Help Pls. AHI 29 feeling bad and not sure I am headed right

[BigBob2]

[img]http://[/img]

@Bob - It would help a bit to show us an overview of these last 30 days, like the following:


I will mimic some past posters comments about your settings and their affect on CA. Some more knowledgeable folks will be along at some point and give even better help...

If I had your scores and had not just made a change in the last 3 days, this is what I would do - (assuming your current setting is min EPAP = 4, max IPAP = 12.6, PS range = 4 min 4 max. Ramp 4 for 15 minutes.)

I would increase min EPAP to 6, leave IPAP at 12.6, change PS range to 2 min 3 max, and ramp OFF. leave for 7 to 10 days. report results.

This would start me at inhale of 8 cmH2O, exhale at 6 cmH2O.

From this change I would expect that my AHI average for the 10 days would be as low as 3 and high as 10, and the CA component of the score would be less than half. My guess is that there will be 0 days over 10, 7 days between 5 and 10, and 3 under 5.

That would be a great baseline to build upon.

QAL

I knew at some point I would need to post a chart and was dreading learning but was actually painless.

Thanks for all the info. your correct the current settings are:4, max IPAP = 12.6, PS range = 4 min 4 max. BUT no ramp.

I have not made changes in the past 3 days

If after viewing the chart and have any changes I should make I am open.
Thanks again,
Bob

[BigBob2]

[img][/img]

Sorry for the mixup But the above is my chart
BOB
[img]http://[/img]

@Bob - It would help a bit to show us an overview of these last 30 days, like the following:


I will mimic some past posters comments about your settings and their affect on CA. Some more knowledgeable folks will be along at some point and give even better help...

If I had your scores and had not just made a change in the last 3 days, this is what I would do - (assuming your current setting is min EPAP = 4, max IPAP = 12.6, PS range = 4 min 4 max. Ramp 4 for 15 minutes.)

I would increase min EPAP to 6, leave IPAP at 12.6, change PS range to 2 min 3 max, and ramp OFF. leave for 7 to 10 days. report results.

This would start me at inhale of 8 cmH2O, exhale at 6 cmH2O.

From this change I would expect that my AHI average for the 10 days would be as low as 3 and high as 10, and the CA component of the score would be less than half. My guess is that there will be 0 days over 10, 7 days between 5 and 10, and 3 under 5.

That would be a great baseline to build upon.

QAL

I knew at some point I would need to post a chart and was dreading learning but was actually painless.

Thanks for all the info. your correct the current settings are:4, max IPAP = 12.6, PS range = 4 min 4 max. BUT no ramp.

I have not made changes in the past 3 days

If after viewing the chart and have any changes I should make I am open.
Thanks again,
Bob

[BigBob2]

Check how long your CA's last. Long ones are a lot more worrisome than short ones. Also, CA's aren't necessarily more harmful than OA's, just harder to eliminate.

Go into the daily tab on SH, go to the events tab, and break out the CA list. You can click on individual events and it will zoom in on the time and you can look at the flow rate waveform.

Thanks for the Info.
Intersting the long ones vs. the short ones but makes sence

all this is new to me and I don't know when events become long
Maybe this helps

[BigBob2]

Your question "How often did you have desats in your sleep study?"
I don't understand the term destats

Oxygen level dropping; the desaturation of your body's oxygen level. When you don't breathe your blood will lose its oxygen. This is expressed in a percentage value. Based off of published material and observations the "normal" range is 88% to 98%. I've seen a 99% but that was after the person had hyperventilated and was getting spacey.

Had a good laugh -thanks
and thanks for the feed back lots to learn

[quiescence at last]

observations -

1. your min EPAP is already set at about 6.5, and max IPAP at a good level, and you have no ramp.
2. your scores for 4 out of the past 5 nights are really good. one of the nights might have been spicy foods.
3. Jan 16, 17, 24, and 31 are essentially the same CPAP condition, but the scores are widely different. I think your body is just getting used to treatment.

The only thing I would consider is - adjust your PS range to 2 min 3 max. if you want to do it in stages, you could do the following, waiting at least 4 nights at each step. You could stop any point you saw results were acceptable.
2/9 - adjust PS to 3-4
2/13 - adjust PS to 3-3
2/17 - adjust PS to 2-3

QAL

[BigBob2]

observations -

1. your min EPAP is already set at about 6.5, and max IPAP at a good level, and you have no ramp.
2. your scores for 4 out of the past 5 nights are really good. one of the nights might have been spicy foods.
3. Jan 16, 17, 24, and 31 are essentially the same CPAP condition, but the scores are widely different. I think your body is just getting used to treatment.

