[Pressure] First Night on APAP - leak advice

[Zedoary]

I made it 6 hours last night!  Pretty good since the best I've been able to do in dx and titration labs was about 3 hrs total with the equipment. I feel just getting to this point is a major success.   

I need some information regarding the Sleepyhead report on the leaking and some suggestions as to what to do if the reported amount is significant.  Leak rate was  minimum = 0,  medium = 0, 95% = 14.40 and max = 67.20. Large Leak was 1.71. I also had questions about the pressure.  The range set on the machine by my MD was 5-15. My EPAP range was 4.02 -6.58. Pressure range was 4.04 - 9.58. Thoughts on that? 
My RDI's on study were 24. I also had significant poor oxygen saturation on study with about 8 min in the 85-66 range. last night unclassified apneas =0, OA=.92, hyponeas=0, clear airway=.13.  So overall a good night.

I am not allowed to post sleepyhead screen shots until I post three more times, so let me know what other statistical information I can type to assist.  Thanks - this site has been invaluable.

 Zedoary

[Ron AKA]

I made it 6 hours last night!  Pretty good since the best I've been able to do in dx and titration labs was about 3 hrs total with the equipment. I feel just getting to this point is a major success.   

I need some information regarding the Sleepyhead report on the leaking and some suggestions as to what to do if the reported amount is significant.  Leak rate was  minimum = 0,  medium = 0, 95% = 14.40 and max = 67.20. Large Leak was 1.71. I also had questions about the pressure.  The range set on the machine by my MD was 5-15. My EPAP range was 4.02 -6.58. Pressure range was 4.04 - 9.58. Thoughts on that? 
My RDI's on study were 24. I also had significant poor oxygen saturation on study with about 8 min in the 85-66 range. last night unclassified apneas =0, OA=.92, hyponeas=0, clear airway=.13.  So overall a good night.

I am not allowed to post sleepyhead screen shots until I post three more times, so let me know what other statistical information I can type to assist.  Thanks - this site has been invaluable.

 Zedoary

Leaks can be difficult. With a nasal mask, it could be that it is being moved as you change sleep positions. Also you could be opening your mouth during the night, allowing air to leak out your mouth. The usual sign of that is high and flat tops on the leak graph in SleepyHead.

Your results look pretty good though. I would suggest a few changes to your pressure settings. They probably won't improve your AHI much, but they may improve comfort some. To get into the Clinical Menu press and hold the Home key and the round Settings knob for 3-4 seconds. In there set the following:

Minimum Pressure - 7 cm
Maximum Pressure - Leave at 15 cm
Ramp Time - Set to Auto
Ramp Start - Set to 6 cm of pressure

The reason for making these changes is that most can find it hard to get enough air with pressures of 4-5 cm. 

Leave everything else the same. This should make breathing a bit more comfortable before you go to sleep, and while you are sleeping. Later you may be able to reduce the maximum pressure, but for now it is doing you no harm.

Keep posting, and get your count up so you can post attachments!!

[Walla Walla]

You don't need 5 posts to upload a chart. Just follow the instructions in the link below. Also I'd skip the ramp. There's no point in having a ramp of 6cm when your starting pressure is going to be 7cm. It just delays treatment.

[Ron AKA]

Also I'd skip the ramp. There's no point in having a ramp of 6cm when your starting pressure is going to be 7cm. It just delays treatment.

No that is not correct. We don't require treatment when we are not sleeping. We breath at the rate we decide to breath at and to the depth that we decide to. The machine does not need to do anything until we fall asleep. The Auto Ramp monitors you to determine when you go to sleep, and applies the extra pressure when you need it. There is no delay in treatment. The actual ramp portion in this setup is very fast - one minute. When you set the Ramp Time to Auto you effectively take the ramp out of the startup routine.

[Walla Walla]

The problem with auto ramp is it's trying to read the flow rate and assume when sleep starts. I don't believe it always can detect that. There's a reason they put a 30 minute cap on it. So if you fall asleep after 5 minutes and the machine can't detect it than your going 25 minutes without treatment.

[Ron AKA]

The problem with auto ramp is it's trying to read the flow rate and assume when sleep starts. I don't believe it always can detect that. There's a reason they put a 30 minute cap on it. So if you fall asleep after 5 minutes and the machine can't detect it than your going 25 minutes without treatment.

I speak from personal experience. The Auto Ramp works very well for me. I can be asleep in 5-10 minutes, or time out at 30 minutes. I have seen no indication that the sleep detection method used is not working. I also have no need for the machine to set false flags due to sleep wake junk, while I am actually still awake.

[Walla Walla]

Ron, Everyone is different. Just because it has worked for you doesn't mean it works for everyone. Besides your talking about 1cm of pressure. Why the big push for Ramp every time?

[Ron AKA]

Ron, Everyone is different. Just because it has worked for you doesn't mean it works for everyone. Besides your talking about 1cm of pressure. Why the big push for Ramp every time?

I recommend the Auto Ramp because it works well. I suspect that ResMed knew what they are doing when they put the feature in the AirSense 10. If it doesn't work for you, then turn it off.

[Walla Walla]

I'm advising the that ramp isn't needed for only 1cm of pressure relief. I'll leave it at that.

[Apnea Infant]

Ron, Everyone is different. Just because it has worked for you doesn't mean it works for everyone. Besides your talking about 1cm of pressure. Why the big push for Ramp every time?

I recommend the Auto Ramp because it works well. I suspect that ResMed knew what they are doing when they put the feature in the AirSense 10. If it doesn't work for you, then turn it off.

Guys, wading in here..........

Walla2, I think sometimes we forget how frightening it all is when we start this business. It can be so overwhelming-so much to know about, so much to digest, so much to understand and so much to get used to.

I did find that ramp helped in my early days only because any little amount of forced positive pressure seemed too much. EPR helped with that but also created CA problems for me.

Now as a newbie veteran, I can start with 9cm H20.......could not have imagined that a year ago. The rush of forced air is familiar and soothing. It is so because this funny forced air makes me feel better in the morning and in the day ahead. I have learned to trust it. My brain has learned to anticipate the advantages and it is now soooo familiar. And then of course we are all different......

I feel Zedoary will 'get there' at his own pace. He has done really well sleeping for 6 hours. There is no limitation on numbers of post now Zedoary, so go ahead, attach away.

We look forward to reading more from you and feel sure that you will go from strength to strength ramp or no ramp.