then have another set of settings, called Accessories. These include
Mask Type (Pillows, nasal, full face)
Tube Type (SlimLine, Standard; this only shows up if you are NOT using a ClimateLine hose)
B/V Filter (Off or On; this is a special filter not needed by most people. So this is most likely set to Off)

Then comes a set of settings called Options. These include
Patient View (Simple or Advanced. Make sure this is set to Advanced so you get all the information in the daily My Sleep View report)
SmartStart (On or off)
SmartStop (On or off)

There are a few other things, but we don't need to know what they are.

Once we know what your settings actually are, we'll be able to help you with the problem that you are facing---i.e. we'll be able to help you figure out why it feels like the pressure is waking you up, whether pressure increases are occurring during the night that may in fact be leading to arousals/wakes, and ideas for how to make the pressure go back to a level where you can comfortably get back to sleep.

Skimo wrote: ↑

Tue Nov 05, 2024 5:07 am

It was lowered to 7 but there is a Problem with the settings i did wake up again with a pressure at 12…

It sounds like you are either running in Auto mode, where the pressure will increase and decrease all night long based on what's happening to your breathing OR you have the Ramp on with a beginning ramp pressure of 7 and you woke up once the pressure hit its therapeutic setting of 12. Without knowing your machine's exact settings we can't tell you which of these things is what happened.

Skimo wrote: ↑

Mon Nov 04, 2024 11:57 am

I did lower it to 12 yesterday evening, called my provider this morning it was 7 previously, my only guess is that my toddler managed to change the settings while i need a youtube video to do it…
And i’ll get the data asap…

I don't think your toddler is responsible for the changes to the clinical settings. There are several things that might be going on:

1) Your machine is running in Auto mode and the different pressure readings are at different times relative to when the machine was turned on.

2) Your machine is set up to start off in Ramp. This allows the machine to deliver a lower pressure during the period when you are going to sleep and the pressure is then increased. If Ramp is set to Auto, the machine waits to increase the pressure until after it "thinks" you are asleep. (It decides you are asleep once a steady breathing pattern that is typical of "sleep breathing" has been established for a few minutes.) If there is a Ramp time, the pressure will increase steadily during the ramp period from the starting (ramp) pressure to the (minimum) therapeutic pressure.

3) Your durable medical equipment provider (DME) is using the machine's cellular connection to not only monitor your usage, but also is using it to change the settings on the machine. CPAP manufacturers built in this ability for DMEs so that if/when a doctor orders a change in the clinical settings, the patient does not have to bring the machine (or its SD card) into the DME. It also means the DME doesn't have to rely on the patient to bring the SD card in when they are obligated to provide usage data to the patient's insurance in order to get paid for the machine.

As I said in my last post, in order for us to help you figure out what's going on, we need to know exactly how your machine has been set up to run.

Skimo wrote: ↑

Tue Nov 05, 2024 5:07 am

I haven’t found out yet how to get the sd card out safely… working on it with the brain cells i have left…

The SD cards are actually pretty sturdy. They are commonly used in digital cameras and the insertion/removal process for a CPAP is exactly like it is for most cameras: The card is inserted into a slot and to remove it, you gently push on the edge of the card until it pops out just enough for you to pull the card all the way out with your fingers.

Because DMEs can now monitor usage data through a CPAP machine's cellular connection, some DMEs are failing to provide patients with SD cards for their machine. If your machine does not have an SD card in the slot, you can buy SD cards at many stores, including Walmart, Target, Best Buy, etd. SD cards are used by many digital cameras. You don't need a fancy SD card, the cheapest one you can buy will store CPAP data for a year or more. But you will only get the detailed (useful) data is the SD card is fully inserted into the machine before you start using it.

Here's a video that shows you exactly where the SD card slot is located on an AirSense 11 and how to insert the SD card: Oh where, oh where does the SD card go? AirSense 11

Removing the SD card is as easy as gently pressing on the card to make it "pop" out of the slot so you can pull it out---exactly the same way you remove an SD card from a camera.

Thank you!

I got the sd card out, uploaded the files on sleepHQ.

Is it this link i am supposed to share?
https://sleephq.com/public/teams/share_ ... 4f8a92923a

Skimo wrote: ↑

Tue Nov 05, 2024 1:01 pm

Thank you!

I got the sd card out, uploaded the files on sleepHQ.