The only thing I would consider is - adjust your PS range to 2 min 3 max. if you want to do it in stages, you could do the following, waiting at least 4 nights at each step. You could stop any point you saw results were acceptable.
2/9 - adjust PS to 3-4
2/13 - adjust PS to 3-3
2/17 - adjust PS to 2-3

QAL

Thanks for the input. However I am not understanding item #3 (essentially the same CPAP condition, but the scores are widely different)
So much to understand, This ~ 1 Mo. for me.
I did adjust my PS fro 4 to 3 last night and will decrease to to over this week.
The centrals are my area of concern as the other events are minimal ( if I am understanding)
I will include a screen shot of last night


This is typical of any night meaning: Centrals in clusters, pressures run about the same Max & 95% 8 / 12 even on high AHI days. The highest day for AHI was 44 and that day was 11/15 MAX but 95% was the norn.

[PaytonA]

The only thing I would consider is - adjust your PS range to 2 min 3 max. if you want to do it in stages, you could do the following, waiting at least 4 nights at each step. You could stop any point you saw results were acceptable.
2/9 - adjust PS to 3-4
2/13 - adjust PS to 3-3
2/17 - adjust PS to 2-3

QAL

Big Bob has a Resmed machine which does not have a PS range. It just has a PS setting.

[PaytonA]

Big Bob,

I have a couple of questions for you with regard to your most recent graphs.

1. Once you turned the machine on when you initially went to sleep, did you fall asleep immediately or did it take a while?

2. Same as question 1 for the ime when you woke up and turned the machine off for a short period.

3. the second time you shut the machine off during the night. When you awakened that time lil you lay in bed awake for a while before you turned the machine off and when you turned the machine back on same question as 1 and 2?

Best Regards,

PaytonA

[BigBob2]

Big Bob,

I have a couple of questions for you with regard to your most recent graphs.

1. Once you turned the machine on when you initially went to sleep, did you fall asleep immediately or did it take a while?

2. Same as question 1 for the ime when you woke up and turned the machine off for a short period.

3. the second time you shut the machine off during the night. When you awakened that time lil you lay in bed awake for a while before you turned the machine off and when you turned the machine back on same question as 1 and 2?

Best Regards,

PaytonA

PaytonA, thanks for clarifying the PS setting.
Answers for:
Item.#1 Normally I fall asleep within 10 Min. last night was an exception. after ~10 Min. with the mach. on I shut it off to adjust a mask due to leaks the duration of that adj. was 3 Min. & back on with the Mach. the next brake was 27 Min later with another mask adj. for 4 min. and started the mach. again. ( rec. a new mask size large they did not have a med.)
Fell asleep shortly after. Sleep was uninterrupted for 3Hrs.&23 Min.

Item# 2 I wake and turn off mach.( no waiting) this was a bathroom break and right back to sleep.3Hrs. & 35 min. no waiting.

Item#3 was another was a bathroom break and right back to sleep no waiting

I always try to turn of the mach when awake to assist in keeping the data clean even when it is about time to get up.

Bob

[quiescence at last]

That is all great info. And sorry on point 3, I was meaning that on each of those nights the max pressure, 95% pressure, and the median pressure were all the minimum set pressure. Therefore, the CPAP therapy was approximately the same, but different results occurred - widely different. There is always a variation of AHI day to day even under similar conditions. But, it just struck me that you might just be still getting used to the treatment.

A lot of us get more activity later in our sleep night. It is also usual to have greater amount of REM sleep and dreaming just before waking in the morning. Do you remember that you were dreaming when you awoke at 5:05am?

Other observations:

1. you will also notice that your pressures adjusted at about 00:10, 01:35, 4:45 (a bit) and 5:10, but no events seem to have tripped these off. The machine has sensed something that starts the pressure building. I think these are RERA or flow restrictions that the machine does not score, but seems to react to.

2. nearly all of your CAs are when erratic shaky tidal volume is occurring. The high volume may be resulting in a hyperventilation of sorts, which your body responds to, and the brain sends a signal to halt breathing until equilibrium sets back in. I would love to see a couple of those periods with your [respiration rate] instead of [mask pressure]. Can you post the section between 04:20 and 06:00?

3. did you feel at all panicky or out of breath when you awoke at 05:10 or do you experience that periodically?

Thanks again. Hope we can get you into a better situation!

QAL