Me again. At what point do I start looking to make changes?

[caedenspa]

I've been on the machine for 7 nights now. I understand that at first my results may be all over the board. My AHI has ranged from 11.7 to 1.54. Most nights it's in the 9 range, only twice below 5.

At what point should I expect the numbers to stabilize (if ever), and when should I start thinking about making changes to bring the AHI down?

[Pugsy]

It all depends on what the AHI is made up of.
How about posting a couple of nightly detailed reports from the software so we can see what you are seeing?
The low AHI night for one...and maybe last night for the other.

[englandsf]

What was your starting point - your sleep study AHI?

[caedenspa]

Started at 48.8.

Is there a sticky with instructions for posting the detailed reports? Which graphs or info should I post?

[Pugsy]

Screen shot thread viewtopic.php?f=1&t=81072&p=737779#p737779

or once you have the screen shot upload it to imgur.com and copy the bbc code for that image and paste it in the body of your text here.

What I like to see...on the left side hide the pie chart (you can turn it off in preferences) and that let's the main statistics move into viewing areas...along with the AHI event category breakdown.
On the right side...these 4 main graphs to start with.
Events
Flow Rate
Pressure
Leak
You can turn off the unneeded graphs and do a bit of resizing and get 4 easily seen graphs.

[caedenspa]

[caedenspa]

[Pugsy]

Question about last night.
How was your sleep quality last night? Specifically around the time of the clusters of CAs? Were you maybe awake?

When we have a night that gives us a really good report with the settings and a night that doesn't look so good at the same settings we have to wonder what changed. The settings worked on the good night so why didn't they work on the not so good night?

Also...on the other not so good nights....was the AHI composed of primarily CAs (centrals)?

Do you sleep on your back or your side or mixed?

The CAs we don't treat with more pressure if they are real and we ignore them if they aren't real.
The only thing that needs any tweaking might be they clusters of hyponeas that are shown. Why the clusters of hyponeas? Assuming you were asleep and not awake....more pressure is needed and the usual suspects for clusters of events that need more pressure are supine sleeping and/or REM stage sleep. The first cluster of hyponeas is probably too soon for REM stage sleep so maybe supine sleeping. The other 2 clusters might be REM stage sleep as the timing would be about right.
Awake events of any kind we ignore....so if you spent a lot of time awake last night then we really can't evaluate pressure needs optimally when we know we have a lot of awake/semi awake time going on.

If you were asleep during those clusters of hyponeas...perhaps the CAs are post arousal centrals related to the hyponea maybe causing an arousal that you may or may not remember.
If that's the case...a little more minimum pressure should be able to ward off those hyponea clusters. Like maybe increasing the minimum to 7 cm from the now 5 cm starting minimum.

So I would be wondering what changed between the good night and the not so good night first. If it was sleeping position perhaps if you could stay on your side you would get more good nights. If that is not possible (and it's easier said than done) then a little more minimum to help out for the times you are on your back.
If it is REM stage sleep we can't do anything about REM so we just have to increase the pressure to help out for those times in REM.

Remember the machine doesn't know if you are awake or asleep and it can and will flag awake breathing irregularities as some sort of apnea event and we can't make pressure adjustments based on awake breathing.

[caedenspa]

Okay, last night I know I was awake from shortly after 3:00 AM until I finally got up and went to the bathroom at about 3:30. Around the CA clusters I don't *think* I was awake.

In the sleep study I only had one central. On the machine I have had (starting with last Monday) 48, 29,11, 22,7,13, 1, and then 30. I was chalking those up to being new to the machine.

The majority of the AHI score has been hypopneas every night. 35,23,19,39,50,63,10,33. In the sleep study I had 231 hypopneas.

My current APAP setting is min 5, max 20.

Edited to add: I sleep on my back and on my right side. Rarely do I lay on my left side.

[Pugsy]

What about sleeping position?
Does your sleep study separate those hyponeas into how many in each position?

It's unlikely that those centrals are related to pressure but wouldn't be totally impossible.

If it were me I would probably increase the minimum pressure to probably 7 cm and see what happens.
Might need a little more but maybe not....go slow because it's easier adjusting when we go slow and maybe won't needs as much as we might have initially thought.

If you end up seeing a truckload of centrals....then we back up and have a different discussion but the odds are that you won't.

[caedenspa]

The sleep study was an in-home study. In hindsight, I wish I had known enough to do one in a sleep center. The data you folks that did them in a sleep center have is far superior to what I have.

So I have no data as to what position I was in when anything happened. Also, my baseline titration seems to have just been a shot in the dark. It was my GP that ordered it set at 5 - 20.

How hard is it to adjust the minimum pressure?

[Pugsy]

Not that big of a deal about not knowing sleeping position.
Not hard at all to change the pressure.
Go here and request the clinical manual for your machine as it explains how to do it and it also has some other useful information.
http://www.apneaboard.com/adjust-cpap-p ... tup-manual
There's a short version of how to get to the clinical setup menu where the pressure can be changed here and there's also a short video.
http://www.apneaboard.com/pr-system-one ... structions

[caedenspa]

Pugsy rocks it, as usual!

[bwexler]

Pugsy os always wright.
If it were me I would also lower the Max pressure to 14 or 15.

Gradually tightening the range of pressure while watching the data may help keep the machine from wild swings if the mask leaks or you open your mouth.

[Pugsy]

If it were me I would also lower the Max pressure to 14 or 15.

Gradually tightening the range of pressure while watching the data may help keep the machine from wild swings if the mask leaks or you open your mouth.

The machine doesn't want to go over 15 cm as it is...or at least it didn't last night.
Actually increasing the minimum will often cause the maximum to stabilize and not go up to where it had been going.
I have seen it often. Do a better job preventing the airway from collapsing and the machine doesn't have to go so high in an effort to fix things.
So unless someone has specific issues that we want to really avoid (like aerophagia or frequent wake ups from the pressure swings) I usually just like to do one little tweak at a time and then see what happens and go from there.
The machine won't go chasing those mouth opening leaks with massive pressure increases....the old machines did that but not these new machines. Pressure increases that are seen are from the machine wanting to do battle with flow limitations, snores or OAs. Better prevention will reduce the wild pressure swings and it simply won't go there or if it does it won't stay long.