Doc Says "Don't Worry About the Numbers!"

[bsokal]

June 29th Data

[bsokal]

Can you drill down to look at a couple of those CA events and see how long they last?

How do you do this in the Sleepy head reports?

[bsokal]

What was the breakdown of the 55 AHI in the home study?

See below:

[palerider]

Can you drill down to look at a couple of those CA events and see how long they last?

How do you do this in the Sleepy head reports?

up and down arrows zoom in and out, left and right move, you can also click drag to highlight a section of any chart and it will zoom to that, there are other ways to navigate down into the data.

[bsokal]

What was the treated AHI and its breakdown in the hospital study.

See below:

[bsokal]

Can you drill down to look at a couple of those CA events and see how long they last?


How do you find out how long a CA event lasts in SleepyHead?

[kaiasgram]

How do you find out how long a CA event lasts in SleepyHead?

On the left side of your SH report, above the orange bar with the AHI, you're on the Details tab -- click on the Events tab to see the events listed one by one, and in parentheses is the duration of the event.

[Guest1]

You are on bilevel with IPAP of 20 and EPAP of 14. IPAP - EPAP is your pressure support (PS) which is 6cm currently.

Since your sleep study didn't show any central apnea events, it's extremely unlikely that you have central apnea issues.

You have clusters of obstructive events. EPAP level is the one you need to raise to eliminate those. I recommend that you raise your EPAP by 1cm and evaluate for 1 week.

Assuming you don't have central or complex apnea, Most of your central events are being caused by CO2 washout due to excessive pressure support (PS). You can reduce your PS to 4 to begin with. So you should set your IPAP to 19.

All in all, try a setting of IPAP/EPAP of 19/15 and see the result for 7 days. It will reduce both the
Obstructive as well as Central events. Do report back your results in this same thread.

[palerider]

All in all, try a setting of IPAP/EPAP of 19/15 and see the result for 7 days. It will reduce both the
Obstructive as well as Central events. Do report back your results in this same thread.

it would probably be better to *lower* epap a little, and pressure support, and put the machine in auto mode.

[bsokal]

Question: How long are Clear Airway events?

They appear to average about 30 seconds each.

See details on left side of below picture:

[Guest1]

All in all, try a setting of IPAP/EPAP of 19/15 and see the result for 7 days. It will reduce both the
Obstructive as well as Central events. Do report back your results in this same thread.

it would probably be better to *lower* epap a little, and pressure support, and put the machine in auto mode.

This would also work if the OP can tolerate variable pressure. Most people are okay with it but some are not. This is a more
Advanced approach to solving this (if we hypothesize that most of the Obstructive event clusters are happening only at certain times in the night (arguably when he is supine or in REM) ).

So if he wants to try auto, he can set min EPAP to 12, max EPAP to 16, PS fixed at 4 and let it drive itself in auto mode, and evaluate
The results after 7 days.

[palerider]

All in all, try a setting of IPAP/EPAP of 19/15 and see the result for 7 days. It will reduce both the
Obstructive as well as Central events. Do report back your results in this same thread.

it would probably be better to *lower* epap a little, and pressure support, and put the machine in auto mode.

This would also work if the OP can tolerate variable pressure. Most people are okay with it but some are not. This is a more
Advanced approach to solving this (if we hypothesize that most of the Obstructive event clusters are happening only at certain times in the night (arguably when he is supine or in REM) ).

So if he wants to try auto, he can set min EPAP to 12, max EPAP to 16, PS fixed at 4 and let it drive itself in auto mode, and evaluate
The results after 7 days.

well, at this point, his primary problem is the centrals, not the obstructives. perhaps less pressure support than he's got now would help with that.

[49er]

All in all, try a setting of IPAP/EPAP of 19/15 and see the result for 7 days. It will reduce both the
Obstructive as well as Central events. Do report back your results in this same thread.

it would probably be better to *lower* epap a little, and pressure support, and put the machine in auto mode.

This would also work if the OP can tolerate variable pressure. Most people are okay with it but some are not. This is a more
Advanced approach to solving this (if we hypothesize that most of the Obstructive event clusters are happening only at certain times in the night (arguably when he is supine or in REM) ).

So if he wants to try auto, he can set min EPAP to 12, max EPAP to 16, PS fixed at 4 and let it drive itself in auto mode, and evaluate
The results after 7 days.

Because centrals are involved, bsokal should see another sleep doctor for another opinion. I wasn't aware that just because they don't show up on a sleep study, doesn't mean there shouldn't currently be concern, particularly if so many of them are showing up on data.

Meanwhile, I like the suggestion to limit PS support to 4. But shouldn't this be a fixed pressure of something in case the increased pressure is driving the centrals just to see if the AHI comes down? Not asking to be critical of previous posts but just wondering.

[palerider]

But shouldn't this be a fixed pressure of something in case the increased pressure is driving the centrals just to see if the AHI comes down? Not asking to be critical of previous posts but just wondering.

well, the fixed pressure isn't doing it, and may be more pressure than is needed except during the few periods of time that there are obstructives, and if they are pressure induced centrals, then less pressure would help, while leaving the auto mode to respond to obstructives when they occur.

[49er]

But shouldn't this be a fixed pressure of something in case the increased pressure is driving the centrals just to see if the AHI comes down? Not asking to be critical of previous posts but just wondering.

well, the fixed pressure isn't doing it, and may be more pressure than is needed except during the few periods of time that there are obstructives, and if they are pressure induced centrals, then less pressure would help, while leaving the auto mode to respond to obstructives when they occur.

Thanks for your response. That makes sense. Hopefully, the advice works as finding another sleep doctor can be a royal pita.

49er