How to identify central or complex apneas using software

[biz1219]

Thank you for your clear explanation.   The hour is late tonight but i'll continue to work on these issues and report back.

Permit me to raise a matter of discussion - with wide fluctuations - how can a sleep lab come up with an "end all" situation finding.   I frankly don't know how that would be possible.   The results of an overnight sleep study seems like a mere snapshot of a moment (night) in time.

The attached chart is of AI and AHI results for the past 177 days ending 30 April 2019.   [I like to see nice smooth consistent results.  These are not!]

I see a small beam of light emerging from the end of the tunnel.   Many thanks,  clif

PS   I am eligible for a new mask of whatever type is appropriate.

[biz1219]

Please clarify your intent on this - I am not understanding:

"...set the min at 'med' median pressure, or 2cm below 90/95%. max at 20cm for now."

thanks
clif

[ajack]

You can have 2 different nights in a sleep lab. They check and rule out a lot of things and get the best settings they can on the night. It is up to your doctor and DME to confirm that it was correct. At this point of time no one can say. They would have got a mask to seal in your sleep study, you may be able to find out what they used.

It seemed clearer than that when I wrote it. it is a jumble and I should clean it up "...set the min at 'med' median pressure, or 2cm below 90/95%. max at 20cm for now."
That is just general advice for setting up an APAP, to get in the ballpark, moving from 4/20 to something that will work.

[biz1219]

This will serve as an overnight update.  Please see .PDF for details and statistics.   Let me say that the mask arrangement last night was nasal pillows with a BreatheWare Halo taught chin strap.  This was the exact same combination used at my last sleep study.  My assessment of last night - it didn't work - it was unsatisfactory with a AHI of 41.58.   Leaks were improved, mask pressure were improved; but results were poorer than previously.

I plan to return to the full face mask tonight.   Hopefully today will allow for adjusting that mask better.

For comparative information - 90 day results at various times.  Figures are for AI, HI and AHI - all covering a 90 day time frame.
1.  90 days post-receiving new ResMed AirCurve10 ST:   AI 3.5  HI 7.7  AHI 11.2
2.  90 days pre-hip surgery:  3.4 7.2 10.6
3.  90 days post-hip surgery starting 2 months after surgery:  6.0  8.6  14.7
4.  90 days current time frame ending Apr 30, 2019:  12.1  15.2  27.3.
5.  Last night's results:  AI 26.21  HI 15.37  AHI 41.58

From Jun 2017 to Oct 2018 - Mask = nasal pillows, same setup as in sleep lab.
From Oct 2018 to present mask = full face mask except for brief trial periods returning to nasal pillows.

[biz1219]

For the last three days I have been using ResMed Mask Fit utility.   Each time the utility indicated a good fit; but nightly results haven't been satisfactory in reducing or eliminating mask leaks.  The night of May 5th I perceived a great night of sleep; but the sleep stats revealed otherwise.  The night of May 7th I was constantly awakened due to mask leaks.   I am feeling very frustrated as I haven't been able to get to even first base with leak elimination.  

Attached are charts with supporting information from three nights.  TIA for help.   clif

[biz1219]

Failed to upload graphics with previous post.

[ajack]

That bit at 4:30 was a winner. Very little leak and the pressure rose to the treatment pressure for a few minutes. All you need to do is get the rest of the chart to look like it. It's back to the DME for them to fit it or try another mask. I'd ask for the manager, who is normally the one who has a better idea and will do something to stop you bothering him. I would guess like here, half the front staff are clueless.
There are also suppliers online that will allow a mask return.

Do you have the tube running back behind your head? arms and bedding can cause issues.

When you do the mask fit function blowing high pressure air, laying down. Have a good pull and twist of the mask, to see where it is leaking. What model of FFM are you using. It's very individual. I tried several, the f20 was the one that worked for me best.

[b.e.wilson]

 How can I identify central or complex apnea events. 

For me it starts with "periodic breathing." This is a pattern that looks like a scalloped wave series (^^^^^) in the airflow with each wave lasting about a minute, and the amplitude of the waves decreasing until I just stop breathing. Then the machine forces a breath and I restart the series. Do an image search on periodic breathing to see the pattern.

[Gideon]

Keep in mind that Central events are more commonly found not associated with periodic breathing.

[Sleeprider]

This looks lke complex apnea with mainly central events to me. You are using an Aircurve 10 ST at 23/14 which is a PS of 9.0 cm. This will trigger centrals in most individuals. You are not experiencing apnea during the ramp period when pressures are lower. In spite of very high pressure support, your tidal volume is only 380 mL, but your respiration rate is over 19 BPM.

Please read the instructions in my signature on organizing your charts, and post some close-up zoomed attachments showing 2-minute segments. This will make the flow wave clearly visible, and we should be able to see what is going on. With these very poor results, your doctor should be making arrangements for a titration to evaluate ST and ASV therapy to find what works, and to differentiate the apnea you are experiencing. We can help on the forum, but you have uncontrolled sleep disordered breathing with undefined events. That is the role of your doctor, not us.