RE: New Member - Hello!
On 6 Aug you are showing a tendency to tuck your chin and restrict your airway. If this continues you need to manage it w a soft cervical collar that is fit just tightly enough to keep it from letting the chin tuck under
Where would you like the balance between obstructive events and Central events?
You have a history that shows you get Centrals when you raise pressure yet you raise your max pressure to allow this to continue to happen. You should be moving toward a narrow band or preferably a fixed pressure. There is absolutely nothing that you can do to treat Central apnea with your machine, you can only avoid them. The
RE: New Member - Hello!
(08-07-2019, 08:11 AM)bonjour Wrote: Where would you like the balance between obstructive events and Central events?
You have a history that shows you get Centrals when you raise pressure yet you raise your max pressure to allow this to continue to happen. You should be moving toward a narrow band or preferably a fixed pressure.
Can you please explain in a bit more detail what you mean by this? I want to minimize my sleep disturbances so I can sleep more normally and feel better in the morning. Other than that, I am open to anything. No magic ratio I am seeking with respect to centrals vs obstructives - I would like to avoid/eliminate both!
I don't believe I have a chin tucking issue, but will definitely think about how to check, maybe using a nest camera. Is there a pattern in my charts that points to this? Just curious about what you look at to determine this on the OSCAR charts.
Aiming towards a more narrow band or even a fixed pressure sounds pretty doable - are you saying that a fixed pressure or narrow band will treat me more effectively? Or just that I shouldn't expect much without changing machines, and that the fixed/narrow band approach is the best I can do for now with my current machine?
RE: New Member - Hello!
(08-07-2019, 11:49 AM)skiajl6297 Wrote: (08-07-2019, 08:11 AM)bonjour Wrote: Where would you like the balance between obstructive events and Central events?
You have a history that shows you get Centrals when you raise pressure yet you raise your max pressure to allow this to continue to happen. You should be moving toward a narrow band or preferably a fixed pressure.
Can you please explain in a bit more detail what you mean by this? I want to minimize my sleep disturbances so I can sleep more normally and feel better in the morning. Other than that, I am open to anything. No magic ratio I am seeking with respect to centrals vs obstructives - I would like to avoid/eliminate both!
I don't believe I have a chin tucking issue, but will definitely think about how to check, maybe using a nest camera. Is there a pattern in my charts that points to this? Just curious about what you look at to determine this on the OSCAR charts. Look on 1 Aug and 6 Aug. you have "clusters" of Hypopneas, this is what indicates the chin tucking. It is quite clear.
Aiming towards a more narrow band or even a fixed pressure sounds pretty doable - are you saying that a fixed pressure or narrow band will treat me more effectively? Or just that I shouldn't expect much without changing machines, and that the fixed/narrow band approach is the best I can do for now with my current machine? I am pretty good at optimizing therapy, somethime I do it a bit slower that others, but I'm methodical about what I do. In the process I'll learn how your apnea responds and tweak to give you the best overall possible. At this point I do not know if you need a new machine or not. That is part of the exploration. But I wrote the WIKI on how to get an ASV machine. Believe me, if I miss something others will come in and question me. I suggested increasing your min pressure to 6. This presents a narrower band and directly addresses the hypopneas. We will see what happens to the hypopneas when you do this. I'm anticipating a further increase to 7. Note: I'm not increasing the max pressure. That should help decrease Centrals but in either case, we will see what happens to the centrals and adapt accordingly. The goal is to see you get the best therapy that you can get.
RE: New Member - Hello!
bonjour -
Thank you for making the time to explain. I genuinely appreciate it and better understand now.
Given we are aiming for a narrow band here, would you suggest bumping the max back from 8 to 7.5?
I would then aim for a min of 6, max of 7.5 (or 8 if I don't change back). I have A-Flex on 1, having tried 3, revertied back to 2, and then settling on 1 as most comfortable.
I will report back!
RE: New Member - Hello!
This is a start, I wouldn't have raised it to 8. But we can start from either.
08-12-2019, 09:19 AM
(This post was last modified: 08-12-2019, 09:26 AM by skiajl6297.)
RE: New Member - Hello!
Interesting developments, although not yet backed up with charts. After above suggestions, I adjusted my min back up to 5.5, and bumped the max down to 7.5. My device's 90% pressure (again, per Dreamstation app, not OSCAR) has bounced around 6.5 on average across several nights, with one night at 7.5, and a 6.3 thrown in.
Using my Dreamstation app on my phone, (haven't had a chance to OSCAR yet), I have had consecutive nights of reduced overall AHI. Normally I have bounced from good nights around 5-6, bad nights being 7-8. The AHI is almost entirely hypopneas and centrals, although clearly centrals have trended down. Obstructive has also seen a small benefit. Hypopneas seem slightly better, but still averaging around 20 events per night.
AHI since the change to 5.5-7.5cm range:
4.1
2.4
4.3
4
3.6
Nearly all of the remaining apneas from these 5 nights at this pressure range are marked as hypopnea. (Charts should help, and will do that as soon as I am able.) Obstructives appear to be improved with this change - the worst night was 9 total obstructives in a night, and the best was zero! On contrast, I still had 27 hypopnea events on an otherwise clear night where I had 2 obstructives and 2 centrals (4.3 overall AHI that night).
I should also note, seeing slight improvement in morning feel too! Not quite waking feeling rested, but not feeling as bad as other nights. I also noticed that with these pressure settings my sleep has been VERY disrupted - tossing and turning and not staying down. I did have some travel mixed in, so some of this may be due to environmental changes.
Welcome any thoughts on further adjustment. Thanks!
RE: New Member - Hello!
Adding some oscar data to follow the comment above. Please let me know if anyone has any thoughts.
Same issue, loads of tossing and turning.
RE: New Member - Hello!
According to my Dreammapper software, these settings are keeping my obstructives down. I continue to see less than 10 obstructive instances per night. However, still dealing with centrals and hypopnea. Centrals are around 10 per night, and hypopnea around 25-35/night. AHI hovering just around 4.5-5.5, but still not feeling great.
I plan to further adjust my min up to 6 from 5.5 to see if it continues to address hypopneas and centrals, leaving max at 7.5 for now.
RE: New Member - Hello!
Latest charts attached. I welcome thoughts on how to proceed. I think I am sensitive to pressure changes above this small range.
RE: New Member - Hello!
two things
set flex off This should help your central apneas
Set min pressure = 7 This should help your hypopneas.
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