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Ave
Unread post  Post subject: New to CPAP - Have Questions - Need advice, thank you  |  Posted: Wed Apr 22, 2020 9:39 am

Joined: Wed Apr 22, 2020 5:24 am
Posts: 19
Location: White Plains, NY
PAP Mask: ResMed Airfit 30 (mouth+nose pillow)
PAP Machine: Phillips Respironics Dreamstation Auto PAP
Humidifier: The unit that came with the Dreamstation + attaches to the back
Pressure Setting: Current: 7-20(low-high) Original: 5-20

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Age 66, male, snored for a long time, but without any noticeable problems during the day.
Recently discovered I do have heart disease by getting a CACS (coronary artery calcium scoring scan)
and my score is high in the 500's (volume in the 400's). Getting tested for sleep apnea was one of the
major suggestions given to me and I did a one night sleep test and discovered I do have strong apnea with
AHI score of 35, but my oxygen stayed above 90% throughout the test except for a brief period.
(Note: for heart disease, I'm also taking many other steps to prevent future heart disease including diet, supplements,
dental hygiene, etc)

Prior to the sleep test, I did use a TSD (tongue stabilizing device) to stop snoring and be kind to my wife. It worked.
Once I got the sleep test result, I started using the device throughout the night comfortably and without issues.
I even noticed some improvement in daytime energy.
But my doctor ordered a CPAP machine and set up for me - CPAP being considered the gold standard for sleep apnea therapy.

I was given a Phillips Dreamstation machine with humidifier and ResMed Airfit30 mask (nasal mask first given to me did not work as I am a mouth breather). I started use on April 7th and continued for 12 days. I keep the machine close to the floor, on a box, lower than my body on the bed.

Discovered I got very dry/parched/leathery throat during the night even with humidifier set to highest level. So I would drink water to help.
That issue may have improved a little but was still happening.

Then, on the last few days, I woke up with distended uncomfortable stomach and gut, filled with air requiring hours of farting and gas release before returning to normal. Really uncomfortable!

So I stopped using CPAP and wrote to my doctor. I used the tongue device for two nights, comfortably.
The doctor wrote back that dry mouth is normal and so is air getting into my stomach and digestive system. He said that if I continue and stick with CPAP therapy, it should eventually work itself out.

I have seen the videos that explain how to adjust the machine's settings including those not available to the user.
But I don't want to change anything yet without the doctor's guidance.

I really do want to use the CPAP if it provides me with the best therapy and best prevention of heart disease and plaque build up. Not to mention that I am an active bicycle rider throughout the year (4K to 5K miles/year) and am curious to see if my cycling and energy improves with CPAP therapy for apnea?

The mask fit is pretty good, usually no leaks, but I noticed last night that there was a little more leakage as I'm letting my beard grow a bit.

I returned to using the machine last night, with my upper body raised up (as suggested in article I found) and still got dry throat and air/ discomfort/ farting in the morning.

QUESTIONS:

Should I keep my beard short or should there be no leaks no matter how long the beard is?

Is there a way to avoid dry/parched/leathery throat?

Is there a way to avoid air getting into my stomach and intestines and causing great discomfort?

Do these issues eventually resolve through continued use?


Thank you so much for reading my history and questions.
I truly appreciate any advice that you experienced users can provide!

Ave (like Dave, without the D)

_________________
Started using Auto PAP on 4/7/20.
Learning as I go along....


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cindyY
Unread post  Post subject: Re: New to CPAP - Have Questions - Need advice, thank you  |  Posted: Sat Apr 25, 2020 9:16 pm

Joined: Sun Apr 23, 2017 8:34 pm
Posts: 451
Location: Southern California
PAP Mask: AirFit P10, DreamWear FFM
PAP Machine: Resmed AirCurve 10 VAuto in S mode
Humidifier: Integrated set to 5 @ 81F; ClimateLineAir heated hose
Pressure Setting: IPAP 19 EPAP 15

