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Reasonable AHI but still tired, day 20
I was diagnosed with a severe sleep apnea last year after many years of being told I snore.

I am 34yo, 6'5" former college football player. I am in good shape, I could probably lose some weight (36" waist) but they told me it was partly due to having a large neck (18.5").

My insurance wouldn't pay for an in-lab titration so I was assigned a Phillips Dreamstation. It is set to start at 5.5 and ramp over 10 minutes. My pressure will be 90% at <10 usually but occasionally will go as high as 16. It seems the machine always tops out at 20 at some point over the night.

Trying to get my AHI down, I still wake up with the "apnea bathroom feeling" at least twice a night now.

Is there any tweaks I could make? I never actually saw a sleep doctor, just did the at-home study and he read the report and said, "Yep, you've got it."
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Welcome to Apneaboard. I read your story, and it looks like you need to increase the minimum pressure a bit. It would help if you reworked the screenshot so you are not zoomed into one minute. Take a snap of the whole night so we can see how your machine responds to the events. Everything looks normal with a bit of residual obstructive breathing. Finally, have you tried any alternative AFlex settings yet?
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(02-06-2017, 07:01 PM)Sleeprider Wrote: Welcome to Apneaboard.  I read your story, and it looks like you need to increase the minimum pressure a bit.  It would help if you reworked the screenshot so you are not zoomed into one minute.  Take a snap of the whole night so we can see how your machine responds to the events. Everything looks normal with a bit of residual obstructive breathing.  Finally, have you tried any alternative AFlex settings yet?

My bad, I fixed the layout. I was rearranging the graphs and didn't notice it had zommed in.

The machine starts off now at 8 I noticed this morning actually now that I think about it.

How does one change AFlex settings? It seems like its very limited as to the menus in the machine.

Thanks for the reply!
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Aflex has to be enbled in clinician mode.  Your DME may not have done this.  If not you can get the clinician manual from this site.  Basically you press ramp and the dial button at the same time.  After 5 seconds or so, clinician setup mode appears on your screen.  Aflex is under the comfort settings. After you enable it, an Aflex option will appear in the user's menu. You can set it from 1 to 3 for pressure relief on exhalation and, I believe, inhalation. It's billed as a setting to increase comfort and, therefore, compliance.
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Hi melloyelloww,
WELCOME! to the forum.!
Good luck to you with your CPAP therapy, hang in there for more responses to your post.
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Much better on the graph, thanks! You can enter the clinical menus by pressing the control knob and ramp button at the same time, then going to settings. The Respironics DS 500 Auto is a good machine, but it's a bit slow to respond to events. The secret to good treatment is the minimum pressure. Enter the clinician menu and change the minimum pressure to 9.0. The events in your chart are obstructive in nature, so increasing minimum pressure usually provides some relief for that. Don't worry about VS2, it's meaningless. Flow limitations are the beginning of obstruction, and is one of the events that will cause pressure increases, much like snores. A minimum pressure increase should reduce all these events, and it will take some trial and error to fully dial things in.

Scrolling through the menus you can also enable Aflex and put in in setting 1, 2 or 3. That is a comfort setting and you will need to experiment to find what feels most natural. It is simply a setting that provides some pressure relief at the beginning of exhale and affects the rate pressure increases at the beginning of inhale 1 is less, 3 is more. You can get a lot more details by getting the CPAP Setup Manual at the link at the top of the page.
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(02-06-2017, 06:20 PM)melloyelloww Wrote: Is there any tweaks I could make? 

If you sleep on your back, see if sleeping on your side reduces your obstructive apneas and hypopneas. They can be much higher when sleeping on your back for some (like me).  
Change 1 thing at a time and hold that for a few days to see if you get a consistent result.
Please organize your SleeyHead screenshots like this.
I'm an epidemiologist, not a medical provider. 
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I sleep on my side normally.

I tried lowering the AFLEX to 2 but it made it somewhat uncomfortable. I don't remember taking the mask off but apparently I did for 2 hours last night from 5-7am.
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Flex is for comfort, and I preferred 1 when I had a Respironics machine. Still looks like you need a minimum pressure of 9.0.
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Please don't let this be discouraging, but the way I look at apnea treatment is twofold - first treatment immediately starts to protect you. But even with treatment optimized it can take some people several months before they start to feel benefits.

In my case I kept hoping for more energy, but it took several months before it started to happen. And in fact it was so gradual that I don't know if I ever explicitly noticed it. It was more a matter of one day realizing "wow, I don't feel tired and like I want to go back to bed all day".

So keep working at optimizing treatment, but don't feel like it's not working if you don't see immediate benefits. They will come, and often so gradually over time that you don't notice them as they are happening.
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