(11-05-2013, 08:44 PM)Thecleanser Wrote: I notice on the bad days FLOW rate is at the top and on the good days its no where to be seen....?The S9 overwrites the FLOW rate data on the SD card every seven days. If you want all of your FLOW rate data, you have to download at least once every seven days. My guess is that you don't download the data every day, and that the data from the good days was NOT downloaded until they were over seven days old and the FLOW data had been overwritten.
Now for the hard question:
Quote:Okay Im posting a few screen shots here the first 2 days Oct 15 and 16 were good days, days i'd like to have all the time - oct 24 and Nov 1st are days I didnt feel good at all. What am I missing here on these reports?I'm not sure you are missing anything. The data from the good days pretty much looks a lot like the data from the bad days. Which points to a different cause of your on-going problems.
But let's try to micro-analyze the data you've posted to see if there's anything in it that might give some insight into what might be different on the good days versus the bad days. We'll start by looking at some standard things that can affect the efficacy of CPAP therapy:
Large leaks can allow events to occur because the machine can have difficulty maintaining pressure. Large leaks can also make it difficult for the machine to accurately record data.
But you summary leak data on all four days indicates your 95% leak rate is well below the 24 L/min red line ResMed uses to define "Large Leaks." Your max leaks are likely spikes caused by momentarily removing the mask or moving it around, perhaps to scratch your nose. (We can see a very short lived spike in leak graph on 10/16 that is likely you scratching your nose, for example.) So leaks are probably not a significant factor in explaining your good days and bad days. (It would be nice to see the leak lines for 10/24 and 11/1 just to be sure.)
During the "ramp" period, the pressure is at a level that is known to be less than what is needed to properly splint the patient's airway. But the idea is that the lower pressure will allow the patient to get to sleep easier, and once the patient is asleep and the pressure has reached the full therapeutic level, things will be OK. Patients can get in trouble when the starting ramp pressure is way, way too low, the ramp period is far longer than it takes the patient to fall asleep AND when the patient repeatedly hits the ramp button every time they wake up. The combination of these things allows the patient to spend too much time sleeping with machine providing inadequate pressure to splint the airway open, and that allows way too many events to occur. Complicating matters further, the S9 does NOT record events during the ramp period. And the S9 does not speed up the ramp period if you fall asleep and have a ton of events.
You have the ramp set to a 45 minute period. But you're only ramping from 4cm to 5cm since your pressure range is 5--20cm. Moreover, on the four days of data you post, the only time you press the ramp button after the beginning of the night is on 10/15 (a "good day"). So if these four nights are typical, we can safely assume that ramp abuse is NOT your problem.. In other words, you're not experiencing gobs of unrecorded events throughout the night because of the ramp being on for extended periods throughout the night.
Clustering of events; possible issues with pressure settings?
There are some clusters of events that are still happening---on both the good nights and the bad nights. How significant of a problem this is is something you may want to try to address with your sleep doc. (Yes, I am aware that you feel as though you're not getting anywhere with him/her.). The thing is, the worst of your clusters is on one of the good days. That may mean that the clinical significance of the clustering is minimal---i.e. the overall number of events is low enough where OSA is no longer an issue.
But still, there are some clusters of OAs and Hs. (The number of CAs is insignificant.) And the timing of those clusters of OAs and Hs indicates they just might be REM-related. Any documentation about whether your OSA is much worse in REM than non-REM?
And your current pressure range (5-20) has a min pressure setting that is well below your original titrated pressure. And it's below a number of pressure ranges that worked for you---at least for a small amount of time. Hence it may be that you are now using a pressure range that on a bad night for REM-related OSA just has a starting pressure setting that is too low and the machine is spending too much time playing catch up.
So if you absolutely feel you must do some more dial wingin' then it may be useful to slowly increase the min pressure setting. Bump it up to 6 and leave it there for a week or two and look at the data. If there's no improvement in the clustering and no improvement in how you're feeling, bump it up to 7 and leave it there for a week or two and look at the data. And so on and so forth. The idea, however, is that you need to both be patient (leave the new setting in place for at least 7-14 days) AND you need to look at the data before making any decision about what to do next.
We still don't know how restless you are during the night. My guess is that you are dealing with other sleep issues and other health issues. As I've said in the past, your description of the headaches indicates that they are an independent cause of how bad you are feeling. And until you figure out what is causing the headaches and an effective way of treating them, you're not going feel any better during the day no matter HOW well you're sleeping at night. (And the Advil is NOT effectively treating your headaches and it IS probably contributing to your problems.)