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1 year and still tired!
#51
RE: 1 year and still tired!
Here are a couple more Hypopneas from later in the night / early morning.

[Image: qQH6cLRl.png]
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#52
RE: 1 year and still tired!
at 9 your OA are sorted for now. I wouldn't even look at the CA number. They will settle down and there is an insignificant number.
My novice opinion....
See how both charts line up with the PB, I wouldn't count them, I think it's just your body getting use to cpap working. It's a breathing response to the pressure and your o2/co2 balance is readjusting and blowing off excess o2. That will settle down. Though some PB is considered normal.

I would look at other H as well

I get a few with a deep breath/messy breathing that are followed by a H, but if you look at this example I've chosen, because there is no low tidal volume response, It's definitely not a H. It's just my bipap/bilevel/vpap being dumb.
http://i.imgur.com/JXuAw0J.png

this is an example of my PB (my machine didn't flag them) In the first few months on auto cpap and although you have been using cpap for a while, in a way you are just starting. note that I needed 16 as a min and was still having OA, your pressure numbers are considered to be on the low side
http://i.imgur.com/a9NbKiI.png

I went and zoomed in more on that PB and H that I had in my library, there was a PB before this that had a less and longer low tidal volume, I would have called that a H and I think if I had my o2 meter on would have shown a desaturation, as I ebbed and flowed. So I think it missed a H and falsely marked a H, all within a minute
http://i.imgur.com/MFxKsSF.png
mask fit http://www.apneaboard.com/wiki/index.php...ask_Primer
For auto-cpap, from machine data or software. You can set the min pressure 1 or 2cm below 95%. Or clinicians commonly use the maximum or 95% pressure for fixed pressure CPAP, this can also be used for min pressure.
https://aasm.org/resources/practiceparam...rating.pdf
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#53
RE: 1 year and still tired!
Here are couple more screenshots showing the Tidal Volume and the Respiratory Rate.  would like your input on these readings. I have a lot of reading to do to catch up with all these numbers. Thank you "ajake" and everyone else for sharing your knowledge. I feel there is more than meets the eye with all this.

[Image: 7Oz7T9lm.png]

This one is zoomed 

[Image: gCSMm1Om.png]
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#54
RE: 1 year and still tired!
To me...The first H is from a preceding deep breath and is waiting for the co2 to build back up. I would ignore. The second is a PB and as said, I think an o2/co2 balance getting sorted. I would also ignore that at this stage too, especially since they only started with a pressure change. The first chart you posted had no PB flags

Have you got a zoomed in after a H, with a recovery deeper breath or two? 9 might have fixed your H too?

If you right click on the name, tidal volume on the chart, you can go to the Y-axis and adjust the vertical size of the display, it will make it a lot easier for you to read.
mask fit http://www.apneaboard.com/wiki/index.php...ask_Primer
For auto-cpap, from machine data or software. You can set the min pressure 1 or 2cm below 95%. Or clinicians commonly use the maximum or 95% pressure for fixed pressure CPAP, this can also be used for min pressure.
https://aasm.org/resources/practiceparam...rating.pdf
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#55
RE: 1 year and still tired!
"ajack" Thanks for the breakdown notes. Makes me feel better about things. 

Not sure what I'm looking for as far as a zoom in for a breath after the H. Would it be a spike in the Tidal volume?

As for the axis change, I don't know what to change it to. Sorry kinda new at this.
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#56
RE: 1 year and still tired!
If you right click with the mouse cursor on the name, "tidal volume" on the main sleepyhead chart, it will open a box of options, go the the Y-axis and then select the 'autofit' drop down and select 'override'. you can then select how much height is shown, you can scale the min max number, so the graph data looks bigger and easier to see. you could start with a tidal volume display of 0-1000 and see how that looks

I'm just a pleb with this stuff and why I suggested youtube...but my 'guess' ...see in your zoomed in chart, when the H finishes, there is just a return to breathing. A big H with a lot of o2 desaturation, could have a deep breath after it, trying to make up for the drop in O2, it's like holding your breath, when you start breathing again, there is a gasp.
mask fit http://www.apneaboard.com/wiki/index.php...ask_Primer
For auto-cpap, from machine data or software. You can set the min pressure 1 or 2cm below 95%. Or clinicians commonly use the maximum or 95% pressure for fixed pressure CPAP, this can also be used for min pressure.
https://aasm.org/resources/practiceparam...rating.pdf
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#57
RE: 1 year and still tired!
I have been mostly absent from the forum lately as I have been slamming out a re-construction and renovation project at a lake cottage. The good news is Ihave probably lost 15 lbs due to hard labor and internet abstinence. The bad news is I have not been around.

Stubborn hypopnea is very hard to treat with a CPAP, but it is a cinch to kill it with a bilevel /BiPAP. Pressure support is the key to increasing tidal volume and avoiding the obstructive hypopnea we see here. In this case the hypopnea is at clinically acceptable levels, but you don't feel rested. This may be a basis you can discuss it with your doctor and ask if you can revise your Rx to bilevel to address the hypopnea. What I did was to buy my first auto BiPAP on Craigslist and used pressure support to reduce RERA and H events and got great results. My experience was not unlike your own with an event rate in the 2-4 /hour range. I just decided to take it upon myself to eliminate it with bilevel. Once I demonstrated the efficacy of bilevel, I then got the doctor to review the results and prescribe bilevel, and I got the Aircurve 10 Vauto last year through insurance.

A key to understanding bilevel and hypopnea is to read the titration protocols from Resmed and Respironics. These are easily found online, and you will see the approach to using EPAP to resolve obstructive apnea, then using pressure support to address snoring, hypopnea and RERA. Be advised excess pressure support may cause central apnea increases in some individuals, and that is a sign to back off, also your initial reaction to pressure support may not predict your long-term tolerance to it. So we can sit here behind our computers all day long and continue to suggest increasing minimum pressure to address your hypopnea issues, or point you to the therapy that really addresses hypopnea as a targeted event. New BiPAPs are about $770 on Amazon, and you may find them locally at lower prices on CL. I got my first one for abut $350 with very low hours. I wish you the best of luck, and based on what we're seeing in your charts, your choices come down to increased minimum pressure until the hypopnea is acceptable, or obtaining a machine with pressure support capability. FWIW, the Airsense 10 with EPR does a pretty decent job of providing up to 3-cm of PS, but the Flex in a Philips CPAP is not so useful as it is a very brief pressure reduction. Good luck!
Sleeprider
Apnea Board Moderator
www.ApneaBoard.com

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#58
RE: 1 year and still tired!
Rough night , going backwards  it seems. Thanks  ajack will play with that axis. And thank you "sleeprider " i will check into it. Congrats on your remodel 

Here is last nights chart. 

[Image: GkDJdPzl.png]
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#59
RE: 1 year and still tired!
Scott do a screenshot of the statistics page from SleepyHead.

Dave
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#60
RE: 1 year and still tired!
Try minimum pressure at 10 and Flex to 1. Your events are obstructive, and should begin to diminish with more pressure. Are you bothered by the pressure at your current settings?
Sleeprider
Apnea Board Moderator
www.ApneaBoard.com

____________________________________________
Download OSCAR Software
Optimizing Therapy
Organize your OSCAR Charts
How To Attach Images And Files to your posts
How To Deal With Equipment Supplier
Mask Primer
Beginner's Guide to Sleepyhead

INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED AS MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEB SITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
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