Best Practices lower AHI/RDI in first 30 mins of sleep

[WillSleep]

THANKS!

I tapped Flags on and off again a few times and the thin vertical Event Bars in the "Event Flags" horizontal chart and the "Flow Rate" chart come on and off but still no longer displays text labels on each event marker (e.g. CA, OA, H, VS, VS2, PB, etc)

[WillSleep]

Thanks for the help Walla Walla.

After full app uninstall + profile & Data directory rename + full reboot + full reinstall + CPAP Data Reload SleepyHead is looking good again.

[WillSleep]

 It might help to zoom in further on this wave for so we can see if it includes flow limitation which would be obstructive.

Hi Sleeprider, 

I am not confident I understood exactly but did the following. 

1) Looked for a Flow Limit chart/waveform to display and did not see one, so I assume the DreamStation does not capture that data.   If I am wrong please correct me.

2) I created two images that are zoomed in closer to show the only FL event in the first thirty mins and between the two images about all the charts/waveform data available for that time period.  

https://imgur.com/q4zmny1.png
 
https://imgur.com/KbSxVNj.png 

[Sleeprider]

Good job. The Dreamstation does not chart flow limitations, but it does flag them. In the first chart at 00:11:30 (beginning of chart), are several breaths that are flow limited, and flagged. They have downward sloping peaks which shows some restriction near the end of inhale. These kind of breaths are present before each of the apnea events.

More surprising to me in this graph is that your machine simply does not increase pressure, even with obstructive apnea being recorded. I ca n't explain why pressure is not increasing, but it should. Since the machine auto algorithm is not doing its job, you are going to have to manually increase minimum pressure. I don't know why this machine is not responding properly, but It's pretty clear you need to increase minimum pressure until these events are reduced. I think it might also help to set Flex to 1. It looks like you might be at 2 or 3.

[WillSleep]

Thanks Sleeprider,

For those images above the  Dreamstation APAP settings were: 
 - Min/Max  = 10cm / 17cm
 - Ramp = 5 mins, starting at 5.5cm
 - FLEX = OFF

Context for tonight's adjustments:
- Still seeing OAs & FLs.  The forum linked PR sleep lab CPAP Titration protocol says in first phase continue to increase pressure until all or most OA & FLs disappear.
- Thus far more pressure has produced better collective results. 
- Average 90% pressure level thus far is 12.8cm
- It was hard to sleep last night, as I am going to increase pressure even more I am going to add back a little AFLEX

 
For tonight's experiment the Dreamstation APAP settings will be:
 - Min/Max  = 12cm / 18cm
 - Ramp = 5 mins, starting at 7cm
 - FLEX = AFLEX, set to level 1

Measurement data collected will be Dreamstation logging, Pulse-Oximeter logs and all night sound recording (mic setting = sensitive)

[trish6hundred]

Hi WillSleep,
WELCOME! to the forum.!
Good luck with CPAP therapy.

[WillSleep]

Thanks Trish!   

Sleeprider, OpalRose, Walla Walla and many of the earlier community threads have been a godsend of help!  

Last nights results:

For this experiment the Dreamstation APAP settings were: 
 - Min/Max  = 12cm / 18cm (Min increased from 10cm the previous night)
 - Ramp = 5 mins, starting at 7cm (ramp starting cm increased from 5.5cm)
 - FLEX = AFLEX, set to level 1  (FLEX was "Off" the previous night)

Top OBSERVATIONS:
- Across all days and all Min/Max pressures thus far the first five mins. following a significant arousal include 1-5 CAs, OA that look like CAs and natural looking OAs.
- Thus far increasing pressure has reduced total significant arousals with a net effect of decreasing total CAs 

Full list of KEY OBSERVATIONS:
a. AHI was Best Night yet
b. The three prime indicators were all lower - YEA!  (OA, CA, H)
c. Thus far increasing pressure has worked to reduce overall CAs (more detail just above).
d. Big mask leak issue last night.  I know how to fix it for the next cycle.
e. I am still in the first phase of the PR titration protocol where you incrementally raise Min cm until most all OAs and FLs disappear
f. 90% pressure = 13.0cm, 95% pressure = 13.5cm

DRAFT RESPONSE PLAN - adjustments for tonight's experiment:
- In light of c, e & f just above and community wisdom in earlier posts increase Min from 12cm to 13.5cm

I am new and an idiot so please if you guys see something else or have other ideas please freely coach.

What do you guys see?   What do you guys think?



Attached below are drill down images highlighting some of the "c." observations mentioned above.  







This drill down highlights what I thought was the other most interesting series of events last night

[WillSleep]

For this experiment the Dreamstation APAP settings were: 
 - Min/Max  = 13cm / 18cm (Min increased from 12cm the previous night)
 - Ramp = 5 mins, starting at 7cm   (No change from previous night) 
 - FLEX = AFLEX, set to level 1   (No change from previous night) 


Results:  

However:
- OA stayed statistically the same
- CAs tripled.  
- Only one nights worth of data so not yet statistically significant,.  However, peaks at the end of the inhale are significantly downward sloping

    Therefore:  The one change I will make for tonight's experiment will be to turn FLEX completely OFF.


Please let me know if you guys see something else.  

Thanks!
JC

[Walla Walla]

I don't need to see your drill downs to know you have a huge leak problem! You need to fix that first. All your other numbers are going to be off with that much leakage going on.

[WillSleep]

.... You need to fix that first. All your other numbers are going to be off with that much leakage going on.

Thank you so much Walla Walla.   That is incredibly helpful wisdom.  


Two questions: 

1. When it comes to Leaks should I only be concerned about events that happen when Leak Rates are high or should I expect that high Leak Rates will be a contributor to events that occur even outside the period when leak rates are high?

2. Even while being worn correctly my Dreamware mask seems to leak a lot by design.   In general, an approximation or rough guide, what Leak Rate numbers should I use to determine when Leak Rates are ok and when the Leak Rate is significantly impacting my results?