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Neophyte Needs A Little Guidance
Ron - The study was a titration sleep study. I didn't know enough at the time to question how the doctor came up with the initial pressure of 17. I do remember him stating that the study results showed no central apnea issues, though.

I will follow up with a SH attachment soon.

Thanks to all for their learned insight into this crazy world of CPAPing!
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Hi MB.
(09-07-2016, 11:05 PM)monkeybusiness Wrote: .....The study was a titration sleep study. ............I do remember him stating that the study results showed no central apnea issues, though.
Ok, two good pieces of information. Here's a guess as to the doc's thinking: "The titration showed no CA issues all the way up, no particular mask leak issues, and this guy's using a Phillips Resperonics machine (which responds to events more sluggishly than the Resmed algorithms), so I'm gonna Rx a high end, constant pressure, and we'll just squash those OA and H buggers before they ever appear."

Problem is, if I read your above data correctly, the treated AHI has gone up, not down. And the Rx is based on 2 hours worth of sleep (including the titration?) in a foreign setting. Not too characteristic of your home sleep settings, leak potential, tossing & turning, etc.

Of course, rather than speculating on how the Rx came about, you could simply ask him. But it'll probably become moot after some experience and adjustments to your settings.

There's nothing to be discouraged about here. The SH displays will suggest parameter changes.

One thing I'd strongly suggest is to get hold of the sleep study report. It may contain additional insights, and certainly contains data against which you'll want to compare your therapy results.

None of us wishes this affliction on ourselves. But thx to SleepyHead, at least we can play Sherlock with it. -Ron
We are such stuff
As dreams are made on, and our little life
Is rounded with a sleep.
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I will get a copy of the original study from the sleep doctor soon; have an appointment with him at the end of the month.

Meanwhile I've attached a couple of typical nightly pictures of what Sleepyhead is reporting here. Hope to hear some constructive comments on them.

The sleep doctor did say I was an 'active' sleeper. While I'm not informed enough to decipher some of the data graphs SH is reporting, I have a gut feel that Sleepyhead's comment earlier in this thread regarding bi-level therapy may be where I'm headed.

Thanks to all for your help!

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Just noting, you have inverse I:E ratio (inspiration/Expiration) and a very very low tidal volume., with ridiculously high AHI. There is something going on here I can't interpret, but you need to consult a pulmonologist not a sleep doc.

It would be really interesting to see a closeup of your flow rate wave-form.
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Hi Sleepyhead - Is this graph of flow rate close-up enough?
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Holy cow! Do you even breath? I think you need to zoom back out a bit to where you're showing about 2-minutes. 0.2 minutes of breathing is't much to go on, but I can honestly say, I have never seen a graph that flat.
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OK, Sleeprider, this is a flow rate shot at about 2 minute intervals. Hope it makes sense.
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Looks a bit better, and as I said before, I have no idea if there is any significance to the relatively shallow breathing pattern with the inhale lasting twice as long as exhale (exactly the opposite of normal). What I actually had in mind was a screen shot at about this scale where individual breaths are visible over a few minutes:

[Image: 5jUMG9Xl.png]

[Image: j8L37m7l.png]
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Thanks for your interpretation, Sleeprider. I wasn't sure what level of detail you were requesting when you mentioned a closer view of the flow rate. (Attached is another view of the flow rate). Your opinion please?

My sleep doctor used to be a pulmonologist before retiring for a less demanding practice. Thanks to you, I now have more in-depth questions to ask of him regarding breathing patterns.

Given what you have seen in these SH pictures, do you still think a bi-level machine is in my future? (I still have a lot to learn in how to interpret the information coming out of Sleepyhead software).
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I don't think a bilevel would hurt at all. Your breathing is very very irregular and shallow. To interpret the graph, you can right click the Y-axis on the flow chart and click the zero dashed line option. You can also drag the chart to increase the height (scale) so you can see better what is going on. Everything above 0 is inhalation. At 01:39"10 there are 3 good inhales that tails off slowly giving a "chair" like appearance. This is probably flow limitation, where the inspriation starts off strong, but becomes obstructed or limited. At the end of each of those inhalations there is a good exhale that tails off quickly to zero-flow until the next inhale. Looking at the flow line, it is obvious that exhale time is longer than inhale, which is normal. I think your breathing is irregular enough that the machine is mis-calculating inhalation/exhalation times.

Following those 3-breaths, there is some larger amplitude wave forms with rounded tops. This looks like recovery breathing or possibly arousal. This slowly wanes into indistinguishable breath fluctuations that are neither inhale nor exhale, and the machine begins to record a periodic breathing event.

I would like you to change the machine to auto mode because it will record flow-limitation and Respiratory Event Related Arousal (RERA) events in auto-mode that it will not record in CPAP mode. I think that information could be useful. You can set the minimum and maximum pressure at 17, and your machine will continue to function as a CPAP, or you can try some variable pressure like 14 min-18 max. Mostly, I'd like to see what kind of flow limitation and RERA the machine records. I suspect this will show your RDI is a much greater problem than your AHI alone suggests.

Bilevel would help you to ventilate better. In bilevel the EPAP would be adjusted to where it stops most OA events, then IPAP will help with hypopnea, flow limits and RERA. In your case, simple bilevel may not be enough. You have enough flow limitation, combined with periodic breathing that a ASV or Spontaneous-Timed (ST) Bilevel may be needed. You're not recording CA events, and I find that interesting since your respiration is so suppressed at times, it seems equal to CA. There is air movement, just not enough to ventilate. It would be interesting to have the opinion of a professional pulmonologist regarding what he sees in this flow wave form. It's not normal, and your breathing is not efficient nor restful. Your current sleep doctor seems only concerned with extinguishing obstructive apnea. I could be wrong, and I hope he/she takes a serious look at what's going on.
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