Looking for advise to fine tune things

[KCFLY]

So, a little background:

My sleep study they started me at 5 and titrated up to 7.

With no CPAP for 167 minutes  I had 67 obstructive, 3 central, 15 hypopnea
With CPAP at 7 for 173 minutes I had 0 obstructive, 5 central and no hypopnea

(They only had me at 6 for about 15 minutes, I had two hypopneas and they pushed me to 7 for the rest of the time.)

With my fancy new APAP machine I did pretty well the first couple of nights..
Night one - min 4 max 10  - 10 minute ramp epr 1  - no central events, AHI of 2.34
night two - min 7, max 12 - ramp to auto and starts at 5, started seeing centrals, AHI 3.86

Here is a link to my 1st two nights data.
http://www.apneaboard.com/forums/Thread-...t-so-great

A couple days later I was told to quit trying to manage it as I was too new at it and to come back with more data...

So, I've got about 68 days under my belt now.

I have adjusted my settings to min 6.8 and a max of 12 now.  I do seem to get up to a pressure of 12 almost every night, but my average pressure is usually around 10.

I've tried to attach last nights data, which is pretty typical.  I'm still seeing a good amount of centrals and RERAs every night.  My AHI is pretty good, but would love a guru or two to look at the chart and give me any feedback on suggestions to improve things.

Thanks so much!

[Gideon]

First of all your numbers are good, so I'll ask the important question, How do you feel?

You do not need to make any changes based on the numbers.  Remember these settings because they are a safe place to return to.

That said, you are bumping into your upper limit of 12 on Pressure, Set your max to 14 to see if you are chasing higher pressures, I don't think so.
Your min pressure could be changed to 8 and not change your therapy.  Neither change should impact your therapy.

Make only small changes after that, less than 1cm at a time and observe.

Again, no changes are needed.

How do you feel?

Fred

[Beej]

In some cases, the Air Sense 10 may stay at a higher pressure than you need. It did this to me. If you find your numbers get worse over a week or so, after you have increased the pressure, you may find that reducing the pressure back down will also reduce the events.

[ajack]

I would probably be a bit more aggressive if it was my chart and set the min to 10cm. I think it may clear up some of the OA events when under 10.
You have a very level pressure response though the night. A fixed cpap of 12 wouldn't be out of the question for me.

[kwhenrykerr]

As I understand the machines they raise the output (amount of air) when the flow changes. With a mask leak the pressure in the system drops and the machine raises the volume of output to try to keep the pressure up to maintain your airway. When the flow of air is restricted the machine raises the pressure to try to keep your airway open.

If the pressure max setting is too low then the airway may close.

I may be more willing to allow the machine to seek its upper limit on its own. As you are setting the max pressure below what the machine is able to do it can not tell you what it took to keep the airflow up. Did your body open the airway or did the machine pressure open the airway ?

Raising the pressure can affect other areas of your sleep. It may be worth it to consider raising the max pressure.

If you do raise the limit you may also consider raising the lower limit. The machine take time to raise its pressure and if it must take big leaps in its output then that also may cause a rough ride.

As you slowly work your way to understanding more and being in control you will feel better.

Read as many post in this forum as you can and

[KCFLY]

Thanks to everyone!

As to Fred's first question, I feel "OK". Some days I wake up and am ready to go, other days I wake up dragging... I can't seem to find any correlation to AHI numbers. But truthfully, I need to do a better job of keeping a sleep journal so i can look at the details on nights I don't feel like I got a great sleep.

So I raised my min to 8 and my max to 14 last night. I slept pretty well, although I woke up with a slight headache. Don't know if that's from higher pressures, or allergies or what.

In looking at the charts again after reading all your comments I can see where raising the min pressure even higher may be worth trying.

Of course, after importing and posting my data yesterday I left my SD card in the computer and have do data from last night to share. I'll let these settings ride a few nights and post some data and we'll see where things are at.

Thanks again.

[Sleeprider]

Your median pressure is consistently 10.5 or greather, and that is where I would set the minimum pressure. I don't see a need for increasing the maximum. Pressure is being driven by flow limitation, and your current minimum pressure is pretty meaningless. the limited changes in pressure from increasing minimum pressure, may improve CA results as well. You're not using EPR, and I was wondering if you had previously tried it and found it caused more CA?

[KCFLY]

Your median pressure is consistently 10.5 or greather, and that is where I would set the minimum pressure.  I don't see a need for increasing the maximum.  Pressure is being driven by flow limitation, and your current minimum pressure is pretty meaningless. the limited changes in pressure from increasing minimum pressure, may improve CA results as well.  You're not using EPR, and I was wondering if you had previously tried it and found it caused more CA?

I used EPR for awhile in the beginning.  Centrals weren't really affected when I turned it off from what I could tell.  They were pretty much in the same range I still see.  I didn't really notice a change when I turned the EPR off, in AHI or ease of using the CPAP.  I haven't missed it, would there be any benefit in turning it back on?

Thanks for taking a look and offering your feedback!

[Sleeprider]

EPR is mainly a comfort feature but has similar dynamics to bilevel. If you use it, remember that your minimum pressure will probably need to be higher than without it. If you're comfortable, no need to use EPR.