Wisdom for my dad's cpap data

[Green Eyes]

My dad has been on cpap for almost 3 years now. Apparently I just discovered that its poor performance was the cause of his daily headaches and the adjustments we've made have helped almost totally eliminate them. However, he is still have a very high AHI rate and I'm wondering if anyone has any wisdom in terms of trying to help deal with this?

He presently uses a a Philips dreamwear nasal mask with the addition of a chinstrap and a Aircurve 10



I'll be honest I'm pretty upset that so many people have not gotten the help they need from their own doctor, my dad and myself included. Thankfully other people have stepped up and I would like to thank all of you here for giving people solutions and hope.

[Pugsy]

How did he come by these settings? Did he have a sleep study done in a lab with a tech fiddling with things?

Is he reporting waking often during the night? Spend much time with mask and machine on?

Obviously leaks are a problem...is he complaining about them?

Could your review this thread for graph format. You are making a lot of work for yourself and you can get all we need in one image.

viewtopic/t158560/How-to-post-images-for-review.html

Tried any other masks?

[Green Eyes]

How did he come by these settings? Did he have a sleep study done in a lab with a tech fiddling with things?

Is he reporting waking often during the night? Spend much time with mask and machine on?

Obviously leaks are a problem...is he complaining about them?

Could your review this thread for graph format. You are making a lot of work for yourself and you can get all we need in one image.

viewtopic/t158560/How-to-post-images-for-review.html

Tried any other masks?

Settings were given to him after a sleep study then adjusted by the doctor later on. He has been dedicated in using the machine everynight and it was only since my therapy had hiccups that I looked at his data and it was really bad.

he does not wake often during the night and since I slightly adjusted his settings and helped him use a chin strap and sealant he has greatly improved both duration and numbers.

the leaks were a huge issue and I helped him get them down by half as they were in the high 90's every night till just last week.

His AHI is down but Im wondering what is causing it to continue and can something be done to improve those numbers

pax tecum

[Pugsy]

What position does he sleep in usually?

He seems to have a lot of centrals/CAs at the beginning of a sleep session but not so much after.
Makes me wonder if he is taking a little while to fall asleep and what we are seeing are false positive awake breathing irregularities in the centrals for the most part.
Like it's obvious he turned the machine off and back on again at around 1:30 so we know he was awake when it got turned back on.
Wonder how long it is taking him to go back to sleep.

He's using a fixed pressure bilevel mode. The machine would want to increase the pressure to fight those OAs but it can't right now.

If it were my dad I would change mode to Auto....
Keep the EPAP minimum at 9 cm
Keep the PS at 4
and change IPAP max to 25 and see what the machine wants to do.

Will worry about the centrals later..if they are real.

[Green Eyes]

What position does he sleep in usually?

He seems to have a lot of centrals/CAs at the beginning of a sleep session but not so much after.
Makes me wonder if he is taking a little while to fall asleep and what we are seeing are false positive awake breathing irregularities in the centrals for the most part.
Like it's obvious he turned the machine off and back on again at around 1:30 so we know he was awake when it got turned back on.
Wonder how long it is taking him to go back to sleep.

He's using a fixed pressure bilevel mode. The machine would want to increase the pressure to fight those OAs but it can't right now.

If it were my dad I would change mode to Auto....
Keep the EPAP minimum at 9 cm
Keep the PS at 4
and change IPAP max to 25 and see what the machine wants to do.

Will worry about the centrals later..if they are real.

He sleeps on his back the whole night and Im not certain how long it takes him to fall asleep. Last night he said he had trouble getting a good seal right off the bat for some reason and had to fiddle with it.

what would the major change be when switching to auto?
And why wouldnt it have been set to auto to begin with?

My only concern is the context of why it was set that way to begin with

[Pugsy]

what would the major change be when switching to auto?

He needs more pressure to deal with the OAs.....that's a given. Going to Auto will let the machine decide how much and when.

And why wouldnt it have been set to auto to begin with?

Beats the hell out of me. Some docs don't understand how auto really works or sometimes they are still in the dark ages and don't want to learn or maybe there was something in the initial sleep study that might point to taking auto out of the picture.
The only reason for it might be if there were some real centrals happening and that's a whole other can of worms to open.

His mask is still leaking too much...if this continues and he can't tame it then I would look at maybe changing frame sizes with the DreamWear or getting a different mask.
Looks more like mask movement leaks than open mouth leaks to me.....been there and done that with this particular mask.

The centrals may or may not be real asleep centrals. I have my doubts and since we can't do much about them right now with this machine we will put them on the back burner for now and try to reduce what else needs fixing that we can fix with this particular machine and that would be the OAs. Once we have the OAs reduced to an acceptable level and maybe get the leaks less likely to be a problem then we look at what's left over in terms of any centrals and evaluate them more closely to figure out if awake or asleep.
If not asleep...nothing flagged even matters.
Gotta be asleep for things to matter.

[Green Eyes]

what would the major change be when switching to auto?

He needs more pressure to deal with the OAs.....that's a given. Going to Auto will let the machine decide how much and when.

And why wouldnt it have been set to auto to begin with?

Beats the hell out of me. Some docs don't understand how auto really works or sometimes they are still in the dark ages and don't want to learn or maybe there was something in the initial sleep study that might point to taking auto out of the picture.
The only reason for it might be if there were some real centrals happening and that's a whole other can of worms to open.

His mask is still leaking too much...if this continues and he can't tame it then I would look at maybe changing frame sizes with the DreamWear or getting a different mask.
Looks more like mask movement leaks than open mouth leaks to me.....been there and done that with this particular mask.

