3rd night on APAP trial - High AHI and pressure is pegged

[Flex Plexico]

Hello! I tried my best to follow the guidelines for posting the images here so please let me know if I can improve. Last night was my third night on APAP. Unfortunately I ripped my nasal pillow off between 11-1, but once I realized that I got what I know was some sleep between at least 1-4. I am seeing some concerning stuff in my data and would love some help interpreting it.

My doctor prescribed me a range of 6-12 based on my sleep study. I did have some centrals in my sleep study, but they were determined to be benign and transitional. Here is the data between 1-6 last night. My AHI was recorded as 25 (My sleep study said I had 22-27 AHI)

TO ME, it looks like my machine is quickly ramping up to the max setting and keeping it pegged there all night, but still isn't able to keep up with my OA's. There are also a lot of centrals marked there, but they taper off as time goes on.. what do y'all think? Thanks in advance.

[Pugsy]

Don't do snippets. Do the entire detailed page.
See my examples in this thread.
viewtopic/t158560/How-to-post-images-for-review.html

The max is 12 and obviously that is not enough. Set the max to 20.
Probably going to need more minimum than the 6...like at least 10 but if that's too big of a jump to start with you can work up to it.
The machine jumps up there and stays there anyway.

The CAs/centrals...might be nothing more than arousal related because the OAs caused you to wake up a bit.
Fix what you can fix with more pressure (that would be OAs, hyponeas, snores, etc)...if you can and then lets see if the centrals/CAs are too numerous once the obstructive stuff is reduced and not potentially causing arousal CA event flags.

[Flex Plexico]

Thanks so much for your insights Pugsy, your comments in my other thread allowed me to adjust the machine so that I didn't feel suffocated at all. I'll adjust the pressure and see how it goes!

Paul

[Flex Plexico]

Here is the data from my fourth night (last night). I set the range from 9-16 to try and give it some more headroom, and I seemed to have a much more drastically reduced AHI despite my pressure not really increasing from the night before. One thing that is concerning me is the large amount of Periodic Breathing... It has averaged about 20-25% each night I have been on the device. Here are some snapshots to illustrate what I am taking about. Here are my thoughts on what I see, I want to see if you agree with me:

1) The periodic breathing for the most part seems to be connected to events (Either OA, CA or Hypo), and after an event I end up in a pattern of periodic breathing for a few minutes until things stabilize.
2) The waveforms don't look incredibly like CSR, but there is an undeniable rise and fall in a cyclical pattern until i've 'caught' my breath.

Here is an overview:


Here is a closeup of one (to me) benign looking event.


Here is something that looks concerning, but again it seems to be connected to the Central that happens and seems to resolve itself into 'normal' breathing after 5 minutes

[Pugsy]

Did you not see my comment above???

PLEASE DON'T DO SNIPPETS....We really need to see at least the entire detailed report in normal format...then you can do the snippets if you wish.
You are omitting some important information that we need to evaluate things.

Can you reduce your Flex exhale relief to 1....or even better turn off FLex...then lets see what happens with the PB stuff.
It's not classic CSR but it is not plain PB either and it leans more towards CSR than plain PB.
It wouldn't be impossible for some of those OAs and hyponeas to be central in nature but given an obstructive related name.
Not common for the miss naming but not impossible either.

[Flex Plexico]

Sorry!! I think I understand now Re: snippets. Tonight I will try reducing or turning off flex and see how it goes.

[palerider]

Here is the data from my fourth night (last night)

Your pictures are a waste of your time, I'm not going to even bother looking at them.

If you won't, or can't, follow Pugsy's link, follow this one:

wiki/index.php/Sleepyhead:Organize

[raisedfist]

Honestly I know that Phillips Respironics reports total leak levels, and your leaks are well within range of what the machine can compensate for, but your total leak rate really sucks for such low pressures. If you are mouth breathing it could be hampering your therapy. As an experiment I would tape your mouth for a night and see if it changes the AHI at all. I use a PR machine with pressures substantially higher than yours and my total leak levels are in the 30s.