APAP user with an AHI that's all over the map.

[SmallCityDave]

I've been using a C-Pap/BiPap for the last 10 years about 5 years ago I started adjusting the settings to compensate a failing machine now I have no idea the settings for my new Apap. I have a Phillips Resprironics System One Auto & a IntelliPAP AutoAdjust Auto-CPAP.

I've been tracking my AHI for the last month (and it has been anywhere from 3.5 to 11.5) the best was night before last at 3.5 and last night it was 8.8 with the same settings. My current settings are maximum of 8.5 and a minimum of 4.

Any help would be greatly appreciated I'm feeling bad, it seems that I will be on the right track and out of nowhere my AHI jumps 6 points. I do have an appointment for a sleep study but it's taken a couple months to get to this point and it's a couple weeks away.

[Pugsy]

Welcome to the forum.

Before anyone can offer ideas about what might be going on with the AHI and/or potential pressure suggestions they would really need to know what kind of events are being flagged and when they are being flagged.
There is available free and easy to use software that will show that information. It much more detailed than the data available on the machine's LCD screen.
Are you familiar with that software?

OSCAR is what I usually suggest. It will work well with both your machines.
https://www.sleepfiles.com/OSCAR/

How to post the data from the software in a format that helps us help you better and faster.
viewtopic/t158560/How-to-post-images-for-review.html

[SmallCityDave]

Lets see if this works.

[SmallCityDave]

That's only info on for the last 2 days I was using the Intellipap previously but it doesn't appear to have a SD card.

Thanks for the software I am not familiar with it but it does have a ton of information.

[Pugsy]

Next time review my thread again....don't need all those graphs and you can get all we need in one image...and can you do screen shots...these images from the phone are difficult to read. Do you know how to do screen shots?

At any rate...you mention a new Bipap..you haven't used it yet because you don't know what settings to start with???

This report above from last night is from an apap machine in auto adjusting mode...it is not a bipap machine.

Your AHI varies probably because the OA or hyponea numbers vary....if you look back on your other reports and that's the case then you need more minimum probably and for sure more maximum pressure.
Current settings aren't doing a good job parts of the night....my guess is you were either on your back or in REM stage sleep when you see those clusters of OAs. Since sometimes you don't have so many OAs (lower AHI nights) and you probably still get REM on those nights then I would suspect that there are times you are on your back and that makes your OSA worse and you need more pressure than the 8.5 max can give you right now. It's little hands are tied.

My suggestion...same machine and same mode...minimum of 6 and max of 12 to start with....see what happens and where the machine wants to go.

Now if you really do have a different machine and it is a BiPap...I need to know which brand and model.
And preferably would need to see an apap report at the above settings that I suggested to get an idea what you need in terms of pressure and then translate that over to bipap settings.

Don't worry about not having the data from the Intellipap...I prefer the data from the Respironics anyway. This here is enough to start with.

[SmallCityDave]

Next time review my thread again....don't need all those graphs and you can get all we need in one image...and can you do screen shots...these images from the phone are difficult to read. Do you know how to do screen shots?

At any rate...you mention a new Bipap..you haven't used it yet because you don't know what settings to start with???

This report above from last night is from an apap machine in auto adjusting mode...it is not a bipap machine.

Your AHI varies probably because the OA or hyponea numbers vary....if you look back on your other reports and that's the case then you need more minimum probably and for sure more maximum pressure.
Current settings aren't doing a good job parts of the night....my guess is you were either on your back or in REM stage sleep when you see those clusters of OAs. Since sometimes you don't have so many OAs (lower AHI nights) and you probably still get REM on those nights then I would suspect that there are times you are on your back and that makes your OSA worse and you need more pressure than the 8.5 max can give you right now. It's little hands are tied.

My suggestion...same machine and same mode...minimum of 6 and max of 12 to start with....see what happens and where the machine wants to go.

Now if you really do have a different machine and it is a BiPap...I need to know which brand and model.
And preferably would need to see an apap report at the above settings that I suggested to get an idea what you need in terms of pressure and then translate that over to bipap settings.

Don't worry about not having the data from the Intellipap...I prefer the data from the Respironics anyway. This here is enough to start with.

Thanks Pugsy!

I'll try 6 and 12 tonight and see how it goes I'll also see if I can post a better screen shot, I don't know how to do a screen shot but I'm sure I can figure it out.

I guess it's an apap not a bipap.