Is it this link i am supposed to share?
https://sleephq.com/public/teams/share_ ... 4f8a92923a

Yep. That link does provide us access to the data you uploaded to SleepHQ.

Looking at all the data since April 16 that is available over at SleepHQ, here's what I notice:

1) You have been running in fixed CPAP mode since April 16, but you have had changes to the pressure settings on the following nights:
April 16 - May 29: fixed CPAP at 8 cm H20
May 30 - Oct 31: fixed CPAP at 7 cm H2O
Nov1 - Nov 2: fixed CPAP at 17 cm H20 (huge jump!)
Nov 3: fixed CPAP with three different pressure settings. Night starts at 17 cm; one session is at 15 cm; and last session is at 12 cm
Nov 4: fixed CPAP at 12 cm

2) You are now using a 40 minute ramp. And your beginning ramp pressure is 4cm. Notably between April 16 and May 29, you had an Auto Ramp starting at 4cm. Since May 30, your ramp has been a 40 minute ramp starting at 4 cm

3) EPR is set to ramp only.

4) Your usage and your AHI seems to be all over the place. In particular, you have numerous days where your AHI is over 5.0, and a significant number of days when your AHI is over 10.0. You even have a bunch of days where the AHI is over 15 and over 20.

Item #4 indicates that a fixed pressure of 7 or 8 cm does not seem to be enough to keep the worst of your obstructive sleep apnea under control. And this raises the question: Did somebody at the DME or in the sleep doctor's office look through your data and decide to tell the DME to increase the pressure setting on or around May 30 and then again on or around Nov 1? If the DME was told to increase the pressure on Nov. 1, is it possible that someone misread 12 as 17 and reset the machine through the cellular connection to 17 without telling you about the increase in pressure? That's a question that I would ask the DME and the sleep doc's office if I were you.

On the night of Nov 3, did you get into the clinic menu to turn the pressure down from 17 to 15 and then to 12? If not, then someone must have used the cellular connection to do that. Again, that might be a question to ask the folks who provided you with the machine.

You haven't asked for specific advice on where to go from here, but I'll offer some anyway:

1) I would consider switching the ramp back to Auto. This will keep the pressure more or less constant at 4cm until the machine thinks you are asleep. It will make that decision based on the establishment of a steady, breathing pattern that looks like "sleep breathing". And then the machine will ramp the pressure up to your current setting of 12 cm over about 5-10 minutes. With the ramp set to 40 minutes, the pressure starts increasing (slowly) as soon as you turn the machine on. At the end of 40 minutes, the machine will be at 12cm of pressure. So that means that the pressure is increasing at a rate of 0.2cm per minute. And it could be that you are sensitive enough where that small rate of increase is making it more difficult for you to fall asleep at least on some nights. There's also the problem that if you fall asleep well before the ramp period is over, the machine won't necessarily start flagging "events" that happen during the ramp period.

2) I would ask the DME if they use cellular data to monitor your usage and/or the efficacy of your therapy. If they do, I would ask them what they do if they notice a lot of days where the AHI is above 5.0. If they report the problem to a sleep doctor and the sleep doctor's office tells them to increase the pressure setting, do they do that using the cellular connection? And if so do they have a policy of trying to contact the patient to let them know the clinical settings have been changed?

3) I would ask the sleep doctor's office whether my machine could be set in Auto mode and if so, what would be a good pressure range to use.

Thank you for your analysis.

My cpap renter and doctor can follow the data at a distance indeed.

On the 30th of may i called my dme because i was awaken the night before because i couldn’t breathe out.
Hence the dme lowering the setting from 8 to seven.

Since i have seen the « sleep doctor » 3 minutes in july and he advised me to use the cpap more than 4hours by night or it wouldn’t be reimbursed by social security anymore.

And the settings did change on their own the 1st of November.
That why i joined this forum and posted here.

I did lower the settings to 15 then 12 on the 3rd of November ( i didn’t know the previous setting of 7)

The 4th i called the dme and he lowered the setting to 7 again but my cpap didn’t register the change and i was on 12 the night after.

The change back to 7 finally worked yesterday and i have been able to sleep 8 hours last night.

Thanks a lot about the advice on the settings i haven’t had much feedback from the doctor or the dme since begining cpap therapy. I am quite sure that there is room for improvement there.

I might try to change the settings friday to see if it helps next weekend.

Have a nice day.