suggestions for adjusting my pressure?

Hi! I'm new to the world of sleep apnea machines, though I have probably had sleep apnea for 4 years. My AHI is 22, just obstructive sleep apnea and not central sleep apnea. I have a new dreamstation apap that is set to 9. I have been using it since August 2, with AHI indices between 1.6 to 8, mostly around 5.6. During my in-lab sleep study I was dialed up to a pressure that reulsted in an AHI of less than 1, and slept comfortably and felt fantastic the next morning.

I've been really impressed with the advice doled out on this forum. I have downloaded my first month of data to sleepy head. What sort of information should I screenshot for advice?


I wear a full face mask ( fischer and paykel) , and the only problems I have had are an occasional "thud" from the silicone flap, and my own drooling ( non-obstructive!)

Thanks in Advance

If you have an APAP is it set to a fixed pressure of 9 ? You could set it to Auto with a range of pressures. Please fill in your equipment so it will show up on all your posts. Download Sleepyhead software so you (and we) can see some charts.

For examples of what we like to see because we don't need all the graphs that Sleepyhead gives us.
https://sleep.tnet.com/resources/sleepyhead/shorganize 3 pages, be sure to read all of them

and how to use imgur to host those images
https://sleep.tnet.com/reference/tips/imgur

While the AHI is important.... the event category breakdown is more important.
If the nights when your AHI is high and the primary component of that AHI is Clear Airway/Central apnea events...you may not need more pressure.
More pressure won't necessarily fix the centrals and for some people it could make the centrals worse.

Thanks for the advice already; I'll look for "clear airway/central apnea"

I couldn't find how to adjust my signature with the info- I will look for that.

The machine is:
Philips Respironics DreamStation Auto CPAP (500X110) ( but set in CPAP mode pressure 9 cmH20)

I followed the instructions. For some reason my data does not include flow rate, and several parameters are missing in spetember data. Therefor I did a screenshot of August data.

With the Respironics machines the Flow Rate graph data files the SD card has to be in the machine so those files can be written to the SD card.
Did you by chance forget to put your SD card in your machine before you went to bed?
Maybe realized it was in the computer so you stuck it in the machine and then put it in your computer?
While the machine stores some files in its internal on board memory the files necessary for flow rate graphs aren't stored so if the card isn't in the machine the flow rate graph files are lost.

I can't read your image. Too small and I can't click on it to make it larger.

When posting your image...after you are logged in and after you have selected the image you want to share look over on the right side for the box of addresses...and right below that box is where all the thumbnail choices are.
Select Large Thumbnail...then copy the last line in that box of addresses and paste it in the body of your text here.
Once you post it the image will be fairly large and might be large enough we can read it but if it isn't then we can click on the link and go to the image and make it larger.

this is large thumbnail and then giant thumbnail











Its possible,, I don't remember. I'll look back at early August data to see if the right information is there, since I hadn't touched the sd then

Do you spend much time awake with mask and machine on? I see one short break in therapy with some green CSR/PB flagged at about the same time. Were you awake?

Are you wanting to make use of auto mode and try a little more pressure?
If so, if it were me, I would just change to auto mode and use the 9 cm as the minimum and maybe try 12 or 13 for the maximum just to see if it wanted to go up anywhere.

Oh..BTW...Flow limitation flagging is turned off when in cpap mode on your machine.
So the lack of Flow limitation flags on that Events graph doesn't mean they didn't happen...just means the machine didn't flag them.
Even when Respironics users prefer a fixed pressure like you are using now if they have an apap capable machine we suggest changing to auto/apap mode and just set the minimum to equal the maximum which makes it a single fixed pressure but FL flagging is turned on.
Flow limitations are like snores in that they are early warning signs that the airway tissues are trying to collapse.

Sorry, flow rate is there. Flow limit is missing and reads as 0. In September flow rate data is missing, along with tidal volume, minute ventilation, inspiratory and expiratory time and respiratory rate- but I bet those last five aren't as pertinent. I know the sd card was in then. But regardless, I'm happy to go with August data!

Ah, I see your comment pugsy as I am writing. I am going to take your advice. I know there is a guide online for changing it to auto mode and will do that. I'll bet I spent some time awake with the mask and machine on- I normally wake up early, so sometimes on days off I still do.

