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Need help with SH charts.
RE: Need help with Sleepyhead charts.
Hi Fred! I looked at flow patterns you supplied and you are right, my flow pattern looks like mouth breathing. Next few nights I taped my lips extra carefully and in the morning I tried breathe out with tape still there. I could not!

I searched for another explanation. I noticed , that I have this breathing pattern often and also with full face mask. Searching internet (PubMed) I noticed, that there is also expiratory flow limitation and I remembered, that when I vent for spirometry test was positive for COPD.
I also noticed when I have this pattern of breathing I am very tired next day, even when I have very low AHI.
My conclusion - it is not mouth breathing, but overlap syndrome.
Looking more closely - at the time of this flow pattern, my tidal volume is only 205, minute ventilation 3,5 l there is no mask leak and my IPAP pressure is 7.60 and EPAP 4.60. Maybe I will try use my daily inhaler Insipiolto Reprimat in the evening instead at noon. 

There is more to this CPAP therapy, then meets the eye. I came here not because apnea, that is controlled nicely, but another problem started with CPAP treatment. Tremendous fluid retention - I gained 15-20 lbs in a few days since CPAP.     I believe fluid retention and my antihypertensive medication were responsible for two hospitalizations in October and November - each almost a week in duration for critical hyponatremia. Internist had no clue why is this happening, but I was so confused I don't think I told them, that I have apnea and started treatment one week ago.
For these answers I have to search elsewhere and I already found some info on medical sites, that may or may not shed some light. (increased intrathoracic pressure and venous return, release antiduretic hormone act.)
BTW my FD has no clue, my pulmonologists said I sound see internist, I have some appointments in near future.

Finley, something very positive about CPAP - not only my AHI are very low, but my HBP is at last under control.
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RE: Need help with Sleepyhead charts.
There is another condition that I am aware of, one we have no guidelines on how to treat. Palatal Prolapse, the palate collapsing on exhale.  See the top graph in the chart.  Looks similar to what I said earlier.  It would be very unusual for you to have this.  This is something to talk to your doctors about.  This means that your CPAP pressure is holding your airway open on inhalation and not on exhalation.

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RE: Need help with Sleepyhead charts.
I agree - 
I don't think I have palatial prolaps, I think I have expiratory flow limitation and I suspect it hapens usually when I sleep on my back ( I have red it at some other site)
Have to try sleep with some tennis balls.

Folowing link may support my theory: 

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RE: Need help with Sleepyhead charts.
thanks, that link just got bookmarked
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RE: Need help with Sleepyhead charts.
Hi Fred, I have had a few bad nights and I wonder if you or someone, would have some advice for me maybe help me to tweak my settings,  I will attach chart and try to explain.
First couple of hours were just awful. I kept falling asleep and waking up feeling like I don't have enough air and at the same time it's hard to exhale.  Second part of night was much better, yet nothing was changed had collar on, lips solidly taped, stayed in same position on my rt, side. This pattern happens occasionally, but I don't usually feel breathless, it felt like I had to breathe when I am not ready.

The Sleep clinic originally set my pressures at 5-10 and no EPR.
I experimented a little with my settings a few times, but obviously I don't really know how optimize  my settings.
Reading some posts here, I wonder if AirSense 10 is best choice for COPD?

Attached Files Thumbnail(s)
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RE: Need help with Sleepyhead charts.
Hi Mila, since you have been diagnosed with COPD, have your talked to a Pulmonologist to see if a bipap machine may help you?

Although, a lot of what I have read doesn’t necessarily mean that a bipap/bilevel would work in all cases of COPD.

This is all very interesting, and I’m hoping that others that have COPD will let us know what machine gives them the most restful sleep.
Apnea Board Administrator

OSCAR Chart Organization
OSCAR - The Guide
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Optimizing therapy

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RE: Need help with Sleepyhead charts.

most of your events are in that hour and a half of h*** that you described and overall that period looks like it is mostly an awake period and other than you associating them with trouble should be discounted.  The events there that you highlighted are obstructive in nature.  If these are bothering you on a regular basis try increasing your min pressure by 1.

Machines are designed to treat specific issues, while there can be some crossover here is a general rule.

CPAP choice to treat OSA, CA, obstructive or pulmonary restriction
The Auto CPAP such as the AirSense 10 AutoSet is typically the initial machine of choice for treatment of obstructive apnea and hypopnea
Just to clarify The VAUTO, ASV and the ST are all BiLevel machines for treating three different conditions, they are NOT interchangeable. They are not a choice between the three to treat a single condition.
They should be chosen to treat the specific condition that the user has,

  • To treat obstructive apnea and minor hypopnea and for most initial treatments a standard Auto CPAP such as AirSense AutoSet (or for her) is appropriate.

  • To treat obstructive apnea and hypopnea, and a standard Auto CPAP is insufficient the treatment of choice is the Aircurve 10 Vauto (has higher pressure and greater Pressure Support (PS) (similar to EPR) available

  • To treat central apnea, the only appropriate therapy would be the Aircurve 10 ASV

  • To treat obstructive or pulmonary restriction including hypoventilation, would be the Aircurve 10 ST
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RE: Need help with Sleepyhead charts.
Thanks for your response. Yes I tried talk to my Pulmonologist, he didn't want to be involved with my sleep therapy too much, he send me to Cardiologist and now he is sending me to Internist. I have appointment in middle of April. Here in Canada we have long waiting time to see any specialist.
Sleep Clinic was big disappointment, I didn't get to talk to any doctor, they didn't even ask me about my medical history. I had at home test and then the sold me CPAP. Polysomnografic tech seen me only couple times and she was not really helpful at all. I had my files transferred to different Sleep Clinic and I have appointment next week this time with respiratory tech.
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RE: Need help with Sleepyhead charts.
Thank you for advise and info.
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RE: Need help with Sleepyhead charts.
I'm guessing you are mouth breathing with a nasal mask, with the reduced flow rates smaller black area on the flow rate chart and larger leaks on the leak chart.
In the interim, till the doctors work it out. I would get a full face mask and see if that improves that part. Then see what the chart looks like. You may need more min pressure and max pressure.
mask fit http://www.apneaboard.com/wiki/index.php...ask_Primer
For auto-cpap, from machine data or software. You can set the min pressure 1 or 2cm below 95%. Or clinicians commonly use the maximum or 95% pressure for fixed pressure CPAP, this can also be used for min pressure.
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