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Best Settings
#1
Best Settings
             
I am struggling with best settings for restful sleep.
Recently tired a second time with a fixed pressure setting. First night brought AHI way down but sleep quality was still poor. 
Second night AHI higher with identical settings and sleep quality was abysmal. 
Previously used the auto function for many months, results were mixed and my sleep quality was and still is on a declining trend. 
One DR thinks that its now psychological and another DR told me to use a fixed pressure @ 15 for two months. 
I tried the 15# for 8 nights and AHI declined rapidly however sleep quality was still poor. 
I went back to auto where I had previously found some good quality nights but was unable to repeat quality sleep. 
Even tried Sleep Restriction Therapy for several nights and did no better on sleep quality at the end. 
If AHI is <5 and sleep quality if poor, it is psychological problem rather than a physical one? 

Sleep has not been improving and I am very frustrated. 
Any help would be appreciated. 
I have attached the last two nights of fixed pressure @ 12 and the SleepHead overview for last 3 months.
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#2
RE: Best Settings
The two things I see, and they are related, you have a lot of Flow Limitation going on and you are not using EPR.

If you don't mind set EPR to Full Time and 3.  This will help with the flow limitations and RERAs and make it easier for you to breathe.
Note: this is a therapeutic use of EPR and not just as a comfort setting.  Reevaluate your settings after this and Please report how you perceive this in detail.  We want to see how you feel.
Fred Bonjour - Project Manager and Lead Tester for OSCAR - Open Source CPAP Analysis Reporter 
OSCAR

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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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#3
RE: Best Settings
your pie charts and overview shots indicate clear airway events that don't show up in your event flags. looks like you've had up to 14.5 ca's per hour. this might explain your 2nd doc's suggestion to try fixed pressure for 2 months - to rule out treatment emergent or pressure induced centrals, although it looks like you have used the machine for long enough to rule that out. also, your inspiration:expiration times are inverted (longer expiration than inspirations). you have hypopnea and rera. you have some mild flow limitation.

folks here can probably guide you to better results with your current machine but if you still have ca and feel bad after a period with fixed pressure, you might be a candidate for a different modality of machine.

regarding psychological causes of poor sleep quality: don't discount it but don't quit looking for physical causes either. there's potential benefit and no harm from working on sleep hygiene. you know how your practices compare to model sleep hygiene strategies. you know if you are anxious or stressed. if so, good to deal with them.

meanwhile, in my laymen's opinion, it's at least as likely - probably more likely - that poor sleep has physical causes, especially in people like us with known physical sleep conditions like apnea. in any event, it's hard to imagine how a doc can look at your charts and have no suggestions for improvement other than it's in your head.
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#4
RE: Best Settings
It does look like you do not have all the event flags checked. On the lower left of the charts Expand the dropdown and make sure all events are checked.
Fred Bonjour - Project Manager and Lead Tester for OSCAR - Open Source CPAP Analysis Reporter 
OSCAR

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New to Apnea? Helpful tips to ensure success
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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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#5
RE: Best Settings
          
You are correct, not all the events were displayed in the 3/27 chart, not sure how that happened., 
Here is the full chart again with the relatively good  AHI night before 

Is there any explanation why there was such a difference in OAs from the previous night?

I do now see why last nights sleep quality was so much worse, 

Thank you,
I will implement EPR - 3, tonight.
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#6
RE: Best Settings
The Apneas on 3/27 look extremely positional.  This usually occurs from tucking the chin.  
If this is a repeating event or is it VERY occasional.  If it is frequent I would recommend the use of a soft cervical collar.

Look at this wiki article to see how much of a difference it can make.

Your centrals are something that I am not worried about, but the higher EPR which will be good for your Flow limitations may be bad for your Centrals.  If so adjustments will be suggested.

It is important that while you are tweaking your settings that you report how you feel.3

Fred
Fred Bonjour - Project Manager and Lead Tester for OSCAR - Open Source CPAP Analysis Reporter 
OSCAR

Download OSCAR
New to Apnea? Helpful tips to ensure success
Mask Primer
Dealing with a DME
Organize Charts
Attaching Charts

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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#7
RE: Best Settings
I defer to bonjour as the much more experienced member but offer my thoughts for whatever they may be worth, even if they differ.

looking again at flow limitations: I realize I have no factual basis to call them mild; honestly I don't know what's mild or severe. someone here called flow limitations like yours "grassy". they're relatively low with median of 0.01 and 95% of 0.23 on the worst night you posted screenshots for, but you do have them pretty consistently throughout the night. folks like bonjour will help you with practical suggestions to get the obstructives down on your apap but to my mind it's what happens with the ca's that will ultimately determine your degree of success.

apparently it is possible for apap to reduce ca's; the question is will it be enough. my sleep test ahi of 72.4 was equally split between oa and ca and apap brought my overall ahi down to roughly 6, reducing ca along with the obstructives. however, I had inconsistent results with ahi's from under 5 to a high of almost 24. I had ragged flows, similar looking grassy flow limitations and a mix of residual oa, ca, h and occasional RERA. in addition, I didn't feel much better than before apap.

hopefully, with help from the experts you will dial in your current machine for success. I'm just suggesting centrals, which weren't visible at the start of this thread, could end up being a significant factor. it should be clearer once you see what happens with epr and other suggestions given to reduce the obstructives.

ditto on the soft cervical collar suggestion. I can't say I like it much but I can attest to it's effectiveness in reducing positional clusters and mouth leaks.
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#8
RE: Best Settings
Always keep your therapy discussions in a single thread. This Maintains history.
BASED ON THAT HISTORY set your EPR to 1 not 3. based on your history let's try to ease back into using EPR.
Fred Bonjour - Project Manager and Lead Tester for OSCAR - Open Source CPAP Analysis Reporter 
OSCAR

Download OSCAR
New to Apnea? Helpful tips to ensure success
Mask Primer
Dealing with a DME
Organize Charts
Attaching Charts

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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#9
RE: Best Settings
Thank you all for your comments, this entire adventure has yet to achieve consistent quality sleep for me.

Attached three nights of fixed pressure 12 with EPR-3. I actually did 4 nights but forgot to return the chip the first night. 
AHI / Sleep quality rating for those  4 nights was: 1.65/7; 3.35/6; 5.0/4;  4.98/4  (Sleep Quality Scale: 1-10 high; 5 being neutral-not bad nor good)
Used the sleep collar except for the last night 3/31. After last night wake up I took a Xanax and turned off EPR, but still woke tired. 

Things start off good and then get worse.
Improving progress has been elusive for me. 
I keep a sleep diary and rate each night on the quality of sleep. That trend over 30 days shows quality is in decline or flat. 

Expect a dental appliance in a week or so, not sure if that will help. 

For then next week or so I wondered what you might recommend trying,  since this appears to be a very trial & error process. 

Also attached the statistics page from SleepyHead. While it shows best setting at 14.6 fixed my sleep quality for those nights was 6 first night 4 the second night (Scale 1-10 high; 5 being neutral-not bad nor good)

               

(Just wondered if it was better to insert the attachments or just attach?)

Thanks
Ed
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