One year -- whazzup with these numbers?

[palerider]

** What are the pressure spikes around 8:00 a.m.? I was awake during that time and felt those spikes.

the respironics machine is like .... I dunno, a bratty kid in the back seat, or the nurse in the hospital.

when everything is quiet and you're just smoothly going along, it starts poking at you, "are we there yet? are we there yet?, are we there yet?", or "are you sleeping ok? poke poke poke poke" the stated idea is that it's checking to see if you'd do better with a bit higher pressure...

if it were me, I'd try 13-16 tonight

[Pugsy]

The pressure spikes around 8 AM are just the routine test pressure probes where every so often, depending on what the machine is sensing in general, it increases the pressure 1.5 cm and tests the "waters" so to speak. Just normal function that happens to look more remarkable due to the scale of the graphs here. On Encore they would be tiny. They aren't as rapid as it initially looks like either...in reality the increase is much more subtle.
See this thread for examples that are a little easier to see.
viewtopic/t80875/Respironics-APAP-press ... se-up.html

I need to go back and look at some of the initial reports where the AHI wasn't so bad.
Given that the AHI seems to have gotten worse instead of better and it seems to be mainly hyponeas and the machine doesn't want to kill them...I am wondering if they are central in nature and if that is the case then I wouldn't be increasing the pressure...I would be backing way up and starting lower at maybe a fixed pressure.

Give me a bit of time to go back and look at the older reports where I was wondering where the titration study came up with RX of 13 and the machine didn't want to go there. I need to refresh my memory a bit.

Edit: Okay I went back and refreshed my memory and the first reports in terms of AHI were a lot better than what we are seeing now and the leaks were better too.
Things have gotten worse with the pressure increases and not better in terms of AHI numbers and that along with the hyponeas in abundance (and I assume you weren't awake during that time period) and the machine not wanting to increase the pressure makes me wonder if they hyponeas are central in nature or maybe half and half or something.
I would back way up if it were me and try 8 or 9 cm with no range or teeny tiny range.
I suppose we could try apap with min of 13 and max of 15 or 16 just to see what the machine wants to do but if those are centrals related to pressure it won't help and may make them worse.

Where's Morbius?

[M'ohms]

I don't remember reading if anyone discussed bed pillows or not. Assuming that the leaks are coming from a dislodged mask, Ruby's pillow might be part of her leak-problem. There are many different pillows that can make mask problems subside. Google CPAP pillows for some ideas. I fought my pillow every night because it pushed against my mask enough to cause problems and keep me awake. I bought a buckwheat pillow and no longer have those issues.

http://www.amazon.com/CPAPfit-Pillow-Co ... B00NERG2O4

[RubySnooze]

July 21
Pressure lowered to 8/8
No tape

Only 3.5 hours of fairly good sleep (problems after 4 a.m.), but ONE hypopnea during that time. Was having well over 100 hypops prior nights.

[OSAHell]

Hi RobySnooze,

I'm glade you finally tried those low pressure! Keep this pressure for a few days and if AHI are in the same range you should try lowering your pressure by 1 for an other few days and see were AHI will go.

What was your problem after 4 AM?

[Pugsy]

try lowering your pressure by 1 for an other few days and see were AHI will go.

I think the AHI will go higher and the bulk of it being OAs but worth trying. If that should happen then I would go 1 higher and try 9/9. Perhaps there is a fine line that takes care of the OAs and won't trigger the hyponeas which I now think are central in nature. If there isn't...there may be a need for that high dollar machine and a sleep study in a lab.

[RubySnooze]

What was your problem after 4 AM?

Sick cat. Had the starving, puking, pooping trifecta.

[RubySnooze]

Perhaps there is a fine line that takes care of the OAs and won't trigger the hyponeas which I now think are central in nature. If there isn't...there may be a need for that high dollar machine and a sleep study in a lab.

Pugsy, is this the same as that (atypical) situation you've described elsewhere where higher pressures cause more central apneas? Or is there something different happening because these are hypops and not apneas?

[Pugsy]

IF (big if) the hyponeas are central in nature that would explain why the machine wasn't responding to them with more pressure like it would if they were obstructive in nature.
Why would it flag them as hyponeas and not centrals....I don't know unless it just couldn't tell and maybe the leak played a factor and maybe it didn't.
Complex sleep apnea where the pressure is the trigger and causing the centrals (if those hyponeas are indeed central in nature) happens to a few people who start cpap therapy and didn't have centrals without cpap therapy.