The centrals may or may not be real asleep centrals. I have my doubts and since we can't do much about them right now with this machine we will put them on the back burner for now and try to reduce what else needs fixing that we can fix with this particular machine and that would be the OAs. Once we have the OAs reduced to an acceptable level and maybe get the leaks less likely to be a problem then we look at what's left over in terms of any centrals and evaluate them more closely to figure out if awake or asleep.
If not asleep...nothing flagged even matters.
Gotta be asleep for things to matter.

Hypothetically if he actually is experiencing CA would switching to auto be worse? Better or no change?


Ill talk with him about it before I change it.

Maybe we can try it for one night and see what the end results are

[Pugsy]

Hypothetically if he actually is experiencing CA would switching to auto be worse? Better or no change?

Might make the centrals worse IF (big if) the centrals were caused by pressure in the first place and then IF more pressure made them even worse.
If the centrals were caused by the pressure itself we would expect to see them all night since the pressure is constant through the night.
But we aren't seeing dense centrals all night...just seeing them when there's a good chance he was awake.

An occasional central apnea that is a real asleep central isn't a big deal. We all can have them from time to time. So those other random times where there are a couple of centrals I am not overly concerned about right now anyway.

We can't fix centrals with this machine....but we can fix OAs and hyponeas so we fix the stuff we know needs fixing and then see what's left over once we have fixed what we can fix. That's about the best we can do and sometimes it works out just fine.

If you want to go reading and digging into information how to figure out if a central is a real asleep central or an awake/arousal related central...you can watch the videos here.
http://freecpapadvice.com/sleepyhead-free-software

I am pretty sure that the bulk of those 2 rather dense clusters when he first started the machine are awake related.

[Green Eyes]

Thank you so very much for your wisdom and expertise. Ill try your suggestions and see how it goes for him

[palerider]

what would the major change be when switching to auto?
And why wouldnt it have been set to auto to begin with?

My only concern is the context of why it was set that way to begin with

The machine would be able to respond to his needs in auto mode.

As to why it's not in auto mode? Many doctors are stupid.

[Green Eyes]

Hypothetically if he actually is experiencing CA would switching to auto be worse? Better or no change?

Might make the centrals worse IF (big if) the centrals were caused by pressure in the first place and then IF more pressure made them even worse.
If the centrals were caused by the pressure itself we would expect to see them all night since the pressure is constant through the night.
But we aren't seeing dense centrals all night...just seeing them when there's a good chance he was awake.

An occasional central apnea that is a real asleep central isn't a big deal. We all can have them from time to time. So those other random times where there are a couple of centrals I am not overly concerned about right now anyway.

We can't fix centrals with this machine....but we can fix OAs and hyponeas so we fix the stuff we know needs fixing and then see what's left over once we have fixed what we can fix. That's about the best we can do and sometimes it works out just fine.

If you want to go reading and digging into information how to figure out if a central is a real asleep central or an awake/arousal related central...you can watch the videos here.
http://freecpapadvice.com/sleepyhead-free-software

I am pretty sure that the bulk of those 2 rather dense clusters when he first started the machine are awake related.

his data from last night.

He did complain about too much pressure and there was very little change in th enumber of events.

any thoughts?

[Pugsy]

He did complain about too much pressure and there was very little change in th enumber of events.

The highest the machine went to was barely over 15...compared to his 13 max before the change.
I suspect what he is sensing isn't so much the pressure increasing but the increased air flow that the machine will do trying to maintain the pressure in the face of so much leak. The pressure really isn't that much higher but it feels higher because of the increased air flow movement.

We don't need to see the machine settings....please review the format here
It would be helpful to see the AHI numbers and graphs.
viewtopic/t158560/How-to-post-images-for-review.html

Don't need mask pressure line...the regular pressure line is sufficient.

Again a sizable number of centrals/CAs flagged and I would be my last dollar he was awake when the bulk of them were flagged.

No...the number of events isn't going to change much until
1...he gets his leaks better controlled
2...he gets more solid blocks of sleep so that the SWJ sleep/wake/junk awake breathing false positive flagging gets reduced.

Does he ever complain of dry mouth? Do you know if he is doing much mouth breathing?

[Green Eyes]

He did complain about too much pressure and there was very little change in th enumber of events.

The highest the machine went to was barely over 15...compared to his 13 max before the change.
I suspect what he is sensing isn't so much the pressure increasing but the increased air flow that the machine will do trying to maintain the pressure in the face of so much leak. The pressure really isn't that much higher but it feels higher because of the increased air flow movement.

We don't need to see the machine settings....please review the format here
It would be helpful to see the AHI numbers and graphs.
viewtopic/t158560/How-to-post-images-for-review.html

Don't need mask pressure line...the regular pressure line is sufficient.

Again a sizable number of centrals/CAs flagged and I would be my last dollar he was awake when the bulk of them were flagged.

No...the number of events isn't going to change much until
1...he gets his leaks better controlled
2...he gets more solid blocks of sleep so that the SWJ sleep/wake/junk awake breathing false positive flagging gets reduced.

Does he ever complain of dry mouth? Do you know if he is doing much mouth breathing?

Yes to the dry mouth. he said he gets it by 1 in the morning. Even before I changed his settings last night

[Pugsy]

Can you confirm which mask he is using?

Does he have insurance? When is the last time he tried a different mask?

Does he complain of any nasal congestion very much either during the day or night?

Is the OptiLife your mask or his?

[Pugsy]

This is his mask????

https://www.cpap.com/productpage/pr-dre ... k-fit-pack

The big leaks....either the mask is moving around an awful lot or he is doing a lot of mouth breathing.
Dry mouth is a symptom of mouth breathing.