Events are on the increase.

[Gillian]

Hi all
After the last time I posted,after much discussion and recommendations I decided to try decreasing the min/max pressure on my S9 to try and bring my numbers down and improve sleeping. However my events have just been steadily getting worse since then even though things like leaks seem to be improving.


To start with only the CAs were increasing but now OAs are as well. Last night was AHI 32.2 (CA 27.2 OA 4.4 HYP .) When looking at the pressure graph the line seems to be right at the max most of the time. Does this mean I should increase pressure a little? I have always known that CAs were more of an issue for me ( my meds are pretty high) but for a few nights both CAs and OAs reduced. I have been under a lot of stress about health issues, inflammation is on the high side as well. I realise these things can also affect the sleep apnea but please could someone have a look at the following graphs and see if anything stands out that I could do to change the numbers



If anyone after reading all this still has the patience to look at these respiration graphs and could tell me if they are ok it would rest my mind because I feel as if I am not breathing properly (too shallow, maybe)

Thanks so much everyone for your endless dedication to this cause, it is so easy to read all about this stuff but when the brain is foggy understanding it all is a different matter.

Thanks again
Gillian

[Pugsy]

Wow, sort of a mess isn't it?
Is your doctor aware of all the centrals? If not, he should be. What meds are you taking that might be a factor in the centrals?
How is your sleep during the night? Is it fragmented at all? Wake up often for some reason or other and maybe spend considerable time awake or semi awake with the mask on?
I wouldn't be increasing the pressure trying to reduce the obstructive events with this number of centrals being flagged.
Right now the central component is huge problem. More pressure might make them worse.
Leaks still appear to be problem...are they causing you to wake during the night?

[Slartybartfast]

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[Pugsy]

Well, you've got a bunch of leaks, and that's not good, but what I see as the problem is the pressure trace is bumping into the upper limit which you set way too low. Try raising the upper limit to over 14 and see what happens.

Slarty, I think she tried higher pressures already. She said this

I decided to try decreasing the min/max pressure on my S9 to try and bring my numbers down and improve sleeping.

She's actually using a range now that is pretty much what the pressure were in the first part of the month where she had a nice low AHI...can't tell date exactly but Nov 4th and 8 where the range was pretty much wide open and the pressure didn't go above 11 it looks like.

I would wonder what cpap mode would do...also wonder if meds are a factor. Something appears to have changed dramatically and not for the good. I noted the hitting of the max line but with the number of centrals being shown last night...I am not so comfortable letting the machine have more pressure available without seeing other detailed reports.
Might be interesting to see the Nov 4th and 8th night's detailed reports (or whichever dates are the dates with the really low AHI).
I also wonder if the meds might be opiates or muscle relaxers that might make obstructives worse or even depress the respiratory system and affect centrals.

[Lizistired]

It looks like the best leak line was the few days she went to CPAP, around nov 17. I think I would go back to cpap and work on the leaks. Try another mask or the tape, chinstrap route. I think the leaks are waking you up, and the pressure is increasing the leaks.

[Todzo]

Well, you've got a bunch of leaks, and that's not good, but what I see as the problem is the pressure trace is bumping into the upper limit which you set way too low. Try raising the upper limit to over 14 and see what happens. Better yet, simply set it at 20 and get it out of your way. I've been running that way for more than 2 years. If your machine isn't allowed to deliver sufficient pressure to keep your airway open you'll have lots of obstructive events, followed by centrals. Frequently what happens is during an obstructive event one will briefly awaken, take several deep breaths, then when O2 level normalizes, the body relaxes and sort of forgets to breathe, and a central is recorded.

if breathing is already unstable at the lower level will they stroke out if they do this

[Gillian]

Good morning and thank you to Slartybartfast, Pugsy, Lizistired and Todzo for your comments.

First I'll answer your questions. All docs know about the centrals and yes, I take opioids for chronic pain and RA drugs. RA specialist reluctant to change anything due to past experience. Sleep doc who I see in 3 mths, isn't convinced about ASV. Maybe I should ask for a trial anyway, what do you think? I can try to very slowly reduce the pain meds, emphasis on slowly!
Sleep is very light most of the time but not really aware of leaking mask, just aching body!
I did bring min/max closer together and reduce pressure because of various posters suggestions about pressure and centrals.

