Sierra

Hi Matt,

Here is how to do it with a PC. With the Daily Detail showing in SleepyHead use the F12 key to save the screen shot as an image file. A window will pop up in the lower right side with the file location. Start a new message with the orange Write a Reply button here. With Windows Explorer locate your saved file, left click on it, and drag it to the body of the new message you opened up. The image will be uploaded to the site and will be part of your new message. You can include text in the same message with your questions or concerns.

To get the most out of the screen space it is a good idea to clean up the SleepyHead layout before you start as follows (instructions for a PC)

• Use the F10 key to hide the navigation screen bar on the right
• Use File, Preferences, Appearance, and uncheck the box that says "Show event breakdown pie chart"
• Click on the black triangle beside the current date to hide the full month calendar

I depends on the data. Here is what I found in the S9 Clinical Manual. Looks like the high resolution flow data is 7 days, and other detailed data 30 days.

The AirSense 10 is quite a bit more and seems to be limited by SD card storage only.

Yes, I might consider testing. I use a home assembled PC. Some details below.

Do you have a PC? If so, just get the Daily Detail full screen and then press the F12 key. A window will pop up briefly in the bottom right of the screen to tell you where the image file was saved. Open a new post here with the orange Write a reply button near the bottom. Enter a few time to give you some space. Then with Windows Explorer find the file, left click on it and drag it to your open message post here. The file should upload to the post. If you have a Mac, I'm sure the method is similar, but I don't know the specific commands. I think the save the screen command is F8 or Shift F8. And I presume Mac has a file manger similar to Windows Explorer.

Fred, I hope it keeps going. The bugs I see in it with the newest generation CPAP and APAP machines are pretty minor. What worries me most is that ResMed is almost overdue to release a new machine to replace the AirSense 10 series. I hate to think what might happen if ResMed or Respironics decides to radically change the data structure with their next series of machines. Many years ago I did a little programming, but I'm afraid the brain cells that had those skills have long since departed. So, I don't think I could help you. However I wish you well with the project. It is amazingly useful software to the PAP user.

If you click on the Oximetery Wizard Icon in SleepyHead it will give you a list of meters that are compatible with SleepyHead. I don't think they are that expensive. There is one thing you can do with SleepyHead that gives you a bit of a proxy for oxygen in your bloodstream. That is to use the graph titled Minute Ventilation. Ideally when you are sleeping this value which is a measure of the air (and oxygen) you are moving on a mass basis into and out of your lungs, is constant. Assuming your lungs are working well, it can reflect the amount of oxygen in the blood. The levels are probably delayed in following the Minute Ventilation value. Here is an example from my data which includes a RERA event and a full obstructive apnea. The interesting part is that the Minute Ventilation dip is more sustained for the RERA than it is for the OA. RERA does not count in the AHI. For that reason AHI does not always tell you the whole story. This said, I have not used an O2 meter, other than during my sleep study, and can't really say for sure how closely it may follow Minute Ventilation. But you have this data already and it is just a matter of looking at it. O2 may not tell you much more.

Respironics uses two measure for hours. One is blower hours and it can be reset with the Reset Data command. The other is Machine Hours and it apparently cannot be reset. If you go to the Provider Menu, and then I suspect the Information sub menu, you should be able to view the Machine hours. Not sure if this Technical Manual link covers your machine exactly, but it probably is close. See Page 4-18 for info on the Provider Menu.

I see from that manual that the sensitivity setting that I was thinking of only applies to the BiPAP machines, and it only affects the switch time from IPAP to EPAP.

Figure 1 in that article shows the inhale flow curve flattening at the top. I believe that is how flow limitation associated with UARS is detected. If you have that then there may be benefit in a investigating the ResMed For Her machine. You would probably need to get a doctor to make a specific prescription. If you are due to upgrade to a new machine, it may be a good idea in any case. The For Her machine costs the same as the standard ResMed machine.

I am not a medical professional but if you want to post a typical Daily Report I could give you my thoughts on it. Good idea to post the whole evening, and then a second one zoomed in to show the detail leading up to a RERA event. With a PC you just use the F12 to save a screen shot and then with Windows Explorer drag the saved file to the body of a post here.