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Hi, air in the stomach is called aerophagia. It's really common. Basically you're swallowing the air all night. I had it when I started and also when I switched masks back and forth, but I almost never get it now (I'm 3 years in), and haven't in a really long time. I found that sleeping with my shoulders and head elevated help to drastically reduce the aerophagia. I don't have an incline pillow, but I built up my pillows to mimic one.
As far as facial hair goes, from what I've read, if you don't want to shave you can try mask liners or make a mask liner out of an old sock or t-shirt.
The dry throat is usually caused by mouth breathing. If you were wearing nasal pillows or a nasal cushion mask this would be a problem, but since you are in a full face mask, your therapy isn't being compromised by mouth breathing, but your comfort is. I suggest trying to train yourself to breathe through your nose. If you can breathe through your nose during the day you CAN also at night, it just takes some work. If you have chronic rhinitis, it may clear up on cpap and then you can practice breathing through your nose during the day and then at night. Even if you end up only breathing through your nose part of the night, it will give your throat a chance to rehydrate. If you have a reason why you absolutely cannot breathe through your nose, maybe try mouth drops, I've heard xylimelts work.

If you have the time, fill out your profile so we know in future posts what machine, settings and mask type you use. I'm thinking you may want to change your temperature if you have a heated hose, if you don't have a heated hose, you may want to look into one, heated humidity can be a wonderful thing.

Good luck!


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Ave
Unread post  Post subject: Re: New to CPAP - Have Questions - Need advice, thank you  |  Posted: Sun Apr 26, 2020 4:07 pm

Joined: Wed Apr 22, 2020 5:24 am
Posts: 19
Location: White Plains, NY
PAP Mask: ResMed Airfit 30 (mouth+nose pillow)
PAP Machine: Phillips Respironics Dreamstation Auto PAP
Humidifier: The unit that came with the Dreamstation + attaches to the back
Pressure Setting: Current: 7-20(low-high) Original: 5-20

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cindyY, Thank you very much for your response! Really appreciate. I do not have a heated hose. I do have a tongue stabilizing device that I might try to use in conjunction with the CPAP machine, to see if it might help me to breathe more through my nose than mouth.

I did try angling my upper body higher when sleeping, but that didn't work. Next, I used two pillows under my head (slight bend in neck) and success!! No more bloating or gas.

_________________
Started using Auto PAP on 4/7/20.
Learning as I go along....


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Ave
Unread post  Post subject: Re: New to CPAP - Have Questions - Need advice, thank you  |  Posted: Wed May 06, 2020 1:52 pm

Joined: Wed Apr 22, 2020 5:24 am
Posts: 19
Location: White Plains, NY
PAP Mask: ResMed Airfit 30 (mouth+nose pillow)
PAP Machine: Phillips Respironics Dreamstation Auto PAP
Humidifier: The unit that came with the Dreamstation + attaches to the back
Pressure Setting: Current: 7-20(low-high) Original: 5-20

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cindyY and Pugsy and all,

It has been about a month since I began using Dreamstation APAP machine.
On 4/28th, I started also monitoring my oxygen and pulse through the night using Wellue/Viatom sleep pulse oximeter, model "SleepU". It provides good information. Here is this unit: https://smile.amazon.com/gp/product/B07 ... UTF8&psc=1

After reading here, I decided to carefully raise my minimum pressure and monitor the results. (For some reason, the only suggestion my doctor gave was to perhaps lower the max pressure down from 20? Nothing about increasing the min. pressure.)

From previous posting here, I'm both concerned about oxygen saturation AND AHI index - how many apneas per hour. Pugsy had explained that getting my O2 level up is fine, but having an AHI index above 5 is still a concern - and that my goal should be to get the AHI index down to the 0 to 5 range.

Question: If O2 level is good, what damage is still caused by AHI index above 0 to 5?

My AHI numbers have been mostly in the 10 to 14 range. Although, you will see that it did drop below 10 on my best recent night.

I'll put remaining questions at the bottom of this post after providing some information to you all.