Below are the graphs for Nov 4 as requested

Now the most amazing thing is last night's graphs. AHI 15.9, H .21, OA 1.55, CA 14.15. Nothing was different from before other than the fact I scratched my nose during the night!


Should I now wait in the hopes that this trend will continue (as has happened before) or do you have any other suggestions?

Todzo, would you mind explaining your comment about unstable breathing for me please? Those respiratory graphs I haven't mastered yet.


Thanks all. Have a good night

Gillian

[xenablue]

Bump.

[ems]

I'm guessing this is the thread you are speaking about. You got several replies and from several knowledgeable people. Anyway, another...

BUMP

[Lizistired]

What I was going to say over there....
I really think you have to get the leaks under control. Your leak line is so jagged that it seems you are either fixing leaks all night, or the mask is leaking with every breath. I also think some of us fight the pressure. Looking at your event line it is hard to believe that you are sleeping at all.
I would like to see more zoomed screenshots of your apneas like the one you posted but with the other graphs included too. The flow graph shows that for that central, your breathing just faded. I would like to see shots where you have OA's too, like in those dense clusters, but please include the event, flow, leak, and minute ventilation.
With your meds and leaks, yours is not a situation where we can look at it and say 'increase this', decrease that', 'turn this off'..... We're not going to pretend we have solutions that we don't have, but we can help you sort through the data and maybe identify thing you might be able to work with your doc on.
Do you have trouble breathing through your nose?

[Pugsy]

I agree with Liz....that Nov 4th leak line is pretty ragged and often well above the 24 L/min line where ResMed says we should stay away from. If that is what you are seeing every night then you need to work on the leak line.

The centrals...unless you are awake fiddling with the mask and leaks and are having awake events being flagged then I think you need to talk to your doctor about them.
Way too many of them to explain away with a little sleep wake junk going on for me to be comfortable with.
Maybe it is a combination of things...meds...pain...whatever but given the number of centrals until you can prove otherwise (like awake events being flagged) they are a concern that needs evaluation by a medical professional.

[Lizistired]

AARRGGHH don't you hate when you lose a really long post!
Soo what I was going to say was... in it's now abreviated format
We forget that new users don't have data to compare to.
Gillean your leak line is scary. Your event line is scary.
This example is 10 hours and the leak stays up for a period. Your's is so jagged that I can't believe you are sleeping through it.
Edit because I'm Ps'd that I lost my last post...
I have leaks but they occur for a period of time, maybe a sleep stage and then I wake up...
Maybe I wake up when I fix a mask leak. But your leak line and event lines are off the charts!
I would like to see zoomed screenshots of your event clusters, but please include the flow, event, minute ventilation, Leak. Sometimes your flow will just fade to nothing and sometimes it will show an increase in breathing before the event. Please show these details.

[Gillian]

Hi Pugsy and Lizistired

Thanks for your responses. I have posted the graphs below that you asked for Lizistired, hope I haven't zoomed in too much AHI 18.87, CA 13.73,A .22, H .45. Resmed always shows smiley face so I assumed leaks were within the limit. Rarely wakeup to adjust mask,maybe once or twice. more likely to scratch an itch! Could Resmed be wrong. Actually I,ll go back in and attach a sleepyhead leak graph for the same period. I find it hard to compare.

Last night I added silicone around the elbow that joins the hose (not on the vents of course) because I have noticed on occasion an excess of air coming from there so wondered if it would make any difference. Does the leak graph look any better to you?

No problem breathing through my nose. Centrals have been there from the start but it gets scary when the numbers are all over the place like this. As well as I feel lousy but I guess that is to be expected at this point. I am going to try and bring forward my appt with sleep doc.

Once again, thanks for looking













Gillian

PS Quickly post. Third time lucky!

[deltadave]

What's the chance of uploading the files from the datacard (DATALOG, SETTINGS, 2 Identifications and 2 STRs) somewhere (like Dropbox)?

[Gillian]

Sorry Deltadave but I'm not familiar with what you are talking about, I only have basic skills. Not too bad at following instructions though if you want to explain further.

Gillian