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1 Month data review request
#1
I have been using my new CPAP for a little over a month now.

my original AHI was 46 untreated. Sleep study titrated to flow rate of 12. I feel like that was a close as they got to with the time that they had. My machine is a DreamStation Auto CPAP but set in constant mode of for 12. I am wondering if switching it to Auto will be better or if I should just leave it alone at 12.

I read the post on arranging the panels and posting images.

Here is last night 08-07 whole daily view.

[Image: f8PFdfyl.png]

Here is one cluster of events

[Image: qTPNLpJl.png]

Another cluster of events

[Image: D4aWFzll.png]

Whole Daily view for 08-06.

[Image: lxaBxmUl.png]

Cluster of events

[Image: 7khsy1vl.png]

Here is a bad night

[Image: aKlAcJGl.png]

And here is the best nigh yet.

[Image: M77I9OTl.png]

I hope I did this right and can get some recommendations.

Thanks!
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#2
All I can say is what I would do. Your centrals are not that high and some no doubt are caused by sleep/wake junk (ie not real apneas). Hypopneas and snores could/should be lower. I would enable auto UNLESS you already know that pressure changes cause you to have centrals, the sleep test should have picked this up and MAY be the reason they put you on fixed pressure. I doubt that they would give you the raw sleep test data, or that you would even want it, but they should give you the summary report that they sent to your Doctor. I got mine from my Doctor.

It would be interesting to see a closet up view of your periodic breathing segment. full screen with what it has flagged as PB.

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#3
Here is a PB segment from last night.

[Image: wlaCrxgm.png]

And another

[Image: UnhF7Cym.png]

My Periodic Breathing averages 10% Max 24%.
My AHI is averages 6 and sleepyhead tells me thats not good.
Sleep study said sever degree of obstructive sleep apena and a mild degree of central sleep apnea.
pre CPA AHI 46.9, RDI 74.6, central apnea index 4.5
Obstructive Apneas were eliminated on CPAP at 10cm water pressure. Residual hypopneas and central apneas were documented at this pressure setting. The optimal positive airway pressure could not be reliably determined.

Trial Treatment with CPAP at 12cm water pressure (2cm of pressure higher than tested) in view of residial hyponeas.
Monitor CPAP unit data for persistence of central apneas that may benefit from treatment with BPAP or ASVPAP.

The machine seems to have taken care of the OAs but CA and Hypopneas seem to persist.

Dr said "your cured". I don't want to be stuck with this machine if another would have a more positive impact.
Should I set it on auto with a 10cm/12 setting?
Please help me either get the most out of the machine I have or document what I need to document to take to the Dr.

Thanks.
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#4
Well technically you are cured, that does not mean you cannot get better or that you will be getting a good nights sleep.
You can try auto, if it does not work your AHI will increase because of the lowered pressure or your centrals will increase because of the pressure changes. With the auto settings you suggested you are not going to do any damage and if you find you cannot sleep with auto, just change it back.

You now know what your base line is for the non-auto settings. Auto will give you a range that you can evaluate with sleephead to see where auto was putting you at and what was going on. It's pretty standard to set the range at -2 and +2 around your 90/95% pressure.

Are you having any problems with exhaling? If so you can try the flex settings to see if you find one you like best.
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#5
Since my machine is an auto I thought about the flex.

I have been using a flex of 1 which is the lowest my machine will go.
If I up the flex setting then I can have 2 different pressure settings and see what happens.

In theory with a pressure setting of twelve and a flex of 3 I should get just about the perfect setting of 12 to clear the OAs and the 10 to remove the CAs?

I will try it and see. But most of the posts I have seen says that going to a higher Flex or EPR actually increased their CAs.

My Centrals are 30 seconds. Is 30 seconds long for a central?
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#6
Flex is for exhale only, I don't have a "flex" brand, but that is what I think I read. Just some background: pressure does not "clear" the OA's it instead tries to prevent them from happening again. The CA's are not caused by the higher pressure, but sometimes they can be caused by pressure changes-auto setting changes pressure as needed to prevent OA's and sometimes that pressure change can trigger a central.

If you set your machine at 10-15, it will start at 10 and if you have an OA, it will step the pressure up. If nothing more happens, it will step back down. If you have another OA, it will keep stepping up, to the max of 15, until the OA's stop.

The flex effects when you change from the end of your inhale to the start of the exhale
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#7
(08-12-2016, 05:52 PM)dontwantapnea Wrote: Since my machine is an auto I thought about the flex.

I have been using a flex of 1 which is the lowest my machine will go.
If I up the flex setting then I can have 2 different pressure settings and see what happens.

In theory with a pressure setting of twelve and a flex of 3 I should get just about the perfect setting of 12 to clear the OAs and the 10 to remove the CAs?