I don't know that is for sure what is going on here but it is sure suspicious especially since the lower pressures significantly reduces the AHI component that is in the hyponea category.
Makes me wonder how they came up with a RX of 13. Makes me wonder about a lot of things.

What's going on is atypical though and I am glad you have that appt with the new sleep doc. There only so much that we can glean from the data the machine provides.

Morbius might be able to look at the breath by breath thing and offer some input but he hasn't dropped by.
He's really the only one I can think of that can look up close and offer an opinion on if those hyponeas are really central or not. I know I sure can't. All I know to do is go by what is common or logical and trust the machine and the machine has limitations.

If it is complex sleep apnea sometimes it will go away with time but you have 7 or 8 months of this therapy and it hasn't gone away. If it is complex sleep apnea sometimes there is a fine line that will treat the OA stuff effectively and not trigger centrals.
Lots of ifs that are probably best figured out by the professionals. I do know that if it is complex sleep apnea then apap mode isn't the way to go unless it is done like you are doing now with essentially no range so we don't lose FL flagging...or maybe a teeny tiny range.

How all this weighs in on your other problem of fragmented sleep...I don't know if it is or isn't a factor. It could be or it could be a totally separate issue.

[RubySnooze]

Thank you, Pugsy!

Also, big thanks for the pillows. Used the small last night and it was a thing of beauty.

And the jerry-rigged hose management system is working swell, too.

Is this forum saving my life, or what??

[OSAHell]

The main problem with hypopneas is that a xPAP DON'T/CAN'T detect if it's central or obstructive in nature, they simply flag them as hyponeas... Even Dr have hard time flagging a hypo as a "central hypo" on a PSG, they simply put them in obstructive category and treat them as such and that's for the ones who knows central hypopnea actualy exist. Probably because most of the time those are obstructive like apneas so not many Dr care about it, like some, but less common, that don't even care about central apneas.

What might be appening here when on APAP is that your machine see those hypos, try to fix them by increasing the pressure but since your AHI go up, the machine back off on the pressure for a while and then try again later...

[Pugsy]

The July 20 report...APAP mode with small range 11/13
There's a truckload of hyponeas and the machine pretty much didn't do anything for a prolonged period of time.
Second half of the night and the longest sleep session.
The machine is doing the pressure pulses, there's a truckload of them too.
If they had been obstructive the machine should have maxed out.
After the cleart reports and the PR S1 calling centrals as OAs...I can't help but be concerned.
Now a long time ago before the system one machines I used to see M series reports with a ton of hyponeas and the pressure not doing anything and the people ended up being on ASV as those hyponeas were centrals.

What might be appening here when on APAP is that your machine see those hypos, try to fix them by increasing the pressure but since your AHI go up, the machine back off on the pressure for a while and then try again later...

[OSAHell]

After the cleart reports and the PR S1 calling centrals as OAs...I can't help but be concerned.
Now a long time ago before the system one machines I used to see M series reports with a ton of hyponeas and the pressure not doing anything and the people ended up being on ASV as those hyponeas were centrals.

Yeah, I remember "clrearyt" case but in his case it was pretty obvious those had an high probability to be central in nature as soon as we got his detailed data. In his case those OAs were probably mixed apneas flag as OAs. In the case here, she show some sign of periodic breathing but not that much from the nights I've check so far. But she surely have some strange breathing at time and hopefully his new doc will be able to clarify that! There’s her other health issue, meds and those damn leaks that also make it harder to make some sens of all this. Not to mention her "famous" perfect titration with a pressure of 13 that her first doc never even care to try...

One of my first clue that many might be central was few weeks ago when she posted her PSG and titration results, in all that split-night study she had 100% hypopneas, not a single one apnea was flag all night long! Adding that to the fact that she struggle on CPAP/APAP, strange behaviour of machine APAP algorithm, don't snore, don't seem to have weight problem, have insomnia problem (often seen in CompSA or CSA), it surely look more CSA or CompSA than plain simple OSA. I fit that profile and look what I'm on now! Also, in all the thread I've read here and other forums in the past year, what seem to happen often is that people which had very high % hypopnea in there diagnosis and struggle on CPAP/APAP often end up on ASV. There is some correlation to what you saw a long time ago with people on M serie.

[RubySnooze]

July 22
Pressure 8/8
Swift FX no tape

[Pugsy]

Would you mind trying taping your mouth tonight and let us know tomorrow how well the tape stayed in place along with the report?