[SmallCityDave]

That seems to be a lot better, do I need to increase my minimum to 8 and max to 14?

Thank you for your help it's nice to get some guidance and visual feedback.

[Pugsy]

You may need more minimum...but you for sure need more maximum.
There's a good bit of the night where the 6 minimum works well.
How about we try just more maximum and see how well that works first?

Might as well open it up to the 20 max and let the machine sort it out. It won't go any higher than it thinks it needs to go.
Open max to 20....if you still get clustering of OAs or hyponeas...then increase the minimum to 8.

[SmallCityDave]

You may need more minimum...but you for sure need more maximum.
There's a good bit of the night where the 6 minimum works well.
How about we try just more maximum and see how well that works first?

Might as well open it up to the 20 max and let the machine sort it out. It won't go any higher than it thinks it needs to go.
Open max to 20....if you still get clustering of OAs or hyponeas...then increase the minimum to 8.

I'll do it!

Thanks again for your insight and for telling me about the software.

[SmallCityDave]

Feels like I'm going in the right direction, I've put a large pillow underneath the head of my mattress to prop my head up and I'm intentionally trying to sleep more on my side. Should I make an more adjustments to the settings?

[Pugsy]

Give yourself 2 or 3 more nights at this setting and if you still see some clustering of events (either OAs or hyponeas) like is shown at around 1:40....increase the minimum to 7 cm.

Next time you post an image...hide the calendar and turn off the pie chart (Preferences/Appearance tab and remove check mark for show pie chart). No need to redo these images though.

[SmallCityDave]

Give yourself 2 or 3 more nights at this setting and if you still see some clustering of events (either OAs or hyponeas) like is shown at around 1:40....increase the minimum to 7 cm.

Next time you post an image...hide the calendar and turn off the pie chart (Preferences/Appearance tab and remove check mark for show pie chart). No need to redo these images though.

A quick questions is it normal for the clusters of OAs and hypopneas to clear up on their own?

Thanks!

[Pugsy]

Well they don't necessarily clear up on their own but maybe the situation that caused the cluster to happen in the first place doesn't repeat itself very often or even ever again. We simply don't sleep the same every night and we all have fluke weird nights and it's best to not make adjustments based on one night's results. We don't know if that one night is a fluke good or fluke bad night.
This is why we usually like to have more than one night at a setting...unless the results are horrible...before we change things again.

All that said, it sure wouldn't hurt anything to go ahead and use the 7 cm minimum if you really wanted to. It's still a modest minimum and you might even like it better.
I tend to be ultra conservative with advising pressure increases just because it's my nature. Other people tend to be more aggressive and that's okay too.

You had that one small dense cluster and maybe the beginnings of one a little earlier in the night. It wasn't a horrible cluster and it was just one. If we had seen more of them or that cluster was much more prolonged in duration then yeah...get a little more aggressive with the increase but that one small cluster isn't enough to make me want to be more aggressive. I get little clusters like that every now and then myself even after 10 years on the machine. I don't worry about them because they don't happen often, they are brief and I sleep through them and they really aren't bad enough to really hurt me.

[Crazytired]

I’m trying to learn and understand the data and graphs. Since this is a CPAP, I don’t get why “EPAP” is listed. I thought only BiPAP had EPAP since CPAP has just one pressure for inhalation and exhalation.
Also, what is the significance of the Flow Limitation and Flow Rate? Does it provide additional info beyond the description of events?
I’m also trying to understand the “Leak” graphics and numbers. The graph appears to indicate some leaks but then on the left it says no leak.
Thanks for your help.

[Dog Slobber]

I’m trying to learn and understand the data and graphs. Since this is a CPAP, I don’t get why “EPAP” is listed. I thought only BiPAP had EPAP since CPAP has just one pressure for inhalation and exhalation.
Also, what is the significance of the Flow Limitation? Does it provide additional info beyond the description of events?
Thanks for your help.

CPAP is perfectly capable of setting different pressures for inhale vs exhale. Yours IS doing exactly that. That's what A-Flex does.

Note on your pressure graph the red and green pressures lines. The red line is your inhale pressure, the green exhale, it's consistently about 2 CM different.

Flow Limitation is what the name suggests, something that limits the air flow, typically it is the narrowing of the passage way and often the precursor to an Obstructive Apnea or Hypopnea.

Passage ways narrow before they close.

The algorithm for many APAP machines detect Flow Limitations and increase pressure to prevent apneas.