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First data download and need advice
#1
Question 
Hello!

I am fairly new to CPAP and I am still struggling with feeling very tired Coffee. Since I couldn't tell what was going on from the information on my machine, I finally got an SD card (long story on that) and recorded some details. Tonight, I downloaded the data and I am having trouble figuring out what's going on. I seem to have a lot of CAs, but I'm too new at this to be able to determine if they are "real" or SWJ or something else. Huh I will include the screenshots from the last few nights, but I wasn't sure what area to zoom in on, and how close to zoom in, so I'm happy to get some advice on that, too. Thanks in advance for any useful information you can glean from the data!

Worst night in a couple of weeks, Jan 9:
[attachment=3093]

Jan 10:
[attachment=3094]

Jan 11:
[attachment=3095]
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#2
Do you have the results of your sleep study? Sometimes those provide clues about what might work optimally or the reasoning behind the device prescribed.

If you've not tried it, I'm wondering if it would help to give the machine a starting pressure of 7.0, rather than 4.0. Your machine is capable of varying the pressure in response to the events it detects; maybe setting the low at 7.0 cm pressure and the high limit at 15.0 cm pressure would let the machine vary as needed to help you.

I discovered that if you use your mouse to highlight a specific section of the night, then the right and left arrows will shift the focus in that direction so you can see more detail on each line.
Try highlighting the section of events just before 3:00 am and see what shows up.
                                                                                                                                                                                  
Please organize your SleeyHead screenshots like this.
I'm an epidemiologist, not a medical provider. 
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#3
Hi Beej,

Thanks for taking a look at this. I'm including a link below for Jan 9 just before 3 am. Let me know if I need to zoom in further. As far as the pressure, the ramp, according to the machine, starts at 7, but the pressure relief makes it 4 on exhale. Does that mean I should start the ramp at a higher rate, to offset the pressure relief? As I'm getting used to the machine, I find that the starting pressure does seem less strong than it did when I first started, so I could probably stand it higher, if needed. Thanks again!

Jan 9 2:30-3 am screenshot (corrected link)
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#4
Oh, and I forgot to mention that I did not receive written results from my sleep study, just some basic information, which was verbally communicated to me at my follow up appointment. If there's something specific that would be helpful to know, I may be have the information and can share it. Thanks!
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#5
After reading another thread, it sounds like zooming to 5 minute increments is helpful in identifying "real" CAs, so I've included some additional links below.

Jan 9 right before 3 am

OAs and CAs on Jan 7

Jan 10 example

Jan 11 example


Also, in going back through another similar thread, I realized it might help to know that my sleep study and titration study both reported zero CAs, with the AHI around 17 made up of OAs and Hs. They tried me on pressures from 4 to 15 and found that at 15, I slept the longest period (about 2.5 hrs) with an AHI under 2. If there's other helpful information from my studies, I can add more details. Thanks again!
Thanks

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#6
I'm wondering why you are using a straight pressure of 15 when you may do better in Apap mode?

That pressure of 15 may be too high for you, plus in Apap mode, it wouldn't go there unless needed.

Since you have alot of clear airways, i would also start lowering the EPR setting to 2, and possibly 1.

Try Apap mode with a range of minimum 9 and maximum of 15. (Ramp set to start at 7 or turned off, and EPR at 2, preferably 1.

Monitor for a few days and post another screenshot.

Hopefully, you should see fewer Clear Airways, and with a range in pressure, the Apap will be able to tackle Obstructives.


OpalRose
Apnea Board Moderator
www.ApneaBoard.com

How to Organize and Post ScreenShots

http://sleep.tnet.com/resources/sleepyhead/shorganize
https://sleep.tnet.com/reference/tips/imgur

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
Hi OpalRose,

Thanks for your insights. I think I'll start with just one change first, which is to reduce the EPR to 1 and see what happens. I'll try that for about a week and compare data. Based on what I've seen on my machine (I'll have to go back through my data to confirm), the machine is actually set to Apap mode, even though the DME told me it wasn't. For the first two weeks, the machine told me the max pressure was only 13, but I was having AHIs in the 10-12 range each night. Now that it's showing a 15, my AHI is down, just not down as far as I would like, since I'm still feeling so tired all the time. Thanks for the suggestions, though. If the EPR change doesn't do the trick, I will try adjusting the pressure settings. In the meantime, I'll check to see if the machine is in APAP or CPAP mode. Thanks again!
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#8
G'day Shylock

The SleepyHead printouts indicate your machine is in CPAP mode with a fixed pressure of 15. You are also seeing an awful lot of central apneas, which may or may not be caused by the high pressure.

It's very important you get hold of your full sleep test report and identify (or have your doctor identify) the number of apneas you were having before you went on the hose. If you were already having so many centrals then the therapy you're on may not be appropriate. On the other hand if you had no centrals before, but are having them now that you're on the machine, then a fair bit of fine tuning of your therapy is needed.

You should also check if your DME is adjusting pressures remotely - if so, then perhaps you could ask them to stop making any changes without discussing with you first. Increasing a fixed pressure is NOT the way to treat central apnea.
DeepBreathing
Apnea Board Moderator
www.ApneaBoard.com


Bed

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
SleepyHead shows that your machine is in Cpap mode. See top left under AHI reading.

It's a good idea to try one change at a time. Lowering the EPR setting has proven for some to lower Clear Airways events.

Its hard to say where your pressure range should be while using a straight pressure of 15. There is nothing wrong if you prefer Cpap mode, just have to find the most optimal pressure to tackle Obstructives which is easier to do in Apap mode.

OpalRose
Apnea Board Moderator
www.ApneaBoard.com

How to Organize and Post ScreenShots

http://sleep.tnet.com/resources/sleepyhead/shorganize
https://sleep.tnet.com/reference/tips/imgur

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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#10
Shylock, you need to go into the settings menu (control knob + Home button), and take a look at the mode and pressure settings. Your machine appears to be setup wrong, and you really need to get into Autoset mode, and a much lower minimum pressure. Since EPR is not even on in your current mode, it won't help. Your pressure is too high, and it is causing centrals.
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