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Please Review The Data & Give Recommendations
RE: Please Review The Data & Give Recommendations
I'm now wondering if part of the part of the problem could be the FFM mask.  I went on a trip and when part of the elbow piece fell out, the one with a little silicone valve.  I put it in, it looks like it can only go one way, but that night is when I started the shallow rapid breathing.  I called the DME and they said possibly it is sticking, and yes, it was very  humid in the hotel room and we couldn't get the humidity down.  Well, I came home and my resp rate got a little better but not great, then I started the CPAP of 12.

As far as panting, it has only recently started to happen, either from the mask or from the change in pressure.
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RE: Please Review The Data & Give Recommendations
Have it inspected or get a replacement today if possible. No point in having a mask malfunction out there as a possibility. I would much rather deal with "simple" complex apnea that to also be dealing with this respiratory panting anomaly. If that is a valve, it is the anti-asphyxiation valve. If you block the hose, it should open and you should still get air when you inhale. The mask should be venting from somewhere, and it's often in that swivel. If you can hear and feel it, then that is probably working okay. Block the tube at the cpap end and exhale. You should be able to easily exhale through the mask vent.

FWIW, I don't see any way a fixed pressure is the cause of this issue. It may help make it more apparent, but even that is a stretch. I think the fixed pressure has reduced your event rate, this other issue needs some detective work to see why it has started.
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RE: Please Review The Data & Give Recommendations
I took everything to the DME and it all checked out fine; machine and mask.  I went back and looked and noticed that my resp rate went up prior to my change from a  pressure of 5/20 to constant 12.  It started the night I went on vacation (I did a lot of driving) and hasn't changed (rate still up). 

I have been taking fish oil, 3 pills a day, one in the morning and 2 at night.  The day I left on vacation my wife found some pills that have a higher omega count and now I only need to take 2 pills, which I started taking both at night.  In other words, my total dose hasn't changed, just that I increased my nightly dose by 33% and stopped taking my morning dose.  I did have some stomach pain a day or so into my trip but didn't think much of it, now I'm thinking my system isn't ready for so much fish at one time, but could it cause enough distress so increase my respiratory rate to 50.  FYI, this issue hasn't caused any issues with my daily function or my cycling work outs, just paranoid to go to sleep.
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RE: Please Review The Data & Give Recommendations
Some more thoughts on my recent issues; last night was very much the same as the last few, very high respiratory rates but a better AHI score.  My wife again noticed my high respiratory rate and gently tapped me (I was awake and her know).  We both know it happened right at 02:30, then again at 4:30.  Both times we both realized that I did NOT have a high respiratory rate, in fact, I was NOT breathing at all. 

My hypopnea was enough to wake me and at 04:30 I was able to realize that what we heard was not my respiratory rate, but the pressure of the machine forcing the valve.  I just got done doing my little 'study' wherein I tried different pressures and EPR and I'm here to tell you, for those of you that have a pressure of 15 or higher, I have no idea how you do it, because I could NOT exhale against the machine without FORCE.  Just laying there relaxed, all I got was hyper-expanded lungs that couldn't exhale.  Now mind you, I'm in very good physical condition so this was a bit of a shock as to how much force is required to exhale.

With my new setting of 12 and turning the ramp off (it was at 20 minutes and last night I turned it down to 15 minutes), I tried the CPAP again.  Guess what, it was difficult for me to be 'relaxed' and to exhale against that pressure.  After a short period of time, I was able to experience exactly what my wife and I heard; the air goes in, pressure builds up, then my gut finally contracts to push a little air out, then I get forced with more air, gut contracts, etc.  This is EXACTLY what I woke up to last night, I was not breathing at all but could feel the air being forced in and my gut doing something to force the air out.

I'm wondering if I have too much pressure (went from 10 the first few days, then the last 3 1/2 weeks at 5/20, and up to 12.  The first night of 12 the EPR was 2, the next two nights the EPR was 1, but I'm wondering if I don't need either a lower pressure or a higher EPR, as it seems I can't exhale.

