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My Wife Keep Waking up at Night!
RE: My Wife Keep Waking up at Night!
Pressure support enhances ventilation rate and reduces CO2 in the bloodstream. The response to this effect of pressure support (the difference between IPAP and EPAP) varies considerably from person to person, but can lead to hypocapnia, which will directly affect respiratory drive and cause CA. The effect increases at high pressure support levels, and decreases as pressure support is decreased. The effect of of a reduction of pressure support in improving CA is not completely predictable, and it is present at low levels with your wife, however that is the principle we use in suggesting lower pressure support in the presence of CA.
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RE: My Wife Keep Waking up at Night!
Hi Sleeprider,
With SH chart, what should I look for if I want to know the quality of a sleep my wife have? Does it tell me when she woke up at night?
I know the AHI showing the amount of apnea events a person have per hours, but is that also indicate the amount
of time a person woken up at night?
I have been slowly increasing the IPAP pressure on my wife's Bilevel machine, and trying out different FFM and 
soft cervical collar and managed to keep the AHI below 2!
So far so good!

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RE: My Wife Keep Waking up at Night!
I'm not sleeprider but I'll answer until he shows up. Looking at the flow chart I'd guess she woke up 3 maybe 4 times during the night. All but one not lasting very long. Now this is all a guess based on the flow rate and no chart can really say how the quality of her sleep was. The best way to know would be to ask her if she felt rested.
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RE: My Wife Keep Waking up at Night!
Walla's guess and advice is as good as mine.   Dont-know
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RE: My Wife Keep Waking up at Night!
After two months with the new Resmed Aircurve 10 vauto and wearing a soft cervical collar, my wife AHI floating between 2-3 cmH2O. The setting of the machine is EPAP=8, IPAP=16.4, PS=4.
The doctor ruled out COPD in restricting her restricted expiration.  
The quality of sleep is not great but tolerating. She keep arousing several time at night, and sometime finding hard to get back into sleep again.
He oxygen blood saturation 95%, and a great improvement from BILEVEL therapy. In 15 September 2015, when she did her first home sleep study, an oxygen nadir of 69% and a desaturation event of 18.6/hr was recorded.
I did tried to reduced the central apnea and obstructive apnea by reducing the PS=3.4. But not much has change in apnea events and the respiratory rate and tidal volume dropped a little.
My question is how can she improve her quality of sleep from here on? Is minimize the complex apnea of central apnea and obstructive apnea the way to do it? Is it worth trying the Resmed Aircuve 10 with backup rate?

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RE: My Wife Keep Waking up at Night!
Your wife's therapy looks good, and you should check if much of the AHI is short duration events as I suspect. We have discussed in the past that your wife's median respiration rate is a slow 9 breaths per minute, or 6.7 seconds per breath. Any pause of 3-seconds above her normal breathing rate can flag an apnea, but may be normal for her.

In this graph, her resp rate is approaching 12 BPM (3-breaths/15 seconds) so during CA clusters, her respiration rate does seem a little higher. The AHI is certainly within tolerable levels and I don't know that it would be helpful to pursue a more aggressive therapy like ASV as there is considerably more disturbance inherent in the varying pressure support with ASV. I'm not sure the events being flagged as centrals are particularly bad in her case, and may be caused by her sleep disturbance as opposed to being the source. Just something to consider.
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RE: My Wife Keep Waking up at Night!
Hi Sleeprider,
After six months on Resmed AirCurve 10 VAuto and with F&P Simplus Full Mask and a soft cervical collar, and the AHI is floating around 3-6. With these combination, she still feel restless and woke up 3-4 time each night, and she also getting neck strain and shoulder pain. The pain is cause by the extra thickness at the back of the soft cervical collar and the rather large flat area at the back of the strap of Simplus headgear. The is no leaks when using the Simplus FFM.
So, we are trying a different combination, by using a Resmed Quattro Air FFM and a modified soft cervical collar such that only the thickness of the velcro strap is at the back of her neck. Also adding a secondary pillow to support her shoulder, so her head and body is aligned in a straight line when she is in resting position. All these seem to lessen the pain around her neck and shoulder, but another problem arose from this experiment, and I needed you expert advise on it.
I attached the report from SleepyHead from last two night, and since using the Resmed Quattro Air FFM for nearly two weeks, my wife experiencing sudden air jet blowing into her mask and waking up 3 to 4 times and night and air leaking through the bottom of the mask.  She sometime adjust the mask and the leaks disappeared. Each time she woke up, she said she felt fresh and alert and hard to get back to sleep. Also, when I look at the SleepyHead results, the leaks rate is around 10%, as yet the AHI is below 5, which I could not understand!
My question is, is there any setting on the Resmed Aircurve that I adjusted to make her feel more comfortable and have a better quality of sleep?

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RE: My Wife Keep Waking up at Night!
Let's zoom in on the flow rate in a couple random locations. Expiration is pretty long relative to inspiration. Does your wife feel like her inhale or exhale is being cut-off? Let me know what settings are for TiMin and TiMax.

Leaks are just something you have to narrow down to find a cause. The mask may be slipping to expose the mouth or nose. If you hear a leak at night, try to observe what is going on. As far as the collar, the main objective is to prevent chin tucking. A wedge style support like the Dr Dakota Snoring stop might do the job without any bulk around the back of her neck.
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RE: My Wife Keep Waking up at Night!
Thanksyou for your quick response! 
My wife felt pretty bad last night, screaming and crying and only used the Resmed Aircurve for an hour!
Anyway, I have attached a few zoomed images of flow rates as requested!
My wife don't felt like her inhalation and exhalation been cut off at night!
The Ti Max set at 2.0s and TiMin set at 0.3s.
I asked her again this morning about the what she think that causing her to wake up at night, and she gave me a different answer today. She said air is leaking at the left side and the bottom of the mask that woke her up. Sometime she adjust the mask and the leaking sensation disappeared. But this going on night and woke her up 3-4 times each night!
She also have the straps pretty tight near the lower jaw and it is still leaking! So it is not the pressure that woke her up and it is the fitting of the mask is the culprit! Maybe the Quartto Air is not the right mask for her, but the minimal contact at the back of the headgear stop the strain at he neck/shoulder area. 
Any suggestion in stopping the leaks of the mask be much appreciated!
I look at some articles in the forum on soft cervical collar, look like the Bell-Horn Low density Soft Cervical Collar may suit 
her better than the DR Dakota Snoring collar, because it is softer and probably worth a try!

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RE: My Wife Keep Waking up at Night!
The OA clusters look a lot more central than obstructive to me. I'm wondering if we have ever tried to maintain lower pressure or less EPR as a possible solution. I'm going to ping Bonjour and ask if he can look in on this as well.
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