I will try it and see. But most of the posts I have seen says that going to a higher Flex or EPR actually increased their CAs.


An auto Cpap cannot "treat" CAs, and in some folk, raising the EPR (ResMed machines) or Flex settings for PR machine can cause more CAs.

The most any of the Flex settings will drop is 2cm pressure on exhale. This is a comfort feature. If you look at SleepyHead while using a Flex setting, you will see the drop in pressure on the graph. There will be two pressure lines, with the bottom one showing the exhale relief pressure.
Flex settings are just something you have to try.

If you are going to switch to Auto mode, you have to be careful not to raise the max pressure too high, and at the same time your minimum pressure should be close to your 90% pressure reading. If it's set too low it won't help with the Obstructives, or hypopneas.

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#8
I don't see any reason not to try auto mode with minimum pressure at 10 and max at 14. Overall, you're doing pretty good at one-month, and in my experience your residual AHI will diminish slowly in time. I would not worry about the PB events as they are not a type that should be a problem, and probably represent some level of sleep disruption, rather than respiratory issue. The nice thing about reasonable experimenting, is that you can always revert to the last, best therapy settings. It's pretty harmless, but give it time to work and for your body to adjust to any differences.

Good luck! You're really doing pretty good with most aspects, including leaks, snores, flow limit, volume etc.
______________________________________________
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Robysue's Beginner's Guide to Sleepyhead
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#9
(08-12-2016, 04:08 PM)dontwantapnea Wrote: Here is a PB segment from last night.

[Image: wlaCrxgm.png]

And another

[Image: UnhF7Cym.png]

My Periodic Breathing averages 10% Max 24%.
My AHI is averages 6 and sleepyhead tells me thats not good.
Sleep study said sever degree of obstructive sleep apena and a mild degree of central sleep apnea.
pre CPA AHI 46.9, RDI 74.6, central apnea index 4.5
Obstructive Apneas were eliminated on CPAP at 10cm water pressure. Residual hypopneas and central apneas were documented at this pressure setting. The optimal positive airway pressure could not be reliably determined.

Trial Treatment with CPAP at 12cm water pressure (2cm of pressure higher than tested) in view of residial hyponeas.
Monitor CPAP unit data for persistence of central apneas that may benefit from treatment with BPAP or ASVPAP.

The machine seems to have taken care of the OAs but CA and Hypopneas seem to persist.

Dr said "your cured". I don't want to be stuck with this machine if another would have a more positive impact.
Should I set it on auto with a 10cm/12 setting?
Please help me either get the most out of the machine I have or document what I need to document to take to the Dr.

Thanks.

Hi dontwantapnea. Welcome to the Apnea Board.

Those "residual hypopneas" don't seem to be obstructive in nature. They seem to be related to your periodic breathing and to your occasional centrals. You might consider reducing your pressure to 10 which was your best number for obstructive events. What I am thinking is that you are sensitive to the pressure and also to the EPAP reduction in pressure. These factors (pressure and EPAP) can cause hyperventilation which in turn causes periodic breathing hypopneas and centrals. In some cases the periodic breathing and centrals can't be reduced and results in AHIs over 5. This could require a more advanced machine known as an ASV machine. In your case it will first be necessary to figure out if the periodic breathing can be reduced sufficiently if not eliminated. As I mentioned, try a reduction in pressure. Maybe 1 cm of H2O at a time. Use your Sleepyhead results as a guide. Then try eliminating the EPAP reduction in pressure. You may be able to find a sweet spot that nearly eliminates obstructive events and greatly reduces the periodic breathing. One more thing. The periodic breathing is a lot more that the scores you see in Sleepyhead. Look at the blow ups of data that you posted. Notice the sine wave pattern in your flow graph. That is periodic breathing that doesnt register as a hypopnea. Next blow up a very short section of the flow graph where you see the dark colored wave forms overlaying the lighter wave forms. This might also show you something. There are others on this Forum who have also had success dealing with Centrals and Central Hypopneas. There might be some other suggestions that you could try. Start making changes slowly and keep in touch.

Rich
Apnea Board Member RobySue has posted a Beginners Guide to Sleepyhead Software here:  http://www.apneaboard.com/wiki/index.php...SleepyHead

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#10
Well,

I think you called that. Sensitive to pressure!

So this is last night. I changed the machine to Auto and set the low to 10 and high to 12. CAs went way down, so did Hypopnea and PB. But OAs went up!

[Image: KTkxUOvl.png]

Here is a previous day with a similar AHI but a constant 12 pressure.

[Image: n9duUGjl.png]

So here is a fun question. Assuming I am mixed which I clearly appear to be. What do you trade for?

Since I just changed it I am not going to change it again for a few days but which is better a few CAs and high PBs for a few OAs and less PB and CAs?

Thanks
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