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RE: Please Review The Data & Give Recommendations
Try lower pressure , and maybe allow EPR back in. Your observations are valuable, and sometimes the problem turns out to be an over-aggressive auto machine. We saw a lot of mixed events that caused your machine to increase pressure, then apnea seemed to stop, but what we may have been seeing was a central apnea and you were all packed up with pressure. I'll have to go back and look at the events and try to figure out what lower pressure might work; however, as I recall you have a lot of central events with variable pressure early in the night, and what you are finding is that pressure simply transitions that complex apnea into not breathing at all. I think ASV may be in your future.
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RE: Please Review The Data & Give Recommendations
Thanks, I agree with everything.  A friend said I needed to chill and stop looking at the data for a day or so any maybe I'd relax at night, but I can't do that; not look at the data....I'll start relaxing when I sleep better.  That being said, I am sleeping better than without CPAP so am happy but now that I can see what is going on every night , I want to fix it NOW.  Oh well, I need to take baby steps, but falling backwards was not my plan.

I'm going to lower the pressure and turn the EPR back up, but I'm not going to lower the pressure all the way back down to 5/20.
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[split] My Experience So Far (and thoughts on changes to therapy)
Sleepyrider:  A lot to learn here, thank you!  I'm wondering if I should go ahead and add a pulse ox so that I can see (and show if necessary) before my next appointment.  My doc is on board with the strong possibility for the need for an ASV machine but he needs to demonstrate that he has tried more therapies (pressure changes).

I will say that when the doctor looked at the numbers my machine generated via the DME, he was okay with the way the CPAP was going but knew it needed more tweaking.  I told him that those numbers did not show the entire picture and I asked him if he had ever heard of Sleepyhead; nope.  I approached him cautiously and professionally and he was very interested in seeing it and agreed that it shed much more light on the CA issues and ASV may be needed for my therapy.
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RE: Please Review The Data & Give Recommendations
So last night I changed my settings to pressure of 8 and max of 12, ramp at 3.  I woke up at 11:30 pm not being able to exhale against the pressure and reached over and shut the machine off to reset it back to the lower pressure to start the ramp all over again.  I woke up at 02:30 and realized that I had not turned the machine back on so I'm sort of tossing out the data from last night and making a note.

While I thought it was a waste of time for me, I hate it that I forgot to turn the machine back on, but it gave me an idea and I looked at my data for the last week and I believe I confirmed my thoughts on waking up; every time the pressure gets to 12 I wake up and reach over and reset the machine thinking something is wrong, and there is something wrong, I can't exhale against that pressure.  All the time I've been on a setting of 5 and 20, every time the pressure gets to 12 (sometimes 11.6-11.8) I reset the machine. 

Last night I changed the pressure from 12 to min of 8 and max of 12 and I should have done 8 and 10, then start working my way up to 8 and 11.  The question is, is this common and for those of you running a much higher pressure, did you have to slowly work your way up or is this a common problem with hypopnea and CA's?

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RE: Please Review The Data & Give Recommendations
When we recommended the last pressure change, the idea was to LIMIT pressure to 12. I think we have shown that may also be too high and I though I had suggested lowering it, but if not then we are of the same mind on that. I don't think very many of your apnea are obstructive at all.

I would try limiting to 8 and see what you get. The other thing to consider is to tell your doctor you'd like to do the titration evaluation. This will be needed in the event you end up with ASV anyway.
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RE: Please Review The Data & Give Recommendations
I know the discussion when I was at 5 and 20 to bump it up to 8 since the machine was slow to respond.  I was thinking last night that if I set it at 8 and 12, I would get the pressure I needed and maybe go up to 12 but then drop right back down.  Unfortunately, I now see that the machine climbs when it sees OA's until I stop having them for a good long time.  I didn't realize it would stay at 20, I was thinking more like a burp and then drop back down.

So do you mean to set the max at 8, like do a 5 min and 8 max or just run with 8 constant?
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