What does the "clear airway number signify? I mean , I know it means whether my airway is obstructed, but it averages 0.6. What is normal?

ok, from sleepy head glossary:

Apnea/Clear Airway Apnea Detection the the Respironics System One.. An apnea is detected when there is an 80% reduction in airflow from a baseline for at least 10 seconds if there is no airflow detected for 10 seconds. During the apnea, one or more pressure test pulses are delivered by the device. The device evaluates the response of the patient to the test pulse(s) and assesses whether the apnea has occurred while the patient has a clear airway or an obstructed airway. The airway is determined to be clear if the pressure test pulse generates a significant amount of flow; otherwise the airway is determined to be obstructed.




So these are events where I am not breathing for 10 seconds, the machine tests me and I appear to be clear, an so maybe it is central then?

I'm not going to worry about that for now and I am going to reset to APAP with 9 min and 12 to 13 Max and see what the data says. I definitely feel like I could tolerate a higher setting,
Does anyone have that link to the provider user manuals? I feel like I am asking for a bit much!

Done! I adjusted the settings to 9 minimum, 12 max, optistart. You guys were way more help then the sleep center, and quicker! Thanks very much, we will see what tonight brings......

You can request the manual here.
There is also a quick setup instruction but I do suggest you get the manual because it has more detailed information in it than the quick setup guide.
http://www.apneaboard.com/adjust-cpap-p ... tup-manual

Centrals...not a big deal and in fact it's quite normal to have a few here and there.
Sleep onset centrals...normal to have them during sleep stage transition.
Also sometimes we pause our breathing when awake and don't realize it and it's likely a central might get flagged at that time.
The machine doesn't know if you are awake or asleep. All it measures is air flow and sometimes our awake/semi awake breathing (it's normal for it to be irregular) to get a flag because the machine sensed some sort of change in the air flow.
So a few centrals here or there is really a normal thing and we don't worry about them unless you start seeing a lot of them over the entire night or some really dense clustering.
Less than 1.0...not even worth a second glance.

Don't know what to tell you about the missing graphs...make sure you haven't inadvertently turned those graphs off in SH...lower right corner of the graphs just expand the menu and make sure all are green.
Might turn the machine off and back on to force it to sort of "reboot".
Make sure when you put the SD card into the machine that it stays put and the machine recognizes it.
I know sometimes I have been known to stick it in there but inadvertently apply a little pressure late and it pops out slightly.

Normally the only graph that goes AWOL when the card isn't in the machine is the flow rate graph.
I don't think that has changed with the new DreamStation model.

You won't have a flow limitation graph...Flow limitations are flagged only on the top Events graph with Respironics machines. Now ResMed will give you a graph and not put it on the top Events graph.

You are showing some Periodic Breathing (that green area) but no real events during them so I suspect it is just plain boring periodic breathing.
The DreamStation calls it CSR for Cheyne Stokes Respiration but it most likely is plain Periodic Breathing.
CSR is one form of PB but by no means the only form.
Most likely some awake/semi awake breathing irregularities going on there with the PB.
I would be concerned if there was a large number of Centrals/CAs or even maybe some OAs mixed in the green shaded area but you really don't have anything like that appearing to be going on.

Not sure why your AHI is high some nights and not others unless it is related to sleeping position.
Perhaps you ended up on your back and you needed more pressure than the 9 was giving you just when you are on your back. Might also be REM stage sleep...same thing. Sometimes our OSA is worse in REM or when on our backs and/or just need more pressure during those times and not so much during the others.
It's quite common. I happen to have the REM worse OSA and sometimes would need pressures of 18 or more and the rest of the night 11 or so worked just fine.

Pugsy are you secretly boarded in sleep medicine? That was incredibly helpful.

Uni wrote:Pugsy are you secretly boarded in sleep medicine? That was incredibly helpful.

no, she's too competent for that.

Good Morning!
So last night I changed the settings to APAP minimum 9 maximum 13.

[url=http://imgur.com/3jyU9b1][/url

What do you all think: Should I up the maximum to 14 or leave alone?

Any problems last night?
Sleep okay last night?

I would probably increase the maximum. The machine won't go up unless it thinks it has a good reason to do so.