Help to Decrease Obstructive Apneas (OA's)

Hello everyone,

Some time ago, I had posted about this and did not provide you all with the correct information.
I believe I have now done so. QUESTION: How do I decrease the obstructive apneas?
Everything would look great if I could just a handle on this.

Thank you,
Starlette

140706SH

Because of the resolution of the SH image, it is too blurred to be able to read accurately the values on the right side.
Your SH chart appears as if you may have the ramp function turned on with a duration of 45 minutes.

Is this so? Then can you try turning the Ramp function off for one night?
The second AHI cluster could be another period of the ramp being turned on. Did you press the ramp button at the beginning of that time?

Notice how the cluster ends each time. That looks as if the pressure is now getting back to the minimum you need to suppress the OSA events.

If you aren't using Ramp, then perhaps you are on your back at these times and you need just a little more pressure to overcome the OSA events in that position. Increasing your pressure just a little will help.

It appears Starlette is running her APAP in CPAP mode, pressure = 9 cm. I was able to read the data on the right side of her screenshot. I enlarged it here -- it's still blurry but readable:



Starlette, is this a typical night for you?

I too am wondering if you have a long Ramp time set and if so, are those two big clusters of obstructives happening during Ramp?

If you are not using Ramp -- Most of your high AHI is Obstructive apneas, so it looks to me like you need more pressure. Since your clear airway index is not too high I think you could afford to try a pressure increase, maybe in APAP mode for a while to see how high the machine wants to go to keep the apneas down. Or if you're opposed to APAP mode, try some small incremental increases in your pressure in CPAP mode and watch the data to see if there's improvement.

JDS74 wrote: Your SH chart appears as if you may have the ramp function turned on with a duration of 45 minutes.

What data are you basing this speculation on?

Usually when someone is using the ramp, it shows up in the min pressure numbers in the statistical data since SH will report min pressure = starting ramp pressure, but looking kaiasgram's crop of the posted data:



the min pressure = median pressure = 95% pressure = max pressure = 9

So it looks to me like Starlette is running her APAP in CPAP mode at 9cm and NOT using the ramp.

Questions for Starlette:

About the first cluster: How long did it take you to get to sleep? Do you think you were asleep or awake from 2:40 to 3:00? If you were awake during that time, my guess is that the OAs are mis-scored wake breathing.

About the second cluster: There's chance that this could be REM-related. Is your OSA known to be substantially worse in REM?

General question: Is this a new pattern in your data? Or has it been there all along? And how often are you seeing these kinds of long, persistent clusters? And is there any history of centrals on any of your sleep tests?

If I were in your shoes and I was seeing this pattern fairly often, I'd contact the sleep doc rather than just increasing the pressure.

robysue wrote:

JDS74 wrote: Your SH chart appears as if you may have the ramp function turned on with a duration of 45 minutes.

What data are you basing this speculation on?

Robysue,
Only on the shape of the graph which seems consistent with a 45 minute ramp and inadequate pressure until the main pressure is reached, I couldn't read the detail that others including yourself have been able to read - so the speculation.

If the OP is not using Ramp, then I have no clue about what else besides positioning might be causing that pattern. Your suggestion that REM issues might be the cause could be the case.

JDS74 wrote:

robysue wrote:

JDS74 wrote: Your SH chart appears as if you may have the ramp function turned on with a duration of 45 minutes.

What data are you basing this speculation on?

Robysue,
Only on the shape of the graph which seems consistent with a 45 minute ramp and inadequate pressure until the main pressure is reached, I couldn't read the detail that others including yourself have been able to read - so the speculation.

What graph are you talking about? No pressure graph was shown, and you can't tell that someone's using a ramp from the Flow Rate or AHI graphs, which were shown.