From overnight pulse oximetry:

4/28 Pressure: 5 to 20 (Auto Pap.) Sleeping on back.
Recording time: 7h24m <90% Time 8m12s
Drops over 4%: 32 Drops per hour: 4.3
Avg SpO2: 95% Lowest SpO2: 72%
O2 score: (app provides a score, 1 to 10, 10 being the best) 7.4
Avg HR: 63


4/29 Pressure: 5 to 20. Sleeping on back
Recording time: 5h48m <90% 48s
Drops over 4%: 21 Drops per hour: 3.6
Avg SpO2: 97% Lowest SpO2: 87%
O2 score: 7.8
Avg HR 61


April 30 Pressure 5 to 20. Only using tongue device.
Recording time: 7h28m <90%: 33m16s
Drops over 4%: 135 drops per hour: 18.1
Avg SpO2: 95% Lowest SpO2: 72%
O2 Score: 5.0 (terrible! Clearly, APAP is better)
Avg HR: 63


May 1st Pressure: 6 to 20. Slept on back.
Recording time: 8h1m <90% time 3m36s
Drops over 4%: 29 Drops per hour: 3.6
Avg SpO2: 96% Lowest SpO2: 80%
O2 Score: 7.9
Avg HR: 68



May 2nd Pressure 6 to 20, slept on side + back
Recording time: 7h37m <90% time 3m4s
Drops over 4%: 44 Drops per hour: 5.8
Avg SpO2: 96% Lowest SpO2: 84%
O2 Score: 7.4
Avg HR: 64



May 3rd Pressure: 6.5 to 20, sleep on side
Recording time: 6h54m <90%: 3m28s
Drops over 4%: 22 Drops per hour: 3.2
Avg SpO2: 95% Lowest SpO2: 84%
O2 score: 7.9
Avg HR: 62



May 4th Pressure: 7 to 20, sleep on side and back?
Recording time: 6h56m <90%: 2m8s
Drops over 4% 20 Drops per hour: 2.9
Avg SpO2: 96% Lowest SpO2: 83%
O2 score: 8.4 (this was probably my best night)
Avg HR 62
(Note: this was the only time that the AHI index reading on the APAP
was below 10. I think it was around 9, but did not write down)


May 5th Pressure: 7.5 to 20, slept on side mostly. Woke with some pain in upper right of my body (plus the usual air in gut - not terrible though, getting better I think)
Recording time: 7h35m <90% time: 2m12s
Drops over 4%: 31 Drops per hour: 4.1
Avg SpO2: 97% Lowest SpO2: 85%
O2 score: 7.8
Avg HR: 58


So, the best overall score was with pressure of 7 to 20.

I have read here that results can vary from night to night.

The pressure in the mask has been very good, at or just below 100%.


Question: Did I increase pressure to quickly? Or, did this test run provide reasonably good information?


Question: Should I hope to get even better results in the future than avg. 96% O2 and 2.9 drops per hour? Or are these numbers considered good/ healthy?


Question: Once I have gotten desired results re: oxygen saturation, what can I do to improve AHI index, if still too high (above 5)?


Question: Is my average heart rate much of a concern? (Notice that at 7.5 pressure minimum, I actually had highest avg SpO2 at 97% and lowest heart rate of 58. Hmmmm...)


Question: Based on the above results, should I try staying at pressure of 7 to 20 for a while?


Question: With consistent use of APAP therapy, does the number of apneas that my body naturally creates improve (and lessen)?


Question: Should I consider lowering the highest pressure down from 20? What if any advantage to doing that?



BTW, I am age 66, 5'10", 153 lbs, 22BMI, thinner than I used to be after changing to a low carb lifestyle for other health reasons back in 2014.

I'm sure I will have more questions in the future.


Sincere thanks for taking the time to review and provide guidance based on your experiences!

_________________
Started using Auto PAP on 4/7/20.
Learning as I go along....


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Ave
Unread post  Post subject: Re: New to CPAP - Have Questions - Need advice, thank you  |  Posted: Wed May 06, 2020 2:38 pm

Joined: Wed Apr 22, 2020 5:24 am
Posts: 19
Location: White Plains, NY
PAP Mask: ResMed Airfit 30 (mouth+nose pillow)
PAP Machine: Phillips Respironics Dreamstation Auto PAP
Humidifier: The unit that came with the Dreamstation + attaches to the back
Pressure Setting: Current: 7-20(low-high) Original: 5-20

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PS .. I should mention that I have never had feelings of tiredness during the day related to my apnea (as many other sufferers describe having) That has not been an issue, and is probably why I didn't feel there was a problem to examine. But once I took a heart scan and discovered serious atherosclerosis, I became very motivated to look at everything, including sleep apnea and discovered I had a problem (AHI of 35 in sleep test).