My method of cleaning the hose (as well as the mask and humidifier water reservoir) is to use pure vinegar first to get the maximum sterilizing effect. Pure vinegar also is helpful in removing any mineral deposits in the humidifier reservoir. Next I use Dawn dish soap and water to thoroughly clean out the vinegar and anything else remaining. Last I rinse thoroughly with just tap water and hang to dry over the bath tub. I do this first thing in the morning so it has all day to drip dry. I can't say I have ever noticed any significant water left in the hose by bedtime. Even if there was it would not be harmful and should evaporate fairly quickly especially with a heated hose. Some, and those in particular using a non heated hose and running high humidity can get "rainout" in the hose, which is just condensation. It can be significant and cause a problem. You should not have anywhere near that kind of water in the hose after a day of drip dry.

In short your CPAP machine is the very expensive hose dryer! No need to buy another one.

The things I have done to help let me sleep on my side with a nasal pillow mask are:

• Use a down alternative pillow. This pillow type gives easily to your mask and does not push back so much. They are fairly inexpensive at Costco, and are designed to mimic the feel of a real down pillow.
• Instead of using a standard pillow case, I use a satin pillow protector which zips up. The zipper keeps it on the pillow because the protector is slippery. I feel this lets my head move on the pillow easier and is less likely to pull the mask away from my nose.
• I try to sleep on the corner of the pillow with my mask out over the end of the pillow. Again to try and not disturb the mask position.

Yes, in theory if you turn flex off it would make it harder to exhale. However, in actual fact especially with the DreamStation you are likely not to notice or if you do easily adapt. Tests have shown that while the ResMed machines with EPR do make a significant reduction in pressure on exhale roughly equal to the EPR setting, DreamStation does not reduce the pressure as much, and mainly changes the shape of the switch over from inhale to exhale. That said your pressures with the nasal mask are quite low, and I suspect you will not notice or adapt easily. I have used a fixed 12 cm pressure with no EPR and have no difficulty at all exhaling against that pressure.

The issue with reducing pressure on exhale is that the reduced pressure can increase apnea frequency. The machine reacts to that by increasing pressure. So, you have gone full circle and it is a bit a zero sum game. My expectation would be that if you turn Flex off, your Inhale pressure (red trace) will actually reduce.

If it were me, I would shut off Flex first, see what it does. In theory the red line could drop down to to where the green line is now. That won't happen though because the green line is not really the effective pressure on exhale. Then next start to increase the minimum pressure to see if you can reduce the incidence of hypopnea events. You do have some central events, but not a lot now that you have pressures lower. DreamStation machines have a characteristic that some have described as hunt and peck (like a chicken!). It periodically spikes pressure up and apparently then checks to see if that helped with flow resistance or not. It it decides no, then is reduces pressure just as fast as it went up. If your minimum pressure is too low then while the pressure is in the low state of hunting and pecking, it can cause an event. Increasing minimum pressure can take some of that hunt and peck out of the machine, and probably improve AHI.

It would be really helpful to know what manufacturer and model of a machine you have. To my knowledge PAP machines may report RERA events, but they do not respond to them with increased pressure. And of course when you increase minimum pressure you are taking manual action which in turn should prevent RERA events from happening. That said I do see RERA flags in my SleepyHead graphs and I am now using a fixed pressure. They can still happen with higher pressures. If you have a DreamStation I believe there may be an option in it to change the sensitivity.

You may be interested in a ResMed article on their For Her algorithm specially developed for what they believe are the different needs of a woman compared to a man. The differences between the For Her algorithm and the standard version are highlighted in the table at the bottom of page 5. Both versions report RERA, but the For Her version is more sensitive to upper airway resistance and flow limitation. It uses single breath data to initiate a change while the standard version uses a 3 breath average and will be slower to react. The For Her version ratchets up pressure in response to apnea in close succession and holds it to a minim for the sleep session. It is more responsive to flow limitation and snoring, and less to apnea. Apnea alone will not increase pressure beyond 12 cm. It raises and lowers pressure at a slower rate. This feature may in fact be an option in the standard machine too, as there is a Response setting which can be set to Soft or Standard. The idea is to prevent arousals. As I understand it the difference between a flow limitation and a RERA is that an arousal is associated with the flow limitation.

The For Her algorithm is included as an option in the specific For Her AirSense 10 AutoSet machine. They sell at the same price, and they can be changed with the Mode setting to the standard algorithm. They can of course be used by men too, if the nature of the apnea they have is more of upper airway resistance and less of the obstructive apnea. The good part is that you can simply try it, and if it works it works. If not you go back to the standard algorithm.

Hope that helps some. Post back with your specific machine and I may be able to add a bit more...