Question about chart (shown inside)… is this caused by leak?

ozij · Post by **ozij** » Thu Apr 10, 2008 12:20 pm

I guess this is one the few times I disagree with Den's interpretation. I also thought the combination of snore+hypopneas+apneas all at the same time was remarkable.

There are more snores on the first chart, slightly more hypopneas, and slightly less apnea. There is also very little consequent time spent at any pressure. All of which indicate to my mind that the bottom pressure is too low on the auto, the top beneficial, but not enough. A possible explanation is of course turning from your side to your back - so 13 is enough for your side, but not your back.

I would actually leave the bottom at 13, and open up the top.

If you're interested in more data (e.g. what happens to flow limitations) at fixed pressure, check if you can set up the machine in APAP mode with top=bottom, that way you'll get flow limitation indications as well. If you can't have a top=bottom, try a minimal (0.5) difference.

O.

Wulfman · Post by **Wulfman** » Thu Apr 10, 2008 12:33 pm

OK.......Go ahead and set the top pressure to 20......I wanna see what happens. After re-reading the first chart, there were no NR's (non-responsive) so that would probably eliminate the thought of Centrals.
It just looked to me like the rest of the night (around those clusters) was pretty "quiet". Could be a positional thing, too.......like sleeping on your back or your head is bent down toward your chest......something that would crimp your airway.

Den

Wulfman · Post by **Wulfman** » Thu Apr 10, 2008 12:36 pm

ozij wrote:I guess this is one the few times I disagree with Den's interpretation. I also thought the combination of snore+hypopneas+apneas all at the same time was remarkable.

There are more snores on the first chart, slightly more hypopneas, and slightly less apnea. There is also very little consequent time spent at any pressure. All of which indicate to my mind that the bottom pressure is too low on the auto, the top beneficial, but not enough. A possible explanation is of course turning from your side to your back - so 13 is enough for your side, but not your back.

I would actually leave the bottom at 13, and open up the top.

If you're interested in more data (e.g. what happens to flow limitations) at fixed pressure, check if you can set up the machine in APAP mode with top=bottom, that way you'll get flow limitation indications as well. If you can't have a top=bottom, try a minimal (0.5) difference.

O.

That's OK......I take rejection pretty well........ <sob> <sob>.

Den

Snoredog · Post by **Snoredog** » Thu Apr 10, 2008 12:42 pm

My opinion:

You have lots of Vibratory Snore, very few HI, lots of OA. that indicates to me you have a big ole stubborn tongue that falls into the back of the throat and events are obstructive.

I also see NO reason to limit the maximum pressure, open it up all the way to 20 cm, let the machine work if it needs to, AFlex will bring it back down. You only need to limit the max pressure if it causes problems with central apnea, if it does it should throw up a NR flag, that is not seen either.

Set the Auto:Min to 12 or 13 cm (or for comfort if that is a problem), set Auto:Max=20, use what ever Aflex setting you want but 3 may be too much.

MikeSleeper · Post by **MikeSleeper** » Thu Apr 10, 2008 2:17 pm

Okay, thanks all... all great advice.

Tonight I am going to crank 'er up to max 20. I hope I don't blow the mask off my face

Will probably set min to 13 or 14.

I'll post the chart tomorrow morning, to continue this learning adventure.

By the way Den, no history of GERD. And will experiment with lower as well, though that is where I started a week ago... And to others, no centrals in first sleep study (someone asked).

I have another sleep study scheduled for April 20, so if no joy at max 20 I will bring these charts in and go over with the tech before hand, so he's prepped. And then after that I have a meeting set with one of the best sleep docs in the area. If I don't figure this out on my own by then maybe I'll have some more pro help at that meeting

In mean time happy to keep y'all entertained. Thanks snoredog for identifying that my "big ole stubborn tongue" is probably the problem, which others have complained about too, but usually for talking back. Now I see maybe there was more to that!

Michael

MikeSleeper · Post by **MikeSleeper** » Fri Apr 11, 2008 6:56 am

I promised to post this. Perhaps the last; ya'll goatta be getting bored of this. And I am traveling for a week after this.

It was a shorter night because I needed to get up early to catch a plane. Set min to 13, max to 20, but max was never needed... I woke up in the middle of the main cluster and got up so pressures never got there but it looked like it settled out anyway just before then. Interestingly OA's from that one continued when I went back to sleep. hmmm.

In any case AHI is a bit better so going the right direction and I am sleeping well, feel better each day.

Tonight I raise the minimum, because that main cluster started at a lower pressure, as did all the other events.

Unless anyone wants (let me know by reply post) this will be my last post on this; I think it is straight shooting for a bit, as I up the min a few nights in a row. Thanks all for the help, Michael

Darntired · Post by **Darntired** » Mon Apr 21, 2008 6:09 pm

I have another sleep study scheduled for April 20, so if no joy at max 20 I will bring these charts in and go over with the tech before hand, so he's prepped. And then after that I have a meeting set with one of the best sleep docs in the area. If I don't figure this out on my own by then maybe I'll have some more pro help at that meeting

Ok, please share the secrets of the sleep study and the best docs in the your area with the rest of us. Was all the free advise from us on the money??

I'm studing my charts and found the discussion of your charts very interesting. I also found that even an half size difference in a mask makes a lot of difference.

I too, bumped up my APAP minimum closer to the 90% target. It took less OA before APAP raised into the necessary treatment range. My AHI lowered and I'm starting to feel much better!