I'm also active and bike with a local cycling club several times a week (since 2007), about 4000 to 5000 miles per year. I don't push myself hard, but wonder if that amount of cardio exercise may have been helpful to my oxygen and heart. I hope so!

_________________
Started using Auto PAP on 4/7/20.
Learning as I go along....


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Pugsy
Unread post  Post subject: Re: New to CPAP - Have Questions - Need advice, thank you  |  Posted: Wed May 06, 2020 2:40 pm
User avatar

Joined: Wed Aug 02, 2017 8:01 pm
Posts: 1856
PAP Mask: Bleep/DreamPort nasal mask
PAP Machine: ResMed AirCurve 10 VAuto

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I need to know the event category breakdown of your higher than 5 AHI to be able to offer advice on pressure settings.

An AHI of 10...that means on average your sleep is being disturbed once every 6 minutes...may or may not have an O2 drop but think about it...if I came over to your house and sat by you and poked you with a stick once every 6 minutes to sort of wake you up...how restful would that night's sleep be?
There is so much more to OSA and treating it than just monitoring O2 levels. Sleep quality is critical even without any drops in O2 levels.

_________________
I may have to rise but I refuse to shine.


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Ave
Unread post  Post subject: Re: New to CPAP - Have Questions - Need advice, thank you  |  Posted: Thu May 07, 2020 6:41 am

Joined: Wed Apr 22, 2020 5:24 am
Posts: 19
Location: White Plains, NY
PAP Mask: ResMed Airfit 30 (mouth+nose pillow)
PAP Machine: Phillips Respironics Dreamstation Auto PAP
Humidifier: The unit that came with the Dreamstation + attaches to the back
Pressure Setting: Current: 7-20(low-high) Original: 5-20

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Pugsy, Thank you for your reply.

I'm not familiar with how to provide "event category breakdown"? Help me understand what is needed. Currently, I don't have access to "readouts" or "graphs" from the machine. But I can see the info provided on the machine itself including AHI, Periodic breathing numbers, therapy hours, mask fit.

The machine showed AHI for last night of "14", and "11.9" avg for last 7 days.

Periodic breathing last night: 4%

Question: What does "periodic breathing" tell us?

Question: Are the AHI readings on the Dreamstation accurate, or, can they be a little inaccurate?

I appreciated your description of what happens each hour with AHI of around 10. I'm still learning about the differences between O2 saturation and AHI.

I had my best night last night according to the pulse oximeter's scoring. I had lowered the pressure back to 7.0 - 20.0 auto.

May 06th Slept on side and back.
Recording time: 6h9m <90%: 52s
Drops over 4%: 25 Drops per hour: 4.1
Avg SpO2: 97% Lowest SpO2: 88%
O2 score: 8.7 (out of 10)
Avg HR: 58

Question: How can I upload images to my replies or posts?

Question: How can I improve/lower my AHI while working to improve my O2 saturation? Is the method the same for both goals or different?

Sincere thanks to you and others helping me!

_________________
Started using Auto PAP on 4/7/20.
Learning as I go along....


Last edited by Ave on Thu May 07, 2020 7:02 am, edited 1 time in total.


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Pugsy
Unread post  Post subject: Re: New to CPAP - Have Questions - Need advice, thank you  |  Posted: Thu May 07, 2020 6:53 am
User avatar

Joined: Wed Aug 02, 2017 8:01 pm
Posts: 1856
PAP Mask: Bleep/DreamPort nasal mask
PAP Machine: ResMed AirCurve 10 VAuto

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Use available software to get more detailed information about your event categories along when when they got flagged which is important.

OSCAR https://www.sleepfiles.com/OSCAR/
http://www.apneaboard.com/wiki/index.ph ... stallation
http://www.apneaboard.com/wiki/index.ph ... rpretation

Won't know what can be done to lower AHI and/or maybe improve O2 levels until we know what is going on with your AHI event categories.
If primarily obstructive in nature...probably more pressure minimum is needed but if primarily central in nature more pressure won't help and might make things worse so I don't know what to offer without knowing what we need to reduce. I don't want to offer anything that might make things worse.

_________________
I may have to rise but I refuse to shine.


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Ave
Unread post  Post subject: Re: New to CPAP - Have Questions - Need advice, thank you  |  Posted: Thu May 07, 2020 7:05 am

Joined: Wed Apr 22, 2020 5:24 am
Posts: 19
Location: White Plains, NY
PAP Mask: ResMed Airfit 30 (mouth+nose pillow)
PAP Machine: Phillips Respironics Dreamstation Auto PAP
Humidifier: The unit that came with the Dreamstation + attaches to the back
Pressure Setting: Current: 7-20(low-high) Original: 5-20

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Pugsy, Thanks.

I'll look at the sites you provided.

When my original sleep test was done, the report said I had severe OSA (AHI = 35), but no mention of central sleep apnea. Nevertheless, it's good to have information to guide us.

_________________
Started using Auto PAP on 4/7/20.
Learning as I go along....


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Pugsy
Unread post  Post subject: Re: New to CPAP - Have Questions - Need advice, thank you  |  Posted: Thu May 07, 2020 9:27 am
User avatar

Joined: Wed Aug 02, 2017 8:01 pm
Posts: 1856
PAP Mask: Bleep/DreamPort nasal mask
PAP Machine: ResMed AirCurve 10 VAuto

Offline
There is a small percentage of people who start cpap with no prior history of central apneas that end up with cpap actually triggering central apneas.
That is why we want to look at the event categories...you might be one of the people in that small minority who got centrals just from cpap itself and more pressure won't help and might make you have even more centrals.

Though I will admit that the chances are you likely just need more pressure but I won't advise doing it unless I can see a report when it is possible to see the report. I have done it when there was no option to see the detailed reports but I don't like doing it.
You have a machine that will provide the needed details and there is free easy to use software that gives us that needed detail...so that's what I want to see before I tell you to change the pressure.

When I do advise changes without data backing me up...it comes with a lot of disclaimers. :lol:

_________________
I may have to rise but I refuse to shine.


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Ave
Unread post  Post subject: Re: New to CPAP - Have Questions - Need advice, thank you  |  Posted: Thu May 07, 2020 12:54 pm

Joined: Wed Apr 22, 2020 5:24 am
Posts: 19
Location: White Plains, NY
PAP Mask: ResMed Airfit 30 (mouth+nose pillow)
PAP Machine: Phillips Respironics Dreamstation Auto PAP
Humidifier: The unit that came with the Dreamstation + attaches to the back
Pressure Setting: Current: 7-20(low-high) Original: 5-20

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Pugsy, I have not yet looked at the links you provided for Oscar. How does the Dreamstation provide info to Oscar? Via Bluetooth? I appreciate your caution.

More later.

BTW, I notice there is another CPAP forum called cpaptalk, and that you also participate there. Is there much difference between that forum and this one?

Thanks.

_________________
Started using Auto PAP on 4/7/20.
Learning as I go along....


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Pugsy
Unread post  Post subject: Re: New to CPAP - Have Questions - Need advice, thank you  |  Posted: Thu May 07, 2020 4:43 pm
User avatar

Joined: Wed Aug 02, 2017 8:01 pm
Posts: 1856
PAP Mask: Bleep/DreamPort nasal mask
PAP Machine: ResMed AirCurve 10 VAuto

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Data is stored on a SD card that is in your machine and you have to put that SD card into your computer and use the software.

Yes, I am over on the other forum and you are welcome to go over there but everyone is going to tell you exactly what I just told you ...but maybe with a bit more "force" or not quite so nice. Some of those folks are pretty darn blunt.

I am the moderator over on that forum. I also help out here when I can....do a bit of spam removal as well here.

_________________
I may have to rise but I refuse to shine.


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Ave
Unread post  Post subject: Re: New to CPAP - Have Questions - Need advice, thank you  |  Posted: Thu May 07, 2020 7:51 pm

Joined: Wed Apr 22, 2020 5:24 am
Posts: 19
Location: White Plains, NY
PAP Mask: ResMed Airfit 30 (mouth+nose pillow)
PAP Machine: Phillips Respironics Dreamstation Auto PAP
Humidifier: The unit that came with the Dreamstation + attaches to the back
Pressure Setting: Current: 7-20(low-high) Original: 5-20

Offline
Pugsy, Thanks for the info and feedback about the other forum. I'll have to learn how to use the SD card. I have a MacBook Pro circa late 2012 and do see a wide slot on the left side that I have never used. I also learned that I will have to upgrade my OS to be able to use OSCAR. (I need OS10.12, currently have 10.10) I've hesitated to do that in the past, not wanting to cause other problems with various programs, but I think I'm going to give it a try.

I also watched TheLankyLefty youtube video about OSCAR which coincidentally showed up on my youtube home page! A bit confusing, but I'll give myself time to learn.

I really appreciate what you are doing here.

_________________
Started using Auto PAP on 4/7/20.
Learning as I go along....


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LeonoraD
Unread post  Post subject: Re: New to CPAP - Have Questions - Need advice, thank you  |  Posted: Wed May 13, 2020 7:19 am

Joined: Mon Feb 17, 2020 1:50 pm
Posts: 21
PAP Mask: Resmed AirFit F30 Full Face Mask
PAP Machine: Resmed AirSense 10
Humidifier: Built In w/Resmed AirSense 10
Pressure Setting: APAP 8-14

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I can comment on your aerophagia issue since I had a big problem with that in the beginning of cpap use. I found that elevated upper body works (I use my adjustable bed to elevate the head) but also turning the ramp setting up on my resmed machine helped even more. I went from 15 minutes up to 30 or 45 for the ramp. The manufacturer's booklet suggested doing this and it worked for me.


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Ave
Unread post  Post subject: Re: New to CPAP - Have Questions - Need advice, thank you  |  Posted: Wed May 13, 2020 7:09 pm

Joined: Wed Apr 22, 2020 5:24 am
Posts: 19
Location: White Plains, NY
PAP Mask: ResMed Airfit 30 (mouth+nose pillow)
PAP Machine: Phillips Respironics Dreamstation Auto PAP
Humidifier: The unit that came with the Dreamstation + attaches to the back
Pressure Setting: Current: 7-20(low-high) Original: 5-20

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LeonoraD, Thanks very much for your advice!

_________________
Started using Auto PAP on 4/7/20.
Learning as I go along....


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Ave
Unread post  Post subject: Re: New to CPAP - Have Questions - Need advice, thank you  |  Posted: Thu Jun 11, 2020 1:18 pm

Joined: Wed Apr 22, 2020 5:24 am
Posts: 19
Location: White Plains, NY
PAP Mask: ResMed Airfit 30 (mouth+nose pillow)
PAP Machine: Phillips Respironics Dreamstation Auto PAP
Humidifier: The unit that came with the Dreamstation + attaches to the back
Pressure Setting: Current: 7-20(low-high) Original: 5-20

Offline
I need some help with SD card issue. The SD card used in my Dreamstation APAP machine did allow me to download information into OSCAR recently with information through 6/4th. But the last time I tried to download, no icon appeared on my screen for the SD card and no information downloaded. (Note: each time I hit the import button, a progress bar did appear and act as if info was being imported. On the bottom of that bar, it asks me to pick a folder to download to, and I have created a data folder for that purpose)

The only thing I can think of that may have caused this is that I "think" I removed the SD card from my laptop without first ejecting it on the computer.

I always make sure to lock the SD card (as instructed for my MacBook Pro) before inserting into the laptop, and then unlocking the card before putting back into the Dreamstation.

Is there a way for me to fix this issue so that I can get the information to load into OSCAR on my laptop?

Thanks very much.

_________________
Started using Auto PAP on 4/7/20.
Learning as I go along....


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